Mental Health Awareness Month Special: Unveiling the Power of Mental Health Awareness - Dr Niti Sapru
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Should mental health be talked about, read about, or discussed only in a particular month, a day, or a date? We know for certain now that the mind-body connection is real, and when we talk of health or disease states the mind too is affected, and involved in most of these presentations to a Physician.
Maybe some statistics are needed to make this argument stronger. A DALY is equivalent to the loss of 1 year of full health of an individual. The burden of DALYs due to mental illness in India is 2443 per 100000 population. Math for 140 crore population is staggering.
The Suicide rate in India is also quite high. The estimated loss to our economy because of mental health conditions is pegged at 1 trillion US dollars, by 2030. Imagine at 3 trillion $ economy it will be 1/3 of our GDP, at 4 trillion it will rob away a quarter of our wealth, and so on. I hope these numbers impress upon all the need for taking Mental health as equally important as physical health.
To understand Mental health, one has to understand mental illnesses, in order to practice activities, and cultivate hobbies that are counterproductive to factors causing, associated with disease states. Over the last 2 decades, it is becoming increasingly clear that almost all mental illnesses are rooted in the brain.
There can be multiples paths to that endpoint of dysfunction of the brain originating in genetics, an insult to a developing brain early on in utero or during the period of development -trauma, toxins, deficiency states, medications, substances of abuse, infections etc and chronic ongoing stress either of a life situation or of diseases-physical and mental. There are many studies to demonstrate abnormalities in different parts of the brain in psychiatric disorders, e.g., PET scans uncover a striking feature of panic disorder.
During an attack, the brain shows significant asymmetry between the left and right hemispheres, in a region that forms part of the limbic system (the "emotional brain"). In patients with panic disorder, the left side of this region shows lower blood volume and blood flow, and less use of oxygen—in short, less activity.
This imbalance is not seen in normal patients. More recently researchers discovered a transdiagnostic neural network in which up to 85 percent of studies showed grey matter decreases in psychiatric disorders. All forms of intervention be they pharmacotherapy, Electroshock therapy, Ketamine, Trans cranial stimulation, psychotherapy, social milieu therapy, and others- all of them operate via these neural networks and hence now all of Mental health and illness are seen as originating from the brain.
Mental health like all health is not merely the absence of a disease. It encompasses mental well-being, prevention of mental illnesses, early detection, treatment, and rehabilitation. There are some simple low-cost doable things that can promote well-being mentally. Mind and body are interconnected, so a healthy body very likely promotes mental well-being.
To maintain that healthy body one needs to exercise, eat a healthy and balanced diet, get adequate sleep, practice some form of breath control pranayam, and ideally meditate regularly, if not done daily. When you or close ones recognize you are stressed, please share your worries with them to reduce the burden of chronic stress operating via raised cortisol levels leading to neural network dysfunction manifesting in disease states, which could be either Mental or physical- Hypertension, Diabetes etc.
There is growing evidence of a strong association between Gut health and mental wellbeing. Stress, anxiety, poor food choices, and lack of sleep all negatively impact gut health by altering the healthy bacteria and other organisms residing in our gut.
Untreated maternal depression is deleterious to the health of the mother, the neonate and the infant. Early recognition of the same and other psychiatric disorders or stress in the ante/post-partum period is very helpful.
Neurodevelopmental disorders like ADHD, Autism, learning difficulties (Reading, writing, Math), Communication disorders, language disorders and intellectual disability are prevalent from a low of roughly 5% of the population to in some studies as high as 80%! There is a pressing need for early recognition of such conditions, and accessibility to centers that have facilities to diagnose and treat these disorders to optimise the potential of these children.
So many of them drop out from the education system early on in life. A child who is performing poorly in studies is very naughty, absent-minded, clumsy, poor in sports activities, doesn’t mix with others, and is very sensitive to particular sounds, and touch- these are some of the symptoms of the above-mentioned disorders.
These disorders require comprehensive management with continued interactions between the parents, family, educational institutions, medical and para medical staff and society in general. These neuroatypical children going on to be adults, are vulnerable to many life situations handled relatively easily by their other peers, all throughout their life.
50 pc of Psychiatric disorders have their origins in childhood and adolescence. How our children are nurtured and groomed can reduce or add to this burden. Adverse Childhood Experiences (ACE) are associated with increased frequency of mental and even physical illnesses like diabetes, heart disease, cancer, etc. So, to promote mental wellbeing in children these areas have to be managed well.
Adolescence is a turbulent period of growth for most. Issues of this period require encouraging a positive sense of identity, providing a platform for their growing independence from family without them fearing losing love and support, and tackling their disappointments related to academics, body image, friendships, etc., paving the way for a healthy adult.
Substance use destroys many homes and lives and there is increasing use of substances of dependence. When there is a strong family history of Substance use, dependence, organ damage secondary to that use, it is not in the hands of the individual alone to shake off that dependence. It’s not just ‘you can do it’.
Psychiatric management including Detoxification, medicines for reducing desire or impulse, rehabilitation, being in therapy for a long time are essential components of a chance for good recovery. Blaming, shaming, guilt inducing, negative empowering (You can) all are counterproductive to a better outcome with the dependence.
There is a component in the management of Mental illnesses that requires better coordination among the various disciplines of medicine, surgery and psychiatry- Consultation Liaison. There is no duality in the functioning of a human being- mind and body are connected and impact each other.
So, is it all in the individual’s hands to maintain his/her/their mental well-being? Not entirely. Poor socioeconomic conditions, poverty, homelessness, being a marginalised group, a minority, a discriminated class, sect or group, living in chaotic homes, in settlements with high criminality or anti-social activities, poor connectedness in the community or society, living a war torn country or in shelter camps -all these adversely affect the wellbeing of individuals.
Loneliness is becoming endemic and, in some countries, assuming the proportions of an epidemic. We must build meaningful relationships, foster community connectedness, play our part in being there for those who are in contact with us, promote harmony and peaceful co-existence.
Dementia steals the dignity in dying, of having a good closure to an inning, leaving raw emotions and disturbances in those left behind. Having access to support groups, good medical care and substitute caretaker reduces care giver burden.
We have to be mindful of our health right from the womb to the tomb.
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