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From the video, I learnt that depression is categorised into 5 different parts : Major Depressive Disorder , Persistent Depressive Disorder, Disruptive Mood Dsyregulation Disorder,  Premenstrual Dysphoric Disorder and Medically Induced Depressive Disorder.

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From this image, I learnt that mental illness have been catorgised according in different parts of the brain. Such as OCD, Paranoia, Panic Disorder, Bulimia and Anorexia and many others each one in different position.

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No i do not agree with how people with these conditions in the society. I feel it is unfair for them as everyone is to be treated the same regardless of their difference. Since everyone wants a inclusive society, each of us should play a part to accept everyone despite their conditions, give tuem a chance and not discriminate them. This includes employers who are also part of the society. In the article i read, a mother diagnosed with mental illness has been turned down by a employer due to her conditions. After her continuous effort she finally found a job. This is very
unfair for mental patients.

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The hallucinations and delusions started in her late teens. Then five years ago, Ms Hafizah Kamarulzaman was diagnosed with schizophrenia after giving birth to her son.

While the single mother, now 23, managed to control her condition after seeking help, she struggled to get a job for almost four years, she told The Sunday Times.

She described how she was turned down for positions in the food and beverage and healthcare sectors, on the sidelines of an event called "Walk with Us, Stamp out Stigma". It was held in Orchard Road yesterday to combat the stigma faced by people with mental health conditions.

She said: "When the boss saw in my application form for a waitressing job that I had a mental illness, he asked what would happen if I had a relapse. I told him I had coping methods that I could use.

"His response was, 'If that's the case, then our position is full'."

FACING OUTRIGHT REJECTION
When the boss saw in my application form for a waitressing job that I had a mental illness, he asked what would happen if I had a relapse. I told him I had coping methods that I could use. His response was, 'If that's the case, then our position is full'.
MS HAFIZAH KAMARULZAMAN

Ms Hafizah finally found a job late last year as a programme executive at Club Heal, a social service organisation that helps people who have mental illnesses. It was also where she had been treated.

Yesterday's event was co-organised by the Agency for Integrated Care alongside 14 other community health partners such as Caregivers Alliance and the Institute of Mental Health, to commemorate World Mental Health Day, which is observed tomorrow.

At the event, Speaker of Parliament Halimah Yacob urged employers not to be prejudiced against people with mental health conditions.

In a recent National Council of Social Service survey of 477 people recovering from mental health issues, seven in 10 said they had problems "living with dignity" because of other people's attitudes and actions, making them feel unaccepted by society or unable to contribute meaningfully to it.

Others interviewed by The Sunday Times said they felt the sense of societal rejection most acutely while job hunting.

Ms Yamuna Segaran, 26, who has had acute anxiety and depression since her teenage years, said an interviewer once pushed her resume away upon learning about her mental health condition.

This was even though the interviewer had initially been impressed by her work experience.

Ms Yamuna, a part-time student at Kaplan Singapore who is pursuing a counselling degree from Northumbria University, said: "The look on the interviewer's face is still etched in my mind."

While she wanted to reintegrate into society, the difficulties she faced in finding a job made it harder to do so. She persisted in her job search, thanks to the support of her family, counsellor and psychiatrist and has since found a job as a supervisor at a bar.

Ms Valerie Liu, 34, who has had schizophrenia since 2008, feels that people with mental illnesses also have to overcome their own biases and fears. Some may themselves hold negative stereotypes associated with mental health sufferers, or be afraid of communicating with people.

Ms Winnie Kong, 28, a thrift shop sales assistant who suffers from borderline personality disorder, said she had been rejected by employers for positions in administration and sales.

She said: "They think that we are violent but this is not true in most cases. I think we should be given a chance."

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People with mental issues face job discrimination

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The hallucinations and delusions started in her late teens. Then five years ago, Ms Hafizah Kamarulzaman was diagnosed with schizophrenia after giving birth to her son. While the single mother, now 23, managed to control her condition after seeking help, she struggled to get a job for almost four years, she told The Sunday Times.

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There are many network agencies and services available in Singapore. One of them is the Clarity Singapore which provides services to people with mental health issues to live meaningful lives through support, therapy, acceptance and recovery. Their aim is to " uphold the dignity of those with mental illness" as mentioned in their website. They also balance long term improvement with short term relief fot the mental patients.

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Clarity Singapore helps beneficiaries suffering from mental health issues and needs donations for therapy programmes, counselling, public talks as well as psycho-education training workshops for our caregivers. All donations are greatly appreciated and will help us to reach out to more mentally distressed people in Singapore.

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Mental illness in young Singaporeans ( Bairavi )

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Mental illness in young Singaporeans ( Bairavi )

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Due to mental illness, young Singaporeans are being avoided and left alone. They are also being bullied by peers in school. This causes the lives of young Singaporeans with mental illness to be dreadful. This will also cause the young patients to feel vulnerable affecting theur everyday lives. This is a pressing problem as if this bullying and discrimination continues, it may lead to the deaths of the young mental patients. The article i read below gives the examples of the behaviour students with mental problems in school.

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(Updated: )
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SINGAPORE: Depression, relationship issues, bullying, family problems - kids as young as five years old are seeking help for these problems.

Suicide prevention centre SOS told Channel NewsAsia last week that it received about 1,900 calls from those aged five to 19 last year - an increase of 70 per cent compared to 2012.

Another helpline Tinkle Friend, which caters to primary school students, saw a 50 per cent increase in the number of calls and messages on its online chat service from 2012 to 2016.
PEER SUPPORT NETWORKS IN ALL SCHOOLS BY 2019
Some of the questions stemmed from boredom and loneliness - "What can I do when I'm bored?" or "How do I make more friends?" But some children in more distressing situations asked questions like: "What will happen to me after my parents get a divorce?"

In 2015, teen suicides rose to a 15-year high, with 27 suicides in the 10 to 19 age group, according to SOS figures.

To help address the situation, the Ministry of Education (MOE) has announced it will roll out a slew of programmes - including a peer support scheme - as part of its NurtureSG recommendations.

In response to queries from Channel NewsAsia, MOE said the peer support programme will be expanded to all primary and secondary schools by the end of 2019. Training for school staff started in May and will be conducted in phases until 2019.

Under the programme, a couple of students - from seven to 17 years old - will be appointed from each class, depending on the school's needs.

The students will keep a lookout for any signs of distress among their peers, and offer emotional support. For more serious cases, such as unexplained injuries - they will have to flag it to their teachers.

Taking the lead is Jiemin Primary School - which conducted its first training session for Primary 2 to Primary 5 students on Wednesday.

The school aims to train about 40 students each year. The students will be taught to spot signs in their classmates such as a change in appearance or habits, appetite loss, or constantly feeling sleepy in class.

Some of these students said the training has helped them to brush up on their social skills, such as approaching a friend who seems isolated.

"There are three students in my class who feel they are really dumb and nobody wants to be their friend. As I'm not that close to them, I never knew how to approach them and help them. But after this course, it has given me some confidence to encourage them to speak up," said eight-year-old Muhammad Rayan.
IS IT TOO MUCH FOR YOUNG KIDS TO TAKE ON THESE PROBLEMS?
Ten-year-old Angie Sia said: "I have this classmate who's always angry and shouting. So, maybe next week, I will try to gently approach him and talk to him in a calm manner and find out what is exactly wrong with him and why is he always losing his temper."

In September last year, then-Social and Family Development Minister Tan Chuan-Jin said in Parliament that it was "not reasonable" to expect teenagers to take crisis calls from their suicidal peers. This was in response to Member of Parliament Saktiandi Supaat, who asked if there was a need to set up a special hotline for teenagers that is manned by their peers trained in counselling.

Counselling such people requires relevant training, skills, emotional maturity and understanding of life's challenges, Mr Tan said.

As such, while the peer support programme is aimed at getting children to open up to other kids their age about their problems, serious cases will still have to be referred to their teachers.

However, this could get tricky in some situations, according to 10-year-old Marati Varshika.

When my friend tells me her problem but doesn't want me to tell the teacher, she would definitely be angry if I reported the matter to my teacher.

"And this would break our trust and she might not share her problems with me in future," she said.

Marati said she hopes teachers will coach students on how to deal with such situations.

To ensure that peer supporters are not overburdened, their teachers will meet them every fortnight to keep track of any problems they are facing.

Student peer supporters also have to meet strict criteria, including good management skills, resilience and the ability to take care of themselves during stressful situations.
PEER SUPPORT PROGRAMME IN THE RIGHT DIRECTION
Parents of the peer supporters are also informed of the duties and roles, and can opt out if they want to.

Child psychologist Associate Professor Daniel Fung from the Institute of Mental Health said the programme is timely given the worrying number of mental-related issues among younger people.

The initiative helps to provide another set of eyes to spot mental distress among students that may not have been picked up by the existing systems and processes, he said.

He also stressed that the programme is not about getting kids to take on the roles of counsellors but to help flag issues which adults may not be aware of.

As young people feel more comfortable to open up to their friends about their problems, those suffering from mental distress could be detected earlier and interventions can be put in place immediately.

Kids are so much more exposed to issues now than in the past - like sexual abuse.

"This programme is also beneficial as we are seeing more problem behaviours such as physical and emotional bullying in schools," said Assoc Prof Fung.

HELPLINES
"Sometimes class sizes may be large, and teachers may miss out some problems. So this helps to give an additional set of eyes and watch out for problems," he added.

Samaritans of Singapore: 1800-221-4444
Singapore Association for Mental Health: 1800-283-7019
Institute of Mental Health's mobile crisis service: 6389-2222
Care Corner Counselling Centre (Mandarin): 1800-353-5800
Silver Ribbon: 6386-1928
Tinkle Friend (for primary school-aged children): 1800-274-4788

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More kids in Singapore seeking help for mental health issues

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(Updated: ) Share this content SINGAPORE: Depression, relationship issues, bullying, family problems - kids as young as five years old are seeking help for these problems. Suicide prevention centre SOS told Channel NewsAsia last week that it received about 1,900 calls from those aged five to 19 last year - an increase of 70 per cent compared to 2012.

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Issues faced by families and sufferers ( Bairavi )

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Issues faced by families and sufferers ( Bairavi )

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From the article below,
I can conclude that caring for a person with chronic mental illness is more stressful than taking care of a physically disabled person. This is because families are not sure of the treatment provided and the help needed. Every family is affected in a different way.
Sufferers are also not able to accept the treatement which causes them to have more emotional distress.

