Mental Health Issues

Everyone experiences some ups and downs, sometimes feeling low and other times being happy. Mental distress occurs when a person finds the way they are thinking, feeling or reacting becomes difficult, or even impossible, to cope with. This can feel just as bad as a physical illness or even worse.

Signs that someone may be experiencing mental distress:

• seeming 'sad'
• lacking energy
• losing interest in day-to-day life
• withdrawing from people
• having negative thoughts
• feeling anxious or worried
• having low self-esteem
• developing sleeping problems

Mental distress may be a temporary issue. For example, it may be tied to grief at the death of a loved one or burnout from a stressful job.

Mental distress is different from mental illness. A mental illness (also referred to as a mental health condition) is a specific disorder that is diagnosed by a medical professional.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is a publication that defines and describes mental disorders and is used to help with diagnosis.

Warning signs

Warning signs of mental illness can include the following:

• excessive worrying or fear
• feeling excessively sad or low
• confused thinking or problems concentrating and learning
• extreme mood changes, including uncontrollable ‘highs’ or feelings of euphoria
• prolonged or strong feelings of irritability or anger
• avoiding friends and social activities
• difficulties understanding or relating to other people
• changes in sleeping habits or feeling tired and lacking energy
• changes in eating habits, such as increased hunger or lack of appetite
• changes in sex drive
• difficulty perceiving reality (delusions or hallucinations, in which a person experiences and senses things that don’t exist in objective reality)
• inability to perceive changes in one’s own feelings, behaviour or personality (lack of insight)
• abuse of substances like alcohol or drugs
• multiple physical ailments without obvious causes (such as headaches, stomach aches, vague and ongoing ‘aches and pains’)
• thinking about suicide
• inability to carry out daily activities or handle daily problems and stress
• an intense fear of weight gain or concern with appearance

Causes

Mental distress can be caused by many different things, often in combination. Some examples include:

• genetic predisposition – some mental illnesses run in families
• brain chemistry imbalances
• environmental exposure – e.g. chemical or lead exposure
• childhood abuse, trauma, or neglect
• drug and alcohol misuse
• some physical health conditions
• significant trauma as an adult, such as military combat, being involved in a serious incident in which you feared for your life, or being the victim of a violent crime
• bereavement (losing someone close to you), particularly at a young age
• severe or long-term stress
• physical causes – for example, a head injury or a neurological condition such as epilepsy can have an impact on your behaviour and mood

Activity

This section describes some of the more common mental illnesses that your tangata may be diagnosed with.

The following list is adapted from the Ministry of Health’s Mental Health webpage.

Depression

With depression, your mood is persistently low, and you experience a loss of enjoyment in activities that you normally enjoy. This continues for a sustained period – weeks or months. Depression can range from mild to severe and can often be triggered by stressful changes in your life.

To read more about depression and how it differs from simply being sad, click on the link to access the following webpage from depression.org.nz.

Anxiety disorder

We all feel worried or anxious sometimes – it is a natural response to a stressful situation such as a job interview. When these feelings of anxiety become extreme and negatively impact our day-to-day lives, it can be classified as an anxiety disorder.

The most common type is generalised anxiety disorder (GAD). As the name suggests, the tangata with GAD will feel anxious about various everyday situations.

Click on the link to access the Mental Health Foundation’s webpage on anxiety to read about GAD.

Bipolar disorder

Bipolar disorder is characterised by a change in people's moods, where they experience periods of both mania (elevated mood) and depression. In the manic state, the tangata might engage in risk-taking behaviour and suffer from insomnia. During the depressive phase, the tangata may feel sad and unable to find enjoyment in usual activities.

Click on the link to access the Healthify web page on bipolar disorder.

Eating disorders

There are a range of disorders based around food. Examples include:

• Anorexia nervosa: where people drastically reduce their food intake, leading to dramatic weight loss.
• Bulimia nervosa: where people eat a large amount of food and then attempt to compensate by vomiting, taking laxatives or exercising excessively.
• Binge-eating disorder: characterised by periods of extreme overeating (binging).
• Avoidant/restrictive food intake disorder (ARFID): characterised by a refusal to eat a full range of foods, potentially leading to malnutrition.

Ref: Adapted from EDANZ Eating Disorders Explained

Click on the link to display the EDANZ page on different eating disorders. Click on the links to read about the disorders listed.

Obsessive compulsive disorder

Obsessive compulsive disorder (OCD) is where someone has obsessive thoughts that make them anxious and lead to compulsive behaviour. Compulsive behaviours can include washing hands frequently or constantly checking that the switches are turned off, or doors are locked.

Click on the link to display the Mental Health Foundation web page on obsessive compulsive disorder.

Panic disorder

Repeated panic attacks characterise panic disorder. These are sudden episodes of intense anxiety and physical symptoms you would have if you were in physical danger. Symptoms include nausea, dizziness, and shortness of breath, and these attacks can be disabling.

