APPENDIX H

CONTENT ON MENTAL HYGIENE

I. INTRODUCTION

A healthy individual is not only physically healthy, but is also mentally healthy. The
modern concept of health extends beyond the proper functioning of the body. It includes a
sound, efficient mind and controlled emotions. Health is a state of being sound, or whole, in
body, mind or soul. It means that both body and mind are working efficiently and
harmoniously. Man is an integrated mechanism, a psychosomatic unit (body- mind), whose
behaviour is determined by both physical and mental factors.

Mental health which today is recognised is an important aspects of one’s total health
status, is a basic factor that contributes to the maintenance of physical health as well as social
effectiveness.

It is not mere absence of mental illness that constitutes mental health. On the other
hand, it is a positive, active quality of the individual’s daily living. This quality of living is
manifest in the behaviour of an individual whose body and mind are working together in the
same direction. His thoughts, feelings and actions function harmoniously towards the
common end. It means the ability to face and accept realities of life. It connotes such habits
of work and attitudes towards people and things that bring maximum satisfaction and
happiness to the individual. But the individual gets this satisfaction and happiness without
any friction with the social order or group to which he or she belongs.

From this one can conclude that mental health has two important aspects. It is both
individual and social. The individual is self-confident, adequate and free from internal
conflicts and tensions or inconsistencies. He is skilful enough to be able to adapt to new
situations. But he achieves this internal adjustment in a social set-up. Society has certain
value systems, customs and traditions by which it governs itself and promotes the general
welfare of its members. It is within this social framework that the internal adjustment has to
be built up. Only then, the individual becomes a person who is acceptable as a member of
society.

II. DEFINITIONS

a. MENTAL HEALTH

Mental health is a state of well-being in which the individual realizes his or her own
abilities, can cope with the normal stresses of life, can work productively and fruitfully, and
is able to make a contribution to his or her community.
 -WHO

b. MENTAL ILLNESS

Mental and behavioural disorders are understood as clinically significant conditions

characterized by alterations in thinking, mood (emotions) or behaviour associated with
personal distress and/ or impaired functioning

-WHO

c. MENTAL HYGIENE

It is concerned with the principle and practice in promotion, maintenance of the mental
health and the prevention of mental disorders.

-JA Hadfield

MEANING OF MENTAL HYGIENE

It is a science, which helps the individual to understand the ways that has to be
followed to lead a peaceful life. We can prevent inadequate judgment and try to develop a
well-balanced personality. It checks emotional maladjustment, promotes fitness for doing his
work skilfully. Mental Hygiene is having a body of knowledge and principles relating to
healthy conditions through Mental Hygiene. It prevents mental diseases and preserves Mental
Health.

III. CRITERIA FOR A MENTALLY HEALTHY PERSON

The following six criteria were offered by Jahoda as empirical indicators, or a sort of
recipe, for Positive Mental Health:

1. Positive attitudes toward the self.

2. Growth, development, and self-actualization—including utilization of abilities, future

orientation, concern with work, and so on.

3. Integration, as in a balance of psychic forces, the unifying of one’s outlook, and

resistance to stress and frustration.

4. Autonomy, as in self-determination, independent behavior, and, when appropriate, non-

conformity.

5. A true perception of reality.

6. Environmental mastery, meaning adequacy in love, work and play, adaptation and
adjustment, and the capacity to solve problems

IV. CHARACTERSTICS OF A MENTALLY HEALTHY PERSON

The characteristics of a mentally healthy person:

 •Positive Self-Concept

•looks at things positively

•Sense of Responsibility

•accepts responsibilities for their actions

•Better Relationship with Other People

•gets along well with others

• Adaptability To Change

•accepts and adapts changes

•Ability to Face Shortcomings or Disappointments

•accepts the fact that not all she likes can happen

•Ability to Face Problems Squarely

•faces various trials in life with calmness and broad-mindedness

•Ability to Accept Criticism

•takes criticism with an open mind

V. COMMON PSYCHOSOCIAL/ MENTAL HEALTH PROBLEMS

Mental health and hygiene is the two sides of a coin. Hygiene is the pre-requisite
condition for maintaining good and sound health. In fact, adjustments mechanisms are the
instrument for maintaining the balanced personality as well as the instrument to rescue from
the various mal-adjusted behaviours and problems.

Adolescence is a crucial period for developing and maintaining social and emotional
habits important for mental well-being. These include adopting healthy sleep patterns; taking
regular exercise; developing coping, problem-solving, and interpersonal skills; and learning
to manage emotions. Supportive environments in the family, at school, and in the wider
community are also important.

Multiple factors determine the mental health of an adolescent at any one time. The more
risk factors adolescents are exposed to, the greater the potential impact on their mental health.
Factors which can contribute to stress during adolescence include a desire for greater
autonomy, pressure to conform with peers, exploration of sexual identity, and increased
access to and use of technology. Media influence and gender norms can exacerbate the
disparity between an adolescent’s lived reality and their perceptions or aspirations for the
future. Other important determinants for the mental health of adolescents are the quality of
their home life and their relationships with their peers. Violence (including harsh parenting
and bullying) and socio-economic problems are recognized risks to mental health.

Some adolescents are at greater risk of mental health conditions due to their living
conditions, stigma, discrimination or exclusion, or lack of access to quality support and
services. These include adolescents living in humanitarian and fragile settings; adolescents
with chronic illness, autism spectrum disorder, an intellectual disability or other neurological
condition; pregnant adolescents, adolescent parents, or those in early and/or forced marriages;
orphans; and adolescents from minority ethnic or sexual backgrounds or other discriminated
group

1) PSYCHOSOCIAL PROBLEMS

Social phobia

Social phobia belongs to the group of anxiety disorders, and the symptoms are triggered
when the adolescent is in a social environment or when they think about being in that
environment. Interacting with strangers or having to go to a place full of people can be a
living nightmare for them.

That’s why it’s common for many young people to stay in their homes during their teenage
years. Insecurities, being self-conscious about their bodies, bullying, and the need for
acceptance can cause social phobia.

Antisocial and oppositional defiant problems

Does the teenager steal? Are they violent towards people or animals? It is easy for people
who are not experts in the field to confuse antisocial and oppositional defiant problems with
just natural problems in adolescence. However, this type of behaviour can be a symptom of a
more serious problem.