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Support is essential for families

No one should ever think they have to carry out their caring role without support.

When you care for a family member or friend who has a mental illness, you shouldn't feel you need to do everything yourself.

Find out about the treatment and support services which are available and discuss together what is practical and reasonable for you to do personally. Enquire about any carer support services too.

Use this guide as a starting point to look at the range of possible support and call 1800 18 SANE (7263) for more details about any of the services described.

Family and friends

Talk over the caregiving role with any relatives, friends or others you feel might be able to help, as well as with the person affected by the illness.

You may be surprised how willing people are to give support once they understand mental illness and its effects. It is natural to lack confidence at ﬁrst about asking for support, but once you speak out it begins to come naturally.

Some people can be wonderful from the start. Conﬁde in them and let them help. Others may not be quite so understanding at ﬁrst, but if you tell them how you feel, and explain about the effects of mental illness, they will begin to be more supportive.

There may be others who have difﬁculty understanding and will not be helpful. That is their problem, not yours.

Support for family and other carers

Carer support organisations such as Carers Associations, Associations of Relatives and Friends of the Mentally Ill (ARAFMI or ARAFEMI) and Mental Illness Fellowships offer education and training courses, and self-help groups providing mutual support.

It is often helpful to talk with others who have had similar experiences, to learn more about the effects of mental illness and what your options are, so that you are in a better position to make decisions.

Going along to a group like this helps you to feel less isolated and to realise you are not alone. See the 'All in the family' section of this guide for details of specific support for different family members.

Other ways to find support:

ask the treating health professionals about carer support organisations in your area, or call 1800 18 SANE (7263) for more information

Details of Carers Association services are available at www.carersaustralia.com.au or by calling 1800 242 636.

Details of government services for people with a disability and their carers are available the National Disability Insurance Scheme website (www.ndis.gov.au). or by calling 1800 052 222.

Mental health services and support

You will be better prepared for dealing with the health system if you understand how it operates in your local area.

Regional mental health services

Most areas are now covered by regional mental health services, which have their own clinics and 24-hour assessment and treatment teams to help people in their own homes. People are generally admitted as in-patients to psychiatric wards only when they are severely unwell. There may also be separate services for people under 18 or over 65.

Case managers and carer consultants

As well as a treating psychiatrist, the person may also have a case manager who coordinates and provides some of their mental health care. This may include seeing a psychologist, social worker, occupational therapist or other health professional. Some services employ a carer consultant to liaise with family and friends.

GPs

After a time, some people only need to see their GP for treatment, and are in contact with the mental health service if they become unwell again. As well as overseeing physical health, a GP can also set up a Mental Health Plan and refer people for treatment to a private psychiatrist or to a psychologist or other appropriately-qualified health professional for psychological treatment.

Involuntary treatment

If someone refuses treatment, and their health and safety, or the health and safety of others, is at risk, then the treating health professional can apply to have them treated involuntarily for their own sake.

This may be as an in-patient, or under a Community Treatment Order where they can continue to live at home, but treatment is supervised by a doctor or other health professional.

Building a good relationship with health professionals

Building a good relationship with the doctor, case manager or other treating health professional is important for family and friends who are carers, as well as for the person with the illness.

If you are able to do this and are well-informed about the situation, they are more likely to listen and be cooperative in providing help. It can help to write down and take along any questions you want to ask, and to note down the answers at the time.

Don't assume that families or carers will be included in treatment

While National and State mental health policies promote inclusion of family and other carers in treatment, be prepared for the fact that some health professionals are not used to communicating and working cooperatively with families. They may inappropriately use 'patient confidentiality' as a justification.

Be polite but persistent. If you feel your concerns are not being taken seriously, put them in writing to a higher authority such as the area mental health service manager or the Chief Psychiatrist in your State.

What if the person is too unwell to decide about medical treatment?

An 'advance directive' is an agreement where the person with the mental illness requests someone else to make decisions about treatment when they are unwell and can't make reasoned decisions themselves. If you think this would help, discuss it with the person and their doctor or case manager.

While an 'advance directive' can be made a legal document (as a medical power of attorney), its main advantages are to formalise trust between the person requested to make decisions and the person with the illness, and to act as a reminder if that person becomes unwell.

What about private health insurance?

For people with a mental illness, private cover means that, compared to relying on the public system, it's generally easier to be admitted to a private hospital and to be able to stay longer.

This is especially useful for women of child-bearing age, as pregnancy can trigger relapses in many mental illnesses. 'Extras' cover can also be used to help cover the cost of seeing a psychologist. These benefits may make the cost worthwhile for those who are able to afford the premiums, although having a pre-existing condition will affect the cost.

Medication

Medication can be one of the best ways to treat some mental illnesses, yet some people don't take it as prescribed for a variety of reasons.

They may be concerned about side-effects. They may not recognise that they are ill, or feel that they don't need medication once symptoms improve. They may become confused about the number of pills they need to take and what times to take them.

When planning for the future, it's important to understand these reasons and to discuss with the person and treating health professional what the best options are to ensure their ongoing mental health care - for example, regular appointments for monitoring of symptoms, or taking medication monthly by injection.

For further information, see ' Medication and other Treatments '.

What about physical health?

People with a mental illness may be in poor physical health if they smoke, have a poor diet or are overweight and physically inactive because of the effects of their illness and sometimes of their medication too. This is why people with psychotic illnesses such as Schizophrenia have a higher risk of physical health problems, such as diabetes and heart disease.

Encourage the person to think about their physical health. A check-up by a GP is a good start, followed by a routine of regular check ups, including blood glucose monitoring, weight and waist measurement, and pap tests and breast checks for women.

Regular dental and eye checks can sometimes be arranged at reduced cost or no cost through a case manager or at a community health centre. Vaccination against Hepatitis B and tetanus are also recommended.

Try to see a regular GP

This helps the doctor get to know the person and their medical history.

Ideally the GP will understand mental illness, keep up-to-date with developments in treatment, listen sympathetically, and be aware of services in the local area. It helps if they bulk bill.

Healthy eating and exercise

Encourage a healthy lifestyle and diet, emphasising how this improves mental health too. Encourage the person to eat fewer fatty foods and more fresh fruit and vegetables. Too much caffeine in coffee, tea, cola or energy drinks may reduce the effectiveness of antipsychotic medication and should also be gently discouraged - by offering tasty alternatives, for example. Exercise is important for all of us. A 30 minute walk daily is a big step towards being healthy.

If the person smokes, talk to them about quitting. Not smoking is not only healthy, it can help medication work better at lower doses and it also saves money.

For further information, please see 'Healthy living' and the ' Guide to a Smokefree Life'

Be aware of the 'wellness trap'

When someone has a mental illness such as Depression or Schizophrenia, medication can be effective at controlling the more obvious, acute symptoms so it may be easy to assume they are 'well' again when these symptoms are no longer present. This is the 'wellness trap'. It is important for the person taking the medication and others to understand that if they stop, or reduce the dose too much, then symptoms are likely to reappear.

Being free, or freer, of psychotic symptoms after many years can also be a strange experience. Having spent so much time and energy coping with symptoms such as hearing voices or paranoia, for example, means that being free of them can be a strange experience. It can be helpful when this happens, therefore, to encourage the person to talk about how they feel, and to become involved in new activities.

Any mental illness can leave people with low conﬁdence and self-esteem. When trying to pick up the threads of life or find work, they may ﬁnd things have moved on in many ways, such as changes in workplace conditions or information technology.

In this case, encourage the person to attend a rehabilitation program or employment service, to re-familiarise themselves with what has changed.

When talking to support agencies (and even some health professionals), it may be necessary to remind them that recovery from mental illness is not simple, and that people continue to need understanding and support when their symptoms have been reduced.

This is the time when family and friends can also help the person make small positive steps towards social, recreational and vocational rehabilitation. They may also need to adjust their own expectations and reassess their caring roles.

Support services in the community

Helping someone access psychiatric disability support services can make a big difference to their quality of life and ability to live more independently - promoting recovery of social and living skills affected by mental illness.

They are often run by community organisations with funding from State or Territory Health Departments.

If the person you care for has a case manager or other key mental health professional, they should arrange referral to support services. If not, or there's no key worker, then you can ﬁnd out what's available yourself.

Contact 1800 18 7263 or email This email address is being protected from spambots. You need JavaScript enabled to view it. to request details of community organisations in your local area.

Community health centres or the Citizens Advice Bureau (sometimes called Community Information Service) may be able to help, or try the State Health Department.

In some areas, particularly rural or remote regions, there are few or no programs providing accommodation, rehabilitation or other forms of support. You may wish to join with others to start up such a program and lobby for funding from government. Local politicians, business people and mental health workers may also be willing to help.

Being active in the community

People who need help from services sometimes feel they have 'nothing to give' and that they have little worth. Not surprisingly this can contribute low self-esteem and make the symptoms of Depression worse.

It helps to remind the person you care for that everyone has a unique value and can contribute to society in some way. This may be through part-time work or by helping others - working in a charity shop for example (a volunteer coordination centre can help here). It may be through membership of a rehabilitation program, taking part in activities and helping others, with household tasks for example.

Centrelink can refer people affected by mental illness to Job Network agencies, or to specialist DEN (Disability Employment Network) agencies to find work. These may help with job applications and interview skills as well as ﬁnding positions, and sometimes provide on-the-job support.

We all need to feel valued, appreciated and part of the community we live in. This is just as important for someone who has lived with the effects of a mental illness for many years.

Making use of other community services

Local councils, community colleges, churches and other organisations in local communities have programs and services which everyone, including people with a mental illness, can make use of for example:

neighbourhood houses for social contact and short courses

using the library to borrow books or access the Internet

doing an adult education course

for older people, the University of the Third Age can be a relaxed way of learning and meeting others.

A case manager or other mental health worker should be able to help the person access community services and accompany them if necessary.

Personal Helpers and Mentors Program staff and outreach workers from rehabilitation programs may, for example, be able to visit the person, have a walk and a cup of coffee, or go with them to concerts or a football game. These activities can help overcome isolation and improve connections with the local community.

Ideally, workers will also remember the person's birthday or other significant dates. The local council office, public library or Citizens Advice Bureau can also help you ﬁnd out what's available.

Financial support

People with a mental illness and their carers may be entitled to a range of beneﬁts and concessions.

What income is available?

The principal ﬁnancial support for people who have a psychiatric disability is the Disability Support Pension, although some may be on the Sickness Allowance or NewStart Allowance. An advantage of the Disability Support Pension is that it is not assessed as taxable income. A Carer Payment is also available with certain conditions. Pensions can be paid directly into bank or credit union accounts.

