1. Concepts and Contexts in Mental Health
A discussion By
Dr David E Bukusi

2. Our Fears
Yalom (Psychiatrist) suggested that as human beings we have four basic fears;
The fear of being alone
The fear of dying
The fear of making decisions
The fear of finding out that all that one has been doing is meaningless

3. Mental Health
Definitions:“a state of emotional and social well- being in which the individual
realises his or her own abilities,
can manage the normal stresses of life,
can work effectively,
and is able to play a role in his or her community” (WHO, 1999)

4. Mental Health: Concepts
Mental health has been conceived as a medical, psychological and sociological phenomenon
- disease entity approach
- normality and abnormality; ‘ideal self’
- social construct - ‘deviance’ and social causation - impact of poverty, social position, poor housing, unemployment, social stressors
The merging of perspectives - biopsychosocial model

5. Concepts in wellbeing Emotional wellbeing - affect/feeling
Psychological wellbeing - positive functioning
Spiritual wellbeing - meaning and purpose in life
Physical wellbeing - physical health and fitness
Social wellbeing - relations with others and society

6. Broad contexts of Mental Health
Healthy structures - economic, political, social and cultural framework for developing and maintaining positive mental health
Citizenship - social support, sense of social integration and inclusion
Emotional resilience - self-esteem, coping , life skills, sense of control

7. Broad contexts of Mental Health
Markers of social disadvantage are all associated with poorer mental health
There is a strong association between mental health, social wellbeing and physical health
Promoting mental health is central to population health and wellbeing

8. Early childhood (0-5years)
Grooming, touch and nutrition
Language development
Early childhood development/schooling
Play- with peers, siblings and parents
Promotes neurogenesis, stable attachments and boundary formation

9. Contexts: In Childhood
Nutrition, touch/(hugging-grooming) and play
close relationships contribute to resilience in adulthood
High-quality early-childhood interventions
parenting programmes- Early attachment, warm and affectionate parenting; secure and safe home, informal sources of community support
Pre-school education, school-based approaches
Sense of connectedness - home, school, community
Reduce health inequalities and eliminate poverty

10. Contexts: As adults
Individual level determinants - life skills and social competencies - protective of mental health
Sense of self -control, efficacy and esteem
Relationship skills
Coping skills
Communication
Cognitive style
Emotional literacy
Problem solving skills

11. Contexts: At Home Safe environment Adequate healthy nutrition
Space for privacy as well as individual growth
Meaningful supportive family relationships
A base from which one can relate to and contribute to the community and society

12. Contexts: At Work
Appropriately skilled and challenged at work with commensurate remuneration
Appropriate work relationships with clearly understood targets and boundaries
To be able to achieve work satisfaction
To be able to contribute to the community/ society

13. Contexts: Relationships
To establish meaningful relationships
Friendly
Reaching out to support
Enjoying each others company
Respectful
Appreciative of boundaries
Loving
Intimacy
Passion
commitment

14. The Triangular Theory of Love (Sternberg)

15. Passionate and Companionate Love
Passionate and Companionate Love. Over time, the thrill of new love usually fades, and a calmer kind of love takes its place.

16. The Four Horsemen. John Gottman identified four conflict styles that can bring about the end of a relationship.

17. Contexts: Substance use

18. Effects of Alcohol Intoxication on Brain Glucose Metabolism (Marker of Brain Function)
Decreases
prefrontal cortex
cingulate gyrus
Increases
amygdala
Alcohol decreases activity of areas involved with control and increases activity of areas involved with emotional reactivity

19. Psychiatric manifestations in substance use/misuse
Normal Brain
Psychiatric manifestations in substance use/misuse
1. Psychiatric manifestations of acute intoxication
2. Psychiatric manifestations in withdrawal
3. Psychiatric complications of substance misuse
Dual diagnosis (co-morbidity)
A Heroin Dependent Brain

20. Common psychiatric symptoms in substance use/misuse
Disturbances of perception
A. Hallucinations
Perceptual experiences without external stimulation
1. Visual hallucinations: e.g. LSD intoxication (trip)
2. Auditory hallucinations: e.g. alcohol hallucinosis (long term use), derogatory voices or pieces of music.
3. Tactile hallucinations: e.g insects crawling under the skin in cocain misuse (after effect i.e. Long term use)
An Alcoholic Brain

21. Common psychiatric symptoms in substance use/misuse
Disturbances of perception
B. Illusions
Distorted perception of external stimuli.
Illusion of time and space: e.g. in a cannabis high
A Marihuana user brain

22. Disturbances in thought
Delusions: false fixed belief that cannot be changed by logic or reality and are not accounted for by the cultural background.
Delusions of persecution in alcohol and in Amphetamine long term use
Delusions of infidelity: alcohol
Drug induced psychoses
Amphetamine user brain

23. Conclusions Develop and strengthen parenting
Emotional support, grooming, stable attachments, safety
Develop and strengthen schooling strategies
Appropriate study/sleep balance, balancing knowledge, aptitude and effort
Develop and strengthen Lifestyle strategies
Nutrition, exercise, relationships, spiritual life goals
Develop and strengthen workplace engagement
Accomplishment, goals and rewards
Develop and strengthen the concept of contributing to the community
Donations, Volunteering, Helping causes

24. Conclusions
Develop strategies addressing the social determinants of mental health – economic, social, political, cultural frameworks
Integration of mental health in health promotion and public health initiatives
Engaging the political will to promote mental health at a policy level
Mobilising a public demand for a mentally healthy society
- concern with emotional and social wellbeing, social values, culture, economic and social policies

25. Acknowledgements
Promoting Mental Health and Wellbeing: Concepts, Practice and Policy-Professor Margaret Barry :World Health Organisation Collaborating Centre for Health Promotion Research National University of Ireland, Galway Ollscoil na hÉireann, Gaillimh
Implementing Mental Health Promotion: M. Barry & Rachel Jenkins
Think Social Psychology- Kimberly Duff: Pearsons education inc.