Disobeying adults, not abiding by the rules, stealing and being permanently angry are
some of the signs that can indicate the presence of these disorders. Young people respecting
no-one, acting without thinking, being very impulsive and not taking into account the
integrity of others. Is the person just going through a difficult time, or is something more
serious. The best thing is to consult a specialist who knows how to deal with problems in
adolescence.

Looking for help is vital. It is common for parents to feel powerless or look for reasons in
the wrong places in a situation of this type. They may even feel that they haven’t been able to
raise their children well enough. However, these misconceptions can make them adopt a
passive and submissive attitude towards their children, something that will not benefit them at
all
Emotional disorders

Emotional disorders commonly emerge during adolescence. In addition to depression or

anxiety, adolescents with emotional disorders can also experience excessive irritability,
frustration, or anger. Symptoms can overlap across more than one emotional disorder with
rapid and unexpected changes in mood and emotional outbursts. Younger adolescents may
additionally develop emotion-related physical symptoms such as stomach ache, headache, or
nausea.

Globally, depression is the ninth leading cause of illness and disability among all
adolescents; anxiety is the eighth leading cause. Emotional disorders can be profoundly
disabling to an adolescent’s functioning, affecting schoolwork and attendance. Withdrawal or
avoidance of family, peers or the community can exacerbate isolation and loneliness. At its
worse, depression can lead to suicide.

Childhood behavioural disorders

Childhood behavioural disorders are the sixth leading cause of disease burden among
adolescents. Adolescence can be a time where rules, limits and boundaries are tested.
However, childhood behavioural disorders represent repeated, severe and non-age-
appropriate behaviours such as hyper-activity and inattention (such as attention deficit
hyperactivity disorder) or destructive or challenging behaviours (for example, conduct
disorder). Childhood behavioural disorders can affect adolescents’ education, and are
sometimes associated with contact with judicial systems.  

Suicide and self-harm

It is estimated that 62 000 adolescents died in 2016 as a result of self-harm. Suicide is the
third leading cause of death in older adolescents (15–19 years).  Nearly 90% of the world’s
adolescents live in low- or middle-income countries but more than 90% of adolescent
suicides are among adolescents living in those countries. Suicide attempts can be impulsive
or associated with a feeling of hopelessness or loneliness. Risk factors for suicide are
multifaceted, including harmful use of alcohol, abuse in childhood, stigma against help-
seeking, barriers to accessing care, and access to means. Communication through digital
media about suicidal behaviour is an emerging concern for this age group.

Risk-taking behaviours

Many risk-taking behaviours for health, such as substance use or sexual-risk taking, start
during adolescence. Limitations in adolescents’ ability to plan and manage their emotions,
normalization of the taking of risks that have an impact on health among peers and contextual
factors such as poverty and exposure to violence can increase the likelihood of engaging in
risk-taking behaviours. Risk-taking behaviours can be both an unhelpful strategy to cope with
poor mental health, and can negatively contribute to and severely impact an adolescent’s
mental and physical well-being.
 Perpetration of violence is a risk-taking behaviour which can increase the likelihood of low
educational attainment, injury, involvement with crime, or death. Interpersonal violence was
ranked the second leading cause of death of older adolescent boys

The period of Adolescence is filled with intellectual and emotional changes in

addition to other major biological and physical changes. It is a time of discovery of self and
one’s relationship to the world around himself or herself.

Sexual abuse/ sexual dysfunction

This is as much a problem for the male adolescent as it is for the female but generally,
the girls stand a greater risk of this. Due to the development of secondary sexual
characteristics following adolescence, teens feel a great push to explore and experiment with
their bodies. Early maturing girls are likely to start dating and a combination of the
overwhelming urge to explore and peer pressure leads many into sex.

Drug and substance abuse.

Substance abuse is a common trigger of behavioural problems and often requires

specific therapy. Behavioural problems may be the first sign of depression or other mental
health disorders. Such disorders typically require treatment with drugs as well as counselling.

Substance use among adolescents occurs on a spectrum; from experimentation to

dependence. Experimentation with alcohol and drugs during adolescence is common.
Unfortunately, teenagers often don’t see the link between their actions today and the
consequences tomorrow. They also have a tendency to feel indestructible and immune to the
problems that others experience.

Teenagers at risk for developing serious alcohol and drug problems include those:
with a family history of substance abuse , those who are depressed , those who have low self-
esteem, and who feel like they don’t fit in or are out of the mainstream.
The majority of adults who smoke cigarettes begin smoking during adolescence. If an
adolescent reaches the age of 18 to 19 years without becoming a smoker, it is highly unlikely
that he will become a smoker as an adult.

Stress and depression

Stress and depression are serious problems for many teenagers. Stress is characterized
by feelings of tension, frustration, worry, sadness and withdrawal that commonly last from a
few hours to a few days. Depression is both more severe and longer lasting. Depression is
characterized by more extreme feelings of hopelessness, sadness, isolation, worry,
withdrawal and worthlessness that last for two weeks or more.

Young people become stressed for many reasons. The most common of these are:
Break up with boy/girl friend, Increased arguments with parents, Trouble with brother or
sister, Increased arguments between parents , Change in parents’ financial status ,Serious
illness or injury of family member , and Trouble with classmates. In addition, Children from
single parents or broken homes are subjected to a near harrowing experience which brings
about Stress and Depression.

Bullying
This is a huge problem that exists among adolescents though it is often neglected in
this part of the world. Bullying is the act of intentionally causing harm to others, through
verbal harassment, physical assault, or other more subtle methods of coercion such as
manipulation. Bullying in school and the workplace is also referred to as peer abuse.

In colloquial speech, bullying often describes a form of harassment perpetrated by an

abuser who possesses more physical and/or social power and dominance than the victim. The
harassment can be verbal, physical and/or emotional.
Every day thousands of teens wake up afraid to go to school. Bullying is a problem that
affects millions of students of all races and classes. Bullying has everyone worried, not just
the kids on its receiving end. Yet because parents, teachers, and other adults don’t always see
it, they may not understand how extreme bullying can get.

Studies show that people who are abused by their peers are at risk for mental health
problems, such as low self-esteem, stress, depression, or anxiety. They may also think about
suicide more.