Most Centrelink ofﬁces have specialist Disability Ofﬁcers. Talk to them about what the entitlements are for you as well as the person who has a mental illness.

Centrelink Financial Information Service

Centrelink has a free Financial Information Service which can help with advice on entitlements in general and on making the most of your income. See centrelink or call 13 1021 to make an appointment.

Besides any personal income and social security payments like the Disability Support Pension and Rent Support, check what other ﬁnancial help is available. It's sometimes possible to get one-off loans or grants from Centrelink for speciﬁc purposes - ask the Centrelink Disability Support Ofﬁcer.

Concessions

For people on low incomes, concessions may be available for some services, such as gas, electricity and water, public transport, vehicle registration, dental and eye care, ambulance cover, telephone, and sometimes a taxi subsidy (if a doctor agrees the person can't use public transport). Any extra income encourages more independence.

Managing money

Encourage the person to manage their own money as much as possible. It may seem easier to do things for them, but it's better in the long-term if they can use an ATM and pay bills themselves. Bank charges can be expensive for people with small accounts, so discuss opening a Credit Union account - similar to a bank account, but cheaper to operate. Centrelink and local councils often have staff to advise on budgeting and may be able to help with managing money.

People with some illnesses, such as Bipolar disorder for example, may spend money irrationally when they become ill - for example, running up excessive credit card debt or giving money away.

Discuss ways of dealing with this with the person when they are well, such as agreeing to freeze their bank account in certain circumstances, or arranging an 'enduring financial power of attorney', see 'Looking ahead' in this guide

Would legal support help?

If there are concerns about mismanaging money when the person is unwell, they can sign a simple legal document giving a trusted person 'enduring ﬁnancial power of attorney'.

This means they can handle their own money as usual, but if they become ill the person with power of attorney can manage things. Discuss this with the person you care for. Ask an understanding solicitor to draw up the document. (A letter from the person's psychiatrist conﬁrming they are mentally well at the time of signing will help this process.)

Somewhere to live

A stable home helps a person with a mental illness cope better and live more independently in the community. It also helps give them a sense of security and the feeling of being part of a neighbourhood.

Living in the same place means the person stays in the same mental health service area and can build a good relationship with their health team. It reduces the risk of drifting into unsuitable accommodation or becoming homeless. When you're planning accommodation, think about location - for example, is there easy access to shops, transport and mental health and support services?

Talk to the person you care for about long-term accommodation. Where would they like to live? If they live with parents, what will happen when the parents are no longer able to provide care? How independent is the person? Do they need more support? Discuss these questions with other family members and the case manager.

The person you care for may be reluctant to think about all this, but emphasise that it will have to be done eventually. The sooner they are able to live more independently and have other supports in place, the better it will be for them.

What are the accommodation options?

Options vary from area to area - ask the case manager for information.

Public housing generally costs less than private rental accommodation. In some States, people with a psychiatric disability have priority on housing lists. Some local councils provide housing for people with disabilities.

Supported accommodation (sometimes called a group home) may be available through community-based agencies such as the Richmond Fellowship or the Mental Illness or Schizophrenia Fellowships. Supported accommodation usually means a home shared with others who have experienced mental illness, with a support organisation providing help with day-to-day living.

When you've decided on the best accommodation, look at making this a reality, by putting the person's name on any waiting lists, for example. If living with family is best for now, think about how this could be done more independently - maybe in a 'granny flat' where, with support, they can do more for themselves?

What accommodation support is available?

Local support services can also help someone live more independently.

This may be available from a team at the local mental health service, the outreach arm of a rehabilitation program, or from other community agencies or the local council. This may include anything from having Meals-on-Wheels to getting help with cooking, cleaning, budgeting or social outings.

Respite care

Respite programs are another option which gives family and friends acting as carers time out to take a break, while giving the person with a disability some experience of living more independently. Contact the Carer Respite Centre in your local area on 1800 059 059 for details.

Multicultural services

In some areas there are special psychiatric units which provide bilingual psychiatrists and other services for people from culturally and linguistically diverse (CALD) communities. Contact the treating health professionals for details. They should also have access to a 24-hour Translating and Interpreting Service.

For further information, please the multilingual factsheets on mental illness.

See also, Mental Health in Multicultural Australia at www.mhima.org.au.

Assistance with human rights

We all have the right to dignity, safety and equal opportunity. If you or the person you care for feel you have not been treated fairly, there is a range of agencies which can help, including:

Political support

The State and Federal members of parliament for your area have a duty to represent your interests.

Do not be shy about contacting them and enlisting their support. Do what you can to educate them about the issues faced by people with a mental illness and their family and friends. Ask them to raise specific issues with a relevant Minister, or in Parliament.

In a crisis

Despite everyone's best efforts, crisis situations can occur.

See 'Learning new skills' in this Guide for how to develop a crisis plan.

See 'In a crisis' in this Guide for a summary of what to do when someone becomes unwell.

See also the seperate SANE factsheet 'How to help in a crisis'.

For more detailed information about treatment and support, see ' Medications and other treatments '.

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No one should ever think they have to carry out their caring role without support. When you care for a family member or friend who has a mental illness, you shouldn't feel you need to do everything yourself. Find out about the treatment and support services which are available and discuss together what is practical and reasonable for you to do personally.

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From the video , it has taught me that there are five major types of anxiety disorders such as Generalized Anxiety Disorder or GAD, Obsessive-compulsive Disorder (OCD), Panic Disorder, Post-Traumatic Stress Disorder (PTSD) and Social Phobia or Social Anxiety Disorder

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Mental illness affecting young Singaporeans (Nurul)

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Mental illness affecting young Singaporeans (Nurul)

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Young Singaporeans that suffers from mental illness are treated very differently by peers and society. They were were very unaccepting and those with mental illness are constantly being picked on and that sometimes trigger their state of mind . With that , it could lead to them self-harming or even suicide if they have lost control or feeling pressurized . Many people may see certain things like pranks or jokes funny but to some people with mental illness , it may not be the same. It could lower their self-esteem and it would be extremely hard for them to cope with certain things in life and that could further cause them stress and worsen their mental state. It would be extremely hard for them to go through their everyday life as it became a routine whereby they have to go through emotional pains as they are constantly being judged and made fun off . The amount of stress could unbearable to the point where many think that suicide is the only way out , where the pain will stop .This kind of mentality and routine causes them to face difficulty getting through their every day life.

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One youngster heard voices in his head, another turned to self-harm to relieve her emotional distress. Depression can persist into adulthood if it isn't adequately treated.

(Updated: )

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SINGAPORE: Even in preschool, Jodee Kua was picked on "quite a bit" by her classmates. And it did not take much, like stealing her seat or making fun of her, to make her burst into tears.

"It was easy to just push that button," said Ms Kua, now 21. "Once, I had some chee cheong fun sauce on my face, and it became a joke to the whole class. So I cried."

In primary school, she had self-esteem issues. To cope, she started to cut herself, at the age of 11.

"I didn't know there was such a thing as depression. I didn't know self-harm was a thing ... that it was in a way a problem, and shouldn't be done," she recounted. "To me, it was just cutting."

Studies suggest that depression - the most common mental illness in Singapore - may affect up to 18 per cent of youths here. And if not treated adequately, it has a propensity to persist into adulthood.
THE PAIN 'BECAME APPEALING'
In the documentary Facing Depression, three young Singaporeans opened up about how they found coping with adolescent life difficult, and their struggles with depression, anxiety and self-harming behaviour.

According to the Samaritans of Singapore, the troubled youths who reach out to the organisation cite mental health issues, academic pressure and relationship problems at home and in school as their greatest sources of stress.

This is because of the great amount of time a child spends in both environments, explained senior clinical psychologist Wong Hui Yi, from the Institute of Mental Health's department of child and adolescent psychiatry.

Ms Kua, for example, started feeling the academic pressure at her elite primary school, where expectations were high. She first engaged in self-harm after a poor mathematics test result.

"My mum was like a math genius, so I felt as if I was terrible at this (maths) and wasn't getting any better at it," she said. "It kept spiralling downwards."

Thinking she was stupid, she cut herself as a form of self-discipline. She said:

With every careless mistake I made, I'd inflict pain one time, so that I'd remember not to do it again.

Eventually, it became something she did every time she was stressed. She had so many scars on her hands that she had to hide them from her teachers.

Her self-esteem was so low that she disliked having her photo taken and did not even want to look at herself in the mirror when she brushed her teeth.

At secondary school, she was ostracised because she was always feeling sad after her first relationship failed, when she was 13. And in a girls' school, where "popularity is important", being alone was a "very bad thing".

Regarding such friendship issues, Dr Wong said: "Among the pre-teens and the teens, the peer group becomes so important that they're an excellent source of support, but at the same time they can be a source of much stress."

So it was for Ms Kua, who tried to cope with her depression through exercise and by confiding in a friend. But in her last year of secondary school, self-harm became her form of emotional release.

"It's like how when we get caned, we feel the pain and we don't want to let this happen again," she said. "Subsequently the pain just became appealing."

Children and adolescents who commit self-harm do so for various reasons, noted Dr Wong. For some, it is a way of coping with "very intense psychological pain". She said:

They feel some relief when they inflict physical pain on themselves.

HORMONAL CHANGES
"That's a very unhealthy way of thinking, but to them it's a way of control. They certainly need help."

A typical teenager undergoes a difficult part of life trying to become an adult because it exposes teens to different kinds of life situations they had not experienced before, said The Resilienz Clinic's medical director and consultant psychiatrist Thomas Lee.

"Throwing tantrums or being moody may be one of the ways they cope. But the hormonal changes kind of add to the picture," he added, explaining that these affect how the teens feel and behave.

While the effects of oestrogen and testosterone on the brain are complex and not fully understood by scientists, what is known is that these two hormones can affect one's moods.

For teens who are already facing some life challenges, these fluctuations in hormones and brain chemicals could make them susceptible to depression, said Dr Lee.

In teenager Jane's (not her real name) case, her behaviour started to change at the beginning of Secondary Three last year. She would wake up crying "uncontrollably", said her mother.

Getting her ready for school was a "hassle", and when she reached, she would sometimes hide in the toilet, cry and call her mother to say that she was scared and did not want to be there.

"It was heartbreaking. For the record, she called me eight times within two hours in the morning," said Jane's mother, whose eyes reddened as she related the episode.

