Mental Health Systems for Non-professionals II Prevention

 Mental Health Systems for Non-professionals II Prevention

Posted to Reflections of an Aging Shrink 2024 9 6

II. Prevention

Prevention was a buzzword when I was training to be a Family Physician in the latter 1970s. It was even more a focus of the Canadian Public Health Association, of which I was a member for some time after my entering practice. It would seem intuitive that this should be a primary focus of our healthcare services. However, although it is regularly paid lip service, there never seems to be enough funding for this. That has resulted in the continued failure of the ability to develop a wide – ranging framework from within which to strategize for prevention. We keep trying to put out the fires without working at how to prevent them.

A. Primary prevention

Primary prevention, put most simply, is simply taking whatever steps we can, to try and prevent an illness, in this case deterioration in a person's mental health to the point where they diagnosed with an illness, from occurring.

One of the best and most successful examples that we are all familiar with is the whole area of immunization. Over the last century, illnesses like smallpox, polio, diphtheria, tetanus ("lockjaw”), rubella ((German measles), measles and pertussis (whooping cough) have practically been eliminated in our country. Unfortunately, there is a strange new anti-science movement which is resulting in many parents refusing to have their children immunized, with the result that many of these diseases are tragically on the rise again. 

Unfortunately, we are nowhere near this type of program when it comes to preventing the occurrence of mental illness. This is because those diseases were caused by viruses and bacteria, against which specific sera could be developed to immunize against them. Mental illness causes are far to multifactorial to be able to work on them simply as that.

Factors that we could work on to prevent mental illness cover the spectrum from pregnancy into adulthood. Comprehensive and adequate pre-natal care for every mother-to–be would be one place to start. We know that what a pregnant woman is exposed to, what her emotional and health status are and what she ingests can all contribute to poor mental health in the offspring. Mothers-to-be need education and support. They need an environment where they're not exposed to undue stress, let alone abuse. Their own health needs to be maintained, along with adequate nutrition for themselves and the fetus. The effects of excessive consumption of alcohol, especially in the face of poor nutrition, can be devastating when the child turns out to have a variation of the adverse effects of that exposure. Other illicit substances such as cocaine and methamphetamine also have delirious effects. These can occur while the mother is consuming, let alone they possibly unrecognized and therefore untreated withdrawal that can occur upon birth when the infant no longer is expoed to those substances.

Doing our best to ensure optimal and non-traumatic births for every infant would be the second step. A variety of injuries can occur at birth, but the worst is brain damage. This can cause disabling effects both physically and mentally, which can be a challenge for both parents and the child down the road, increasing the stress and potential for the development of poor mental health.

Many of these same factors require the same attention throughout the child and adolescence's lifespan to try to minimize the risk of the development of poor Mental Health. The infant especially requires both the physical and emotional nutrition that lead to optimal physical and personality development, based on positive and adequate development of the all – important attachment bond. What happens in this area sets the stage for personality and relationships for the rest of one’s life.

I have not even so far mentioned directly economic factors, although it is easily to extrapolate their effects on nutrition especially. Inadequate income to be able to provide suitable housing and nutrition are obvious drawbacks. The housing and school environments also need to be safe and positive. Poverty and marginalization are huge negative factors in this picture. Important social and family connections are also vital for support, belonging and education of both mother and child. What goes on at school ,as well as between peers outside of school, especially in this day of the negative influence of social media, is also very important. Factors ranging from neglect and abandonment to bullying and outright abuse must all be fought against.

When it comes to adult mental health, what goes on in relationships, or their lack, is also important. Many of us have heard of the so-called epidemic of loneliness in our society today. Too many are lonely and as many as one third of American households were reportedly only single adult units. The type and level of education obtained as well as one's employment situation, are also all important factors, both economically and when it comes to self esteem and having a sense of well-being and purpose in life.

When can see that there are no readily available fixes for such wide-ranging and influential factors that play on the potential for mental health problems throughout the lifespan. We all play a part in these scenarios.

Mental Health Systems for Non-professionals

Mental Health Systems for the Non-Professional 

OUTLINE

The Title 

I. Introduction

1. Language

2.. Background and qualifications

    i. Experience:

    ii. Training and work:

3. Scope

II. Prevention

A. Primary prevention

B. Secondary prevention

Treatment

A. Emergency

B. Community

C. Institutional 

1. Hospitals

2. Long-term institutions 

Para-and post treatment

A. group homes 

B. support groups

C. Self-help groups

Prisons

****

The Title

Most of us agree, when it comes to the crunch, nothing is more important than our health. In our contemporary, increasingly rushed, stressed and divided world, mental health is perhaps by now the largest component of health that concerns us all. The toll that poor mental health takes on our families, our communities, not to mention our emotional suffering and the economic costs, is truly staggering. Given all of that, I intended this for those having difficulty understanding and navigating these systems, hence the given title. Also, there is no one system. There are many, according to the type of care or treatment offered, or the geographical area in which one finds one self, to name but a couple of variables in which systems can be found.

I. Introduction

1. Language

Some words about language would also be in order. To begin with, what follows is not about differentiating between mental health and mental illness. Nor will there be explanations of the different types of mental illness and their treatments. There are many resources available to answer questions about those subjects. However, I think one of the weaknesses in this whole area is obtaining the care necessary, which means, in a sense getting into ‘the system.’ This is what presents the first hurdle to good mental health when it has been adversely affected, and also one of the most notoriously difficult to get across. My purpose is to try to shed some helpful light on that for those who are looking for help for themselves or those near and dear to them.

Also,  when I first entered this field, individuals in care of any type were referred to as patients. Now, with increased focus on collaboration of care between individuals with autonomy, their families and caregivers, the term client is preferred by many. Along with that, has come the shift to speak not of outpatient care but as individuals in community care. Similarly, the tendency is to speak more of hospital care versus inpatient, or certainly the more foreboding, for many, institutional care.

2.. Background and qualifications

i. Experience:

Let me put forward first of all what I would consider my qualifications for writing in this area. I am fortunate in that we have not really had significant mental health troubles in our own family or my family of origin, other than the woman who became my stepmother when I was already a young adult, now suffers from dementia. Therefore, I cannot claim to speak from the authority as someone who has, as the expression now goes, much ‘lived experience.’ However, I have certainly faced mental health issues in my extended family.

ii. Training and work:

On the other hand, I have worked in the healthcare field for over 50 years. The first few years of that were as a frontline worker, a nursing orderly in hospital care. Then, I served a rural community, followed by a small city, for 12 years as a family physician. During the 4.5 years I spent in that city, I also worked in one of the long term mental health care facilities that were spread across our country. This was done even though I was a family physician, because of the shortage of psychiatrists in all but the larger centers. As such, I work in a variety of words, including tending to admissions, and oversaw the transfer of care, in the case of an older adult unit on which I was the primary care physician, to a brand new long term care facility. Here, I stayed on as the Medical Director/attending physician for a couple of years. This was during the 1980s when the old long-term mental health care institutions were being emptied out across the country. Then I added to that 21 years as a psychiatrist. In that capacity I worked in community (outpatient) care, special school classrooms and programs for mentally disturbed students, and both institutional (inpatient) and emergency care.

3. Scope 

It needs to be mentioned here as well that this is being written by one whose primary knowledge of the field is based on what we have in Canada. Even within that, it relates to what has existed during my lifetime. Furthermore, although I have some knowledge of systems across the country, and there are similarities, the experience I speak from is mainly in the places where I have worked, namely Manitoba, both rural and urban, and British Columbia, suburban/urban.