MENTAL HEALTH Ahmed Mandil, Prof of Epidemiology Dr. Mohammad Afzal Mahmood College of Medicine, King Saud University

MENTAL HEALTHMENTAL HEALTH

Ahmed Mandil, Prof of EpidemiologyAhmed Mandil, Prof of Epidemiology

Dr. Mohammad Afzal MahmoodDr. Mohammad Afzal Mahmood

College of Medicine, King Saud University College of Medicine, King Saud University

HeadlinesHeadlines

General reflectionsGeneral reflections Magnitude of the problemMagnitude of the problem ClassificationsClassifications

DisordersDisorders EtiologyEtiology

Prevention and controlPrevention and control Integration into PHCIntegration into PHC

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Teaching and Learning AimsTeaching and Learning Aims

There is ignorance, There is ignorance, superstition, stigma and superstition, stigma and fear around Mental fear around Mental IllnessIllness

Etiology, pathogenesis Etiology, pathogenesis diagnosis and treatment diagnosis and treatment are imperfect.are imperfect.

There is a different There is a different paradigm and a less paradigm and a less rigorous epidemiologyrigorous epidemiology

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Often sad,sometimes Often sad,sometimes mad,occasionally badmad,occasionally bad

The medical model The medical model is:is:– InsufficientInsufficient– Diagnosis is Diagnosis is

largely clinical largely clinical and experientialand experiential


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More of an art than a scienceMore of an art than a science

Treatment is Treatment is pragmaticpragmatic

Prevention is about Prevention is about the politics of healththe politics of health

““populations,populations,

people pressures, people pressures, poverty”poverty”


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Mental Health is a Mental Health is a worldwide problemworldwide problem


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We are all vulnerableWe are all vulnerable


Global Burden Mental & Substance Use disorders StudyGlobal Burden Mental & Substance Use disorders StudyHarvey A Whiteford, et al: Global burden of disease attributable to mental andHarvey A Whiteford, et al: Global burden of disease attributable to mental andsubstance use disorders: findings from the Global Burden ofsubstance use disorders: findings from the Global Burden ofDisease Study 2010. Lancet: August 29, 2013 http://dx.doi.org/10.1016/S0140-6736(13)61611-6Disease Study 2010. Lancet: August 29, 2013 http://dx.doi.org/10.1016/S0140-6736(13)61611-6

183·9 million DALYs 183·9 million DALYs (disability adjusted life years)(disability adjusted life years)

7·4% of all DALYs worldwide. 7·4% of all DALYs worldwide. 8·6 million YLLs 8·6 million YLLs (Years of life lost)(Years of life lost)

175∙3 million YLDs (22·9% of all YLDs) 175∙3 million YLDs (22·9% of all YLDs) (Year of life lost to (Year of life lost to disability)disability)

Leading cause of YLDs worldwide. Leading cause of YLDs worldwide. Depressive disorders 40·5% of DALYs caused by Depressive disorders 40·5% of DALYs caused by

mental and substance use disordersmental and substance use disorders Anxiety disorders 14·6% Anxiety disorders 14·6%

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Global Burden Mental & Substance Use disorders StudyGlobal Burden Mental & Substance Use disorders StudyHarvey A Whiteford et al,: Global burden of disease attributable to mental andHarvey A Whiteford et al,: Global burden of disease attributable to mental andsubstance use disorders: findings from the Global Burden ofsubstance use disorders: findings from the Global Burden ofDisease Study 2010. Lancet: August 29, 2013 http://dx.doi.org/10.1016/S0140-6736(13)61611-6Disease Study 2010. Lancet: August 29, 2013 http://dx.doi.org/10.1016/S0140-6736(13)61611-6


Global Burden Mental & Substance Use disorders StudyGlobal Burden Mental & Substance Use disorders StudyHarvey A Whiteford et al: Global burden of disease attributable to mental andHarvey A Whiteford et al: Global burden of disease attributable to mental andsubstance use disorders: findings from the Global Burden ofsubstance use disorders: findings from the Global Burden ofDisease Study 2010. Lancet: August 29, 2013 http://dx.doi.org/10.1016/S0140-6736(13)61611-6Disease Study 2010. Lancet: August 29, 2013 http://dx.doi.org/10.1016/S0140-6736(13)61611-6