At first, she wondered whether her daughter was calling for attention. "But there was never a lack of attention at home because we were so close," she said, describing her 15-year-old as having been "quite emotional" since young.

Jane herself realised something was wrong when she stopped talking and hanging out with her friends, and started losing her appetite and dreading school more and more. "I felt as if I was drowning," she shared.

Sometimes I got better, and it was as if ... I found a log and could float with that. But after that, it was as if another wave came and hit me. It's like a roller-coaster.

While everyone has unhappy days and mood swings, a prolonged and intense mood swing, which may even last for months, could indicate depression, said Dr Lee.
'MY BRAIN BROKE'
"If these changes start to affect the kid's life, academically or his relationship with the peers or parents, then we have to start considering whether this kid is having depression," he added.

Mr Chia Xun An's depression started when he was 10, triggered by an asthmatic episode and having sore eyes, which changed his appearance and affected his self-esteem.

The situation at home did not help. Money was an issue, and for a few years, his family had to live in his maternal grandmother's home. This resulted in frequent arguments among the adults, which took a toll on him.

He had difficulty sleeping and would even hit his head against the wall at night.

"They always say that depression is marked by low mood most of the time," said Mr Chia, now 25.

I tried my best to get rid of it, but unfortunately life had other plans. I really hit rock bottom - I thought I had lost hope forever.

Diagnosed with major depressive disorder, he had to repeat a few years at school. But he worked hard to cope with his emotions, got into a polytechnic at the age of 19 and was discharged from his condition.

"I just wanted to live life ... to be like everybody else and break free from my past," he said. "I was adjusting. I felt that I was finally reaching that sense of normalcy."

In his final semester in 2013, however, things took a turn for the worse. He started seeing scribbles and lines that were not there and hearing voices in his head that kept repeating, "Burn, burn, kill, kill, die."

He had never experienced these symptoms before. "It was terrifying," recalled Mr Chia, who tried to fight off the depression, telling himself he did not want it to happen again.

"But it got worse and worse," he said. "I finally felt a shift in my mind ... My brain broke. I finally lost control."

He dragged a chair to the front of the classroom, sat down and rambled for half an hour. He cannot remember what he said, but because of the relapse, he had to repeat his final year.
DEPRESSION ISN'T TRANSIENT
"Sometimes when things like this happen, you just wish people would be more understanding," he said. "But they didn't really get it, they didn't really see the severity of it or maybe they thought I was bluffing - I don't know."

Ms Kua's turning point also came at polytechnic. With a new environment and new friends, she was feeling happier and her self-harming habit was seemingly a thing of the past - until one day when she started to experience bodily pains.

To handle the pain, she grabbed a penknife off her table without thinking and cut her wrist so hard that it bled profusely.

"The doctor said, 'You were 0.1mm from the artery. A little bit more pressure, and you may not have been here today,'" recalled Ms Kua, who was 18 years old then.

She could not understand why she lost control, since she thought she was happy, had things to strive for and reasons to live. Only then did she seek help for her depression.

Dr Lee noted that many people, including parents, believe that depression or a change in mood "is just something that's transient, or it's some character defect".

But it's not. Depression is very much a medical condition ... which definitely needs treatment.

As for Jane, she has her mother to thank for recognising that she had a problem, sitting her down and discussing why she was constantly feeling frustrated and crying. Together they ruled out cyberbullying, unhappiness at home and boyfriend issues.

The girl said: "I knew there was something wrong - it could be depression or anxiety. But reading about the symptoms and actually feeling them yourself are very different things."

It was not long before she told her mother she wanted help. She was diagnosed with clinical depression and has been getting help since February last year.

Looking back, Jane thinks her illness came about because all her friends went to another class after streaming at the end of Secondary Two and because of anxiety about her Higher Chinese course.

She also thinks the stigma to seeking treatment means "people who are sick aren't getting the help they need". She admitted: "I was very ashamed of having to see a doctor."

A 2010 Singapore Mental Health Study found that the average time taken to seek help for major depressive disorder is four years, and Dr Lee agreed that stigma is "a very big obstacle" here. He added:

(Another) very, very common reason is denial. Parents may think that the kid is just not feeling well ... and hope that the kid will become better.

TREATING DEPRESSION
"The other thing is that, even if they may really want to (get help), they may not know how to or where to get the help."

There are generally two kinds of treatment: Antidepressants and psychotherapy. The latter involves a trained mental health professional exploring the issues that caused the depression in the first place.

The health professional would guide the children towards what they should do when faced with certain kinds of adversities, shared Dr Lee.

This includes teaching stress management skills, such as breathing exercises and muscle relaxation, as well as other coping strategies like sports and reading.

Full recovery is possible, especially with support from the parents and other family members, said Dr Lee. But for some patients, certain setbacks, challenging situations or difficult relationships can trigger their depression again.

"The whole purpose of therapy is to really teach these kids how to handle those situations or similar situations better in future," he added.

For Jane, slime-making and having a pet have helped her cope with her depression. "I had wanted a dog for the longest time ever. And she's a blessing," she said.

"When I'm sad, she lies beside me and falls asleep. And it makes me a little bit happier. She doesn't talk, but she gives me a lot of love."

Ms Kua, on the other hand, has turned to dancing, especially hip-hop.

If she has a bad day, she would be dancing with "a lot of hard energy". But if she is feeling sad, she would "do movements that I could relate that emotion to, and it would leave my body".

"Dance is like the friend I never had - my perfect friend. It doesn't judge; it never leaves you unless you choose not to do it," she said.

She is now working at the IMH as a peer support specialist, helping others with their recovery journey.

Meanwhile, Mr Chia is actively raising awareness about mental illness. He has been volunteering with Over The Rainbow, a charity promoting youth mental wellness, and has self-published a book about his experience with depression.

An undergraduate today, he is working on a second such book. His parents, who did not understand his depression for a long time, have finally accepted him for who he is.

And in doing outreach work in the community, he wants to spread the message that it is a medical condition that can be treated and managed with a support system.
*Editor's note: An earlier version of this story identified Jane. We have updated the story following the family's subsequent request not to name her. The story's headline has also been changed from the earlier version. Watch this episode of Facing Depression here. The four-part series addresses misconceptions about how depression affects working adults, women, children and the elderly. Read about the demons and stigma working adults must battle, and about the loss, loneliness and killing pain of elderly depression. Where to find help: Institute of Mental Health's Helpline: 6389 2222 Samaritans of Singapore Hotline: 1800 221 4444 Singapore Association of Mental Health Helpline: 1800 283 7019
"I've been particularly vocal about stigma and discrimination. And by doing that, I hope that things will change," he said. "I hope that in future, individuals with mental health challenges can face it without fear and without being alone."

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Under pressure at home and in school, youths battle depression

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One youngster heard voices in his head, another turned to self-harm to relieve her emotional distress. Depression can persist into adulthood if it isn't adequately treated. (Updated: ) Share on Facebook Share on Twitter Share via E-Mail SINGAPORE: Even in preschool, Jodee Kua was picked on "quite a bit" by her classmates.

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Issues faced by family when getting treatment (Nurul)

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Issues faced by family when getting treatment (Nurul)

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Family members will have a very difficult time as some types of mental illness could cause a huge impact on  the family's routine , activities , financial and emotional components. Sometimes , families are just too ashamed to have any family members that suffers from mental illness and therefore , they would always try to not have the sufferers to go for the treatment and they will never acknowledge that they require special help and treatment. For the sufferers , it would cause damage to them as they are not able to receive the help that is required and if it is further delayed , it might be too late for them to get any treatment. Looking after a family member with a mental illness can be an extremely stressful time and coping with the stress may rouse various reactions such as somatic problems , cognitive and emotional problems and behavioral troubles.

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A survey showed that more than 80% of patients agreed that their mental health conditions had had a detrimental effect on their family.

Mental health issues can be an extremely painful and traumatic time for all of the family and have huge impact on a family's financial and emotional components. When it comes to mental illness, the emotional and behavioural consequences for family members go largely ignored. It is clear that individuals' mental health problems have consequences for others within their social networks, most notably, their family.

Looking after a family member with a mental illness can be an extremely stressful time and coping with stress may rouse various reactions such as somatic problems (migraines, loss of appetite, fatigue, and insomnia), cognitive and emotional problems (anxiety, depression, guilt, fear, anger, confusion) and behavioural troubles (changes in attitude, and social withdrawal).

According to a Swedish study, one half of family members claimed they had developed psychological or social problems (such as sleeping problems and depression) of their own, to such an extent that they also needed help and support.

However, whilst the influence of poor mental health on families is largely misunderstood, the consequences are extremely apparent to those actually suffering from mental illness. Those surveyed by Priory reported that their emotions and behaviour put "extra stress" on their family, with one patient reporting that: "my addiction affected everyone close to me." Another mentioned that they "isolated" their family and some even reported being physically violent towards members of their own family. Nearly all mentioned that their loved ones became upset and worried about them.

Another area highlighted by the survey was the effect that mental health had on patients' children. Children are often too young to fully grasp the consequences of mental illness and find it difficult to understand why their parent isn't well or is acting unusually. Therefore, many tend to blame themselves and grow up feeling different, lonely, and isolated. Ultimately this may lead to the child developing mental health concerns as well as other psychological, behavioural, and social problems.

Family life can become unsettled and unpredictable as the needs of the ill become paramount. Studies show that a large number of family members have had to, on one or more occasions, leave their job, whilst others said they have had to give up their recreational pursuits. Social lives are usually the first to go as they may feel nervous about inviting people into their home and find it difficult to open up to people about their relative's problems.

Dr Niall Campbell (MBBS, MRCPsych), Consultant Psychiatrist at Priory Hospital Roehampton (London): "It is easy for family members to feel guilt or blame themselves for their relative's decline in mental health. For a long time, parents and other family members were the focus of blame for the occurrence of psychological problems.

"This was largely due to Freud's early psychoanalytic theory which states that problems in adulthood are due to early childhood experiences. Other psychological theories have developed since then and we now know that the family actually plays a huge role in their relative's recovery.

"It has always been clear to us how much illness and addiction can affect a patient's family. This survey was excellent in outlining the main areas and relationships that are influenced. At Priory, we always try to treat holistically so that the family are always involved and understand what is happening."

Dr Niall Campbell (MBBS MRC Psych), has been a consultant adult general psychiatrist since 1996, initially completing 6 years in the NHS at Tolworth Hospital.

