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What is mental illness?
How is it diagnosed?
What forms can mental distress take?
What are the causes of mental distress?
How can the mental health system help?
What are the different treatments?
What can friends and relatives do to help?
How can I improve my mental health?
Useful organisations
Further reading
Mental illness is very common. About one in four people in Britain has this diagnosis, but there is a great deal of controversy about what it is, what causes it, and how people can be helped to recover. People with a mental illness can experience problems in the way they think, feel or behave. This can significantly affect their relationships, their work, and their quality of life. Having a mental illness is difficult, not only for the person concerned, but also for their family and friends.
Mental illnesses are some of the least understood conditions in society. Because of this, many people face prejudice and discrimination in their everyday lives. However, unlike the images often found in books, on television and in films, most people can lead productive and fulfilling lives with appropriate treatment and support. For some people, drugs and other medical treatments are helpful, but for others they are not. Medical treatment may only be a part of what helps recovery, and not necessarily the main part. It's important to remember that having a mental illness is not someone's fault, it's not a sign of weakness, and it's not something to be ashamed of.
Seeing someone's problems solely as an illness that requires medical treatment is far too narrow a view. It discourages people from thinking about the many different influences on someone's life, thoughts, feelings and behaviour that can cause mental distress. It may also prevent people from exploring the various non-medical treatment options that are available. For these reasons, some people prefer to talk about mental or emotional distress, rather than mental illness.
Psychiatrists have classified mental distress into different categories, or diagnoses. Making a diagnosis helps a doctor to assess what treatment is needed and to predict what is likely to happen. It can also be a relief to a distressed person to be able to put a name to what is wrong. But there are limits to diagnosis. Each person's experience of mental distress is unique and it can be misread, especially if there are cultural, social or religious differences between doctor and patient. Different doctors may give one person completely different diagnoses. Simply focusing on the symptoms can mean that not enough attention is paid to the person as a whole, and to their situation. Their experience may hold a meaning for them, which no medical diagnosis can do justice to.
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, a person may be seen as 'a schizophrenic', as though this diagnosis summed them up. It's important to remember that a diagnosis does not have to determine the whole course of life, and may come to be a relatively minor part of an individual's identity or history.
It's possible to recover completely from mental distress and many do. Sometimes, they even emerge from the experience feeling stronger and wiser. Others get over the worst, but remain vulnerable, and relapse from time to time. Some don't recover, and will continue to receive treatment in the long term.
Psychiatrists aren't able to predict, accurately, what each individual outcome will be. Recovery is possible with all types of mental distress but, unfortunately, people are sometimes told that they won't recover. Such statements can become self-fulfilling because they add to existing feelings of hopelessness. It's important never to give up, whatever you are told.
Mental distress takes many forms. The terms used to diagnose them are sometimes words that are in everyday use, for example, 'depression' or 'anxiety'. This can make them seem easier to understand, but their familiarity can mean underestimating just how severe and incapacitating these conditions may be. Some of the most commonly diagnosed forms of mental distress are described below.
Depression lowers a person's mood, and can make them feel hopeless, worthless, unmotivated and exhausted. It can affect sleep, appetite and self-esteem, and interfere with daily activities. It may even affect their physical health. This may set off a vicious cycle, because the worse they feel, the more depressed they are likely to get. Depression often goes hand in hand with anxiety. (See Understanding depression. Details of this and other publications mentioned here can be found under 'Further reading'.)
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. Someone who is highly anxious may also develop related problems, such as panic attacks, a phobia or obsessive compulsive disorder. (See Mind's booklet, Understanding anxiety)
These are sudden, unexpected bouts of intense terror. A person experiencing an attack may find it hard to breathe, and feel their heart beating hard. They may have a choking sensation and a pain in the chest, begin to tremble or feel faint. It's easy to mistake these for the signs of a heart attack or another serious problem. Panic attacks can occur at any time, and this is what distinguishes them from a natural response to real danger.