Bullies are at risk for problems, too. Bullying is violence, and it often leads to more
violent behaviour as the bully grows up. It’s estimated that 1 out of 4 elementary-school
bullies will have a criminal record by the time they are 30. Some teen bullies end up being
rejected by their peers and lose friendships as they grow older. Bullies may also fail in school
and not have the career or relationship success that other people enjoy. Some bullies actually
have personality disorders that don’t allow them to understand normal social emotions like
guilt, empathy, compassion, or remorse. Such teens need help from a mental health
professional like a psychiatrist or psychologist.

School problems

The School constitutes a large part of an adolescent’s existence. Difficulties in almost

any area of life often manifest as school problems. School problems during the adolescent
years may be the result of rebellion and a need for independence. Less commonly, they may
be caused by mental health disorders, such as anxiety or depression. Substance use, abuse,
and family conflict also are common contributors to school problems. Sometimes,
inappropriate academic placement particularly in adolescents with a learning disability or
mild mental retardation that was not recognized early in life causes school problems.
Particular school problems include fear of going to school, truancy, dropping out, and
academic underachievement. Problems that developed earlier in childhood, such as attention
deficit/hyperactivity disorder (ADHD) and learning disorder’s, may continue to cause school
problems for adolescents.

Suicidal ideation/attempt

Suicide is rare, but thoughts about suicide (called suicidal ideation) are more
common. Suicidal ideation requires an immediate mental health evaluation; parents should
not be expected to determine how "serious" the problem is on their own.

Anxiety

Often manifests during adolescence, as do mood disorders and disruptive behavioural

disorders such as oppositional defiant disorder and conduct disorder.

Eating disorders

Especially in girls, are common and can be life threatening. Some adolescents go to
extraordinary lengths to hide symptoms of an eating disorder, which may include substantial
reductions in food intake, purging after eating, use of laxatives or extensive, vigorous
exercise

VI. SIGNIFICANCE OF PROBLEMS

A number of factors combine to impact adolescence risk taking behaviour including age,
socio economic status, education, race, gender, self esteem, autonomy, social adaptation,
vulnerability, impulsivity and thrill seeking activity. Teachers can engage in screening and
early intervention with high risk teenagers to promote adaptive responsive and prevent the
development of future problems. Sexual behaviour can be cause of many teenage problems.
46% of students have had sexual intercourse, 7% of students have had sexual intercourse with
four or more person.5% of students has got pregnant.
A survey conducted in 150 schools by youth risk behaviour surveillance system. The
data reveal many threats to the health and wellbeing of teenagers as follows.19% of students
had rarely or never worn seat belts when driving in a car.37% had ridden one or more times
with a driver who had been drinking.46% of the male students and 26% of female students
have been involved at least one physical fight in the past 1 year.28% of the male students and
7% of the female students carried a weapon at least in the past 1 month.72% of the male
students and 54% of the female students participated in vigorous activity
Suicide in those ages 15 to 24 year since accounted for 5 % of all suicide tried on
alcoholic but now accounts for 14 %.This make adolescents suicide the third leading cause of
death among American teens. Research as shown that school based prevention program can
help decreased suicidal behavioural. Homicide is the second leading cause of death in teens
10–19 years of age and 82% of those who died were killed by guns.
 VII. FACTORS AFFECTING MENTAL HYGIENE

While the promotion of positive mental health in all members of society is clearly an
important goal, much remains to be learned about how to achieve this objective. Conversely,
effective interventions exist today for a range of mental health problems. Because of the large
number of people affected by mental and behavioural disorders, many of whom never receive
treatment, and the burden that results from untreated disorders, this report focuses upon
mental and behavioural disorders rather than the broader concept of mental health. Mental
and behavioural disorders are a set of disorders as defined by the International statistical
classification of diseases and related health problems (ICD-10). While symptoms vary
substantially, these disorders are generally characterized by some combination of abnormal
thoughts, emotions, behaviour and relationships with others. Examples include schizophrenia,
depression, mental retardation, and disorders due to psychoactive substance use.

The artificial separation of biological from psychological and social factors has been
a formidable obstacle to a true understanding of mental and behavioural disorders. In reality,
these disorders are similar to many physical illnesses in that they are the result of a complex
interaction of all these factors. For years, scientists have argued over the relative importance
of genetics versus environment in the development of mental and behavioural disorders.
Modern scientific evidence indicates that mental and behavioural disorders are the result of
genetics plus environment or, in other words, the interaction of biology with psychological
and social factors. The brain does not simply reflect the deterministic unfolding of complex
genetic programmes, nor is human behaviour the mere result of environmental determinism.
Prenatally and throughout life, genes and environment are involved in a set of inextricable
interactions. A science-based appreciation of the interactions between the various factors will
contribute mightily to eradicating ignorance and putting a stop to the maltreatment of people
with these problems.

 BIOLOGICAL FACTORS

Mental and behavioural disorders have been shown to be associated with disruptions of
neural communication within specific circuits. In depression, however, it is possible that
distinct anatomical abnormalities may not occur. Some mental disorders, such as
psychoactive substance dependence, may be viewed in part as the result of maladaptive
synaptic plasticity. In other words, drug-driven or experience-driven alterations in synaptic
connections can produce long-term alterations in thinking, emotion and behaviour. In parallel
with progress in neuroscience has come progress in genetics.

Almost all of the common severe mental and behavioural disorders are associated
with a significant genetic component of risk. Studies of the mode of transmission of mental
disorders within extended multigenerational families, and studies comparing risk of mental
disorders in monozygotic (identical) versus dizygotic (fraternal) twins have, however, led to
the conclusion that risk of the common forms of mental disorders is genetically complex.
 Mental and behavioural disorders are predominantly due to the interaction of multiple
risk genes with environmental factors. Further, a genetic predisposition to develop a
particular mental or behavioural disorder may manifest only in people who also experience
specific environmental stressors that elicit the pathology. Examples of environmental factors
could range from exposure to psychoactive substances as a fetus, to malnutrition, infections,
disrupted family environments, neglect, isolation and trauma.

 PSYCHOLOGICAL FACTORS

Individual psychological factors are also related to the development of mental and
behavioural disorders. One main finding throughout the 20th century that has shaped current
understanding is the crucial importance of relationships with parents or other caregivers
during childhood. Affectionate, attentive and stable caring allows infants and young children
to develop normally such functions as language, intellect and emotional regulation. Failure
may be due to the mental health problems, illness or death of a caregiver.