In 2002, Dr Campbell joined Priory Roehampton as a full time adult general psychiatrist. In 2013, he additionally became lead consultant for addictions. Dr Campbell has considerable experience treating patients with affective disorders including depression and bipolar disorder; psychotic disorders such as schizophrenia; and anxiety states including panic disorder and post-traumatic stress disorder (PTSD).

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Does mental health affect and impinge on family relationships?

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A survey showed that more than 80% of patients agreed that their mental health conditions had had a detrimental effect on their family. Mental health issues can be an extremely painful and traumatic time for all of the family and have huge impact on a family's financial and emotional components.

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No , I do not agree on how people suffering from these conditions are treated in society. I feel that being 'different' should not allow the 'normal' people to discriminate them. After all , we are all humans. Being different is nothing wrong , we should never bring anyone down due to their differences . We might think that we are better than them but really, there are things that they can excel in better than the 'normal' us but being 'different' stops them . Which should not be that way and it really made me question where is the society's sense of humanity . For example , from this article . Mr Tan who is diagnosed with a post-traumatic stress disorder after a car accident, his emotions took a turn for the worse, culminating in fits of rage and hallucinations. It was then, in 2002, that he was diagnosed as bipolar. He was struggling to get a job due to his mental illness. He is always recognized as Eugene Tan with Bipolar . He wants to be recognized as JUST Eugene Tan instead because mental health does not define his ability and strength in work.

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(Updated: )

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SINGAPORE: At first glance, Mr Eugene Tan's 20-year work history shows a strong background as a counsellor and social worker.

But on closer inspection, you will find that he took a year's break at the age of 24 and there have been some gaps between jobs.

This was due to Mr Tan's condition. He has bipolar disorder - a mental condition characterised by extreme highs and lows in mood.

Diagnosed with post-traumatic stress disorder after a car accident, his emotions took a turn for the worse, culminating in fits of rage and hallucinations. It was then, in 2002, that he was diagnosed as bipolar.

After that, he was reluctant to declare his condition in job applications.

"Once you declare, you may not even get an interview," he told Channel NewsAsia.

While that had been a hunch, proof that it was true came earlier this year. During an eight-month break, and looking to switch careers, he asked a consultant at a recruitment agency: What if the potential candidate has mental health issues?

The answer he received was: "Better not, lah. We don't know when the person will snap. And I don't think the company will know how to handle this group."

But withholding the truth at work comes with its own challenges, he said.

"There's always this insecurity. When colleagues' behaviour towards me suddenly changes, I will wonder whether they found out from somewhere that I have bipolar. I will also think about what the consequences would be if my employer found out," Mr Tan said.
CAMPAIGN TO GET RID OF THE STIGMA
He is now one month into his job at Club Heal, a voluntary welfare organisation that helps people with mental illnesses and their families.

Mr Tan could be better off than others who have a mental condition struggling to find a job.

The National Council of Social Service (NCSS) on Saturday (Sep 8) revealed findings of a study showing that five in 10 respondents believe that those with mental conditions should not be given any responsibility.

NCSS hopes to change this perception through the first nationwide anti-stigma campaign.

The Beyond the Label campaign launched on Saturday is a five-year public education effort funded by the Tote Board's Mental Health Strategic initiative.

NCSS deputy chief executive Tina Hung, deputy chief executive at NCSS, said research shows that perceptions and attitudes are the most critical in changing the behaviour of individuals.
TACKLING MISCONCEPTIONS
"Hence, it's crucial for us to change perceptions and attitudes towards persons with mental health conditions, to support inclusion and a better quality of life for all. With support and acceptance, persons in recovery can integrate into society and thrive," she said.

Employers need to understand that mental illness is a disease and, like other illnesses, it is manageable with medication, therapy, self-help and societal support and understanding of the affliction, a spokesperson for the Singapore Association for Mental Health said.

Ms Li Zhong Ying, principal occupational therapist at the Institute of Mental Health's (IMH) Job Club, said very often supervisors and managers on the ground do not know how to better support employees with mental health conditions, or are unsure about the community support and services that are available.

"I've heard some of them say that they might as well set up a charity if they are going to employ people from this group. Others are afraid of being held responsible. They think the staff will have outbursts, and that there will be complaints," said Ms Porsche Poh, executive director of mental health advocacy organisation Silver Ribbon.
REMOVING EMPLOYMENT DISCRIMINATION
It has been reaching out to firms to provide them with the information they need on hiring people with mental health issues.

However, the need to declare one's mental health history when applying for a job remains a bugbear among advocates.

Ms Li from IMH's Job Club said it encourages discrimination.

"The job market is already very competitive, and to state it on a job application form will only further lower the chances of persons with mental health conditions securing a job, given the negative assumptions held by the public towards people with mental health conditions," she said.

She stressed that people with mental health conditions deserve a chance to prove that they can work productively.

"Many such individuals are not only able to function as well as others in the workplace, but also often have qualifications, skills, abilities and experiences as required by the jobs," she said.

A perception shift is critical when it comes to the declaration of mental illness in a job application process, the Singapore Association for Mental Health said.

"With greater awareness and understanding of mental health conditions, the declaration of one's mental health conditions should be considered with respect and empathy as this is an act of strength and courage," its spokesperson said.

Even for those willing to hire, Ms Li cautioned against treating this group differently.

"Employers should accord them the same pay rates and benefits as other workers. Employers should not have a mindset of doing 'charity work' and pay people with mental health conditions less or view them as beneficiaries," she said.

Still, the organisations acknowledged that more employers are now open to hiring those with a history of mental health issues. Between 2015 and 2017, Job Club has been in touch with 45 new companies who expressed interest in hiring its clients, Ms Li said.

The Singapore Association for Mental Health's MINDSET Learning Hub, the first vocational training centre for those with mental health issues has placed 123 individuals in jobs between July 2016 and July this year.
LEADING BY EXAMPLE
"To encourage a more inclusive workforce, incentives could be given to employers to encourage them to employ persons with mental health conditions, as well as to reward organisations that have already been doing so," Ms Li said.

Eyewear shop Nanyang Optical has pledged to hire people with mental illnesses. So far, the firm, which has about 100 employees, has hired three people with schizophrenia and depression, said managing director Bernard Yang.

"We made a slight adjustment to the job scope and environment so that it is easier for them to adapt. In addition, we also try to be more generous in giving words of encouragement to them," he said, adding that a lot of understanding and cooperation is required across departments and colleagues.

Mr Yang encouraged other companies to hire people with mental illnesses, and stressed the need for inclusion, as "everyone deserves a chance".

"Actually, they are not any different from any of us. If we can adapt to the different kinds of people at a workplace, we can definitely work with people with mental illness. All they need is a little encouragement and a little kindness, and also an opportunity," he said.

Although it may entail making changes to workflow, he said he believes it means a lot to them. There is also satisfaction, he said.

"We feel good and happy when we see them improving along with the job, their condition becomes stable, and they smile more often," he said.

Mr Tan hopes that more employers will be accepting, hire people with mental health issues and see them for who they are.
Editor's note: An earlier version of this story reported that the survey found that six in 10 people believe employees with mental conditions are less reliable. This statistic has been updated by NCSS.
"I don't want to be Eugene Tan with bipolar. I want to be just Eugene Tan."

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'I don't want to be Eugene Tan with bipolar': People with mental health issues face workplace discrimination

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(Updated: ) Share on Facebook Share on Twitter Share via E-Mail SINGAPORE: At first glance, Mr Eugene Tan's 20-year work history shows a strong background as a counsellor and social worker. But on closer inspection, you will find that he took a year's break at the age of 24 and there have been some gaps between jobs.

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There are many different kinds of support network agencies and services that are available in Singapore . The one that caught my eye is the Agency for Integrated Care which developed a resource kit comprising a resource directory and magnet, sharing on the community mental health services available and where to seek help.

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Community Mental Health Resource Directory

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Find out more about the mental health services available in the community.

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from the video, i have learnt that the ten rare psychological disorder that people aren’t aware of is split brain, cotard’s syndrome, fregoli delusion, stendhal syndrome, dissociative identity disorder, alice in wonderland syndrome, reduplicative paramnesia, lima syndrome, triskaidekaphobia and the jumping frenchmen of maine. Schizophrenia could occur alongside with cotard’s syndrome and fregoli delusion.

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10 Rare Psychological Disorders You May Not Know About

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increase in youths with mental illnesses (sabrina)

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increase in youths with mental illnesses (sabrina)

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There are many factors that can trigger ones emotions deeply and cause them to have all sorts on mental illnesses. Based on the article i have learnt that ‘There has been an increase in the number of teens who present at KK Women’s and Children’s Hospital (KKH) with stress and emotional problems’ and ‘Most of them are between 13 and 16 years old.’ this is due to having ‘trouble making friends or being accepted by their peers, and face family problems or have high personal expectations,’ which means that more youths are lonely and has difficulties opening up to their peers as their fear of being judged, they are just too shy or they have past bad experiences of not being accepted in. children facing family problems are mostly helpless as the family problems might be between the adults as the parents might be fighting or are financially unstable which will definitely affect the children the most even if then parents know it or not. Once the children start to feel helpless and feel like they have to one to talk to or be there for them, this could cause them to be stress and that could trigger ‘anxiety, depression and self-harming behaviour, and cause sleep problems, social withdrawal, angry outbursts and obsessive-compulsive behaviours.’

This is confirm something that would affect their lives as they are constantly in tears, sorrow, pain or anger and they do not get to lead a happy childhood that everyone yearns to have. Not only is it affecting their everyday lives, but also the people around them who cares are they would constantly have to wonder if the person is fine or is he/she is going to harm themselves or when is he/she going to snap back to being angry or have river of tears being flown down of their cheeks because of then disorder that they are being diagnosed with.

This is definitely a pressing problem as once the youths/children start to have a record of mental illness or self-harm, it is going to be a factor that brings down their self esteem and a barrier between them and their future lives and jobs as people might see them as mentally ill people even if they have recovered. Hence, if the number of youths who has family problems or have difficulties mingling around with people doesn’t decrease instead of increasing, the number of youths with mental illness or similar records doesn’t decrease too, hence, more futures are to be worried for.

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Last year, a Primary 5 pupil fell 17 floors from his bedroom window on the day he was supposed to take his exam papers home.

He had never fared poorly in his examinations from Primary 1 to 4, and scored an average of 70 marks

His mother would cane him on his palm "lightly" for every mark he fell short of her stipulated standard of 70 per cent.

But he failed his Higher Chinese and mathematics in his latest mid-year exam. Out of 100 marks, he scored 50 for English, 53.8 for Chinese and 57.5 for science.

