What are mental health problems?

Some mental health problems are described using words that are in everyday use; for example, ‘depression’ or ‘anxiety’. This can make them seem easier to understand, but can also mean people underestimate how serious they can be.

Mental ill health feels just as bad, or worse, than any other illness – only you cannot see it.
Although mental health problems are very common – affecting around one in four people in Britain – stigma and discrimination towards people with mental health problems is still very common and there are a lot of myths about what different diagnoses mean.

There is also a lot of controversy about the way mental health problems are diagnosed, what causes them, and which treatments are most effective.

However, despite these challenges, it is possible to recover from a mental health problem and live a productive and fulfilling life. It is important to remember that having a mental health problem is not a sign of weakness.

Never be ashamed of having bad days, weeks or even months – because they show your inner strength, even if you can’t see it yourself at the time.

What are the most common mental health problems?

Some of the most commonly diagnosed forms of mental health problem are described below.

Common diagnoses

Depression
Depression lowers your mood, and can make you feel hopeless, worthless, unmotivated and exhausted. It can affect sleep, appetite, libido and self-esteem. It can also interfere with daily activities and, sometimes, your physical health. This may set off a vicious cycle, because the worse you feel, the more depressed you are likely to get. Depression can be experienced at different levels e.g. mild or severe, and can be related to certain experiences; for example, postnatal depression occurs after childbirth. Depression is often associated with anxiety. (See Mind’s booklet ‘Understanding depression‘.)

Anxiety
Anxiety can mean constant and unrealistic worry about any aspect of daily life. It may cause restlessness, sleeping problems and possibly physical symptoms; for example, an increased heart beat, stomach upset, muscle tension or feeling shaky. If you are highly anxious you may also develop related problems, such as panic attacks, a phobia or obsessive compulsive disorder. (See the relevant sections below and Mind’s booklet, ‘Understanding anxiety‘.)

Obsessive-compulsive disorder
Obsessive-compulsive disorder (OCD) has two main parts: obsessions and compulsions. Obsessions are unwelcome thoughts, ideas or urges that repeatedly appear in your mind; for example, thinking that you have been contaminated by dirt and germs, or worrying that you haven’t turned off the oven. Compulsions are repetitive activities that you feel you have to do. This could be something like repeatedly checking a door to make sure it is locked or washing your hands a set number of times. (See Mind’s booklet ‘Understanding obsessive-compulsive disorder‘.)

Phobias
A fear becomes a phobia when you have an exaggerated or unrealistic sense of danger about a situation or object. You will often begin to organise your life around avoiding the thing that you fear. The symptoms of phobias are similar to anxiety, and in severe forms you might experience panic attacks. (See Mind’s booklet ‘Understanding phobias‘.)

Bipolar disorder (formerly known as manic depression)
If you have bipolar disorder you will experience swings in mood. During ‘manic’ episodes, you are likely to display overactive excited behaviour. At other times, you may go through long periods of being very depressed. There are different types of bipolar disorder which depend on how often these swings in mood occur and how severe they are. (See Mind’s booklet ‘Understanding bipolar disorder‘.)

Schizophrenia
Schizophrenia is a controversial diagnosis. Symptoms may include confused or jumbled thoughts, hearing voices and seeing and believing things that other people don’t share. If you have these symptoms you might also become confused and withdrawn. There is debate about whether schizophrenia is actually one condition or more a collection of symptoms that are not clearly related. (See Mind’s booklet, ‘Understanding schizophrenia‘.)

Personality disorders
Generally speaking, personality doesn’t change very much. Yet it does develop as people go through different experiences in life, and as their circumstances change. If you have a personality disorder, you are likely to find it more difficult to change your patterns of thinking, feeling and behaving, and will have a more limited range of emotions, attitudes and behaviours with which to cope with everyday life. (See Mind’s booklet ‘Understanding personality disorders‘.)

Eating disorders
Eating disorders can be characterised by eating too much, or by eating too little. If you have an eating disorder you may deny yourself anything to eat, even when you are very hungry, or you may eat constantly, or binge. The subject of food, and how much you weigh, is likely to be on your mind all the time. Your eating disorder is likely to develop as a result of deeper issues in your life and is possibly a way of disguising emotional pain. Anorexia, bulimia, bingeing and compulsive eating are some of the most common eating disorders. (See Mind’s booklet ‘Understanding eating problems‘.)

Common behaviours

In addition to the more formal diagnoses above, there are some behaviours and feelings which are strongly associated with mental health problems.

Self-harm
Self-harm is a way of expressing very deep distress. You may not know why you self-harm, but it can be a means of communicating what you can’t put into words, or even into thoughts, and has been described as an ‘inner scream’. After self-harming, you may feel better able to cope with life again, for a while, but the cause of your distress is unlikely to have gone away. (See Mind’s booklet ‘Understanding self-harm‘.)