The child may be separated from the caregiver because of poverty, war or population
displacement. The child may lack care because of the unavailability of social services in the
broader community. Regardless of the specific cause, when children are deprived of nurture
from their caregivers they are more likely to develop mental and behavioural disorders, either
during childhood or later in life. Evidence for this finding comes from infants living in
institutions that did not provide sufficient social stimulation. Although these children
received adequate nutrition and bodily care, they were likely to show serious impairments in
interactions with others, in emotional expressiveness, and in coping adaptively to stressful
life events. In some cases, intellectual deficits also occurred.

Another key finding is that human behaviour is partly shaped through interactions
with the natural or social environment. This interaction can result in either desirable or
undesirable consequences for the individual. Basically, individuals are more likely to engage
in behaviours that are “rewarded” by the environment, and less likely to engage in behaviours
that are ignored or punished.

Mental and behavioural disorders can thus be viewed as maladaptive behaviour that
has been learned – either directly or through observing others over time. Evidence for this
theory comes from decades of research on learning and behaviour, and is further
substantiated by the success of behaviour therapy, which uses these principles to help people
change maladaptive patterns of thinking and behaving. Finally, psychological science has
shown that certain types of mental and behavioural disorders, such as anxiety and depression,
can occur as the result of failing to cope adaptively to a stressful life event. Generally, people
who try to avoid thinking about or dealing with stressors are more likely to develop anxiety
or depression, whereas those who share their time. This finding has prompted the
development of interventions that consist of teaching coping skills. Collectively, these
discoveries have contributed to our understanding of mental and behavioural disorders.

 SOCIAL FACTORS
 Although social factors such as urbanization, poverty and technological change have
been associated with the development of mental and behavioural disorders, there is no reason
to assume that the mental health consequences of social change are the same for all segments
of a given society. Approximately half of the urban populations in low and middle income
countries live in poverty, and tens of millions of adults and children are homeless. In some
areas, economic development is forcing increasing numbers of indigenous peoples to migrate
to urban areas in search of a viable livelihood. Usually, migration does not bring improved
social well-being; rather, it often results in high rates of unemployment and squalid living
conditions, exposing migrants to social stress and increased risk of mental disorders because
of the absence of supportive social networks.

Rural life is also fraught with problems for many people. Isolation, lack of transport
and communications, and limited educational and economic opportunities are common
difficulties. Moreover, mental health services tend to concentrate clinical resources and
expertise in larger metropolitan areas, leaving limited options for rural inhabitants in need of
mental health care

In broader terms, and perhaps more appropriately for discussions related to mental
and behavioural disorders, poverty can be understood as the state of having insufficient
means, which may include the lack of social or educational resources. Poverty and associated
conditions such as unemployment, low education, deprivation and homelessness, are not only
widespread in poor countries, but also affect a sizeable minority of rich countries.

The poor and the deprived have a higher prevalence of mental and behavioural
disorders, including substance use disorders. This higher prevalence may be explainable both
by higher causation of disorders among the poor and by the drift of the mentally ill into
poverty. Such deprivation includes lower levels of educational attainment, unemployment
and, in extreme cases, homelessness. Mental disorders may cause severe and sustained
disabilities, including an inability to work. If sufficient social support is not available, which
is often the case in developing countries without organized social welfare agencies,
impoverishment is quick to develop.

There is also evidence that the course of mental and behavioural disorders is
determined by the socioeconomic status of the individual. This may be the result of an overall
lack of mental health services together with the barriers faced by certain socioeconomic
groups in accessing care. Poor countries have very few resources for mental health care and
these are often unavailable to the poorer segments of society. Even in rich countries, poverty
along with associated factors such as lack of insurance coverage, lower educational level, un-
employment and minority status in terms of race, ethnicity and language can create
insurmountable barriers to care. The treatment gap for most mental disorders is high, but in
the poor population it is indeed massive. Across socioeconomic levels, the multiple roles that
women fulfil in society put them at greater risk of experiencing mental and behavioural
disorders than others in the community.

Women continue to bear the burden of responsibility associated with being wives,
mothers, educators and carers of others, while they are increasingly becoming an essential
part of the labour force and in one-quarter to one-third of households they are the prime
source of income. In addition to the pressures placed on women because of their expanding
and often conflicting roles, they face significant sex discrimination and associated poverty,
hunger, malnutrition, overwork and domestic and sexual violence. Violence against women
constitutes a major social and public health problem, affecting women of all ages, cultural
backgrounds, and income levels. Racism, too raises important issues. Although there is still
reluctance in some quarters to discuss racial and ethnic bigotry in the context of mental health
concerns, psychological, sociological and anthropological research has shown racism to be
related to the perpetuation of mental problems.

The available evidence indicates that people long targeted by racism are at heightened
risk for developing mental problems or experiencing a worsening of existing ones. And
people who practise and perpetuate racism themselves are found to have or to develop certain
kinds of mental disorders.

Psychiatrists examining the interplay between racism and mental health in societies
where racism is prevalent have observed, for example, that racism may worsen depression.
Racism’s influence can also be considered at the level of the collective mental health of
groups and societies. Racism has fuelled many oppressive social systems around the world
and across the ages. The extraordinary scale and rapidity of technological change in the late
20th century is another factor that has been associated with the development of mental and
behavioural disorders.

VIII. WARNING SIGNS OF MENTAL ILLNESS

When someone you know is going through a tough time, it can be worrying for yourself
and others involved and sometimes you might not know what to look out for.

Here are some common signs and symptoms:

 A noticeable change in their usual behaviour

 If you have noticed they are feeling down for some time and they don’t seem to be
getting any better
 Lack of energy and motivation to do everyday things
 Withdrawal from friends and activities
 Emotional outbursts
 Significant tiredness, low energy or problems sleeping
 Increased use of alcohol or other drugs
 Major changes in eating habits
 Sleeping longer hours.