Click on the link to display the Mental Health Foundation web page on panic disorder.

Post-traumatic stress disorder 

If someone has been through a traumatic event, this can cause ongoing problems with Post-Traumatic Stress Disorder (PTSD). Symptoms last at least a month and can continue for years. PTSD can result in nightmares and flashbacks.

Click on the link to display the Mental Health Foundation’s page on post-traumatic stress disorder (PTSD).

Schizophrenia

Schizophrenia is characterised by episodes of psychosis where the person loses touch with reality. Psychotic episodes may include hallucinations and delusions, where the person hears voices or sees things that others cannot see. It can majorly impact the person’s ability to work or maintain relationships.

Click on the link to display Healthify’s page on schizophrenia.

Stress

Stress is your body’s physical reaction to a perceived threat. Some stress is necessary in our lives, as it motivates us to achieve. However, sustained high-stress levels can impact our ability to manage our day-to-day lives. It can cause physical symptoms such as headaches and stomach pain. It can also affect your sleep and make you moody and irritable. If untreated, it can contribute to the development of heart disease, high blood pressure and mental health issues such as anxiety.

Click on the link to display Healthify’s page on stress.

Promoting mental wellbeing is crucial for overall health. Nonetheless, it's important to acknowledge that mental distress is widespread. In New Zealand, approximately 80% of adults (aged 15 years or older) have encountered mental distress either personally or within their social circles.

It's worth noting that mental health disparities exist within our population. Māori individuals are 1.5 times more likely to experience mental distress compared to non-Māori, while Pasifika people are 1.0 times more likely to face similar challenges compared to their non-Pasifika counterparts.

Ref: Te Whatu Ora.

Mental health for Māori

‘Nōku te Ao Like Minds' is a public awareness programme that aims to increase social inclusion and end discrimination towards people with experience of mental illness or distress.’ (Ref: Nōku te Ao — Tō mātou whare.) In the following activity, you will read a portion of a 2022 report designed to present a Māori worldview of discrimination faced by people experiencing mental distress.

Activity

1. Click on this link to access Te Whatu Ora’s page, Nōku te Ao. 
2. Locate and click on the link to download the publication Nōku te Ao: Sovereignty of the Māori Mind.
3. Open the downloaded file.
4. Go to page 20. Read the section Snapshot of Mental Health in Aotearoa on pages 20-22.
5. Go to page 56. Read the section on the 7 Levers for Change: Addressing Mental Distress on pages 56-60.
6. Complete the quiz that follows.

Medications

Sometimes, medications are used to treat mental illnesses. These are always prescribed by a GP or specialist. Any medications that your tangata takes should be noted in the personal plan, along with details on when and how many should be taken.

The following table lists some prescribed medications your tangata might be taking and how to pronounce them. This might be helpful when you remind your tangata to take their medication or help them to do so.

Ref: Medication pronunciation notes taken from Healthify, Medicines A-Z.

Therapies

There are a range of non-medicinal treatment options available for tangata experiencing mental illness.

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) is a form of talk therapy that combines cognitive (thought) therapy with behavioural therapy. CBT allows a person to identify thought patterns that negatively impact behaviour and replace them with healthier ones. Similarly, unhelpful behaviour can be identified and replaced with behaviours that support problem-solving and mental wellness.

Watch: What is Cognitive Behavioural Therapy? (1:39 minutes)

Watch the following video that provides a quick description of CBT.

Acceptance and commitment therapy

Acceptance and commitment therapy (ACT) encourages participants to stop avoiding negative thoughts and emotions and accept that these thoughts and emotions are a normal part of life. They can then commit to changing behaviours and pursuing their values despite these negative thoughts.

Watch: What is Acceptance Commitment Therapy? (3:15 minutes)

Watch the following video on ACT.

Meihana model

The Meihana model is a mental health assessment and intervention tool that builds on Te Whare Tapa Whā. It is designed to increase successful outcomes for Māori seeking help with mental health issues.

It includes six dimensions:

1. Whānau – family and support networks.
2. Wairua – connectedness and attachment.
3. Tinana – physical body and health.
4. Hinengaro – emotional wellbeing.
5. Taiao – physical environment.
6. Iwi katoa – societal context.

Ref: Meihana Model: A Clinical Assessment Framework.

Lifestyle for mental health

Medications and formal therapies can be supported by good lifestyle choices. Behaviours that contribute to mental wellness include:

• being active and getting outdoors
• eating nutritious food
• connecting with whānau and friends
• having a routine
• learning new things
• being aware of the world around you
• helping others

Watch: Canterbury Medical Officer of Health Dr Ramon Pink (2:58 minutes)

Watch this clip on improving mental health. Note the five ways to mental wellness and complete the reflection activity that follows the video.

Physical health and mental health

There is a strong link between mental health and physical health. People with poor mental health and addiction issues tend to have poorer physical health as well.