Suicidal thoughts
It is common to have suicidal thoughts if you are experiencing mental health problems – especially if you have a diagnosis of depression, borderline personality disorder or schizophrenia. The deeper your depression, the more likely it is that you will consider killing yourself. However, you can help yourself and you can get help from other people. A great many people think about suicide, but the majority do not go on to kill themselves. (See Mind’s booklets ‘How to cope with suicidal feelings‘ and ‘How to help someone who is suicidal‘.)

Panic attacks
These are sudden, unexpected bouts of intense terror. If you experience an attack you may find it hard to breathe, and feel your heart beating hard. You may have a choking sensation, chest pain, begin to tremble or feel faint. It’s easy to mistake these for the signs of a heart attack or other serious medical problem. Panic attacks can occur at any time, and this is what distinguishes them from a natural response to real danger. (See Mind’s booklet ‘Understanding anxiety‘.)

What causes mental health problems?

There are many opinions about what causes mental health problems. This is part of a wider debate about whether personality is shaped by life experiences, or determined by genes. The following are some of the factors that may play a role in the development of mental health problems.

Difficult family background

Coming from a difficult background where you have experienced neglect, violence, abuse or been overprotected can make people highly insecure and more vulnerable to mental health problems.

Stressful life events

These may be traumatic events, such as the death of someone close, or longer-term struggles, such as being the victim of some form of harassment or oppression. In recent years, research has shown that being made redundant or spending significant periods out of work can also have an impact on your mental health.

Biochemistry

Your body chemistry can affect your mind. For example, if you are frightened, it triggers the body’s ‘fight or flight’ response to produce a
hormone called adrenalin. If physical activity doesn’t use up all the adrenalin, the body remains tense and the mind stays over-active.

Genes

There are genes that cause physical illnesses, so there may be genes that play a role in the development of mental health problems. Research suggests that genes might make certain people more vulnerable to mental health problems than others. For example, if you have a parent with schizophrenia you are more likely to develop it yourself. However, most people with schizophrenia do not have a parent with this diagnosis, so it seems unlikely that a gene can be said to cause a mental health problem.

Physical health problems

If the brain is physically damaged by a head injury or a condition such as epilepsy this can have an impact on behaviour and mood, and lead to symptoms associated with some mental health problems. Long-term physical illnesses have also been shown to put people at greater risk of depression and anxiety.

Social problems

Social factors such as poverty, domestic violence, isolation, poor housing and addiction have been associated with mental health problems. It is not always clear whether these factors trigger the problems, or whether having a mental health problem can lead to social problems you might not otherwise experience.

How are they diagnosed?

In order to make a diagnosis, psychiatrists (mental health doctors) look for groupings of certain symptoms which have been present for a defined period of time; for example, to diagnose depression they look for symptoms such as low mood and a lack of interest or pleasure in usual activities for a period of more than two weeks.

Because diagnoses are based on grouping symptoms together, there is a lot of overlap between different conditions; for example, a change in sleeping pattern is a feature of both depression and anxiety. Therefore, if you are experiencing mental health problems, this can mean that you receive more than one diagnosis over a period of time.

Making a diagnosis helps a doctor assess what treatment you need and predict how your condition is likely to develop. But there are different ways of understanding mental health problems.

The ‘medical model’ approach sees them as illnesses and they are therefore diagnosed and treated by a doctor, as described above. However, a lot of people (including some doctors) disagree with using a purely medical model and – as discussed in the previous section on causes – psychological and social factors are likely to play a role.

Labelling

If you receive a diagnosis, you might feel relieved and be glad that you can put a name to what is wrong. However, if a diagnosis becomes a label, it can be very damaging. For example, instead of being seen as a parent, writer, mechanic or student who has schizophrenia, you may be seen as ‘a schizophrenic’, as though this diagnosis is all that you are.

Many people prefer to see mental health problems as part of human experience rather than distinct illnesses. A diagnosis does not have to determine the whole course of your life, and may come to be a relatively minor part of your identity or history.

It is not about being classified by your mental illness: it is about learning to accept yourself and seize the day for all it is worth – because tomorrow will be different.

What treatments are available?

The two most common forms of treatment offered though the NHS are talking treatments and medication. Treatments aim to relieve and help you cope with distressing symptoms.

There are clinical guidelines issued by the National Institute for Health and Clinical Excellence (NICE) which medical professionals are encouraged to follow. These guidelines are based on published evidence, expert contributions and real life experiences. They often recommend different treatment options based on the severity of a condition; for example, NICE does not recommend the use of antidepressants for mild depression, but they are recommended where depression is judged to be severe. Copies of these guidelines are freely available on the NICE website (see ‘Useful contacts’ ).

