Just what exactly is mental health?

Earlier this month it was World Mental Health Day. I was fortunate to take part in a public discussion at the EDP on ways to solve the 'mental health crisis' in society. I was struck by our collective struggle with the appropriate language to describe and explain mental health concepts. One parent asked: "What do we tell our school children on World Mental Health Day?" We ask people to wear yellow in a bid to raise funds and awareness, but awareness of what exactly? Greater awareness is important, but for me this demonstrates an unhelpful vagueness when discussing mental health issues. We need to do better if we are to collectively move forward to address the 'mental health crisis'.

To collectively move forward, we first need to answer to the question of what we call people who have mental health issues. Do they describe them as having disorders, issues, illnesses, diseases, conditions or problems? All these words have subtle different meanings, but they also have important implications for treatment and societal views. For example, calling something a disease implies some kind of degeneration that someone may not recover from, whereas calling something a problem implies something that can be overcome. Both perspectives have important implications for the stigma people experience.

Currently, if you are thinking, feeling or behaving in some unusual or abnormal way, a mental health professional would conduct an interview assessment with you. This assessment look for certain signs and would ask about symptoms you are experiencing. If what is reported causes sufficient dysfunction or distress or if there is risk of danger to the individual or others, then the assessor would make a diagnosis of a particular disorder based on a classification scheme used. The most commonly used classification scheme is called the Diagnostic and Statistical Manual. Examples of disorders in this scheme are major depressive disorder, schizophrenia and bipolar disorder.

However the latest research is showing the limits of this classification system. By following-up large numbers of individuals over time, we know that among individuals meeting criteria for one disorder in their lifetime, 66% meet criteria for a second; of those meeting criteria for two disorders, 53% meet criteria for a third; of those meeting criteria for a third disorder, 41% met criteria for a fourth. Therefore the idea that everyone neatly fits boxes that correspond to different disorders doesn't fit the reality. No biological tests exist to identify these disorders and it is unlikely such tests will ever exist. We also know that there are no specific causes for specific disorders, the same treatments seem to work across disorders, and the same brain regions and genes underlie multiple disorders. So we need to beyond this approach of viewing mental health in terms of disorders.

A different way of looking at it is, rather than using terms like disorders, illnesses and diseases, we can talk of problems or adaptations. In no way does this downplay the distressing symptoms experienced; it just changes the nature of the causes of those symptoms. People learn patterns of thinking and behaviour growing up because they are useful, and help in coping with stress or challenges they have experienced in their lives. For example, ways of coping with stress may be to regulate your eating, to socially withdraw, to self-harm, to get angry or to abuse substances. In the short-term these coping strategies bring relief and are adaptive solutions to coping with stress. However, these coping strategies may lead to longer-term problems such as inability to get along with people, complete school or work, and achieve your goals. This shift then asks the question of what can we do as a society to reduce the kinds of stress people are exposed to; and how we can help young people find better solutions to the problem of managing that stress.

This is especially critical early in life, before these maladaptive patterns fully take hold.