Mental Health:  definition

In some situations, it’s obvious: the person has a mental illness. In others, it is less obvious. Is he or she sick or not? Defining what mental health is and especially what good mental health is is an exercise that leads us to discover that mental health is not as simple as we might think. Let’s take a step-by-step approach by first establishing what mental health is.

First, in seeking to be inclusive of the cultures on our planet,  the World Health Organization (WHO) came up with this definition: :

Mental health is an essential component of health. The WHO Constitution defines health as follows:

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. An important corollary of this definition is that mental health is more than the absence of mental disorder or disability.

Mental health is a state of well-being in which a person can achieve self-fulfillment, overcome the normal stresses of life, perform productive work and contribute to the life of the community. In this positive sense, mental health is the foundation of an individual’s well-being and the functioning of a community.

Mental health and well-being are essential for human beings to be able, individually and collectively, to think, feel, interact with others, earn a living and enjoy life. (…)  »

In 1989, the Quebec Mental Health Committee adopted the following definition, which clearly expresses the dynamic aspect of mental health that is experienced on a daily basis:

Mental health, briefly defined as a person’s state of psychological equilibrium at a given time, is assessed, among other things, through the following elements: the level of subjective well-being, the exercise of mental capacities and the donné relations with the environment.

It is the result of interactions between three types of factors: biological factors, relating to the genetic and physiological characteristics of the person; psychological factors, relating to cognitive, affective and relational aspects; and contextual factors, relating to the relationship between the person and his or her environment. These factors are in constant evolution and are integrated dynamically in the individual. (p. 9)

After reading these definitions, it’s fairly easy to see that there are many things that influence our ability to maintain good mental health. Here is what the WHO says:

Multiple social, psychological and biological factors determine how mentally healthy a person is at any given time. For example, persistent socio-economic pressures are recognized risk factors for the mental health of individuals and communities. This is best evidenced by indicators of poverty, including low levels of education.

Mental health problems are also associated with: rapid social change; stressful working conditions; discrimination against women; social exclusion; unhealthy lifestyles; risks of violence or physical ill health; and human rights violations.

In addition, certain psychological profiles and personality traits predispose to mental disorders. Finally, mental disorders may have biological causes, including genetic factors that contribute to chemical imbalances in the brain.

Some thirty years ago, the Quebec Mental Health Committee also formulated a list of determinants that affect people’s mental health:

Mental health is linked both to the dominant collective values in a given environment and to the values specific to each individual. It is influenced by multiple and interdependent conditions such as economic, social, cultural, environmental and political conditions.

Any condition that interferes with a person’s ability to adapt to the environment, such as poverty, pollution or discrimination, is a barrier to mental health.

Conversely, any condition that facilitates this reciprocal adaptation, such as the equitable distribution of collective wealth, access to education qualité́ or to a healthy environment, promotes and supports mental health. In this perspective, mental health can also be seen as a collective resource, to which social institutions and the entire community contribute as much as individuals individually.

In more recent times, certain elements have become more important and influence mental health. Legal access to alcohol, gambling and cannabis has become integrated into society without always emphasizing prevention among the most fragile people. After the rise of the written word, radio and television, the Internet has brought new challenges for mental and physical health. Even the brain development of new generations is changing.

The expansion of the Internet in many spheres of our daily lives is creating a new way of living in society that requires learning, tools such as a computer or a smart phone and access to the Internet. This accelerated evolution affects social relationships, finding a spouse, studies, work, health, consumption, media, travel, the arts and many other activities. While information travels almost instantaneously, people who live without access to the Internet are placed on the margins of society.

Those who are born “inside”, exploring from an early age the multiple propositions, can get lost or become addicted to it, especially with games, pornography or sites in the dark part of the internet. Social networks have created new incentives that can become sources of social pressure. The almost permanent and exclusive interconnection between people in the same family or between like-minded individuals creates closed relationship systems. Relative anonymity, the creation of avatars, the possibility to idealize one’s reality, to lie or to express extremist statements without being identifiable can also create difficult situations in the evolution of people.

Other contemporary topics can change the lives of some people around us to the point of altering their mental health. Instability, tensions and wars in international politics affect the daily lives of millions of people, causing population movements. Often traumatized, these people become refugees or immigrants, some of whom arrive in our country.

Global economic changes are reshaping local economies, for example by relocating jobs, leading to unemployment in the country of origin. We have gone from a marginal activist activity about 40 years ago, ecology, to a large and fervent social movement to save the planet, which is becoming emotionally transformed into eco-anxiety for some of those who are concerned about our collective future.

These examples show the wide range of mental problems, disorders and illnesses.