Having one panic attack doesn't necessarily mean that someone will have another one. But, sometimes, the experience is so frightening that people become afraid of having another. This fear may actually trigger another attack when a similar situation arises. (See Mind's booklet How to cope with panic attacks)
Someone with an obsessive-compulsive disorder feels they have no control over certain thoughts or ideas that are highly disturbing to them, but which seem to force themselves into consciousness. These thoughts, or obsessions, create unbearable anxiety, which can only be relieved by performing a particular ritual to neutralise them. This could be something like repeatedly opening and closing a door, washing hands, or counting. (See Mind's booklet Understanding obsessive-compulsive disorder)
A phobia is an unreasonable fear of a particular situation or object. It may cause major disruption to life because it imposes such restrictions on the way people live. Agoraphobia can cause such paralysing fear that a person may remain isolated in their own home, afraid to go out. Other common phobias include fear of animals, heights, flying and enclosed spaces. (See Mind's booklet, Understanding phobias)
Bipolar disorder is a mood disorder. During 'manic' episodes, people tend to be hyperactive, uninhibited, reckless, full of grandiose schemes and scattered ideas. At other times, they may go through long periods of being very depressed. Not everyone experiences both these extremes. (See Mind's booklet, Understanding bipolar disorder (manic depression))
Schizophrenia is one of the most debilitating of all mental illnesses and can severely interfere with someone's ability to perform everyday tasks and activities. Symptoms may include hearing voices and seeing things that other people can't. Someone with these problems may become confused and withdrawn. (See Mind's booklet, Understanding schizophrenia)
There are many opinions about what causes mental distress. It's part of a wider debate about what makes people the way they are, whether their personality is shaped by the life experiences they have gone through, or whether it's determined by their genes, inherited from their parents. It's possible that some people are more vulnerable to mental health problems, which could be triggered by stressful or traumatic events. The following are some of the possible causes of mental distress. It may be due to any one of these factors, or to a combination of them.
Growing up feeling uncared-for, scared of a parent, or having been sexually abused can make people highly insecure and more vulnerable to mental distress. But being much too overprotected as a child can also put you at risk.
You may have been discouraged from expressing your feelings from a very early age. As a child, you may even have been punished for getting angry, crying or laughing too loudly. Feelings that are held back, and which are not expressed, affect your physical and mental health.
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.
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.
You inherit physical characteristics from your parents and can pass them on in the same way. It's possible that your genes can also affect your personality.
There are genes that cause physical illnesses, so there may be genes that predispose a person towards mental illness. There is some scientific evidence to support the idea that one person may be more likely than another to develop a particular problem, such as bipolar disorder or schizophrenia.
Victorian institutions have slowly been closed down, to be replaced by care in the community. However, the large psychiatric hospital on the edge of town is a long-lasting and powerful image of the mental health system. It is now being overtaken by an image, drawn from news reports, of people with mental health problems, who are living in the community, being violent or homicidal. Both images are very misleading: the vast majority of people diagnosed as mentally ill are not violent and, for the small minority still needing hospital admission, psychiatric wards in general hospitals are taking the place of separate psychiatric hospitals.
If you are having problems, your first point of contact with the mental health system is likely to be your GP. Under the Government's Care Programme Approach, 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).
CMHTs support people with mental health problems living in the community, and also their carers. The teams consist of social workers and health professionals, since the NHS and local authority can join forces to provide both community mental health care and community care services (see below). 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.
Although NHS services are free, you may have to contribute to the cost of community care services, which are the responsibility of the local authority. This should be taken into account, as part of the initial assessment of your needs.
A GP or hospital doctor can refer people separately for assessment for community care services. These include day centres, housing with care and support, help with employment, support groups, advocacy services, social clubs, befriending schemes and welfare rights advice. Some services are set up to respond to the needs of particular groups, such as women, or black and minority ethnic groups. There are also practical services available, in the form of laundry services, home helps and 'meals on wheels', should you need them.
Day hospitals are increasingly being replaced by day centres, which should provide recreation, therapy and rehabilitation, as well as helping people to feel less lonely and isolated. Drop-in centres and social clubs offer people the chance to stay in touch with others in a similar situation. For one-to-one support, there are schemes which put people in touch with volunteer befrienders.
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, while 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 Mind's web-based factsheet Housing and mental health)
Hospital can provide a place of asylum, offering shelter and protection. It can also supply an opportunity for the staff to assess people's needs and find the best way of helping them. Unfortunately, a stay in hospital can be distressing for some people. A hospital ward may offer little privacy, and it can be frightening to be with other people who are acting in a disturbed way.
