Mental health problems
Explains the most commonly discussed mental health problems, including possible causes and how you can access treatment and support. Includes tips for helping yourself, and guidance for friends and family.
What are mental health problems?
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.
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 depression for more information.)
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 anxiety and panic attacks for more information.)
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 obsessive-compulsive disorder for more information.)
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 phobias for more information.)
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 bipolar disorder for more information.)
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 schizophrenia for more information.)
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 personality disorders for more information.)
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 eating problems for more information.)
In addition to the more formal diagnoses above, there are some behaviours and feelings which are strongly associated with mental health problems.
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 self-harm for more information.)
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 how to cope with suicidal feelings and how to help someone who is suicidal.)
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 anxiety and panic attacks and panic attacks-tips.)
Causes and diagnosis
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.
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.
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 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.
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 can help?
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.
Although health professionals are encouraged to follow these guidelines, in practice, access to treatment varies enormously across the NHS.
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.
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 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 who have met nationally agreed standards. Many therapists are also 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 '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).
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 housing and mental health for more information.)
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 guide to the Mental Health Act for more information.
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 crisis services for more information.)
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.
Feeling connected to other people is important. It can help you to feel valued and confident about yourself, and can give you a different perspective on things. Think about the interactions you have every day, with family, friends, colleagues, neighbours or people you haven’t met before. Spending a little more time on relationships you’re interested in can enrich your life.
Activity makes us feel better. Some people enjoy running marathons or playing football, but other people are happier taking a gentle walk or playing with their children. Find something which suits your level of fitness and makes you feel better, and build it into your routine. See Ecominds for details of projects that provide a range outdoor of outdoor green activities for people with mental health problems.
I once told my therapist I could not remember when I last had a whole good day. He told me that a whole good day might be too much to ask for, but that if I looked carefully, I could probably find something good in each day.Be more aware of the present moment. This can mean both outside, in the world around you, and inside, in your feelings and thoughts. Notice the flavours in your evening meal, or the way the sun sets as you leave work. When you slow down and observe, you can catch sight of amazing things, and you can become better at understanding your own reactions and moods. (Visit www.bemindful.co.uk for further information.)
Learning new things can boost your confidence and provide a healthy alternative to negative or stressful thoughts. You might want to work towards a qualification, learn a craft, or a new practical skill like fixing a bike. Taking up a new interest can also be a good way to connect to people, and can open up opportunities you haven’t thought of before.
It feels good to give. This doesn’t need to involve lots of money; sometimes small things like cooking dinner for a friend can have the biggest impact. You might enjoy volunteering with a charity you support, or just thanking the bus driver at the end of a long day can make you both smile.
Learn to assert yourself
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. See How to improve your self-esteem.
This involves thinking about ways to improve your life. You need to ask yourself, ‘Where would I like to be in a month’s / year’s time?’, ‘What small changes can I begin to make now?’ You might find it helpful to keep a diary and record the progress that you make.
Expressing feelings openly helps you process and recover from hurtful experiences. You might find it helpful to cry, shout or just talk things through with someone outside the situation. Repressing feelings and emotions can cause stress and lead to tension and anxiety.
Facing up to problems
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.
Will I recover?
It is possible to recover from mental health problems and many people do. Often people emerge from the experience feeling stronger and wiser and having learnt more about themselves. For many people, recovery does not mean going back to a previous life, but might mean making choices to live differently and having power over areas of life that seemed out of control before.
... The first step was making cups of tea. Admitting that at the time I couldn’t solve my problems or manage much more; But holding on to the idea that one day I would. And I did... I am now married, working full time and looking ahead.
How can family and friends help?
What can friends and family do to help?
This section is for friends and relatives who would like to support someone they know with a mental health problem.
It can be very difficult to see someone who you care about becoming distressed and unwell, but you don’t need to be an expert on mental health to offer support. Often small everyday actions can make the biggest difference.
Show your support
If you know someone has been unwell, don’t be afraid to ask how they are. They might want to talk about it, they might not. But just letting them know they don’t have to avoid the issue with you is important. Just spending time with the person lets them know you care and can help you understand what they’re going through.
Ask how you can help
People will want support at different times in different ways, so ask how you can help. It might be useful to help keep track of medication, or give support at a doctor’s appointment. If your friend wants to get more exercise, then perhaps you could go swimming together, or help your partner to get into regular sleeping patterns.
Be non-judgemental and listen. Phrases like ‘Cheer up’, ‘I’m sure it’ll pass’ and ‘Pull yourself together’ definitely won’t help.
Don’t just talk about mental health
Keep in mind that having a mental health problem is just one part of the person. People don’t want to be defined by their mental health problem; so keep talking about the things you always talked about.
Learn about the mental health problem
Reading up on the problems your friend or relative is facing, will enable you to better support them and understand what they are going through.
Trust and respect
Trust and respect between you and the person experiencing a mental health problem are very important – they help to rebuild and maintain a sense of self-esteem, which mental health problems can seriously damage. This will also help you to cope, in most cases, by being able to see your support having a positive impact on the person you care about.
Look after yourself
It is often 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. It is important to set boundaries and maintain your own mental wellbeing – if you become unwell you will be less able to offer support. 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. (See 'how to cope as a carer'.)
tel. 08444 775 774
Information, counselling, helpline and online support for those suffering from anxiety disorders.
tel: 020 7931 6480
Support for people with bipolar disorder (including hypomania) and their families and friends.
British Association for Behavioural and Cognitive Psychotherapies (BABCP)
tel. 0161 705 4304
Online directory of psychotherapists.
British Association for Counselling and Psychotherapy (BACP)
tel. 01455 883 300
For Information about counselling and therapy. See website or sister website, itsgoodtotalk, for details of local practitioners.
helpline: 0808 808 7777
Information and advice for carers.
Complementary and Natural Healthcare Council
tel. 020 3178 2199
Regulatory body with a register of complementary therapy practitioners.
tel. 0845 123 2320
Information and support for anyone affected by depression.
Hearing Voices Network
tel. 0114 271 8210
Local support groups for people who hear voices.
NICE (The National Institute for Health and Care Excellence)
Evidence-based guidelines on treatments.
24-hour helpline: 08457 90 90 90
Freepost RSRB-KKBY-CYJK, Chris
PO Box 90 90
Emotional support for anyone feeling down, experiencing distress or struggling to cope.
To be revised 2013
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