KSA EstimatesKSA Estimates

RiyadhRiyadh: 30 – 40 % of PHC patients had mental disorders : 30 – 40 % of PHC patients had mental disorders (mostly undiagnosed)(mostly undiagnosed)

Al-KhobarAl-Khobar: 22 % of health clinics patients had mental : 22 % of health clinics patients had mental health disorders (8 % diagnosed)health disorders (8 % diagnosed)

Central provinceCentral province: 18 % of adults with minor disorder, with : 18 % of adults with minor disorder, with rates higher among: rates higher among:

– Young: 15-29 years (23 %)Young: 15-29 years (23 %)

– Divorced and widows (40 %)Divorced and widows (40 %) Suicidal ratesSuicidal rates: 1.1 per 100,000 mostly among:: 1.1 per 100,000 mostly among:

– MenMen

– Age: 30-39 yearsAge: 30-39 years

– ImmigrantsImmigrants

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Classification of Mental Illness (I)Classification of Mental Illness (I)

The Neuroses: The Neuroses: e.g. depression, anxiety, mania, e.g. depression, anxiety, mania, obsessions and compulsions (usually the patient retains obsessions and compulsions (usually the patient retains insight and orientation; they experience deep distress insight and orientation; they experience deep distress and may commit suicide)and may commit suicide)The Psychoses: The Psychoses: e.g.e.g. schizophrenia, puerperal schizophrenia, puerperal psychosis (the patient is disorientated, deluded, and psychosis (the patient is disorientated, deluded, and lacking in insight)lacking in insight)The Dementias: The Dementias: e.g. progressive deterioration with loss e.g. progressive deterioration with loss of recent memory and deterioration of a normal of recent memory and deterioration of a normal personality. They may be primary or more commonly personality. They may be primary or more commonly secondary to another condition e.g. alcohol, cerebro-secondary to another condition e.g. alcohol, cerebro-vacular strokevacular stroke


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Classification of Mental Illness (II)Classification of Mental Illness (II)

Affective DisordersAffective DisordersAnxiety, depression, mania, obsessional Anxiety, depression, mania, obsessional

disorders disorders

SchizophreniaSchizophreniae.g. paranoid type, disorganized typee.g. paranoid type, disorganized type

Organic statesOrganic statese.g. dementiae.g. dementia

Personality DisorderPersonality DisorderAbnormal personality Abnormal personality

• Substance abuse Substance abuse •Drugs, alcoholDrugs, alcohol

• Learning disordersLearning disordersSubnormalitySubnormality


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Classification of Mental Illness (III)Classification of Mental Illness (III)

Drug Problems

Addictive drugs, (Heroin, Cocaine, Amphetamines,) alcohol nd drug related illness-psychosis, delirium and dementia

Personality DisordersA personality and behaviour that is damaging to the individual and/or to society and which is not tolerated by the dominant culture

Mental subnormality / learning disorders:Problems around intelligence and ability to learn on the basis of teaching and experience


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Mental Handicap/Mental Handicap/learning disabilitylearning disability

The mind of a young child in the body of an adult


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Etiology of Mental Illness (I)Etiology of Mental Illness (I)

• Multiple factors (individual, family and community)

• Genetic factors• Social / environmental factors (e.g. stress,

deprivation)• Physical factors (e.g. trauma, disease as:

syphilis and pellagra)


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Etiology of Mental Illness (II)Etiology of Mental Illness (II)

Inheritance-Genetics/Intra-uterine environment

Schizophrenia,Huntington’s

Infections-HIV,Syphilis,CJD

Drug Abuse

Alcohol,Heroin etc

Trauma/head injury Biochemistry/metabolic

Porphyria,Diabetes

Vascular-CVA

Neurological diseases

MS,Brain tumour

Upbringing

Mothering,education,parenting

Nutrition/PCMApril 19, 2023Mental Health

PREVENTION AND CONTROLPREVENTION AND CONTROL


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Preventive NetworksPreventive Networks Mosque, Family, Home, Mosque, Family, Home,

Friends, Work Friends, Work


Primary PreventionPrimary Prevention(Ref: WHO, Prevention & Promotion 2002(Ref: WHO, Prevention & Promotion 2002

WHO, Prevention of Mental Disorders 2004)WHO, Prevention of Mental Disorders 2004)

Universal prevention: targeting the general public or a whole population group.

Selective prevention: targeting individuals or subgroups of the population whose risk of developing a mental disorder is significantly higher than that of the rest of the population.