This case shows what too much stress can lead to.

Stress can trigger anxiety, depression and self-harming behaviour, and cause sleep problems, social withdrawal, angry outbursts and obsessive-compulsive behaviours.

Experts have observed a rise in the number of stressed-out children and youth in Singapore. While the demands of school are often blamed, the stress often stems from multiple sources.

Some have trouble making friends or being accepted by their peers, and face family problems or have high personal expectations.

The NurtureSG committee, a taskforce formed to promote the physical and mental health of children, suggested steps that included training students to look out for peers in distress and setting up a workgroup to study suicidal and self-harming behaviours in children and youth.

The Health Promotion Board said last month it would enhance the training for pre-school educators so that they can help build emotional resilience in young children.

"There has been an increase in the number of teens who present at KK Women's and Children's Hospital (KKH) with stress and emotional problems," said Dr Vicknesan Marimuttu, a consultant at the child and adolescent mental wellness service of the hospital's psychological medicine department. "Most of them are between 13 and 16 years old."

Increased awareness of mental health services as well as efforts to move away from the stigmatisation of seeking help could have led to the rise, said Dr Marimuttu.

Young people may also not be getting adequate support from their parents, who are busy with work.
Related: SCHOOL STRESS IS A BIG THING How to be a supportive parent
Associate Professor John Wong, head of the National University Hospital 's psychological medicine department, said a Primary 6 pupil told him last August that he was stressed because he had to score at least 245 for the PSLE.

His mum wanted him to aim for that score as it was the cut-off point for a good neighbourhood school and she had promised him a laptop.

"The child is not psychologically mature to know he wants 245, but he wants a computer," said Prof Wong.

"His mum wanted to motivate him. But she didn't tell him she'd still be happy with a 240 score."

Academic and social pressures tend to pile up in school. In Singapore, many children attend tuition, enrichment classes or sports activities on top of a long school day.

They do homework when they reach home, leaving little "me" time, and often do not have enough time to sleep.

School is a big stressor because they spend most of their time there, doctors said.

During the Education Ministry's budget debate last week, Mr Lim Biow Chuan (Mountbatten) asked if some schools were setting the bar too high for non-national examinations. And Dr Intan Azura Mokhtar (Ang Mo Kio GRC) called for an end to streaming students into normal and express classes.
Related: BUT DON'T JUST BLAME SCHOOL Academic stress in Singapore: are parents to blame?
Stress is not necessarily a problem but a challenge, said Prof Wong. "Minimal stress may not motivate a child aged seven to 18, but some stress can facilitate his learning. It's when it exceeds his capacity that it becomes a problem."

While academic stress can be a problem in the pressure-cooker education system here, social issues are a big stressor for teens.

Dr Chua Siew Eng, a specialist in psychiatry and consultant at Raffles Counselling Centre, cited the case of a 16-year-old boy who had been seeing a cardiologist for his heart palpitations that surfaced whenever he had a panic attack.

The boy had complained of feeling anxious for an entire year. His anxiety worsened during situations such as speaking up in class and ordering food at the canteen.

He slept poorly and criticised himself for not performing well. This led to fatigue and poor concentration, said Dr Chua. The boy was diagnosed with social anxiety disorder.

Another often-overlooked factor is that each child has his own expectations, said Prof Wong.
Related: CHILD'S TEMPERAMENT IS KEY Why does my child compare himself to his friends?
A child will want to achieve something that his parents want or he may form his own expectations based on the incentives or how his siblings have performed.

"As a result, stress occurs. It's not the fault of the school or the curriculum," added Prof Wong.

"It's okay for parents to motivate their child but don't use a blunt approach," said Prof Wong.

A child's temperament is something he is born with and it may result in him reacting differently to situations. "Those who are happy- go-lucky tend to be more resilient," he said.

"For those who are more sensitive and fragile, their parents and teachers must understand their temperament and make sure they do not get rushed."

Rather than have unrealistic expectations of their child, parents should find out his interests and capabilities, he said.
Next page: Signs that show your child may be too stressed out
Parents may also not think through their demands and expectations to make sure these are attainable. As a result, he added, they do not know why their child is depressed or overwhelmed.

"As parents, we may miss opportunities to validate them and recognise their efforts," said Prof Wong.

"I learnt from a youth social worker that we need to be there for teenagers when they are hurt emotionally, when they are sad and when they are celebrating."

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This is why more Singapore children are stressed | Young Parents

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Last year, a Primary 5 pupil fell 17 floors from his bedroom window on the day he was supposed to take his exam papers home. He had never fared poorly in his examinations from Primary 1 to 4, and scored an average of 70 marks His mother would cane him on his palm "lightly" for every mark he fell short of her stipulated standard of 70 per cent.

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difficulties in receiving treatment ( sabrina )

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difficulties in receiving treatment ( sabrina )

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There are definitely mental illness patients around who has difficulties in applying for treatment and that their families could not help them with the support they need on getting better as they might not want to accept the fact that they have a family member or more with a disorder and that they are categorised as abnormal and different from everyone else, also known as ‘off-centred’. Or the family is suffering financially and could not provide the person with the amount they need to get the treatments or the right therapist with a adjustable amount of money they are able to give. In some cases, it is not the families that are not able to provide. The person who might be or is already diagnosed as mentally ill patients might face ‘Stigma, shame, (and) embarrassment’. Others could not accept their differences if the patients themselves could not accept themselves for their differences. Once they are not able to accept themselves, they would not want to seek for help and thus causing their condition to go untreated and become worst. For example, ‘People with depression, might only experience a handful of symptoms at first. Left untreated, they may begin to experience the full range of depression symptoms, necessitating more intensive treatment and a more uncertain recovery journey.’

To summarise, some issues that that sufferers and their families face with regards to receiving treatment is that the family is not willing to accept their family members for their illnesses, they are financially low in income hence they do have enough to pay for the treatments or the person suffering from mental illness is ashamed for their differences.

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Though mental illness remains heavily stigmatized, with politicians blaming everything from poverty to crime on mental health issues, mental illness is common. About a quarter of the population will face a mental health issue in any given year. With more than half of all mental illnesses left totally untreated, though, millions of Americans needlessly suffer with unnecessary symptoms.

Stigma, shame, embarrassment, and poverty can all play a role in the decision not to seek treatment, as well as the inability to find quality treatment. Many people struggling with mental health issues are unable to find a therapist they like, or they encounter intolerable side effects associated with the medications they take. But giving up, rather than trying a new strategy, is extremely risky, and can cost you your health, happiness, and even your life. Here's what happens when mental illness is left untreated.
Worsening Mental Health Problems
The most obvious effect of untreated mental illness is a steady-and often rapid-decline in mental health. Mental illness will not go away on its own, and the longer it persists, the harder it is to treat. People with depression, for instance, might only experience a handful of symptoms at first. Left untreated, they may begin to experience the full range of depression symptoms, necessitating more intensive treatment and a more uncertain recovery journey.
Unexplained Aches and Pains
When mental illness becomes too challenging to deal with, sometimes the body bears some of the burden. You might involuntarily tense your muscles, leading to headaches and muscle pain. Or maybe chronic stress will lead to gastrointestinal distress. It's common for people with underlying mental health problems to complain of aches and pains that have no physical source. But over time, these aches and pains can become real health problems. If you tense your shoulder in response to stress, for example, you might eventually develop a painful or debilitating shoulder injury that worsens both your physical and mental health.
Chronic Physical Health Problems
Mental illness is not all in your head. It's the product of brain chemistry changes. Mental illness can undermine your physical health in at least two ways. First, chronic mental health issues may cause you to neglect your health, as when a diabetic is too depressed to monitor her blood sugar levels. And second, mental illness can cause health problems all its own. Chronic stress is associated with a risk of heart attacks, stroke, obesity, and premature death, and many other symptoms associated with mental illness can also lead to serious health issues.
Homelessness and Job Stability Issues
Mental illness makes it difficult to cope with the demands of daily life. Whether it's struggling to get out of bed for work because of depression, or experiencing communication difficulties due to schizophrenia, the longer mental illness is left untreated, the more likely it is to interfere with your ability to do your job and effectively interact with others. This can lead to financial troubles, job loss, and potentially even homelessness. And all of these challenges, of course, can further complicate your mental illness, making it increasingly difficult to pull yourself out of a challenging situation. More than a third of homeless people have a serious mental illness.
Incarceration
First, it's important to clear up a myth: mental illness does not cause violence. It does make it more difficult to conform to society's norms. For instance, a woman with PTSD pulled over by the police may enter a flashback, causing her to behave in an apparently non-compliant manner. A man with depression may feel so sad he's unable to muster the energy to pay a traffic ticket, eventually leading to the issuance of a warrant. Seventy-three percent of female state prison inmates, and 55% of men, have a serious mental illness.
Victimization and Trauma
When your brain undermines your ability to react, feel happy, or think clearly, you're more vulnerable to victimization. This can set off a chain reaction of victimization, followed by PTSD, followed by unusual behavior that leads to even more victimization. People with mental illnesses are significantly more likely to be victimized than those in the general population.
Suicide
Mental illness isn't a lack of coping skills or a personal failure. It's a serious, and potentially life-threatening, illness. Left untreated, mental illness can make life so intolerable-and cloud your judgment so thoroughly-that you see no way out and no hope. Life with mental illness is hard, and for some, it's unbearable. More than 90% of suicides are directly attributable to untreated mental illness.

If you or someone close to you is struggling with untreated mental health issues, consider seeking help; you won't regret it.
References:
About 50% of individuals with severe psychiatric disorders (3.5 million people) are receiving no treatment. (n.d.). Retrieved from http://mentalillnesspolicy.org/consequences/percentage-mentally-ill-untr...

Mental disorders in America. (n.d.). Retrieved from http://www.thekimfoundation.org/html/about_mental_ill/statistics.html

Varney, S. (2014, May 25). By the numbers: Mental illness behind bars. Retrieved from http://www.pbs.org/newshour/updates/numbers-mental-illness-behind-bars/

What percentage of individuals with serious mental illnesses are receiving no treatment? (2014, November). Retrieved from http://www.treatmentadvocacycenter.org/resources/assisted-outpatient-tre...

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Though mental illness remains heavily stigmatized, with politicians blaming everything from poverty to crime on mental health issues, mental illness is common. About a quarter of the population will face a mental health issue in any given year.