Mental Problems, Disorders or Illnesses

Our mental balance is maintained in the course of the events we live through. This balance can be broken for many reasons: the health of the body influences the health of the mind and the opposite is also true. There is a gradation in the intensity of the momentary or longer term imbalance that a person experiences.

The term “mental health problem” is often used to refer broadly to the seemingly erratic or unreasonable behaviours of a person who is having difficulty coping with an ordeal or moment in his or her life. The term may imply that the person is solely responsible for his or her situation, which is rarely the case. The terms “social adjustment problem” and “psychosocial problem” give a broader perspective of social situations in which some people may become exhausted and eventually develop psychological distress or a mental disorder while others manage to maintain a balance despite everything.

The term “psychosocial problem” refers to a disturbance in the relationship between the person and his or her environment. This disturbance takes many forms of expression and is the result of difficult living conditions such as poverty and isolation. They are expressed within an environment and in relation to the dynamics of that environment. This expression refers to a situation when it is not possible to determine what is causing the problem between an individual’s abilities and the opportunities offered by the society in which he or she lives. Take housing, for example. Despite all of a person’s good will, intelligence and best abilities, there is not always healthy and affordable housing available in a given area.

We can speak of “social adjustment problems” for stressful events such as the serious illness of a loved one, the loss of a loved one or disruptive behaviours (love break-up, conjugal violence or sexual abuse) that lead to break-ups. Some people will have the ability to maintain a balance in this change while others will be disrupted to the point of having difficulty maintaining their daily activities. They will have difficulty adapting. Psychological support will then be necessary.

“Psychological distress” is distinct from mental disorders.

“Psychological distress is to mental health as a whole what fever is to all infectious diseases: a measurable symptom, a clear sign of a health problem, but which alone cannot shed light on the etiology and sévérité́ of the problem to which it relates” (Perrault, 1987, p. 14). It generally stems from an overload or too much stress intensité́ and can take four forms: depressive states, anxiety, cognitive problems and irritability (Desmarais et al., 2000).

A “mental disorder” can be defined as a characterized, diagnosable illness that results in a marked deterioration in an individual’s cognitive, affective or relational abilities. It is recognized that these disorders emerge at a point of interaction between biological, psychological, social and cultural factors. It may be transient or permanent and moderate or severe. In the Mental Health Action Plan (MHAP) 2005-2010, we can read the following details:

Mental disorders are said to be moderate if they meet certain diagnostic criteria, are significant enough to interfere with an individual’s usual functioning and require treatment, according to widely accepted professional standards. Moderate mental disorders are therefore generally less disabling than severe mental disorders. On the other hand, they are much more common. Moreover, they are on the rise.

Mental disorders are classified as severe when they are associated with a level of disability that significantly interferes with interpersonal relationships, basic social skills and functional ability to produce work. A disability (sustained, prolonged or long-lasting) in at least one of these three major areas of life is an indication of what we mean by severe mental disorders.

In Québec, as elsewhere in the world, 2 to 3% of the adult population has a serious mental disorder. Approximately 150,000 to 200,000 Quebec adults, including seniors, are therefore living with the significant consequences of these health problems.

For many physical illnesses, a blood test, an electrocardiogram, a CT scan or other means can usually identify the type of illness, its extent and clues as to the best treatment for the person. To assess a person’s mental health status, there are as yet no reliable tests to detect possible physical markers of mental illness. However, medical research has led to some advances and in some situations, physical data (e.g. detection of drugs or tumours) will make it possible to make a diagnosis.

Other research has led to the development of reliable psychological tests to identify certain problems. The person’s behaviours can be seen and analysed as possible symptoms of a mental disorder.

The American Psychiatric Association publishes a  Diagnostic and Statistical Manual of Mental Disorders (DSM-5)  the fifth edition of which was published in 2013. This manual  is a tool that groups symptoms together to assess whether a person is living with a mental health disorder and to determine which one(s). It remains a subjective part of the process leading to a diagnosis, which may occasionally lead three specialists assessing a person’s situation to come to different conclusions. The situation can also evolve and cause the professionals who assess to change their diagnoses.

Helping a suffering person to regain good mental health requires a personalized intervention on a psychological, social and medical level. Depending on the situation, the person may need help in different areas of his or her life: studies, work, housing, recreation, sports, respect for rights, etc.

Helping a person regain his or her mental health

Understanding what a person is going through at a given point in their life is not an easy matter. Is this colleague simply going through a prolonged period of grief or is he experiencing depression? When this other person tells me that he or she distinctly hears voices in his or her apartment, are they talking about the neighbourhood or voices inside? And is this relative, who is selling all his assets with the plan to go to the Amazon in search of a lost civilization, sane? What about the mental health of this young androgynous young woman dressed in black, withdrawn, pessimistic, living at night and quoting poets or her own verses that are apparently not understandable?