Warning signs that your child might have a mental health condition include:

 Mood changes. Look for feelings of sadness or withdrawal that last at least two
weeks or severe mood swings that cause problems in relationships at home or school.
  Intense feelings. Be aware of feelings of overwhelming fear for no reason sometimes
with a racing heart or fast breathing or worries or fears intense enough to interfere
with daily activities.
 Behaviour changes. These include drastic changes in behaviour or personality, as
well as dangerous or out-of-control behaviour. Fighting frequently, using weapons
and expressing a desire to badly hurt others also are warning signs.
 Difficulty concentrating. Look for signs of trouble focusing or sitting still, both of
which might lead to poor performance in school.
 Unexplained weight loss. A sudden loss of appetite, frequent vomiting or use of
laxatives might indicate an eating disorder.
 Physical symptoms. Compared with adults, children with a mental health condition
might develop headaches and stomach-aches rather than sadness or anxiety.
 Physical harm. Sometimes a mental health condition leads to self-injury, also called
self-harm. This is the act of deliberately harming your own body, such as cutting or
burning yourself. Children with a mental health condition also might develop suicidal
thoughts or attempt suicide.
 Substance abuse. Some kids use drugs or alcohol to try to cope with their feelings.

VI. SCREENING/ DIAGNOSTIC FACILITIES

School health screening programme

Virtually every community has a school and most children spend at least 6 hours a
day there. Schools offer an ideal context for prevention, intervention, positive development,
and regular communication between school and families. School-employed professionals like
school psychologists, school counsellors, school social workers, and school nurses know the
students, parents, and other staff, which contributes to accessibility of services. In fact,
research has shown that students are more likely to seek counselling when services are
available in schools. In some cases, such as rural areas, schools provide the only mental
health services in the community.

Mental status examination

Children’s ability to reflect and discuss their feelings or experiences is influenced by

maturational factors. This means that child and clinician are at different developmental levels
and speak “different languages”. Moreover, stage-specific developmental features can
impede communication. For instance, younger children may not trust unfamiliar adults,
adolescents often perceive clinicians as simply another adult imposing expectations or
judging them. Therefore, information-gathering from the child often requires modes of
communication other than question and answer or verbal discourse. Children of different ages
need different methods of collecting data and interviewing (e.g., observing a baby, playing
with preschool children, talking directly about symptoms to articulate children or adolescents,
drawing with anxious or uncommunicative children). The clinical assessment of children
typically requires more time than adults (about 2 to 5 hours), thus using time efficiently is an
important consideration. Rating scales and questionnaires is a way of increasing efficiency
(see below), but can never replace a thorough face-to-face evaluation

Child behaviour checklist & youth self- report

The Child Behaviour Checklist (CBCL) is a component of the Achenbach System of

Empirically Based Assessment (ASEBA). The ASEBA is used to detect behavioural and
emotional problems in children and adolescents. The CBCL is completed by parents. The
other two components are the Teacher’s Report Form (TRF) (completed by teachers), and the
Youth Self-Report (YSR) (completed by the child or adolescent himself or herself). The 2001
revision of the CBCL, the CBCL/6-18 (used with children 6 to 18), is made up of eight
syndrome scales:

• Anxious/depressed
• Depressed
• Somatic complaints
• Social problems
• Thought problems
• Attention problems
• Rule-breaking behaviour
• Aggressive behaviour.
These group into two higher order factors internalizing and externalizing. The time frame
for item responses is the past six months. The 2001 revision also added six DSM-oriented
scales consistent with DSM diagnostic categories:
• Affective problems
• Anxiety problems
• Somatic problems
• ADHD
• Oppositional defiant problems
• Conduct problems.
The CBCL (and the YSR) are also scored on (optional) competence scales for
activities, social relations, school and total competence. In 2001, options for multicultural
norms were added allowing scale scores to be displayed in relation to different sets of
cultural/societal norms. Scales were also added for obsessive compulsive disorder (OCD) and
posttraumatic stress disorder (PTSD).
Child Behavior Checklist The CBCL consists of 113 questions, scored on a three-point Likert
scale (0=absent, 1= occurs sometimes, 2=occurs of

VII. MANAGEMENT OF MENTAL HEALTH PROBLEMS

Many people diagnosed with mental illness achieve strength and recovery through
participating in individual or group treatment. There are many different treatment options
available. There is no treatment that works for everyone – individuals can chose the
treatment, or combination of treatments, that works best.
  Psychotherapy – Psychotherapy is the therapeutic treatment of mental illness provided
by a trained mental health professional.  Psychotherapy explores thoughts, feelings,
and behaviours, and seeks to improve an individual’s well-being.  Psychotherapy
paired with medication is the most effective way to promote recovery.  Examples
include: Cognitive Behavioural Therapy, Exposure Therapy, Dialectical Behaviour
Therapy, etc.
 Medication – Medication does not outright cure mental illness.  However, it may help
with the management of symptoms.  Medication paired with psychotherapy is the
most effective way to promote recovery.
 Case Management – Case management coordinates services for an individual with the
help of a case manager.  A case manager can help assess, plan, and implement a
number of strategies to facilitate recovery.
 Hospitalization – In a minority of cases, hospitalization may be necessary so that an
individual can be closely monitored, accurately diagnosed or have medications
adjusted when his or her mental illness temporarily worsens. 
 Support Group – A support group is a group meeting where members guide each
other towards the shared goal of recovery.  Support groups are often comprised of non
professionals, but peers that have suffered from similar experiences. 
 Complementary & Alternative Medicine – Complementary & Alternative Medicine,
or CAM, refers to treatment and practices that are not typically associated with
standard care.   CAM may be used in place of or addition to standard health practices.
 Self Help Plan – A self-help plan is a unique health plan where an individual
addresses his or her condition by implementing strategies that promote wellness. 
Self-help plans may involve addressing wellness, recovery, triggers or warning signs. 
  Peer Support-Peer Support refers to receiving help from individuals who have
suffered from similar experiences.