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All of us know at least a few mental illnesses or disorders such as schizophrenia, Obsessive-compulsive disorder(OCD) and even Biopolar disorder. However, in this video, I learnt 7 rare psychological disorders. They are, Alice in the wonderland syndrome, Body Integrity Identity Disorder,Capgras Delusion/Syndrome,Fregoli Syndrme,Clinical Lycanthropy, Stockholm Syndrome and Fugue State.

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Youth with mental illness in Singapore
With increasing numbers of youth in Singapore, the future of the youths can be ruined. Socio-demographic factors like  age, gender, marital status, education and income status can trigger mental disorders. For example, alcohol abuse is more prevalent among the lower-educated, compared with those who have received tertiary education. This is because those with low education status may have poor coping mechanisms and may not be fully aware of the dangers of alcohol addiction. In a recent study , youth between the age range of 18 to 34 are more likely to suffer from mental illnesses as there are many changes going on in thier life at this point of time. This is because youths are concerned on which educational or career path to follow and create their future.Prof Chong from IMH said that an increased use of social media could also be a reason why young people are more at risk of experiencing mental disorders as social media is one of the main target when it comes to cyber bullying, peer pressure which can lead to mental disorders and self harm. However if used in a proper and useful way, social media can be used to reach out to those with mental disorders by spreading the word about organisations that help those in need.  Mental illness is a pressing problem in our society as it does change a person's life , character and people surrounding them. One finding from the study was that those who are divorced and separated tend to experience depression and bipolar disorder, compared with those who are married.  This is because Relationship problems are often tougher to deal with as they are intertwined with other parts of life. (It often involves) children, finances and it is much more complicated to deal with compared with a job, which one can just leave.

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Youth with mental illness in Singapore(Maha)

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Youth with mental illness in Singapore(Maha)

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With increasing numbers of youth in Singapore, the future of the youths can be ruined. Socio-demographic factors like  age, gender, marital status, education and income status can trigger mental disorders. For example, alcohol abuse is more prevalent among the lower-educated, compared with those who have received tertiary education. This is because those with low education status may have poor coping mechanisms and may not be fully aware of the dangers of alcohol addiction. In a recent study , youth between the age range of 18 to 34 are more likely to suffer from mental illnesses as there are many changes going on in their
life at this point of time. This is because youths are concerned on which educational or career path to follow and create their future.Prof Chong from IMH said that an increased use of social media could also be a reason why young people are more at risk of experiencing mental disorders as social media is one of the main target when it comes to cyber bullying, peer pressure which can lead to mental disorders and self harm. However if used in a proper and useful way, social media can be used to reach out to those with mental disorders by spreading the word about organisations that help those in need.  Mental illness is a pressing problem in our society as it does change a person's life , character and people surrounding them. One finding from the study was that those who are divorced and separated tend to experience depression and bipolar disorder, compared with those who are married.  This is because Relationship problems are often tougher to deal with as they are intertwined with other parts of life. (It often involves) children, finances and it is much more complicated to deal with compared with a job, which one can just leave.

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Mental illness more prevalent among young adults, OCD one of top disorders in S'pore

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SINGAPORE - Young adults are most at risk of suffering from mental disorders in Singapore, the latest Singapore Mental Health Study found. Those aged between 18 and 34 are more likely to have experienced bipolar disorder, major depressive disorder, alcohol abuse, and obsess

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Issues faced by sufferers and families. (Maha)

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Issues faced by sufferers and families. (Maha)

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Not only suffering from mental issues, sufferers also have to worry about their family and future. This is because when one is diagnosed with a mental disorder, they would lose thier job, reputation, and salary. When they have no job , they would not be able to receive proper treatement and medication thus not being able to control their emotions and actions which would affect the sufferers family as the family members are the ones trying to so hard to support their loved one who  is suffering. Another problem the sufferes face is when the therapist is not available or reliable enough to handle a certain degree of mental illness. Thus the patients have to spend a very long time in finding the right treatment that helps them and is suitable for them.

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Mental health issues receive an increasing amount of attention from the media these days. Whether it's anxiety levels in college students, concerns about the opioid epidemic, rising rates of autism diagnoses, or the potential to overdiagnose ADHD, there's no doubt that public awareness of mental health is growing. However, despite this increased awareness, all mental health issues face a common challenge: Individuals in need of treatment often struggle to receive timely treatment and effective treatment.

Most individuals who need mental health services either do not or cannot access appropriate treatment. ¹ The reasons for this are multifaceted and complex. Aside from longstanding challenges-such as the difficulty of acknowledging that you may be struggling with mental illness and the potential stigma associated with seeking mental health treatment-there simply are not enough trained providers to meet the demands of the population. While there are multiple ways for someone to address their behavioral health concerns (e.g., self-help books, online resources, spiritual counsel, peer support), the primary modality by which mental health issues are treated is through weekly, individual therapy services with a trained service provider. Time is finite, and this model significantly limits how many individuals in need can receive therapeutic services. Furthermore, identifying a potential provider who 1) is in your area, 2) has availability for new clients, 3) has an open therapy time that you can attend, 4) either takes your insurance or has a fee schedule you can afford, and 5) has expertise in the area of mental health for which you are seeking services is unfortunately a tall order.

When individuals are able to receive treatment, the type and quality of the treatment they receive can vary quite widely. The past few decades have seen a shift to a greater emphasis on encouraging providers to use evidence-based practices in mental health, which means that treatments should have evidence from research studies that that they lead to improved outcomes. However, most research studies examining the type of treatments delivered in routine clinical settings suggest that many providers do not use evidence-based practices. This is often referred to as a "research to practice gap" in mental health. Again, the reasons for this gap are quite complex - the type of treatment any given individual receives is influenced by many factors, including individual choices and preferences, organizational values and resources, systems/policy level factors, and much more. 2,3 Complicating this challenge further, there is widespread disagreement about what constitutes appropriate "evidence" for whether or not a particular type of mental health treatment works or is appropriate for certain individuals.

The goal of this blog is to delve into these issues and more surrounding the challenges of accessing timely and effective mental health treatment. Exciting work is occurring in this space aimed at improving the reach of high-quality mental health interventions. This blog will explore and highlight new service models and strategies that are being developed to address the mental health needs of the population and improve the quality of mental health care that is delivered across clinical settings. The ideas I will discuss will draw from the numerous domains that influence mental health care, including individual, organizational, and political factors.

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Two Major Problems Facing Mental Health Treatment

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Mental health issues receive an increasing amount of attention from the media these days. Whether it's anxiety levels in college students, concerns about the opioid epidemic, rising rates of autism diagnoses, or the potential to overdiagnose ADHD, there's no doubt that public awareness of mental health is growing.

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 How are Mental patients being treated in the society? (Maha)

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 How are Mental patients being treated in the society? (Maha)

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No I do not agree on the way people suffering from mental illness are being treated in the society. These people who are suffering are not very different from us. They are still humans and so are we. If everyone is "normal" I think we would not be able to learn how to empatise with one another and that makes us human kind heartless. Instead of discriminating or following stereotypes of the society, we should instead support , encourage and empower those who are going through mental illnesses as you may never know the suffering unless you undergo it. Furthermore, Stigma and discrimination can  worsen someone's mental health problems, and delay or impede their getting help and treatment, and their recovery. Thus if all these are going around the sufferers, they may not be able to recover from  their disorders. Thus, mental patients should be given opportunities like others get. For example like stated in this article, "People with mental illnesses deserve a chance to prove that they can work productively. Many with mental illness not only function as well as others, but also often have knowledge, skills, capabilities and experiences that a perspicacious employer would value." thus we should accept the mental patients for who they are as that makes them them, and they are part of their society.

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As far as work is concerned, we have come a long way from the elite of ancient Greece who had held it in contempt (they had an underclass and their slaves to toil for them). They thought that life was for leisurely contemplation, and "paid employment", as Aristotle had put it rather disdainfully, would "absorb and degrade the mind".

Through subsequent millennia, the idea of work and the attitude towards it have evolved; it is for most of us today our livelihood, and for many it is also more: Our work is melded into our identity, it buttresses our self-esteem, and it gives us purpose and a sense of belonging to a community.

There is a group, however, who is often excluded from this community. The unemployment rate of people with mental illnesses almost everywhere (including Singapore) is strikingly and disturbingly high - despite having the highest "want to work" rate of any unemployed group. One British survey found that as many as 90 per cent of people with mental illnesses wanted to return to the workplace.

The reasons for this high rate of unemployment are varied and overlapping. For one thing, there is that widespread discrimination that stymies and disables people with mental disorders in so many ways. Studies done on both sides of the Atlantic, as well as in Australia, found that a considerable proportion of people with such health problems reported that they have been fired or forced to resign from their jobs, demoted, had their work hours or responsibilities reduced, were denied a job because of their history of psychiatric treatment, had a job offer withdrawn, and/or were ostracised and hassled by co-workers.

Their adverse experiences have burdened them with disabling self-doubt and inculcated in them a sense of self-stigmatisation so deep that a great number would avoid applying for a job as they do not expect to be given a fair chance. Nor is this an unjustified pessimism: In surveys over the past five decades, employers have been found to be consistently far more reluctant to hire workers with mental illnesses than almost any other group, including those with a physical disability and former convicts.

Many of these individuals also lack the necessary education and training required for a vocation - often this is due to the early onset of their illnesses: Half of all lifetime cases begin by age 14 and three-quarters by age 24. The disruptive emotional, behavioural and interpersonal difficulties that arise from the illness would derail their schooling, and some fail to get back on track. In our qualification-obsessed society, this impediment in education is a large stumbling block for securing a job with good career prospects.

And then, there is the issue of whether these individuals receive good continuous management of their illnesses. Optimal treatment of serious disabling mental illnesses requires not just medication but also a raft of other psycho-social interventions to improve functioning, including vocational rehabilitation and what is called supported employment.

Research has shown that people with serious mental illnesses can successfully participate in the open labour market through supported employment. This is provided by mental health and rehabilitation professionals working together to do rapid job searches for a patient, placing him or her in a job, and backing that with ongoing support. But the evidence is that many who need these services are not receiving them for various reasons.

DISCLOSURE OF ILLNESS

There is one question that I'm asked every now and then by my patients: Should they disclose their history of mental illness to their employer or manager at their place of work? Or, how should they respond when faced with that pointed question on whether they have any history of mental illness? This question is so ubiquitous in job application forms that it seems to be a norm with most companies, and has made job-seeking an even more suspenseful undertaking for patients. I used to have to suppress that spurt of reflexive response to urge them not to tell the truth, and to counsel that discretion is the better part of valour. But now, I would have a more considered discussion which involves drawing up a balance sheet of pros and cons.

