Mental Health refers to a broad array of activities directly or indirectly related to the mental well-being component included in the WHO’s definition of health: “A state of complete physical, mental and social well-being, and not merely the absence of disease”. It is related to the promotion of well-being, the prevention of mental disorders, and the treatment and rehabilitation of people affected by mental disorders.
World Mental Health Day, celebrated on 10 October, raises public awareness about mental health issues. The day promotes open discussion of mental disorders, and investments in prevention, promotion and treatment services. This year the theme for the day is “Depression: A Global Crisis”. Depression affects more than 350 million people of all ages, in all communities, and is a significant contributor to the global burden of disease. Although there are known effective treatments for depression, access to treatment is a problem in most countries and in some countries fewer than 10% of those who need it receive such treatment.
– More than 450 million people suffer from mental disorders. Many more have mental problems.
– Mental health is an integral part of health; indeed, there is no health without mental health.
– Mental health is more than the absence of mental disorders.
– Mental health is determined by socio-economic, biological and environmental factors.
– Cost-effective intersectoral strategies and interventions exist to promote mental health.
Determinants of mental health
Multiple social, psychological, and biological factors determine the level of mental health of a person at any point of time. For example, persistent socio-economic pressures are recognized risks to mental health for individuals and communities. The clearest evidence is associated with indicators of poverty, including low levels of education.
Poor mental health is also associated with rapid social change, stressful work conditions, gender discrimination, social exclusion, unhealthy lifestyle, risks of violence and physical ill-health and human rights violations.
There are also specific psychological and personality factors that make people vulnerable to mental disorders. Lastly, there are some biological causes of mental disorders including genetic factors and imbalances in chemicals in the brain.
Strategies and interventions
Mental health promotion involves actions to create living conditions and environments that support mental health and allow people to adopt and maintain healthy lifestyles. These include a range of actions to increase the chances of more people experiencing better mental health.
A climate that respects and protects basic civil, political, socio-economic and cultural rights is fundamental to mental health promotion. Without the security and freedom provided by these rights, it is very difficult to maintain a high level of mental health.
National mental health policies should not be solely concerned with mental disorders, but should also recognize and address the broader issues which promote mental health. This includes mainstreaming mental health promotion into policies and programmes in government and business sectors including education, labour, justice, transport, environment, housing, and welfare, as well as the health sector.
Promoting mental health depends largely on intersectoral strategies. Specific ways to promote mental health include:
- early childhood interventions (e.g. home visits for pregnant women, pre-school psycho-social activities, combined nutritional and psycho-social help for disadvantaged populations);
- support to children (e.g. skills building programmes, child and youth development programmes);
- socio-economic empowerment of women (e.g. improving access to education and microcredit schemes);
- social support for elderly populations (e.g. befriending initiatives, community and day centres for the aged);
- programmes targeted at vulnerable groups, including minorities, indigenous people, migrants and people affected by conflicts and disasters (e.g. psycho-social interventions after disasters);
- mental health promotional activities in schools (e.g. programmes supporting ecological changes in schools and child-friendly schools);
- mental health interventions at work (e.g. stress prevention programmes);
- housing policies (e.g. housing improvement);
- violence prevention programmes (e.g. community policing initiatives); and
- community development programmes (e.g. ‘Communities That Care’ initiatives, integrated rural development).
NIOH response: mental health in the workplace
A major development, in the Occupational Medicine Division at NIOH, over the past year was the decision to expand activities and services in the neglected areas of work capacity (including disability) and mental health at work. Globally, these areas are prominent in occupational medicine, but the NIOH has provided very limited service and conducted scant research. Capacity building is planned in stages: initially gaps in service, training and knowledge were identified followed by the introduction of key services, training programmes and research projects. Currently, occupational stress is the focus of the Mental Health at Work area. The objective is to identify a locally suitable tool for workplace surveys.
Mental disorders have a high prevalence and are a leading cause of disability in many countries, including South Africa. The burden of these disorders is underestimated in low and middle income countries despite the strong evidence regarding their social impact. South Africa lacks capacity to deal with work related mental health issues. Public health services are over-burdened and under staffed, and unable to deal with mental health issues.
The NHLS, through the NIOH as a centre of excellence in occupational health, is strategically positioned within the public health system to take the lead in finding solutions for occupational health problems, strengthening the occupational health knowledge base and influencing policy decisions.
The long term objectives are to increase knowledge and awareness among workers, managers and occupational health practitioners on the impact of work-related mental health; establish a mental health service that seeks to fill existing gaps in identifying risk factors for mental health; diagnosis of these diseases and advice on holistic management and accommodation of employees within workplaces. This has to be parallel to building the capacity of occupational health practitioners in dealing with mental health issues proactively.