VIII. MENTAL HYGIENE PRACTICES

Here are some things you can try that may help to look after your mental health and
wellbeing:

1. Do things with others. Spending time with family or friends, meeting new people
and getting involved in activities can make a difference to how you feel. Get involved
in community activities
2. Do something creative.  Activities or hobbies can keep you distracted, have a
positive impact on your sense of mental health and wellbeing and can help increase
your confidence and self-esteem. This could be building something, playing an
instrument, gardening, art, doing a puzzle, painting, cooking, writing etc.
3. Invest time in relationships. Connecting with people and investing in good
relationships are important for your mental health. Get in touch with people who you
 trust or feel good around. Give them a call, send them a message or organise to catch-
up with them.
4. Focus on strengths. Having positive thoughts can help you feel better. Try these
support tools for guidance on how to feel positive. 
5. Take time out. When you relax, you give yourself permission to let go of worries for
a while. Relaxing gives your mind and body time to recover from the stresses of
everyday life. Try some relaxation apps to guide you on how to relax.
6. Sleep well. We cannot function properly without sleep. Sleep helps us to repair and
restore our bodies and minds. Try these tips from the Sleep Health Foundation for
guidance on how to get a better night’s sleep.
7. Keeping active. Your physical health plays a key role in keeping you mentally
healthy. Being physically active can improve your mood and reduces stress.
8. Eat well. Nutrition and eating well can make a difference to the way you feel and in-
turn may improve your mental health.
9. Mindfulness. Mindfulness can help you feel better and reduce stress. It is easy to fit
into your day. You can do it one minute at a time.  

Physical Activity
Keeping active is important for your mental and physical health. It can help improve
your sleep, reduce stress, help you relax and make you feel better overall.

Research has shown that physical activity is associated with better mental health. Exercise
releases feel-good chemicals including endorphins and serotonin, which improve your mood
and make you feel good.

There are many benefits of exercise, some of these include:

 Boosting your mood, concentration & alertness

 Improving your sleep
 Providing distraction from unhelpful thoughts
 Giving you a chance to socialise and meet new people
 Increasing your energy
 Improving blood pressure, cholesterol and reducing your blood sugar
 Preventing or reducing anxiety and depression.

Other ways to keep you physically active, socially connected and to help reduce stress
include:

 Finding something that you enjoy – football, swimming, walking, dancing, jogging,
cycling etc
 Start off gently and aim to increase activity by 10 minutes each day
 Try different things such as group activities or sports
 Ask a friend to join you to make it more fun and help you both commit to it
 Spend time in nature and go for bush walks
Nutrition

Eating well is important. When it comes to mental health, what you eat can make a
difference to how you feel.

Eating well helps maintain brain health throughout your lifespan. Eating a balanced,
wholesome diet can improve your mental and physical health.

There are little things you can do to eat well for your mental health such as:

 Eat lots of vegetables - vegetables and legumes (e.g. beans and lentils) are rich in
nutrients and fibre. 
 Avoid processed sugar and additives. Highly processed food has been linked to poor
mental health.
 Relax and enjoy a balanced and healthy diet.
 Be mindful of what foods you are eating.
 Include foods rich in omega-3. Omega-3 fatty acids which are found in oily fish like
tuna and salmon have a positive influence on parts of the brain and can help with
depression 
 Eat wholesome nutritious foods. Studies indicate that poor quality diets increase the
risk of depression. 
 Snack on healthy foods. When you feel like a snack, try a healthier option such as
nuts or fresh fruit.
 Drink plenty of water and avoid sugary drinks. Drinking enough water regularly helps
prevent dehydration which can make you irritable.

Remember small changes to your diet can make a difference to your mental health. Some
changes will be easier than others and if you have a slip-up with your eating, don’t be hard on
yourself, just try to start again the next day.

Mindfulness

Mindfulness is about being in the present (i.e not dwelling on the past or worrying
about the future). It can help you feel better, reduce stress and improve your wellbeing which
in turn has shown to have many health benefits.

Mindfulness is self-awareness training originating from Buddhist meditation

principles. It was initially developed to help people improve their moods and prevent
depression. Anyone can practice mindfulness. When you are mindful you pay full attention to
what is going on in the moment without judgement. You are fully aware of your surroundings
which enables you to observe your thoughts and feelings in a positive way and concentrate on
taste, touch, smell, sight and sound.
Mindfulness is easy to fit into your day. There are a number of mindfulness programs
designed to help you deal with stress and the challenges of daily life. 
IX. PREVENTION OF MENTAL HEALTH PROBLEMS

1. PRIMARY PREVENTION

Risk Factors Identification Risk Control Hectic Life Schedule and Sedentary life
style Meditation, Religious activities & exercise Academic failure and scholastic
demoralization Good parenting Family conflict or family disorganization Positive attachment
and early bonding Exposure to aggression, violence and trauma (especially in case of
childhood abuse) Stress and conflict management skills School Psychological counsellor
Support Loneliness, Cultural Shock Pro-social behaviour Medical illness, Neurochemical
imbalance, Disability Medical / Surgical support Substance abuse (access to drugs and
alcohol) De addiction Stressful life events Eg: death of spouse/ Divorce etc. Social support of
family and friends Individual and family-related determinants of mental health:

Social, environmental and economic determinants of mental health: Risk Factor

Identification Risk Control Lack of education, transport, housing Literacy and proper
economic stability Poor nutrition, Poverty Empowerment, Proper Nutritional care
Urbanization Safe Shared Places to interact Violence and War Social responsibility and stable
environment Unemployment Literacy and skill development Peer rejection Positive
interpersonal interactions Racial injustice and discrimination Ethnic minorities’ integration
Social Networking. 23% of teens report that they are or have been the target of cyber bullying
ultimately leading to depressive episode and other conduct disorders.

2. SECONDARY PREVENTION

Early diagnosis: Screening programs in school, universities, industry, recreation

centers, etc. for early diagnosis of mental illness, Screening of substance abuse disorders, Pay
attention to warning signs, Get routine medical checkup, Don’t hesitate to ask for help
treatment, Pharmacological, Psychotherapy, Group therapy, Cognitive behavioural therapy,
Biofeedback therapy, Creative therapy (art therapy, music therapy, play therapy),
Electroconvulsive therapy,

Secondary prevention in the Case Discussed: Is made through symptoms and signs,
Symptoms & Signs, Feeling of sadness, Social cutoff, Reduced Motivation, Helplessness,
Suicidal Tendency Early Diagnosis, Pharmacological: SSRIs(Selective Serotonin Reuptake
Inhibitors), FluoxetineTreatment

Warning signs (prodromal symptoms), Seeing hearing things which are not there
confused, hard to cope with life Anxious, find hard to sleep or sleep more than usual
Seclusion, feeling of extreme high and low Self inflicted injuries, Suicidal thoughts Changes
in school performance hyperactivity conc. loss

