1 Promoting mental health

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Contents

• Objectives
• An introduction to mental health
• Stress
• Stigma
• Mental and physical health
• Healthy routine and habits to promote mental health
• Case studies

Objectives

When you have completed this chapter you should be able to:

1. Have an understanding of mental health and why it is important.
2. Understand the difference between positive stress and toxic stress.
3. Understand why humans need to feel connected to one another.
4. Understand why stigma and social exclusion are harmful.
5. Understand how mental and physical health affect each other.
6. Understand how healthy habits promote mental health.

An introduction to mental health

1-1 What is mental health?

Mental health means the mind is well, relaxed and working normally. Healthy minds are positive and happy, able to learn and get along with other people. Mental health is about feeling safe and emotionally well, being able to handle stress and having a sense of purpose and belonging. We usually don’t even think about mental health until we have to face challenges.

Mental health means the mind is well, relaxed and working normally.

1-2 Why is mental health important?

Mental health is important because it affects the choices we make, the way we work with others and how we handle challenges. Mental health is important in every stage of life and allows people to reach their full potential. Mentally healthy people are able to develop, grow and thrive, and make a contribution at home, work, school and in their community.

1-3 Is the brain the same as the mind?

No. The brain and the mind are not the same. The brain is part of the body, and a living brain is needed to create the mind. The mind gives us a sense of awareness and helps us understand and make sense of the world. The mind and body are different, but connected. This means what happens in the body affects the mind, and what happens in the mind affects the body. The mind connects us to the world through sight, smell, hearing, taste and touch.

Stress

1-4 What is stress?

Stress is the way the mind and body respond and manage change or demands in our lives. Stress can be positive or negative. Positive stress is normal. It makes us get up in the morning and allows us to feel motivated, excited and full of energy. Negative stress stops us functioning normally.

Stress is the way the mind and body respond to change and demands in our lives.

1-5 What causes stress?

Stress happens when the body feels at risk because some need is not met. This could be because we are hungry or tired or when we feel frightened. Our bodies can become stressed without us even noticing, when we don’t feel safe, don’t get enough healthy food or quality sleep, or if we don’t have fresh air, clean water or are not able to move. We can also become stressed when we feel unnoticed and alone.

1-6 Why do being alone and not feeling seen cause stress?

Humans normally live in groups and have difficulty surviving alone. We need to be able to connect with other people. Humans are not the biggest, fastest or scariest animals on earth, yet humans are the most successful because we are able to connect, support one another and work together.

Pregnant women, babies, as well as sick, old and dying people get mental health problems more easily than other people and need extra kindness and support. We all need to know we have been ‘seen’ before we can feel safe and relax.

Most people become stressed when they are alone and not supported by others.

1-7 Why is it so important for babies and young children to feel safe?

We all need to feel safe and loved. Babies and young children are especially vulnerable and cannot survive without adult care. They need to feel connected, safe and loved so their brains and minds can develop in ways that allow them to think clearly and get along with other people.

1-8 What is toxic stress?

When something is very bad, it is called toxic. Stress is toxic when it is serious and goes on for a long time. Toxic stress makes people feel overwhelmed, helpless and unable to cope. When young children and adolescents experience toxic stress it can change the way their brains develop.

Toxic stress makes people feel overwhelmed, helpless and unable to cope.

1-9 What causes toxic stress?

Some of the causes of toxic stress, especially for young children and adolescents, are:

• Extreme poverty and food scarcity
• Physical, emotional or sexual abuse
• Physical or emotional neglect and lack of love
• Witnessing domestic violence, especially against the mother
• Disappearance of the mother or care provider due to divorce, death, being jailed or the child being removed from her
• Stigma and exclusion.

Toxic stress can also happen when family members have mental health conditions, or if they are addicted to alcohol or abuse substances, and because of this do not spend much time listening to or being kind to their children.

1-10 What is poor mental health?

People with poor mental health are unhappy and do not enjoy life. They can develop a mental health condition. A mental health condition is a problem of the mind that can affect mood, thinking and/or behaviour. The most common mental health conditions are depression and anxiety.

1-11 Are mental health conditions the same as stress?

No. Mental health conditions such as anxiety and depression are not the same as stress. Mental health conditions are caused by many things including stress, especially toxic stress during early childhood and adolescence.

