Promote Mental Health and Well-Being

Introduction

The Sustainable Development Goal-SDG's were adopted by the United Nations General Assembly in September 2015 and to be achieved by 2030. They are broader in scope than the Millennium Development Goals-MDG's. Goal 3 of the SDG's is 'Ensure healthy lives and promote well-being for all at all ages. Target 3.4 'By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being'. There are two indicators within this target:

Indicator 3.4.1: Mortality rate attributed to cardiovascular disease, cancer, diabetes or chronic respiratory disease.

Indicator 3.4.2: Suicide mortality rate (per 100 000 population).

Facts and Figures

• The World Health Organisation stated that one in hundred deaths or more than 700 000 deaths per year are by suicide. Furthermore, for each suicide, there are more than 20 suicide attempts.
• Suicides and suicide attempts have a ripple effect that impacts on families, friends, colleagues, communities and societies.
• Suicide is the fourth leading cause of death among 15-29 year-olds.
• 77% of global suicides occur in low- and middle-income countries.
• Ingestion of pesticide, hanging and firearms are among the most common methods of suicide globally.
• Suicides are preventable.?Much can be done to prevent suicide at individual, community and national levels.

Risk Factors

While the link between suicide and mental disorders (in particular, 
depression and alcohol use disorders) is well established in high-income 
countries, many suicides happen impulsively in moments of crisis with a 
breakdown in the ability to deal with life stresses, such as financial 
problems, relationship break-up or chronic pain and illness- WHO
        

There are number of factors like conflict, disaster, violence, abuse, or loss and a sense of isolation are associated with suicidal behaviour. It has been observed that suicide rates are high amongst vulnerable groups who experience discrimination, refugees, migrants; indigenous peoples; lesbian, gay, bisexual, transgender, intersex (LGBTI) persons; and prisoners. The WHO's suicide page further adds that about 20% suicides are committed by pesticide self poisoning where as hanging and firearms also contribute in large number of suicides.

Although most people are resilient, people who are exposed to adverse 
circumstances – including poverty, violence, disability, and inequality – 
are at higher risk. Protective and risk factors include individual 
psychological and biological factors, such as emotional skills as well as 
genetics-WHO??        

Prevention and Control

Suicides can be prevented by taking following interventions suggested on the Suicide page of WHO.:

• Keep pesticides, harmful medications away from people thinking of suicide.
• foster socio-emotional life skills in adolescents
• identify, manage and follow up the person affected by suicidal behaviors.
• analyses situation, raise awareness, build capacity, and manage finance.
• suicide is a complex issue and any specific approach will not work rather it requires coordination and collaboration with multiple sectors of society like health, education, labour, agriculture, business, justice, law, defence, politics, and the media in a comprehensive and integrated manner.
• raising community awareness and and helping people thinking of suicide financially, emotionally and other means they are looking for.
• The physical, mental and social well-being can be improved through funding and creating more green spaces. The earth.org claims that spending time in green spaces can lower the risk of psychiatric disorders and mitigate the impact of conditions related to stress, anxiety, and depression.

Mental Disorders

The WHO's Mental Disorders division mentions that mental disorders are usually associated with distress or impairment in important areas of functioning. In 2019, 1 in every 8 people, or 970 million people around the world were living with a mental disorder, with anxiety and depressive disorders the most common. This number was further increased by 26-28% in 2020, the number of people living with anxiety and depressive disorders rose significantly because of the COVID-19 pandemic.?