Indicated prevention: targeting persons at high-risk for mental disorders.


Primary PreventionPrimary PreventionReducing/Eliminating Risk & Facilitating Protective FactorsReducing/Eliminating Risk & Facilitating Protective Factors

(Ref: WHO, Prevention & Promotion 2002(Ref: WHO, Prevention & Promotion 2002WHO, Prevention of Mental Disorders 2004)WHO, Prevention of Mental Disorders 2004)


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Prevention of Mental IllnessPrevention of Mental Illness

• Protection of the very young (promotion of family life)• Prevention of social stress and insecurity• Protection of the aged who may suffer from cerebral degeneration, depression and/or psychopathic states• Prevention of brain damage• Public education in mental health• Premarital consultations and medical examination• Provision of suitable institutions• Legislation as regards drug abuse, compulsory admission to residential hospitals and guardianship• Rehabilitation


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Treatment and CareTreatment and Care

Hospital Care

Community Care


Integration of Mental Health Integration of Mental Health into PHCinto PHC

The morbidity burden in greatThe morbidity burden in great Mental and physical health problems are interwovenMental and physical health problems are interwoven Treatment gap is enormousTreatment gap is enormous PHC care for mental health PHC care for mental health

– Enhances successEnhances success– Promotes respect for human rightsPromotes respect for human rights– Is affordable and cost-effectiveIs affordable and cost-effective– Generates good health outcomesGenerates good health outcomes


KSA Mental Healthcare Facilities KSA Mental Healthcare Facilities

Facility Number Beds

MoH Psychiatric Hospitals 14 30-120 each

Al-Taif Hospital 1 570

Military, National Guards and University Hospitals

165 total

Private Hospitals 146 total

Hospitals for Ʀ of Drug Dependence

3 280 each

Departments / Clinics attached to General Hospitals

61 20-30 each


References (I)References (I)

1.1. WHO. WHO. Integrating mental health into primary care: A Integrating mental health into primary care: A global perspective.global perspective. Geneva: WHO, 2008 Geneva: WHO, 2008

2.2. WHO. WHO. Saudi Arabia: Integrated primary care for Saudi Arabia: Integrated primary care for mental health in the Eastern Provincemental health in the Eastern Province. In: Integrating . In: Integrating mental health into primary care: A global mental health into primary care: A global perspective. Geneva: WHO, 2008perspective. Geneva: WHO, 2008

3.3. Sims P. Sims P. Mental health and illness: An Mental health and illness: An epidemiological perspectiveepidemiological perspective. University of Papua . University of Papua New GuineaNew Guinea

4.4. Al-Fares E, Al-Shammari S, Al-Hamed A. Al-Fares E, Al-Shammari S, Al-Hamed A. Prevalence of psychiatric disorders in an academic Prevalence of psychiatric disorders in an academic primary care department in Riyadh. Saudi Medical primary care department in Riyadh. Saudi Medical Journal 1992; 13: 49-53Journal 1992; 13: 49-53


References (II)References (II)

5.5. Al-Khathmi A, Ogbeide D. Al-Khathmi A, Ogbeide D. Prevalence of mental Prevalence of mental illness among Saudi adult primary care patients in illness among Saudi adult primary care patients in central Saudi Arabiacentral Saudi Arabia. Saudi Medical Journal 2002; . Saudi Medical Journal 2002; 23: 721-72423: 721-724

6.6. Elfawal M. Elfawal M. Cultural influence on the incidence and Cultural influence on the incidence and choice of method of suicide in Saudi Arabiachoice of method of suicide in Saudi Arabia. . American Journal of Forensic Medicine & Pathology American Journal of Forensic Medicine & Pathology 1999; 20: 163-1681999; 20: 163-168

7.7. Al-Khathami A. Al-Khathami A. The implementation and evaluation The implementation and evaluation of an educational program for PHC physicians to of an educational program for PHC physicians to improve their recognition of mental illness in the improve their recognition of mental illness in the Eastern Province of Saudi ArabiaEastern Province of Saudi Arabia [dissertation]. Al- [dissertation]. Al-Khobar: King Faisal University, 2001 Khobar: King Faisal University, 2001


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MENTAL HEALTH Ahmed Mandil, Prof of Epidemiology Dr. Mohammad Afzal Mahmood College of Medicine, King Saud University