3. TERTIARY PREVENTION

Disability limitation: Family support Compliance towards long term medications De

addiction Counselling. Rehabilitation Community residential services Workplace
accommodations Social and family support Coping skills and activity of daily life and
socializing Support employment Institutionalization Ecological: Reduce potential stressors
And create social support Individual centered: Developing skills and social interaction

X. MENTAL HEALTH SERVICES/ PROGRAMME

India is a signstory state to the Alma-Ata declaration, envisaged Health For All by the
Year, 2000 AD. For the provision of mental health care to total population, at a reasonable
cost to enhance healthy psychosocial development of the people; mental health services has
to reach needy group and to the total population.
Objectives
 To ensure availability and accessibility of minimum mental health care for all the
population, specific to the most vulnerable and under privileged sections of
population in all the geographic areas
 Apply mental health knowledge in general health care and as a measure to social
development
 To Promote community participation
 Stimulate efforts towards self help in the community
 To prevent and to treat psychiatric disorders
 To utilize appropriate mental health technology to improve general health services
 To apply mental health principles for improving quality of life for entire population.
Targets
 National coordinating group will be formed, comprises of representatives from all
states, senior health administrators, professionals from relative fields like
psychiatry, education, social welfare.
 Curriculum of mental health for the health workers
 Non-medical professionals, physicians at PHC will have a 2 week training
programme in mental heal th care
 Creation of a post for psychiatrist at districts, he will be visiting PHC settings
regularly, supervise and organize mental health training programmes and
continuing education programmes
 Appointment of a programme officer for teaching and supervision
 Provision of additional support for inclusion of Community Mental Health
components in teaching institutions
 Psychotropic drugs will be included in the list of essential drugs in India.

Approaches
 Integration of mental health care services to the existing general health services. Thus
mental health care starts at gross root level.
 Specified tasks has to be provided at all levels by providing appropriate task oriented
training to the existing health staff.
 Equitable distribution of resources to strengthen mental health care.
 Integration of Basic Mental Health Care into General Health Services-Inclusion of
Basic Mental Health Care is one of the essential functions of primary health care.
  Linkage of mental health services with the existing community development
programme
 Mental health care includes treatment, rehabilitation and prevention.
 Mental Health training.
Components
1. workshops
Workshops were organized to sensitize and motivate the health care professional to
implement as considering the local priorities and resources.
2. Treatment
Specified treatment plans and diagnostic work will be implemented by personnel (MPHN,
HS and at all levels. The health professionals have been trained up in following areas:
 Management of Psychiatric Emergencies through medicines and crisis intervention
strategies
 Treatment for chronic psychiatric disorders
 Diagnosis and management of grandmal epilepsy, specially in children; treatment of
functional psychosis
 Liaison with the school teachers and parents in the management of children with
mental retardation and behavioural problems
 Counselling of addicts
 Supervision of MPHW-s performance of specified mental health tasks
 Management of uncomplicated psycho-social problems without use of drug
 Bpidemiological surveillance of mental morbidity
District hospital-Medical consultation to the health center’s medical officer with regard to
management of ‘difficult’ cases of psychiatric disorders. One psychiatrist will be posted
into each district hospital as an integral part of the district health services. 30-50
psychiatric beds will be available in district hospital; psychiatrist will provide clinical
care, training and supervision of non-specialist health workers.
3. Rehabilitation
 Development of rehabilitation centers both at district level and the higher referral
centre
 Treatment of epileptics and psychotics at community level.\\
4. Prevention
Community based services with limited involvement of health care professionals.
Medical officer and community leaders at the PHC will be involved.
5. Mental Health Training
To provide first level of care, training programmes for para professionals and professionals
will be conducted. Involvement of community leaders, volunteers, focus groups in mental
health training programmes is essential.
6. Mental Retardation
Counselling of parents, referring the cases, utilizing welfare agencies in rehabilitation of
services.
7. Research
Evaluative research programmes will be conducted to determine the outcome of service
deliveries and different levels of functioning and on outcome of training programmes.
After in depth situation analysis and extensive consultations with state authorities.
The NMHP underwent radical restructuring to have a balance between various components of
mental health care delivery system, and clearly specified budget allocations. The Re-
strategized NMHP was formally launched on 22-10-2003 by Honble Health Secretary at a
National workshop held at Vigyan Bhawan, New Delhi.

FIVE YEAR PLANS

1. Tenth Five Year Plan (2002-2007)
 DMHP was extended to 200 districts across the country.
 Infrastructure support has to be provided psychiatry departments in the hospitals and
strengthening of medical college hospitals.
 Streamlining and modernization of mental hospitals to reduce chronicity by intensive
therapeutic intervention.
 Usage of out reach services, promoting care of chronically ill. At their doorsteps by
ensuring qualitative mental health services.
 Ensure effective coordination in all areas of activity.
 Sponsoring community based research projects.
 Innovative IEC strategies (Information, Education and Communication) will be
generated through multidisciplinary collaboration.

2. Eleventh Five Year Plan (2007-2012)

 DMHP will be extended to another 200 districts
 Reinforcement of upgrading psychiatry departments with adequate infrastructural
facilities
 Construction of modem buildings with good infrastructure
 Provision of adequate man power for all psychiatry units
 Research, Training Programmes have to be organized for qualitative and quantitative
improvement
 lEC training programmes has to be conducted.
3. Twelfth Five Year Plan (2012-2019)
 DMHP will be extended to remaining 193 districts
 20 mental hospitals will be taken up for reconstruction
 Non-viable mental hospitals will be closed or merged with general hospitals
(GHPU)
 Long term community based Research Projects be initiated
 lEC activities will be planned to cover all sections of population.
 X. MENTAL HEALTH AGENCIES

National Alliance on Mental Illness (NAMI)

The National Alliance on Mental Illness (NAMI) is a non profit organization dedicated to
connecting mental health patients and their families with the resources they need to better
understand the nature of the illnesses, share their stories, and connect with others who are
also living with a mental health disorder. They offer:

 Analysis of a range of issues about or related to mental illness and/or brain disorders
 Access to current mental health research and data
 A place for people living with mental health issues and their caregivers to share their
stories
 A forum for people living with mental illness and their families to speak out and
connect with others
 Opinion on mental health policy and policies that impact mental health treatment,
patients, and their families

The National Alliance on Mental Illness began in 1979 when a small group of
families first began meeting to support one another and share their experiences living with
mental illness. It has since grown into a grassroots advocacy organization with hundreds of
affiliates staffed by volunteers who work to increase awareness of the issues facing people
living with mental illness and support people in their journey toward balance through
treatment.

