Losing It

Background information

Mental health problems are not unusual. Just like physical health, mental health is variable, often depending on what is happening in our lives and on how we respond or react to this. Depression, for example, is very common. Over a lifetime, there is a 60-70% chance that a person will suffer some kind of depression or worry bad enough to affect his or her daily life.

Episodes of mental illness or disorder can come and go throughout our lives. Some people experience a mental disorder only once and fully recover, while for others, it recurs or is something they have to learn to live with. However, unlike physical illness, there is still a stigma attached to the term 'mental illness'.

From a problem to an illness
When does a mental health problem – for instance, stress from examinations or distress following the break up of a relationship – become a mental disorder or illness?

The DSM-IV – the Diagnostic and Statistical Manual produced by the American Psychiatric Association, the standard reference book used to diagnose psychiatric disorders – makes clear that the boundary between normality and mental disorder is not clear cut. The DSM-IV emphasises that a mental disorder is 'a condition which causes someone clinically significant impairment or distress', but it admits that 'clinical significance' is likely to vary according to cultures and the availability and interests of psychiatrists and other health professionals.

The causes of mental disorder
Although many mental disorders are linked to chemical changes in the brain, what exactly triggers these changes is unknown. However, various factors can increase the risk of having a mental disorder. These fall into three main categories:

Psychotic and non-psychotic disorders
Mental disorders can be separated into two main categories:

Psychotic disorders These include schizophrenia and bipolar affective disorder (frequently called manic depression). A psychosis is a major mental disorder in which the personality is very seriously disorganised and the person's sense of reality is usually altered. Brain function is affected, causing changes in thinking, emotion, behaviour and perception.

During the acute phase of a psychotic disorder, a person may become very frightened, developing delusions (fixed false beliefs – for example, that they are being persecuted, or are very special in some way or worthless and deserve to die) or experiencing hallucinations (false perceptions, where they see, hear, smell, taste or physically feel things that are not there). They may also be depressed or elated in a completely irrational way.

Non-psychotic disorders These include anxiety and related conditions (such as panic attacks, phobias and obsessive-compulsive disorders), depression (unipolar affective disorder – that is, depression without mania), eating disorders and physical symptoms involving tiredness or pain.

Treatment of mental illness
It is rarely possible for someone to 'just snap out of it', and suggesting this is not helpful. However, most mental disorders can be effectively treated with a combination of medication and 'talking treatments'.

The first line of action is usually to see the family doctor (GP). The GP may offer some form of drug treatment, such as antidepressants to decrease anxiety in the short term. They may suggest seeing someone to talk to, such as a counsellor, psychotherapist or clinical psychologist, or may refer the patient to a psychiatrist for more specialist help and treatment. The doctor may also put the person in touch with the local community mental-health team or social services or an appropriate voluntary agency.

Helplines can sometimes be a way to get further support. The Samaritans are perhaps the best known of these (see Find out more). Self-help organisations can also provide a great deal of support, as well as advice on appropriate treatments.

There is an increasing use of alternative and complementary therapies – such as meditation, massage, aromatherapy, homoeopathy, art therapy and creative therapy – sometimes in addition to more orthodox treatments.

People with a mental illness are often rejected and discriminated against, although they need the same understanding and support as if they were suffering from a physical illness.

Depression
Clinical depression is not the same as the temporary unhappiness or sadness that all of us feel at some time in our lives, which we often describe by saying, 'I’m depressed.'

The common symptoms of clinical depression include:

• low mood
• loss of interest and pleasure
• feelings of worthlessness and guilt
• tearfulness
• poor concentration
• reduced energy
• a change in appetite and weight (usually decreased but sometimes increased)
• sleep problems
• anxiety

People who are clinically depressed may seem simply lazy or difficult to others, when, in fact, they may need professional help and treatment in order to recover. Some, especially men, also find it hard to admit to feeling emotionally bad, especially when they are not sure of the reasons for it. Instead, they may go to the doctor complaining of physical problems, commonly headaches, stomach problems or general pain.

Bipolar affective disorder is a particularly severe and frequently recurrent type of depression that may be associated with extreme swings in mood. It is also known as manic depression because of the extreme highs (mania) and lows (depression) in mood that a person with the illness can experience.