• 1 in every 8 people in the world live with a mental disorder.
• One in seven Indians were affected by mental disorders of varying severity in 2017. The proportional contribution of mental disorders to the total disease burden in India has almost doubled since 1990 claims The Burden of Mental Disorders Across the State of India article.
• Mental disorders involve significant disturbances in thinking, emotional regulation, or behaviour.
• WHO noted that effective psychological treatment exists, and depending on the age and severity, medication may also be considered in following mental disorders:

Anxiety Disorders

As per the WHO data In 2019, 301 million people were living with an anxiety disorder including 58 million children and adolescents.?People with this disorder experience excessive fear and worry and related behavioural disturbances. Symptoms are severe enough to result in significant distress or functional impairment. The disorder is broadly classified into:

• Generalised anxiety disorder: characterised by excessive worry,
• Panic disorder: characterised by panic attacks
• Social anxiety disorder: characterised by excessive fear and worry in social situations,
• Separation anxiety disorder: excessive fear or anxiety about separation from loved ones

Depression

WHO defines depression as a different situation than usual mood fluctuations and short-lived emotional responses to challenges in everyday life. In 2019, 301 million people were living with an anxiety disorder including 58 million children and adolescents. In depression the person experiences feeling sad, irritable, empty or a loss of pleasure or interest in activities nearly everyday, for at least two weeks. Besides this other symptoms like poor concentration, feelings of low self-worth, hopelessness about the future, thoughts of dying, disrupted sleep, changes in weight, and feeling tired.?People with depression are at an increased risk of suicide.

Bipolar Disorders

Person suffering the bipolar disorder alternating depressive episodes with periods of manic symptoms.?In 2019, 40 million people experienced bipolar disorder. During a depressive episode, the person experiences feeling sad, irritable, empty or a loss of pleasure or interest in activities, for most of the day, nearly every day.?Manic symptoms may include increased activity or energy, decreased need for sleep and symptoms of:

• Delusions: Delusions are false beliefs or ideas that are incorrect interpretations of information. An example is a person thinking that everyone they see is following them.
• Hallucinations. Having a hallucination means you see, hear, taste, smell or feel things that aren’t really there.?People with bipolar disorder are at an increased risk of suicide.

Post-Traumatic Stress Disorder (PTSD)

Post-Traumatic Stress Disorder is usually seen conflict affected/horrific settings. PTSD's are characterised by intrusive memories, flashbacks, or nightmares, avoidance of thoughts and memories of the events, and persistent perceptions of heightened current threat. These symptoms persist for at least several weeks and cause significant impairment in functioning. Effective psychological treatment exists.?

Schizophrenia

As per WHO 24 million people or 1 in 300 people suffer this disease worldwide. People with schizophrenia have a 10-20 years less life expectancy and with significant impairments in perception and changes in behaviour.?Symptoms may include persistent delusions, hallucinations, disorganised thinking, highly disorganised behaviour, or extreme agitation. Effective interventions include medication, psycho-education, family interventions, and psycho-social rehabilitation. ?

Eating Disorders

As per WHO's 2019 records, 14 million people experienced eating disorders including 3 million children and adolescents. This disorder involve abnormal eating and strong concern for body weight and shape. The symptoms results into damage to health, significant distress or premature death due to medical complications or suicide.?Individuals are also at a risk of substance use, suicidal feelings, and health complications. Family-based treatment and cognitive-based therapy Management are the WHOs' suggested interventions.

Disruptive behaviour and dis-social disorders

40 million people, including children and adolescents, were living with conduct-dis-social disorder in 2019. Disruptive behaviour and dis-social disorders are characterised by persistent behaviour problems such as persistently disobedient to behaviours that persistently violate the basic rights of others or major age-appropriate societal norms, rules, or laws. Onset of disruptive and dis-social disorders, is generally observed during childhood but not always. Effective interventions require involving parents, caregivers, and teachers, cognitive problem-solving or social skills training.

Neuro-developmental disorders

Neuro-developmental disorders are behavioural disorders that arise during the developmental period, and involve significant difficulties in the acquisition and execution of specific intellectual, motor, language, or social functions. The person experiences significant limitations in intellectual functioning and difficulties with everyday conceptual, social, and practical skills that are performed in daily life. Psycho-social interventions, behavioural interventions, occupational and speech therapy and medications in certain cases are suggested.

Who is at risk?