Although health professionals are encouraged to follow these guidelines, in practice, access to treatment varies enormously across the NHS.

Medication

The most common type of treatment given by GPs and psychiatrists is prescription medication. These drugs don’t ‘cure’ mental health problems, but aim to ease the most distressing symptoms.

Depending on the diagnosis, there are a variety of drugs commonly used:

• minor tranquillisers or sleeping pills – to help someone calm down or sleep
• antidepressants – to lift depression
• antipsychotics – to control disturbing thoughts
• mood stabilisers – to control extremes of mood

Many people find these drugs helpful, as they can lessen symptoms and allow them to function at work, look after children or take part in their normal activities. However, drugs can have side effects that may make people feel worse rather than better. They can also be addictive, difficult to withdraw from or cause physical damage if taken in too high a dose. Therefore, they need to be used with caution, ideally in the lowest possible dose for the shortest possible time. (See Mind’s booklets in the ‘Making sense‘ series.)

Talking treatments

Talking (psychological) treatments can help you to overcome emotional difficulties and free yourself from self-destructive ways of feeling, thinking and behaving. Some of the more common types are:

• Counselling – an opportunity to talk about what is troubling you and be heard
• Psychotherapy – aims to help you understand why you feel the way you do
• Cognitive behavioural therapy – aims to challenge negative thinking and behaviours
• Group therapy – aims to help you deal with problems you may have in relating and communicating with other people and develop self-awareness
• Relationship or family therapy – aims to help you work with your partner or family to understand and deal with problems you are facing.

There are many more types of therapy practiced in the UK and it is important to find a style and a therapist that you can trust and feel comfortable with. For more information see Understanding talking treatments or the ‘It’s good to talk’ website.

Complementary and alternative therapies

Some people find complementary therapies such as hypnotherapy, massage and acupuncture helpful to manage stress and other common symptoms of mental health problems. The clinical evidence for these therapies is not always as robust as it is for other treatments. A body called the Complementary and Natural Healthcare Council exists to provide regulation for complementary therapists. Their website holds details of therapists registered with recognised professional organisations.

Arts therapies are a way of using the arts – for example, music, painting, dance, voice or drama – to express and understand yourself in a therapeutic environment with a trained therapist. Arts therapies are especially helpful if you find it difficult to talk about your problems and how you are feeling. See ‘Making sense of arts therapies‘ for further information.

How can the mental health system help?

The mental health system is a description that aims to cover all the support services available from the government, through the NHS and social services.

If you are experiencing mental health problems, your first point of contact with the mental health system is likely to be your GP. Your GP should make an assessment of your needs and offer you appropriate treatment at the local surgery. This may be advice and information, a prescription for medication, and/or counselling. Your GP can also refer you to specialist mental health services if necessary. You may be referred to a consultant psychiatrist attached to a hospital or to the Community Mental Health Team (CMHT).

The Community Mental Health Team (CMHT)

CMHTs support people with mental health problems living in the community, and also their carers. The team may include a community psychiatric nurse (CPN), a psychologist, an occupational therapist, a counsellor and a community support worker, as well as a social worker. One member of the team will be appointed as your care coordinator, to keep in regular contact with you. (See Mind’s information on community based mental health and social care).

Residential care

If you aren’t able to cope on your own at home, there are other options.

• Hostels are short-term accommodation, with supervision, to help people until they can live more independently,
• Residential care homes offer a much higher level of input for people with severe mental health problems.
• Therapeutic communities are for short stays, and provide group or individual therapy as part of their rehabilitation programmes.
• Supported housing schemes enable people to live independently, in furnished accommodation, with the back-up of a mental health support worker.
• (See the Mind guide to housing and mental health.)

Hospital treatment

Hospital in-patient facilities exist for people with severe mental health problems, or people who are experiencing a crisis. The majority of hospital admissions are voluntary, but if you are assessed and judged to be at risk of harming yourself or others you can be detained under a section of the Mental Health Act (see the Mind rights guide series of booklets).

Crisis intervention

In a growing number of areas, there is special crisis intervention, or rapid response teams. These are able to support someone through a major crisis at home or in a residential crisis centre, without going into hospital. (See the ‘Mind guide to crisis services‘.)

How can I help myself?

Mental wellbeing is a phrase that is often used to describe having good mental health. Having good mental health doesn’t necessarily mean being happy all the time, but is about having the ability to cope with difficulties when they arise. Making changes to your lifestyle can help with this, and prevent problems from developing.