These few questions call for dozens of others in order to clarify the situation of each of her people. We will want to determine the extent to which the person is aware of his or her situation, if he or she suffers from it. Does she sleep at night? Does he or she eat? We will want to know what she is doing and what she wants to do.

Some people will not recognize that they have a mental health problem. The person does not want or cannot see their situation. The perception of reality may be altered by delusions and hallucinations, or shame or strong emotion may prevent him from seeing himself in his real situation. A law has been created to intervene exceptionally in these situations: the Act respecting the protection of persons whose mental state presents a danger to themselves or to others, often referred to as P-38 in the jargon. The application of this legal approach obliges the person concerned to undergo a psychiatric assessment while in hospital custody. As the person concerned is generally not consenting, the law sets out what rights he or she retains in the circumstances. Associations of relatives and friends and advocacy organizations assist individuals in this process.

Stigmatization

Once the nature of the mental health problem or disorder is established, the reflex is often to look at the negative effects of the situation while neglecting the positive strengths of the person. This person will be imagined as “unable” to achieve anything and, in the most pessimistic visions, will be confused with people living with a significant intellectual disability. When the person with mental health problems is very sensitive to stigma and its consequences, he or she will avoid using the assessment of his or her situation for as long as possible, especially in psychiatry. He or she does not want having a psychiatric medical record to interfere with his or her life.

A person is not a disease. Few people are going to present themselves socially as being diabetic. This health problem will occasionally appear in social exchanges when a situation arises (topic of conversation, physical discomfort, etc.) and will sometimes give rise to a sharing of experiences.

People living with a mental illness should be able to experience the same thing. This is not often the case.  Stigma and prejudice still too often result in a person who talks about a mental illness diagnosis being ostracized. The conversation changes. Sometimes the person instantly loses all credibility. People no longer see his or her qualities, skills, strengths.

Fortunately, mentalities change. The media, television and movies more often than before feature characters who demystify people with mental health problems. Unfortunately, however, violence and mental illness are still closely associated in the news as well as in the stories we hear in novels, films and television series.

Recovery

Today’s mental health workers will build on a person’s talents and skills (and not just academic ones!) to take them on a recovery journey. The notion of recovery has a great influence on the help offered to people living with a mental health problem or disorder.

Here is what the Mental Health Commission of Canada website has to say: :

In the field of mental health, “recovery” refers to the possibility of leading a satisfying, rewarding and hopeful life despite the disadvantages caused by mental health-related illnesses and problems. The recovery process builds on the strengths of the individual, family, culture and community. It can be supported by many types of services, supports and treatments.

The principles that underlie recovery, such as hope, dignity, self-determination and responsibility, can be adapted to the reality of different stages of life and the full range of illnesses and problems associated with mental health. Recovery is not only possible, it is to be expected.

Groups of people who have experienced mental illness have been advocating for recovery for decades. This approach has been adopted by practitioners, service providers and policy makers in Canada and abroad. It is now recognized as an essential element in improving mental health status and mental health systems.

In recovery-oriented practice, service providers make decisions in concert with people who have experienced mental illness. They provide a wide range of services and supports to help them achieve their goals and meet their needs.

Recovery approaches are based on two pillars:

• Recognizing that each person is unique and has the right to determine his or her own path to better mental health and well-being.

• Understanding that we live in complex societies where many factors (biological, psychological, social, cultural and spiritual) intersect and influence mental health and well-being.

of experiences.

People living with a mental illness should be able to experience the same thing. This is not often the case.  Stigma and prejudice still too often result in a person who talks about a mental illness diagnosis being ostracized. The conversation changes. Sometimes the person instantly loses all credibility. People no longer see his or her qualities, skills, strengths.

Fortunately, mentalities change. The media, television and movies more often than before feature characters who demystify people with mental health problems. Unfortunately, however, violence and mental illness are still closely associated in the news as well as in the stories we hear in novels, films and television series.

Asking for Help

The search for help and solutions does not always involve psychiatry. For many psychosocial or social adjustment problems, finding a psychologist and talking about your problems can lead to positive changes. You may be relieved to discover in a self-help group that you are not alone in the world with this type of problem, and discussions can help find solutions. Discovering a community food bank to eat better at a lower cost can reduce family tensions. Many organizations offer free or low-cost help to improve living conditions.

The discovery or confirmation of a mental health problem has a great impact on the person’s parents and loved ones. Often, the situation has gradually deteriorated to the point where it is socially unbearable. Relatives have tried to help the person to the best of their ability with little or no success, or it has been very temporary. Professional help becomes essential for both the person and the parents and relatives to better understand the situation. The family and friends will discover tools for themselves and for helping the person. Relatives will be able to find their possible roles in the person’s recovery.