Many people go into hospital on a voluntary basis, but there are between 25,000 and 30,000 compulsory admissions, each year, under the Mental Health Act 1983. It's very important that people in that situation should know their rights. (See the Mind rights guide series, under 'Further reading'.)
In a growing number of areas, there are special crisis intervention teams. These are able to support someone through a major crisis at home or in a residential crisis centre, without going into hospital.
Users of health services are increasingly being consulted about treatments and conditions in NHS facilities and the decisions made about how health services are run and what they provide. Above all, they want to have more say in their own treatment. This means being properly informed about the undesirable effects of drugs, for example. It also means being offered choice: residential crisis centres as alternatives to hospital; talking treatments as an alternative or complement to drugs (as recommended by the National Institute for Health and Clinical Excellence – see 'Useful organisations'). They want to be seen as individuals, not simply as passive patients.
By far the most common type of treatment is prescription medication, given by a GP or psychiatrist. Depending on the diagnosis, there are a variety of drugs commonly used. Different types of medication can be used to help someone calm down, or to help them sleep (minor tranquillisers or sleeping pills), to lift depression (antidepressants), or control disturbing thoughts (antipsychotics). The great advantage of drugs is that they can help people to keep going. Millions go to work each day, or look after their children, while taking them. Without drugs they might have lost their jobs or been separated from their families. However, these drugs don't 'cure' mental distress. Medication can relieve the symptoms of mental distress, but the underlying problems often remain. Drugs can also have side effects that may make people feel worse rather than better. They can also be addictive, or cause physical damage if taken in too high a dose. Therefore, they need to be used with caution. (See Mind's Making sense series, under 'Further reading'.)
Talking treatments, sometimes in combination with medication, can be very successful in helping people deal with mental distress. Professionally qualified therapists and counsellors are specially trained to help people to a better understanding of themselves, and to overcome difficulties in their lives. There is a wide variety of talking treatments, and they may be available on the NHS, through GP surgeries or hospitals (although waiting lists can be long), or privately.
GPs often employ counsellors, who are trained to listen, and who may see you once or twice a week. They can help you deal with specific issues, such as bereavement, or to find strategies for managing your life better. Longer-term psychotherapy, individual or in groups, helps you understand the origins of your problems in the past and to bring about change in the present. Your GP can also refer you to a psychologist who can provide cognitive behaviour therapy. This is a short-term treatment, which has been actively promoted by the NHS in recent years. It can help you to identify and change unhelpful patterns of thinking and behaving. (See 'Useful organisations' and 'Further reading'.)
ECT is a controversial medical treatment for mental illness. It involves passing an electric current through the brain, under anaesthesia, to produce a seizure similar to a fit, with the aim of relieving severe depression. ECT can cause unwanted side effects in some people, including drowsiness, confusion, memory loss, headaches and nausea. (See 'Further reading')
If someone close becomes mentally distressed, it's likely to provoke strong feelings. It can be painful to see them suffering, and it can also be frightening to be with someone who is feeling desperate or acting strangely. It can disrupt life and, sometimes, people find themselves in a caring role they have not chosen. There can be a positive side too. A crisis can bring people together, giving them a chance to express love and affection in a way that has not been possible before. In many cases, people will have the pleasure of seeing their friend or relative make a recovery. It's easier to support someone well if the caring role is shared with others. Finding someone to talk to about the situation is also very helpful. (See How to cope as a carer) If your friend or relative has been given an assessment, you may be entitled to have your needs as a carer assessed and taken into account.
This is a skill everyone should acquire. There are many books and audio tapes on relaxation techniques available, and classes are organised by adult education institutes. Yoga, meditation, massage and aromatherapy can all help with relaxation. There is an increased interest in complementary and alternative medicine as a way of tackling mental distress. Practitioners of this kind of medicine take a 'holistic' approach, looking at the whole person, not just their symptoms. Many people appreciate being able to take a more active part in their treatment. (See 'Further reading'.)
Physical activity can boost both your physical and mental wellbeing. It can change your whole outlook on life, helping you to deal with negative emotions, alleviating anxiety or depression, and boosting self-esteem. It may even help prevent mental health problems from arising in the first place. (See The Mind guide to physical activity)
If you have been taken advantage of, or mistreated in some way, you may find it hard to stand up for yourself. Although it may feel easier just to keep quiet, anger can build up inside, causing tension and anxiety. Assertiveness training classes can improve your ability to handle such situations.