Individuals themselves, family, community and other socioeconomic and environment factors either protect deteriorate the mental health. Though many people are resilient, but people who are exposed to adverse circumstances – including poverty, violence, disability, and inequality – are at higher risk of mental disorders. Individual psychological and biological factors, emotional skills and genetics plays important role in mental disorders. ?

Stress Management

The Stress Management Guide Coping with Adversity developed by World Health Organisation aims to equip people with practical skills to help cope with stress. A few minutes each day are enough to practice the self-help techniques.

If you are experiencing stress, this guide is for you. The guide contains information and practical skills to help you cope. Even in the face of tremendous adversity, you can find meaning, purpose and vitality in your life by practicing the guidelines.
                Doing What Matters in Times of Stress WHO        

Tool 1: GROUNDING

Ground yourself during emotional storms by noticing your thoughts and feelings, slowing down and connecting with your body by slowly pushing your feet into the floor, stretching and breathing, and then REFOCUSING and ENGAGING with the world around you. Not only during stressful situations but grounding can also be done after or before washing, eating, cooking or sleeping for about 2 minutes which will make these activities enjoyable.

• What can you see, hear, touch, taste and smell?
• Pay attention with curiosity to what is in front of you.
• Notice where you are, who is with you and what you are doing.

Tool 2: UNHOOK YOURSELF

1. NOTICE that a difficult thought or feeling has hooked you. Realise that you are distracted by a difficult thought or feeling, and notice it with curiosity.
2. Then silently NAME the difficult thought or feeling; for example: “Here is a difficult feeling” “Here is tightness in my chest” “Here is a feeling of anger” “Here is a difficult thought about the past” “I notice here is a difficult thought” “I notice here are fears about the future”
3. Then, REFOCUS on what you are doing. Pay full attention to whoever is with you and whatever you are doing.

Tool 3: ACTING ON YOUR VALUES

Choose the values that are most important to you. For example:

• being kind and caring
• being helpful
• being brave
• being hardworking.

You get to decide which values are most important to you! Then pick one small way that you can act according to these values in the next week. What will you do? What will you say? Even tiny actions matter!

Remember that there are three approaches to any difficult situation:

1. LEAVE
2. CHANGE WHAT CAN BE CHANGED, ACCEPT THE PAIN THAT CANNOT BE CHANGED, AND LIVE BY YOUR VALUES
3. GIVE UP AND MOVE AWAY FROM YOUR VALUES.

But sometimes you cannot leave… for example, if you are in prison, or if leaving is worse than staying.

True! If so, you must choose between options two and three.

But I do not like to give up and move away from my values.

So then option two is what is left.

Tool 4: BEING KIND

Notice pain in yourself and others and respond with kindness. Unhook from unkind thoughts by NOTICING and NAMING them. Then, try speaking to yourself kindly. If you are kind to yourself you will have more energy to help others and more motivation to be kind to others, so everyone benefits.

You can also take one of your hands and imagine filling it with kindness. Place this hand gently somewhere on your body where you feel pain. Feel the warmth flowing from your hand into your body. See if you can be kind to yourself through this hand.

Tool 5: MAKING ROOM

Trying to push away difficult thoughts and feelings often does not work very well. So instead, MAKE ROOM for them:

1. NOTICE the difficult thought or feeling with curiosity. Focus your attention on it. Imagine the painful feeling as an object, and notice its size, shape, colour and temperature.
2. NAME the difficult thought or feeling. For example: “Here is a difficult feeling” “Here is a difficult thought about the past” “I notice here is sadness” “I notice here is a thought that I am weak”
3. Allow the painful feeling or thought to come and go like the weather. As you breathe, imagine your breath flowing into and around your pain to make room for it. Instead of fighting with the thought or feeling, allow it to move through you, just like the weather moves through the sky. If you are not fighting with the weather, then you will have more time and energy to engage with the world around you and do things that are important to you.Tool 1-5 Source: WHO's Stress Management Guide