Common symptoms of mania include:

• feelings of euphoria
• extreme optimism
• inflated self-esteem
• difficulty sleeping
• poor judgement
• reckless behaviour
• racing thoughts
• agitation
• extreme irritability

The times of depression can bring despair and thoughts of suicide. The person may lose interest in things that were once enjoyable, may become withdrawn and may sometimes find it impossible to get out of bed.

What causes depression?
It is still not known for certain why some people lack the resilience to cope with stressful events and get depressed, or why depression sometimes seems to happen for no apparent reason. There are often many interrelated factors:

Heredity The tendency to develop depression runs in families. This may not necessarily be genetically based but could be the result of early life experience.

Biochemical imbalance Depressive episodes are thought to be partly due to an imbalance of chemical transmitter substances in the brain, especially the 'amines', which include serotonin.

Outside life events Depression may be brought on by a bereavement or by problems with money, work, housing or relationships. Ongoing problems may make recovery harder.

Physical illness This may trigger or maintain depression. It is likely to result from direct effects on brain chemistry and indirect effects of the illness on physical and social functioning. Some prescribed drugs such as steroids (and illegal drugs such as ketamines) may also cause depression.

There are two other specific relationships between physical causes and depression:

• seasonal affective disorder (SAD), depression caused by the reduction in light reaching the brain's pineal gland through the eyes, which comes on with the shortening of the day during the winter.
• post-natal depression (PND), thought to be the result of hormone imbalance following childbirth.

Treatment of depression
Clinical depression is a serious condition and requires professional help. A combination of drug treatments and talking treatments is often the best way forward. The first step is to visit a family doctor (GP) who may offer treatment or refer the patient to a psychiatrist.

Anti-depressant drugs aim to increase levels of certain neurotransmitters – the natural chemicals by which brain cells communicate. There are three types of anti-depressants currently in use:

• selective serotonin re-uptake inhibitors (SSRIs) – for example, Prozac, Seroxat
• tricyclics – for example, Prothiaden, Lustral
• monoamine oxidase inhibitors (MAOIs) – for example, Nardil

Bipolar affective disorder is most commonly controlled by the drug lithium carbonate, which stabilises mood.

'Talking treatments' give people a chance to express their feelings, to take greater control of their lives and to be treated as a whole person rather than as a group of symptoms. There are specific kinds of talking treatments or psychotherapies used in the treatment of depression. These are generally short term (about 16 weeks) and structured and focus on current problems. One is cognitive behavioural therapy (which aims to change self-defeating thought patterns and overcome a lack of energy and motivation), and another is an interpersonal approach (focusing on problematic relationships and life difficulties). Counselling can also be helpful.

Family therapy is often appropriate where a young person is concerned. This gives an opportunity to explore the dynamics and social interactions of the family rather than assuming that it is just the young person who has a problem.

For their own safety, people with particularly severe depression may need to spend some time in hospital. Most are admitted informally and are free to leave when they wish. If they are so ill that they have to be admitted for their own safety without their consent, there are legal safeguards under the 1983 Mental Health Act (and the 1984 Mental Health [Scotland] Act) to ensure that nobody is kept in hospital indefinitely against their wishes if they are no longer a danger to themselves or others.

A different form of treatment for people who are severely depressed and may be actively suicidal is electro-convulsive therapy (ECT), usually as two treatments per week for three to six weeks.

What schools can do
Schools have an important role to play in raising issues about mental health and in reducing the stigma attached to mental health problems. In addition, a school, like any organisation, can promote the mental health of those working there (both students and staff) or it can add to their distress. It can also help to prevent mental health problems and support those who are already experiencing problems.

To promote mental health effectively, there needs to be a wide range of interventions, from those involving the whole school community to those involving a minority of students who need clinical treatment. Everyone in a school benefits from a healthy environment, one that promotes psycho-social skills and well-being. Education about mental and emotional health is an important part of the general curriculum. Young people can be helped to be more emotionally literate.

However, 20–30% of adolescents are likely to need additional help with specific problems – for example, bullying, bereavement or problems at home. And a small minority of students may have severe emotional and psychological problems – such as eating disorders or panic attacks – requiring treatment by professionals working outside the school.

Back to 4Learning Xtra