NAMI is dedicated to giving a voice to the millions of people and their families who
are living with a mental health disorder and helping patients to improve their lives through
treatment and reduced stigma. They recognize that improved quality of life for people living
with mental illness comes through support and treatment and believe that no mental health
symptoms should be an obstacle to a person’s ability to live a balanced and meaningful life.
Their goal is to advocate for people impacted by mental health issues and work to ensure that
all who need it can connect with treatment that will help them thrive.

NAMI also advocates for public policy changes that empower families living with mental
health disorders, sponsors public awareness events, provides educational services on mental
health disorders and related issues, and maintains their toll-free NAMI helpline (800-950-
NAMI) to provide information and support to people in need. Families and their loved ones
living with mental health symptoms are encouraged to call weekdays between 10 am and 6
pm Eastern time, connect with them online, or seek out a local affiliate for support and
information.

National Institute of Mental Health (NIMH)

The National Institute of Mental Health (NIMH) is focused on researching the nature
of all mental health disorders to better understand the impact on patients, and thus create new
and effective treatments. NIMH also provides open access to its findings as well as a wealth
of mental health information on its site. From anxiety disorders and personality disorders to
suicide prevention and autism spectrum disorders as well as other mental health-related
topics, NIMH is a premiere resource for families impacted by mental health disorders.

History

The National Institute of Mental Health story begins in 1946 when President Truman
signed the National Mental Health Act calling for the creation of an organization dedicated to
learning more about mental illness. In 1949, NIMH was formally created and became one of
the first four National Institutes of Health (NIH).

In the 1950s, NIMH’s first order of business was to contribute to the creation of a 10-
volume report assessing the state of mental health in the US and its impact on communities.
In response to the needs identified in that report, in the 1960s, NIMH began to establish
community mental health centers focused on special mental health concerns (e.g.,
schizophrenia, child and family mental health, etc.) across the country and granted funds to
pay the salaries of mental health professionals who staffed these centers.

In 1993, NIMH established the Human Brain Project, a neuroscience database that
utilized cutting-edge imaging and technologies, and it was placed on an internationally
accessible computer database to facilitate worldwide research collaboration.

Since 1996, NIMH has worked to improve its functioning on every level, collaborate
with other neuroscience researchers, safeguard human subjects, and include the public when
determining priorities in research.

Mission

The mission of the National Institute of Mental Health is to prevent and cure all
mental illnesses. To do this, NIMH seeks to form a more comprehensive understanding of
mental health disorders and their treatments through clinical research.

Today

Currently, NIMH is supporting a range of research studies and providing access to

their findings to the general public. For example, NIMH is funding the Biomarkers
Consortium Project’s efforts to test and fine-tune the clinical measures used to assess social
impairment in patients on the autism spectrum. Additionally, NIMH is conducting trials of a
new computerized attention control training program with the goal of reducing the experience
of post-traumatic stress disorder symptoms in combat veterans.

The public as well as mental health patients and their families can connect with trials
conducted by NIMH and learn more about their latest findings as well as access a
compendium of information on the nature of any mental health disorder on their site or by
connecting with them on Facebook, Twitter, YouTube, and other venues.

World Health Organization (WHO)

The World Health Organization (WHO) is an international organization dedicated to

increasing the health and wellness of people in countries around the world. According to
WHO, 14 percent of the disease burden of the world can be attributed to mental health
disorders, substance abuse and addiction, and neurological disorders, yet 75 percent of the
patients live in countries where they do not have access to treatment that can help them to
heal. Lack of access to appropriate or effective mental health care is an issue that WHO is
dedicated to addressing through research, education, and policy reform.

The World Health Organization was initially conceived in 1945 by diplomats who
were meeting to form the United Nations. Just three years later, on April 7, 1948, the WHO
Constitution was created, and this day is now celebrated as World Health Day around the
globe.

In addition to addressing the medical needs of low-income countries, WHO has long
been focused on educating governments about the nature of mental health disorders and
helping them to understand that there are treatment options and medications available – and
that incarcerating patients is not the answer, a common practice in many countries to this day.
Unfortunately, even with the knowledge that there are mental health treatment options
available, many countries simply did not – and do not – have the resources to provide their
residents with the treatment necessary to heal.

To address this issue, WHO created their Division of Mental Health in the 1970s. A
regional adviser was appointed in each of the six WHO regional offices, and soon the
Division’s network of 10 collaborating centers grew to more than 100 across 80 countries.

In 1999, WHO continued its work on worldwide mental health reform by

collaborating with the European Commission to increase awareness of mental health issues
and working to connect patients with appropriate care.

Additionally, in the 1990s, WHO created a research measurement tool known as

disability-adjusted life-years (DALYs). It is this tool that allows researchers to quantify the
loss associated with untreated mental illness, or the burden of disease, by calculating the
number of years lived with disability (YLD) and the number of years lost due to mental
illness (YLL). This tool not only allows researchers to better assess the impact of mental
health disorders but also aids in the effective planning and management of programs
dedicated to helping mental health patients and their families.

The mission of the World Health Organization is to increase the services made
available to people struggling with mental health disorders, neurological disorders, and
substance abuse and addiction around the world, with a special focus on aiding patients living
in low- and middle-income countries. With the right intervention, medication, and treatment,
WHO asserts that tens of millions of people could be treated for various disorders, including
depression and schizophrenia, and ultimately maintain balance and wellness.

The World Health Organization has a number of active core projects that are serving to
close the gap between the need for mental health services and access to treatment. These
include:

 Mental Health Atlas: This project focuses on the collection of worldwide data on
mental health-related topics, including financing of mental health treatment, how
treatment is provided, medications available, information systems in use, mental
health-related policies, and more. The data was first collected in 2001 and updated in
2005, 2011, and 2014.
 WHO-AIMS: The World Health Organization Assessment Instrument for Mental
Health Systems is a tool for gathering information about the mental health system of
an area with the goal of making improvements to that system and creating a baseline
that will facilitate positive change.
 Mental Health in Emergencies: This project focuses on providing mental health
services to people in areas struck by crises, including natural disaster, war, terrorism,
refugees, and others.