This involves thinking about ways to improve your life. You need to ask yourself, 'Where would I like to be in ten years time?', 'What small changes can I begin to make now?'. It's possible to make positive changes in life, however daunting.
Expressing feelings openly, by getting angry, crying or shouting, helps you recover from hurtful experiences. Repressing feelings and emotions can cause stress and lead to tension and anxiety.
When things are going wrong for you, it's tempting to ignore the problem and hope it will go away. It may not. Usually, the quicker you start dealing with a problem, the easier it is to solve.
Most of the advice given here is easier to follow if there is someone you can talk to openly and honestly. It could be a friend, a counsellor or a psychotherapist. Or it could be someone in a similar situation, who you might meet through a self-help or support group, or a local befriending group.
There are many ways of trying to understand mental distress. This booklet has concentrated on views that are currently held in the West. In other countries and cultures, attitudes may be very different. It would be reassuring to have more agreed facts about mental distress, but since this isn't possible, individuals need to think for themselves, reflecting on their own experiences, listening to others and staying open-minded. There is no disputing the fact that millions of people lead impoverished lives because of mental distress, and that society needs to find better ways of preventing it and helping people to help themselves.
British Association of Cognitive and Behavioural Psychtherapies
tel. 0161 797 4484
web: www.babcp.com
British Association for Counselling and Psychotherapy
tel. 01455 88 33 00
web: www.bacp.co.uk
Contact for details of local therapists
Carers UK
carers line: 0808 808 7777
web: www.carersuk.org
Information and advice on all aspects of caring
Depression Alliance
tel. 0845 123 2320
web: www.depressionalliance.org
Member-led charity, with a network of self-help groups
No Panic
helpline: 0808 808 0545
web: www.nopanic.org.uk
Helpline for people experiencing anxiety disorders
Samaritans
Chris, PO Box 9090, Stirling, FK8 2SA
Helpline: 08457 90 90 90
Minicom: 08457 90 91 92
email: jo@samaritans.org
web: www.samaritans.org.uk
24-hour emotional support
web: www.nice.org.uk
The National Institute for Health and Clinical Excellence produces evidence-based guidance on the prevention and treatment of ill-health, including mental health problems, such as depression, schizophrenia, self-harm and eating disorders.
How to assert yourself (Mind 2006)
How to cope as a carer (Mind 2008)
How to cope with panic attacks (Mind 2008)
How to improve your mental wellbeing (Mind 2007)
How to look after yourself (Mind 2006)
How to recognise the early signs of mental distress (Mind 2008)
How to stop worrying (Mind 2006)
Making sense of antidepressants (Mind 2008)
Making sense of antipsychotics (Mind 2007)
Making sense of cognitive behaviour therapy (Mind 2009)
Making sense of counselling (Mind 2008)
Making sense of electroconvulsive therapy (Mind 2008)
Making sense of psychotherapy and psychoanalysis (Mind 2004)
Making sense of sleeping pills and minor tranquillisers (Mind 2008)
The Mind guide to managing stress (Mind 2009)
The Mind guide to massage (Mind 2004)
The Mind guide to physical activity (Mind 2008)
The Mind guide to relaxation (Mind 2009)
Mind rights guide 1: civil admission to hospital (Mind 2009)
Mind rights guide 3: consent to medical treatment (Mind 2009)
Mind rights guide 6: community care and aftercare (Mind 2009)
The Mental Health Act 1983: an outline guide (Mind 2008)
Troubleshooters: panic attacks (Mind 2009)
Troubleshooters: stress (Mind 2008)
Understanding anxiety (Mind 2008)
Understanding bereavement (Mind 2008)
Understanding bipolar disorder (manic depression) (Mind 2009)
Understanding depression (Mind 2008)
Understanding obsessive compulsive disorder (Mind 2008)
Understanding phobias (Mind 2004)
Understanding schizophrenia (Mind 2008)
Understanding talking treatments (Mind 2009)
For a catalogue of publications from Mind, send an A4 SAE to:
Mind Publications
15-19 Broadway
London E15 4BQ
tel. 0844 448 4448 fax: 020 8534 6399
email: publications@mind.org.uk
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This booklet was written by George Stewart
First published by Mind 1993. Revised edition © Mind 2009
ISBN 978-1-874690-78-8
No reproduction without permission