World Mental Health Day is held on 10 October. At IMC we see patients present with various mental health challenges therefore we asked Dr Charu to explain what we mean by ‘mental health’ and the ways that a GP can help people suffering with mental health issues.
What does ‘mental health’ actually mean?
Mental health includes the emotional, psychological and social well-being of a person. It determines our ability to cope with life’s stresses, work productively and relate to others in society. It is not the mere absence of negative emotions but a positive state of mind which reflects itself in our thinking, emotions and behaviour.
Mental health issues are under recognized in society and it is important for us to be aware of how much they can influence the physical health of a person. Physical health problems that can be quantified by blood testing and scans are often the priority for health professionals whereas mental health which can be equally distressing to the individual and his/ her family are easily missed. The effect on work, personal life and social relationships can be debilitating. To add to this, the stigma attached to many mental health conditions (especially in certain cultures and in males more than in females) prevents people from seeking early help.
What are the most common mental health complaints you see in the clinic?
‘I think I am not coping doctor – (often a tearful during consultation)’
‘I hate waking up in the morning and thinking of the day ahead’
‘I feel like I am in a black hole and just can’t come out of it’
‘I just don’t feel any joy in what I used to enjoy– I feel numb’
‘I have no interest in sex’
‘Some days I wish I wasn’t around anymore’
‘I woke up sweating and with a fast heartbeat – thought I may be having a heart attack!’
‘I worry that something is going to happen to my children when they are not with me – I can’t seem to get rid of this thought’
‘At the moment I lose my temper at anything and everything’
‘I don’t feel like going out with friends anymore and socializing is an effort’
‘I used to be able to stop drinking on days that I didn’t want to but now it’s the only way I can relax’
‘I have headaches and other aches and pains frequently – yet my tests are all normal’
Below are a few of the complaints that would trigger further history-taking in a sensitive manner;
- Low mood as a result of stressful events in life e.g. bereavement is perhaps the commonest scenario that all of us are familiar with. Most people will gradually feel better with the passage of time.
- Depression is diagnosed when there is a persistence of low mood for weeks or months, severe enough to affect the individual’s daily functioning. These individuals may suffer with poor concentration, poor sleep or appetite. Thoughts of self-harm or suicide can occur and require urgent intervention. Depression is the most common mental illness worldwide with the WHO estimating that 300 million people (approximately 4.4% of the world’s population) suffer from it. The Singapore Mental Health Study in 2016 revealed a 6.3% prevalence of a major depressive disorder.
- Anxiety triggered by life stresses is not uncommon but when it becomes constant, unrelated to any specific triggers and interferes with daily functioning, it is termed generalized anxiety disorder (G.A.D.). Sleep, memory and concentration may be affected. Anxiety and depression can co-exist and constant anxiety can result in a low mood. The lifetime prevalence of G.A.D. in Singapore is around 1.6%
- Panic disorder and specific phobias are other presentations. 20% of adults may suffer a panic attack at least once in their lifetime. These episodes are often unprovoked and the sufferer experiences sudden fear associated with physical symptoms such as chest pain, breathlessness, choking and sweating.
- Obsessive-compulsive disorder is marked by recurrent obsessive thoughts or impulses e.g. fear of germs. Obsessions trigger compulsive behavior to overcome the anxiety created by the obsession. It has a lifetime prevalence of about 3.6% based on a 2016 study. There is often associated anxiety or low mood as it interferes with a person’s ability to continue a normal routine and relationships.
- Alcohol abuse and addiction has increased in Singapore (prevalence of 4.1%). In addition to a myriad of physical illnesses, it leads to anxiety and depression as it wreaks havoc on the neurotransmitters in the brain.
- Psychotic symptoms and bipolar illness are more severe forms of mental health. The former is marked by disordered thinking wherein the person is not in touch with reality. Delusional thinking and hallucinations should prompt an early assessment of these patients by a doctor.
- Bipolar illness is a mood and activity disorder marked by either elated mood (mania), hyperactivity or depression causing severe disruption to one’s normal routine.
- Insomnia is seen as a symptom of the above conditions or may be primary in nature. Chronic sleep deprivation can lead to a worsening of mental health. 10-15% of adults suffer with insomnia.
- Another group of sufferers include those with personality disorders, who exhibit dysfunctional behaviour and thinking. These individuals struggle to cope in the family and in society.
- Post-traumatic stress disorder ensues after a traumatic event such as war or natural disaster.
- Physical symptoms as a presentation of an imbalance in mental health – headaches, aches and pains are common and it takes an interested GP to delve further!
What is the ‘treatment’ for mental health challenges?
This depends on the cause but some basic underlying principles will help recovery :
Lifestyle: In mood disorders such as depression and anxiety, optimizing one’s lifestyle can make a huge difference – this includes a healthy diet and regular exercise. Exercise facilitates the release of feel-good chemicals – ‘endorphins’ – and these lift the mood and ease anxiety. Healthy sleep patterns cannot be underestimated. Avoidance of alcohol is advised due to its effect on depressing the mood and worsening anxiety.
Counselling and psychological input: Talking therapy and techniques such as Cognitive Behavioural Therapy can work as well as medication in mild to moderate cases. Methods of coping with stress in healthy ways are learnt from trained professionals.
Medication: May be required especially in severe cases and works in conjunction with talking therapy. Sufferers of major depression, psychosis and bipolar illness may need this urgently to manage symptoms.
Relaxation techniques: Breathing exercise and progressive muscle relaxation are beneficial.
Supportive family, friends and support groups can make a big difference in enabling recovery.
Severe cases of depression and strong suicidal risk may require E.C.T. – electroconvulsive therapy – this is a specialized treatment offered in hospital.
Is there a demographic that is more likely to suffer from mental health issues?
There are various theories on causation:
- Genetic factors and traumatic experiences in childhood.
- Life changing events that can create a prolonged strain on mental health and may be triggers e.g. unemployment, bereavement and pregnancy or the postnatal period.
- Long-standing chronic illnesses such as heart disease, diabetes, chronic back pain or cancer are linked with depression.
- Substance misuse is strongly linked to mental health disorders and can be a trigger for
If someone reading this is concerned about a partner / teenager / child – when should they seek external support? And who should they go to for support?
The family doctor is in a good position to coordinate cases. A discussion about their symptoms, possible trigger and severity of the condition can occur in a confidential manner. A decision on treatment, medication and psychological input is made after collaboration with the patient.
School-going children may confide in school counselors who can offer talking therapy and refer to a psychologist or a doctor depending on the severity of the condition.
Counsellors in the community are easy to access by self-referral too. Psychiatrists who are mental health specialists are seen after a referral by the family doctor.
The following contacts in Singapore can offer advice and support:
- Suicidal Prevention and Crisis Helplines :
- SOS (Samaritans of Singapore) – 1800 221 4444 – 24 hr helpline
- Emergency Helpline (IMH) – 63892222 – 24 hr helpline
Mental health issues are commonly seen in the community. A fear of not being understood and the social stigma attached to mental health are barriers to seeking help. Sadly some with a severe mood disorder end up with self-harm or suicide.
Approaching these patients with empathy, sensitivity and in a non-judgmental fashion may help many of our patients seek help early, access the right treatment and prevent wasted years and prevent suicides.