Negative stress can cause mental health conditions.

1-12 Why are mental health conditions often not noticed?

Many people do not know about mental health. They may not even realise they have a mental health condition or know that this can be treated. When people feel depressed or worried for a long time, they start to think this is normal for them, and often don’t think to ask for help. Fear of stigma also stops people from asking for help.

Stigma

1-13 What is stigma?

Stigma is when people feel judged and pushed away (rejected) by the community because they are different. They may look or behave in a way the community doesn’t like. Sometimes they have a problem or illness that people don’t understand or find frightening.

Stigma is when people feel judged and rejected for being different from others.

1-14 What conditions carry stigma?

People with mental health conditions are often stigmatised. This is because people don’t understand about mental health and think it is a very bad problem. Sometimes people think poor mental health is a punishment because the person has done something bad or that they have been bewitched. This is not true, and makes people suffer more.

People with HIV or TB also experience stigma. In many communities, adolescent girls who are pregnant experience stigma. There may be other things in your community that make people judge others badly.

1-15 What causes stigma?

Stigma happens when people don’t understand why some people are different from them. Not understanding can make people feel frightened. People then make up stories and myths to help them feel safe. Some of the untrue beliefs that people have about mental health conditions include:

• People with mental health conditions are violent or have no self-control.
• Having poor mental health is the person’s own fault.
• People with mental health conditions are lazy, stupid and can’t make decisions.
• Mental health conditions cannot be treated.
• Only specialists can treat someone with a mental health condition.
• People with mental health conditions are bewitched.
• Mental health conditions are easy to catch from other people.

None of these beliefs are true. You may think of other beliefs people have about mental health conditions. Check if these are true or myths (untrue beliefs).

1-16 Why is stigma harmful?

Stigma makes people ashamed to share their problems. This can make them feel very alone, which makes them suffer more. People need to connect with other people, especially when they are sick or frightened. Being unfairly judged and rejected causes toxic stress.

Stigma causes problems for the person and the family. Stigma is very difficult for adolescents because they need to connect with peers so their brains can develop properly. Stigma and fear of not being liked makes adolescents more vulnerable to peer pressure.

Because of stigma and fear of rejection, people with mental health conditions often:

• Don’t tell others how they are feeling and don’t ask for help
• Feel unsafe about finding support, even within a clinic
• Feel ashamed, embarrassed and judge themselves
• Have low self-confidence and doubt their abilities
• Isolate themselves because they don’t want to be judged, which makes the problem worse.

1-17 What can be done to stop stigma?

Stigma can be stopped by education. When the community understands about mental health and mental health conditions, people will stop judging people who suffer. We can also all help by showing we are not frightened of people with mental health conditions and instead be kind and supportive of them.

Stigma can be stopped by education and understanding.

Mental and physical health

1-18 How do mental health conditions affect physical health?

The body and mind are connected. We can see problems in the body (physical) but problems in the mind are often missed if we don’t look for them. Often the physical problem won’t get better until the mental health condition is treated. For example:

• A person with depression and very low energy will struggle to make plans. It is hard for them to go to the clinic. They may forget to collect their medicine. They can struggle to take their children for routine immunisations.
• A person with depression can have no hope for the future and feel bad about themselves. They may not care about taking regular medicine, looking after themselves or even practicing safe sex.
• A person with anxiety worries a lot about their health and may go to the clinic all the time, or is too afraid to go to a clinic in case they hear bad news.
• A mother who thinks she is bad inside may not want to breastfeed her baby.

1-19 How do physical health problems affect mental health?

Illness of the body and the side effects of medicine can change the way people think and feel. A serious illness can make people feel sad, frightened, worried or angry. When people feel they have no control they can begin to feel hopeless and can get depression.

Almost half of people with HIV and TB are depressed. A quarter of people with cancer, high blood pressure and diabetes also have mental health conditions. Mental health can also affect physical health. People with depression are more likely to get HIV or have a heart attack or a stroke.

Mental and physical health affect each other.

Healthy routine and habits to promote mental health

1-20 What is a habit?

A habit is something we do in a regular and repeated way, often without thinking. When we do something over and over it becomes like a well-worn path and we follow it automatically. Knowing what to expect helps our mind and body feel less stressed. For example, if the body is used to eating at certain times, that is when the person gets hungry. If the body is used to going to sleep at a certain time, that is when the person gets tired. The person may wake up at the same time because of habit.

