CHAPTER 1 :GENERAL INTRODUCTION
FACTS AND STATISTICS ABOUT MENTAL ILLNESS

Mental disorders are the largest cause of disability world-wide

Mental health is a burden and challenge to governments to develop comprehensive
services

Mental health is not the absence of mental illness

Mental illnesses affect hundreds of millions of people and if not treated will create
an enormous suffering, disability and economic loss

Despite the potential to successfully treat mental disorders, only a small minority of
those in need receive even the most basic treatment.

The burden of mental disorders is great. They create a substantial personal burden
for affected individuals and their families, and they produce significant economic
and social hardships that affect society as a whole.

Mental and physical health problems are interwoven. Many people suffer from both
physical and mental health problems.

There is a wide gap between the prevalence of mental disorders and the number of
people receiving treatment and care. This is called Treatment Gap for mental
disorders.
MISCONCEPTIONS ABOUT MENTAL ILLNESS
1. Mental disorders affect only a small subgroup of the population
2. Some cultural groups are more likely than others to experience mental illness
3. Mental disorders cannot be treated
4. People with mental disorders are violent and unstable and should be locked
away
5. Once people develop mental illnesses, they will never recover
6. I can't do anything for someone with mental health needs
7. Mental illnesses are all the same
8. Mental illnesses cannot affect me
9. Mental illness is the same as mental retardation
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10. Mental illnesses are caused by a weakness of character
11. People with mental illness, even when treated successfully, should be considered
as second-class workers
12. Children do not experience mental illnesses. Their actions are just products of
bad parenting
13. People with mental illnesses cannot work
14. Only crazy people see shrinks and psychologists
15. You can always tell if a person has a mental illness
PREVALENCE OF MENTAL DISORDERS WORLDWIDE

Within countries, the overall one-year prevalence of mental disorders ranges from
4% to 26%.

The overall prevalence of mental disorders has been found to be almost the same for
men and women

WHO estimates that:
 154 million: Depression
 25 million: Schizophrenia
 91 million: Alcohol use disorders
 15 million: Drug use disorders
 50 million: Epilepsy
 24 million: Alzheimer and other dementias
 1 million: People die by suicide every year

By 2030, depression alone is likely to be the second highest cause of disease burden
second only to HIV/AIDS.
Mental disorders are prevalent in primary care settings
The prevalence of mental disorders in primary care settings has been researched
extensively in a range of different countries. Over the years, the prevalence among
adults has been documented to range between 10% and 60%.
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The main mental disorders presenting in primary care settings are:

Depression: ranging from 5% to 20%

Generalized anxiety disorder ranging from 4% to 15%

Harmful alcohol use and dependence ranging from 5% to 15%

Somatization disorders ranging from 0.5% to 11%
MENTAL AND PHYSICAL HEALTH PROBLEMS ARE CONNECTED

Strong research evidence has revealed the multidirectional links between mental
and physical health and illness. Thoughts, feelings and health behaviour have a
major impact on physical health status. Conversely, physical health status
considerably influences mental health and well-being.

Mental disorders can be indicators to physical health problems, or consequences of
physical health problems, or the result of interactive effects.

Most co-morbid conditions require the coordinated and holistic treatment of both
physical and mental health symptoms.
Examples of how mental disorders influence physical health
1. Depression predisposes individuals to developing myocardial infarctions, and
conversely, myocardial infarctions increase the likelihood of depression.
2. Panic attacks are strongly associated with asthma. People with panic disorder
have a higher prevalence of asthma, and people with asthma have a higher
prevalence of panic attacks.
3. Anxious and depressed moods initiate a surge of adverse changes in endocrine
and immune functioning, and create increased susceptibility to a range of
physical illnesses.
4. Studies indicate that stress is related to the development of the common cold
and that stress delays wound healing.
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Examples of how mental disorders compromise health behaviour
1. Discrimination against people with mental illnesses prevents them from attending
regular medical check ups
2. People with mental disorders are more likely than others to develop significant
physical health conditions, including diabetes, heart disease, stroke and respiratory
disease
3. People with mental disorders have a higher mortality rate than the general
population
4. People with mental disorders are at heightened risk of contracting HIV and
tuberculosis
5. Depression, anxiety, disorders and schizophrenia are associated with tobacco use
6. Schizophrenia and depression reduce adherence to medication therapies
7. Some treatment interventions for mental disorders, particularly those for
schizophrenia, can lead to an increased risk of metabolic syndrome and diabetes.
8. Individuals with serious mental disorders are more likely to suffer stroke and
coronary heart disease before 55 years of age, and to survive for less than five years
thereafter.
FACTORS LEADING TO UNDER-DETECTION AND UNDER-TREATMENT OF MENTAL
DISORDERS

There are many reasons why mental disorders are under detected and under
treated. These can be divided broadly into patient factors, health worker factors,
health system factors, and societal and environmental factors.
Patients’ factors
1. Misrecognition of Symptoms: Many patients do not recognize they have symptoms
of a mental disorder, and instead focus on physical health problems such as
gastrointestinal symptoms, fatigue, headaches, pain, and sleep disruption.
2. Underestimation of the severity of mental problems: Many people
underestimate the severity of their problems and mistakenly believe they can
manage without the help of formal health services.
3. Psychological barriers: Patients might view themselves as morally weak, unable to
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care for themselves, unable to handle responsibility, dangerous or unworthy of
respect.
4. Hospitalization: Fears of involuntary hospitalization and concerns about
embarrassment from using mental health services also stop people from seeking
help.
Health workers factors
1. Inadequate Training: Many health workers do not receive adequate training on
mental health issues. In most countries, care worker training ranges from a few
hours to a maximum of one or two weeks.
2. Misunderstandings about the nature of mental health problems
3. Prejudice against people with mental disorders
4. Inadequate time to evaluate and treat mental disorders within clinical settings
5. Physical disorders can divert health workers’ attention from mental disorders
and there may be an underlying reluctance to suggest diagnoses and treatments that
patients will resist.
6. Lack of interest or attention from health workers can easily divert patients from
raising mental health issues in the context of clinical consultations.
7. Burnout among primary care workers: is also common. Feelings of burnout can
be generated by inadequate training and support, competing responsibilities,
inadequate reimbursement, poor patient adherence to treatment , feelings of
powerlessness in the face of patients’ social and economic difficulties, and suffering
stigma themselves because of their association with people who have mental
disorders.
Health system factors
1. Inadequate financial and human resources

This could contribute to the lack of adequate mental health care and the large
gap between the number of people in need and those that receive care. This is
especially true in low- and middle-income countries, where most nations devote
less than 1% of their health expenditure to mental health.

In Africa, for example, there are only 0.04 psychiatrists, 0.20 psychiatric nurses
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and 0.05 psychologists per 100 000 population compared with 9.8, 24.8, and 3.1
respectively in Europe.
2. Lack of adequate insurance or government reimbursement for mental health
treatments
3. Poorly structured or fragmented mental health systems
4. Absence of facilities for vulnerable and special needs populations
5. Pharmaceutical rights laws
Societal and environmental factors

Societal and environmental factors that impede diagnosis and treatment of mental
disorders include:
1. Stigma
2. Discrimination
3. Misconceptions about mental disorders
4. The association of mental disorders with psychotic, irrational and violent
behaviour
5. Not regarding mental disorders as amenable to treatment.
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