The Health of Our Minds: Mental Illnesses vs. Mental Disability

April 4, 2014

Frederick Wekesah, Research Officer, APHRC

The WHO refers to mental health as “A state of complete physical, mental and social well-being, and not merely the absence of disease”. The Cent for Disease Control defines mental illnesses as “disorders generally characterized by dysregulation of mood, thought, and/or behavior” that affect individuals to the extent that social integration becomes problematic. The TheFreeDictionary.com as you would expect is more elaborate in its definition of mental illnesses: “any of various conditions characterized by impairment of an individual’s normal cognitive, emotional, or behavioral functioning, and caused by social, psychological, biochemical, genetic, or other factors, such as infection or head trauma.” Mental illnesses are also referred to as emotional illnesses, mental diseases or mental disorders.

Mental illnesses include cerebral palsy, depression, schizophrenia, and drug and substance abuse.  Of these mental disorders, mood disorders which include depression (in which the individual commonly reports feeling, for a time period of two weeks or more, sad or blue, uninterested in things previously of interest to them, psychomotor retardation or agitation, and increased or decreased appetite since the depressive episode ensued) are among the most pervasive. Depression is a common mental disorder with an estimated 350 million people of all ages suffering from the condition globally.
Mental health is a positive concept and refers to resilience and good functioning of the body and mind, emphasizing the flourish, state of happiness and the aspect of getting the most out of life. Ironically, mental illness and mental wellbeing can be experienced by a single individual at the same time while on the contrary some people may actually not show signs of mental illnesses but will still experience poor mental health. These traits are exhibited in poor social relationships, poor outputs at work and underachievement of desired goals.
While mental or intellectual disability is almost always congenital and permanent, and incurable in most scenarios, mental illnesses are mostly acquired and can be prevented if care is sought at the earliest possible opportunity. Depression that present with manic episodes may be mistaken with intellectual disability. These are however two different conditions.
According to the WHO (http://www.who.int/mediacentre/factsheets/fs369/en/), depression becomes a serious health condition especially when it is long-lasting and with moderate or severe intensity. Affected persons suffer greatly and function poorly at work, at school and in the family. Extreme depression can lead to suicide. Available data indicates that deaths from suicide number an estimated 1 million every year globally.
The good news is that, if diagnosed early, depression is easily managed and treated. The same can’t be said for mental or intellectual disability.

The scale of the burden

The WHO estimates that mental illness accounts for up to 14% of the global burden of disease with approximately 450 million people worldwide having some kind of a mental disorder. In Africa, 5% of the population suffers from mental illnesses and it is expected to rise to 15% by the year 2030. It is also estimated that at any given time, 10% of adults are experiencing a current mental disorder; and that 25% will develop one at some point during their lifetime [1]. In Kenya, statistics indicate that one in four patients presenting to a primary health facility suffers from a mental illness [2, 3]. Reports suggest that poor mental health is increasingly becoming a big issue in urban areas and especially in the informal settlements, majorly due to the high incidences of drug abuse and poverty [4, 5].

How stigma interferes with health seeking for the mentally ill

Stigma associated with about mental illnesses greatly affects the uptake of available healthcare services. For patients to avoid the label of mental illness and the harm it brings, they decide not to seek or fully participate in care. Stigma diminishes the self-esteem and robs the affected of social opportunities [6]. This means that those suspected to be mentally sick stand a higher risk of being violated and denied their human rights.
According to the Kenya National Commission on Human rights report “silenced minds: The systemic neglect of the Mental health System in Kenya”, as a result of stigma and discrimination against mental illnesses and mental disorder in the country, the policies and practices of the Government of Kenya have been inadequate and resulted in mental health system that is woefully under-resourced and unable to offer quality inpatient and outpatient care to the majority of Kenyans who need it.  There is need for the development of anti-stigma programs that should promote care-seeking and participation among mentally ill patients in Kenya.

References

1.    WHO, Global Burden of Disease 2004 update. 2008, World Health Organization: Geneva.
2.    Kiima, D.M., et al., Kenya mental health country profile. International Review of Psychiatry, 2004. 16(1-2): p. 48-53.
3.    Kiima, D. and R. Jenkins, Mental health policy in Kenya -an integrated approach to scaling up equitable care for poor populations. Int J Ment Health Syst., 2010. 4:19.(doi): p. 10.1186/1752-4458-4-19.
4.    Kemppainen, J.K., et al., Antiretroviral adherence in persons with HIV/AIDS and severe mental illness. J Nerv Ment Dis., 2004. 192(6): p. 395-404.
5.    Do, N.T., et al., Psychosocial factors affecting medication adherence among HIV-1 infected adults receiving combination antiretroviral therapy (cART) in Botswana. AIDS Res Hum Retroviruses., 2010. 26(6): p. 685-91. doi: 10.1089/aid.2009.0222.
6.    Corrigan, P., How stigma interferes with mental health care. American Psychologist, 2004. 59(7): p. 614.


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