A habit is something that we do automatically without thinking.

1-21 Why are positive habits important, especially in adolescents?

People usually know they need to eat properly and get enough sleep and exercise to keep the body strong. We also need healthy ways of thinking to make our minds strong.

Habits are especially important for adolescents because:

• Adolescent brains are becoming more fixed. Their usual ways of thinking and patterns of behaviour are becoming stronger and automatic.
• If adolescents learn positive habits of thinking and behaving, this will probably stay with them and help throughout their life.
• Habits can be changed later in life, but it is much easier to make changes at this age.
• Adults must help adolescents develop healthy habits of managing emotion, behaving and communicating.
• Adolescents who have adult support, enough sleep, healthy food and exercise are better able to cope with the challenges of this age, and much less likely to develop mental health conditions.
• Adolescents are more likely to listen to adults if they feel heard and seen, i.e. if there is good communication.

Developing healthy habits is very important during adolescence.

1-22 How can adults communicate better with adolescents?

The best way to get an adolescent to cooperate is to be a good role model. Adolescents need adults to give them attention, notice when they do well, support and encourage them, and listen to their ideas respectfully and without judgement:

• Adults must make time available so that it is easy for adolescents to approach and talk to them. Adults must try to listen with empathy, in order to hear and understand the adolescent’s perspective, even if they do not agree.
• Adults must try to be open, trusting and respectful of the adolescent while also providing them with different ways of seeing life.
• It works better when adults talk to adolescents about their concerns around any behaviour and link these concerns to their values and beliefs. Simply trying to control or force adolescents to think and behave in specific ways is usually not helpful.
• It’s sometimes useful to speak to adolescents while they are doing something else, for example, while cooking, walking or after watching a TV programme.
• Adults should try to talk openly, honestly and in a balanced way about topics that are important to adolescents like friendship, sex, love and relationships. Adults can warn them about the signs of unhealthy relationships, such as possessiveness, greed, jealousy and excessive control and manipulation, without frightening them.

1-23 Why is sleep so important?

There is a strong link between lack of sleep and mental health conditions. Adolescents need more sleep than when they were younger because of all the changes happening in their bodies and brain. Most adolescents need between 8 and 10 hours of sleep a night as sleep is important to support growth and brain development. Adolescents usually do not get enough sleep, and this is often the cause of many behaviour problems:

• Tiredness makes people get upset more easily.
• Tiredness makes it difficult to concentrate or solve problems properly.
• Tiredness makes us forget important things more easily.
• Tiredness can also make it hard to get along with friends and family.
• People lacking sleep usually eat badly and easily become angry and behave badly.
• Lack of sleep is a very common cause of poor school performance in adolescents.

There are many reasons why adolescents do not get enough sleep. Hormones change sleep patterns, so the body only feels tired later in the day or evening. They still have to start school early, which can mean less sleep.

Lack of sleep is a very common cause of bad behaviour and poor school performance in adolescents.

1-24 How can modern technology prevent healthy sleep?

There are a number of ways that smart phones, TV and computers make normal sleep difficult:

• The blue light from computer screens and smart phones stops people from feeling sleepy. This makes people struggle to fall asleep and also makes peaceful sleep difficult, especially if they have been looking at screens just before bedtime.
• Adolescents struggle with controlling their wishes. If they are able to use devices in their rooms they often stay awake messaging friends, playing games or watching a series when they should be sleeping.
• If adolescents have a smart phone, TV or computer, these should be kept in another room at bedtime.

1-25 How can adults encourage healthy sleeping habits?

The best way to do this is for the adults to have healthy sleep habits themselves. Adults must be aware of how adolescents are sleeping and set limits if necessary:

• Encourage the adolescent to use their bed only for sleeping and not for homework.
• Let them go to bed only when tired.
• Avoid or limit technology use, such as TV or cellphones, at night.

1-26 Why are regular meals and healthy eating also important?

