Thinking about mental health.

According to the National Institute for Health and Care Excellence (NICE) common mental health problems include depression and anxiety disorders such as generalised anxiety disorder, panic disorder, obsessive-compulsive disorder (called OCD for short) and post-traumatic stress disorder (called PTSD for short). Other common mental health problems include phobias about a specific thing (such as spiders) or situations (such as being embarrassed in front of other people). These mental health problems are called ‘common’ because combined they affect more people than other mental health problems (up to 15% of people at any one time in the UK). Some people may have more than one mental health problem (such as depression and anxiety).

For Depression, the main symptoms are feeling ‘low’ and losing pleasure in things that were once enjoyable. These symptoms may be combined with others, such as feeling tearful, irritable or tired most of the time, changes in appetite, and problems with sleep, concentration and memory. People with depression typically have lots of negative thoughts and feelings of guilt and worthlessness; they often criticise themselves and lack confidence.

For Generalised Anxiety Disorder, the main symptoms are having a number of different worries that are excessive and out of proportion to a particular situation, and having difficulty in controlling one’s worries. A person with generalised anxiety disorder may also feel irritable and have physical symptoms such as restlessness, feeling easily tired, and having tense muscles. They may also have trouble concentrating or sleeping.

For Panic Disorder, the main symptoms are having unexpected and recurring panic attacks, and also worrying about having another panic attack. One of the symptoms of a panic attack is an increased heart rate. A panic attack may happen because of a particular situation (something that the person fears or wants to avoid), or it may have no obvious cause. People who have panic attacks often change their behaviour because of the attack, which may develop into phobias such as agoraphobia (a fear of being in places or situations that are difficult to escape from).

For Obsessive-Compulsive Disorder, the main symptoms are having thoughts, images or impulses that keep coming into the mind and are difficult to get rid of (called obsessions), and a strong feeling that the person must carry out or repeat certain physical acts or mental processes (called compulsions). Common obsessions include being afraid of dirt and germs, worrying that something is not safe (such as an electrical appliance), wanting to have things in a particular order, and thoughts and fears of harming someone else. Common compulsions include excessive washing and cleaning, checking things repeatedly, keeping objects that other people might throw away, and repeating acts, words or numbers in a pattern.

For Post-traumatic stress disorder, psychological and physical symptoms that can sometimes follow particular threatening or distressing events. One of the most common symptoms of PTSD is having repeated and intrusive distressing memories of the event. There may also be a feeling of reliving the event through flashbacks or nightmares. There can also be physical reactions, such as shaking and sweating.

[Source: National Institute for Health and Care Excellence, Clinical guideline CG123, May 2011].

Explanations for the incidence of these problems in society could be both population size and deprivation levels. Age can be a factor, along with population change brought about by inward migration and household changes. Risk factors for suicide are being male, living alone, unemployment, drug or alcohol abuse and a history of mental illness. The recession has also had an impact. There is growing concern that social media may be harming more than healing in terms of common mental health problems. Another factor can be relationship problems. Between 10 and 15% of women experience some mental health problems during pregnancy, with post-natal depression affecting 2% of women. Post-traumatic disorder is estimated to affect up to 7% of women after delivery [as cited in undated Mental Health Needs Assessment — Health and Wellbeing Suffolk].

At any one time it is estimated that more than 300 million people have depression — about 4% of the world’s population when the figures were published by the World Health Organization (WHO) in 2015. Women are more likely to be depressed than men. Depression is the leading global disability, and unipolar (as opposed to bipolar) depression is the 10th leading cause of early death, it calculates. The link between suicide, the second leading cause of death for young people aged 15–29, and depression is clear, and around the world two people kill themselves every minute. While rates for depression and other common mental health conditions vary considerably, the US is the “most depressed” country in the world, followed closely by Colombia, Ukraine, the Netherlands and France. At the other end of the scale are Japan, Nigeria and China. Causes or triggers can be past trauma or abuse; a genetic predisposition to depression, which may or may not be the same as a family history; life stresses, including financial problems or bereavement; chronic pain or illness; and taking drugs, including cannabis, ecstasy and heroin.

Life is much harder now. People work longer hours for less money and job security. The terms and conditions of most peoples’ employment has worsened over time, and there is a prevalence of zero hours contracts. Commutes are getting longer, in many cases, as jobs have become either scarcer, or more competitive. The cost of living is higher and it is harder to maintain close relationships with family as people become more scattered geographically. Childcare, once commonly done by relatives, is now funded out of salaries at great expense with many people unable to afford dropping down to one income only. Access to psychological therapies on the NHS is often limited to telephone cognitive behavioural therapy and medication. People have got better at looking after their bodies, but not their minds.