Adolescents are growing quickly and need healthy food and regular healthy snacks to stay healthy. Healthy eating can be a problem when money and food are scarce. Fresh fruit and vegetables are healthier than food like chips, biscuits and sweets (‘junk food’), which are usually full of sugar and chemicals. Adolescents who eat unhealthy food have double the risk of developing mental health conditions:

• Adolescents like junk food because it gives them a quick energy boost and good feelings. They can easily become addicted to junk food.
• Too much junk food and sugar can make adolescents fat (obese) which can make them feel bad about their body. Junk food also makes attention deficit and hyperactivity (ADHD) and mood and sleep problems worse.
• Unhealthy eating habits often lead to lifelong (chronic) bad health.

1-27 How can we help encourage good eating habits?

Adults need to be role models for healthy eating:

• Make sure that there is only healthy food and no junk food in the home.
• Encourage adolescents to start and take care of food gardens.
• Keep healthy, fresh food options prepared and easily available for adolescents to snack on. For example, leave out fruit where it can be seen, prepare food and vegetables in advance, keep boiled eggs and beans in the fridge.

1-28 Why is exercise important?

Exercise and sport improve mood and limit depression and anxiety. Team sports also have many other benefits, especially for adolescents. Benefits of exercise include:

• Exercise helps adolescents develop lifelong healthy lifestyle habits.
• It brings them into contact with other adolescents.
• It gives them a healthy and safe way to use up emotional and other energy.
• It gives them a sense of achievement and causes less stress and more ‘happy’ hormones to be released, which makes them feel more positive
• It improves their body image.
• Exercise also helps adolescents to sleep better.
• People who exercise are more likely to eat healthily and less likely to use substances like drugs and alcohol.

Many schools do not offer sport, so it is important to find places outside school where adolescents can do sport.

It is important for adolescents to develop good communication, sleep, eating and exercise habits that will reduce the risk of mental health conditions.

Case study 1

Your 15-year-old daughter stayed up late studying for a test. When she gets home from school the next day, you ask how the test went and she tells you it’s none of your business. You tell her to stop being so rude. She runs out of the room shouting that she hates you. On the way out she knocks over and breaks your favourite mug.

1. Is this child just being naughty?

No, there are many reasons why children often behave badly when they get home after school. She may be tired and hungry. She may be disappointed because the test went badly, even though she worked hard to try to understand the work.

2. Why is she always so dramatic?

Adolescents are often overwhelmed by their strong emotions. When they are tired and hungry this can make it more difficult for them to cope. Adolescents are often able to pretend to be okay while with their friends, but then lose control when they get home. Adolescents need to be understood, but be clear that they need to take responsibility for their behaviour. Always wait until everyone has calmed down, or the situation will get much worse.

3. It’s so painful when your child says she hates you. Should you send her away to live somewhere else?

No, she probably means her world feels out of control and she hates how she feels. It would make things worse to get angry with her.

4. Does this mean parents should let their children shout and say mean things to them?

No. Children must respect their parents. This is just not the right time to correct them. The best thing to do is to calm down yourself and leave her to calm down. When you are both calm, go and sit with her without saying anything. When she has calmed down you can try to find out what happened to make her feel so overwhelmed. Listen without judgement. When you have understood her, you should tell her how sore you feel inside when she says hurtful things. Together discuss what can be done to repair the damage. For example, she can clean up the mess while you make her a sandwich.

Case study 2

A 15-year-old girl is pregnant. She stops going to school and spends her time in her room lying on her bed. She says she is ashamed to go out because everyone is looking at her. She says she cannot sleep and has stopped eating properly.

1. What are the reasons this young girl is behaving like this?

Pregnant adolescents often feel very ashamed because of community stigma. They judge themselves and also feel judged by their family and friends. Adolescents who isolate and don’t eat or sleep properly are at very high risk for mental health conditions. The longer the young girl behaves like this, the more difficult it will be to help her.

2. Is it important to punish this girl so she can understand what she has done?

This girl will already understand that she has made her life more difficult. Her pregnancy may already feel like a punishment. She may be feeling very frightened and sad about her future and be unsure how she will manage. Adults often want to punish pregnant girls by chasing away their friends, keeping them busy with chores or locking them up in the house. This is not helpful as it makes the young person more at risk of developing a mental health condition that will harm her and also the unborn baby.

3. Does talking about sex make young girls more likely to fall pregnant?

No. The best way to keep adolescents safe is for them to have good mental health. This is encouraged when adults talk openly to them about the things that matter to them, like sex and relationships. Adolescents need to know this information, and if their adults don’t talk to them and let them know what they think, then they will find out from other less trustworthy people.