Disclosure might provide an opportunity to ask for some reasonable adjustments such as a more flexible workday, or to explain those symptoms (or the side-effects of medications) that might be affecting their performance in the workplace. Disclosure to colleagues could lead to getting much needed help and emotional support from them. And in no small way, it might also educate others in the workplace about mental health issues.

But there are obvious downsides and risks, one of which is the possibility that disclosure will leak out in one way or another and give rise to mean and mischievous gossip. It could also result in other egregious forms of discrimination. A pusillanimous employer might wait a few months before terminating the services or forcing out the employee on a different pretext , without it seeming like the admission of mental illness was the reason.

DISABILITIES LEGISLATION

There is no law in Singapore for preventing any job discrimination against those with mental illnesses - in contrast to Britain and the US, where there are laws that ban the use of pre-employment questionnaires asking prospective job seekers about their mental health.

The Americans with Disabilities Act (ADA) of 1990, for instance, seeks to protect people with mental health disabilities by prohibiting discrimination in job application procedures, hiring, firing, advancement, compensation, fringe benefits and job training. The ADA allows these individuals to request "reasonable accommodations" to enable them to do their jobs with the caveat that these accommodations must not give their employers "undue hardship" - meaning that they must not be prohibitively expensive, extensive or disruptive, or change the nature or operation of a business. The fact that we have no such law in part comes from the "medical model" that we use to see a person with a disability. From that perspective, such a person is someone who cannot function adequately because of the presence of an organic condition.

In contrast to this "medical model", the "social model" of disability views the disability as an imposed condition that is created by society. Or as summarised by the American writer Andrew Solomon: "If most people are geniuses, those of moderate intelligence would be disastrously disadvantaged." (The more extreme expression of this "social model" is made by the British academic Michael Oliver, who said: "Disability has nothing to do with the body; it is a consequence of social oppression.")

But we can't repudiate the fact that mental illnesses are medical conditions that can result in impairment of functioning - and for which we should ensure that people with such illnesses are given whatever means possible to have access to effective treatments. But neither can we deny that we have also disabled them with various barriers that are created from our prejudices; and in some way, we may have also socially conditioned them to fit our negative stereotypes.

If we take in and accept some aspects of the "social model", it will be an acknowledgement of those unjust societal constraints and signal a willingness to change our prejudicial mental habits. It would also go some way in reducing the stigma that clings so tenaciously to people with mental illnesses and allay their fears of being regarded as disabled and incapable.

If we do want to move towards a more inclusive society, we should not just mouth the usual platitudes about how much we care about people with mental illnesses. Well-intentioned though they may be, such expressions are easy and smack of an ineffectual and insincere kind of sentimentality.

Should we not take the more practical and concrete steps of providing legal protection to prevent discrimination? While we have some laws to support people with disabilities, there is no specific law to penalise discriminatory practices related to disabilities, let alone mental disabilities.

People with mental illnesses deserve a chance to prove that they can work productively. Many with mental illness not only function as well as others, but also often have knowledge, skills, capabilities and experiences that a perspicacious employer would value. The World Health Organisation has estimated that one in four people have a mental illness some time in their lifetime, and it is likely that among our work colleagues, there are some who have mental illnesses unbeknownst to the rest - but who live in fear of that being uncovered one day.

Next Tuesday, Oct 10, is World Mental Health Day and the theme this year is "Mental Health in the Workplace". If anything, it is to remind us again that we still have quite a way to go in making the workplace a stigma-free environment for those with mental illnesses, where they will be treated with decency, compassion and fairness, and where there is no fear and no need for denial and subterfuge.

The writer is vice-chairman of the medical board (research) at the Institute of Mental Health.

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People with mental illness deserve a shot at work

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As far as work is concerned, we have come a long way from the elite of ancient Greece who had held it in contempt (they had an underclass and their slaves to toil for them). . Read more at straitstimes.com.

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There are a handful of support network agencies and servives available in Singapore. The one I have attached here is the National Council of Social Service (NCSS). The NCSS beleive that all patients  in recovery from mental health conditions should be  empowered to live with dignity in a caring and inclusive society. Thus, the NCSS has different Rehabilitation and support services such as peer support, employment, youth mental health services and suicide intervention and management to help patients and their caregivers to be integrated into the community.

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NCSS - Persons with Mental Health Conditions

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All persons in recovery from mental health conditions are empowered to live with dignity in a caring and inclusive society. Rehabilitation and support services are available to help these individuals and their caregivers to be integrated into the community. For a list of mental health services and resources, go to Mental Health Resource Directory.

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From the video, I can learn that there are many types of mental illness, all differently affecting the mentally ill and some examples are schizophrenia, depression, Post Traumatic Stress Disorder, Autism, Anxiety, Insomnia and ADHD. The video also informs me about each mental illness and how it affects a person.

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Artist Suffering From Anxiety Draws Mental Illnesses As Real Monsters

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Mentally Ill youths in Singapore (Pearlyn)

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Mentally Ill youths in Singapore (Pearlyn)

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Mental illness affect the lives of young Singaporeans today by distracting them, making them outcasted and having inner conflict all the time. They also cause youths to breakdown and sometimes be suicidal. Mental illness hinders study as the mentally ill youths are too distracted to study or busy trying to be calm or not thinking of suicide. Mental illness also is a permenant label on youths and are negatively perceived by society as "weird", "stupid" or"emo". Society thus shuns them or make the mentally ill uncomfortable and thus their social lives are over. This is a pressing problem as more youths in Singapore are becoming mentally ill but Society will do nothing to help them and do not give them the help they deserve, making this a huge problem.
https://www.todayonline.com/singapore/crazy-weird-scary-survey-unveils-negative-labels-youths-associate-mental-illness

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Issues sufferers face along with their family with regards to treatment (Pearlyn)

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Issues sufferers face along with their family with regards to treatment (Pearlyn)

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The issues sufferers and their families face with regards to treatment are uncertainty, stigma and cost. They are unsure if the medicine will cure them and whether it will be temporary or a waste of time. Mental illness is perceived negatively, and medicine is often associated with it. Most family members are afraid of being shunned due to a mentally ill relative/sibling owning them and possibly exposing them to the public accidentally. Since treatment is costly, mentally ill patients and their family might not be able to afford the treatment and thus unable to be cured.
https://psychcentral.com/blog/what-ive-learned-about-relationships-and-mental-illness/

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Views on treatment from society of victims of mental illness (Pearlyn)

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Views on treatment from society of victims of mental illness (Pearlyn)

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I do not agree as it is totally unfair. They aren't allowed to do certain things , are handicapped mentally and bullied. They are in everyway the same as us. They are humans. Sure, they might have outbursts, cannot control themselves or their behaviour is violent but that does not mean they are stupid. They do not deserve to get bullied and deserve the life of a normal person.

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Support network agencies and services in Singapore (Pearlyn)

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Support network agencies and services in Singapore (Pearlyn)

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There are quite a handful of support hotlines but here the link I have attached to this post is the SOS(Samaritans of Singapore). They allow you to talk with them or ask for help from them while remaining anonymous. All private information remains confidential with them and I think they are quite helpful as they do not ask for a person's information before guiding them.
https://www.sos.org.sg

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From the picture below, I can see that there are many different types of mental illnesses and that the different types such as bipolar,ocd,etc and they can each affect different emotions in people (Justin)

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How mental Illnesses affect lives of young people in Singapore 

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How mental Illnesses affect lives of young people in Singapore 

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To me personally, I feel that mental health and illnesses is a very significant thing for most youths in Singapore today and it can affect them in many different aspects of life: school,friendship,family etc. When young people have mental illnesses, they are discriminated by others who don’t really understand what they are going through.this makes me think that most other young people are not sensitive to people without mental illnesses and just discriminate them as they please without considering their feelings.i think this is a pressing problem as with discrimination comes bullying and with bullying comes lowering the self esteem of people and lowering people’s self esteem could really make them think more negatively about themselves and even result in them having mental illnesses such as depression etc (Justin)

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Issues sufferers and family face when receiving treatment

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Issues sufferers and family face when receiving treatment

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Some of the issues that a sufferer of mental illnesses and their families can face is definitely financial trouble as receiving treatment for mental illnesses is not the cheapest thing in the world and can sometimes even cost up to 5 figures. This can really impact the financial situation of some families that are not very well to do. This will in turn cause a domino effect as when the families which are barely making ends meet spend so much money on treatment for the sufferer, they won’t have much money left for themselves and their Everyday lives this will make them have to change the way they live their lives significantly and they will have to be more cost effective, thrifty,etc if they want to be able to fund for treatment of mental illness for the sufferer (Justin )

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Agree/Disagree on how people with mental illness are treated in society

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Agree/Disagree on how people with mental illness are treated in society

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No,personally I do not agree with the treatment of how people with mental conditions are treated in society as I feel everyone is equal , everyone is all a human, there is no elite class or no lower class but mostly the majority is making the people with mental illnesses feel that they are a worst cut and that they do not belong in society but they really are not Any much different from us. Even though they might need a little more support then most people, they are still human and when they need support, all the more should we offer it to them as I feel we should go through these problems as a society and help as many people as we possibly can so that everyone can live their life to the fullest and truly enjoy life without being afraid of being insulted or discriminated (Justin)

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Types of support agencies in Singapore for mentally ill

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Types of support agencies in Singapore for mentally ill

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Singapore, has many different types of support agencies for people with mental illnesses. But one that really caught my eye was definitely the caregivers association of the mentally Ill (CAMI) Without even diving too deep into the website but just looking at their motto below their name “because we understand” really shows me that this is a group of very empathetic and passionate people who want to help people with mental illnesses to become better and they feel that everyone has a voice in society and no one should ever be afraid to voice out their personal view or opinion to any matter which is something I agree to very strongly hence this support agency stoodout  to me the most (Justin)

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Caregivers' Association of the Mentally Ill - CAMI Singapore

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The Caregivers' Association of the Mentally Ill (CAMI) was formed by a group of caregivers who have family members suffering or recovering from mental illness

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I do not totally agree with how people suffering from these conditions are treated in society. There are definitely more discrimination towards the mentally ill patients than people actually supporting them and accepting them despite of their condition. The title of the article that i have read up on already sums up what the conclusion of the survey is. ‘Many in Singapore unwilling to live or work with people with mental health conditions’.  This title is rather upsetting as singaporeans were the ones who took the survey and the fact that i am a part of the singaporean society and that there are only a minority amount of us willing to accept this group of mentally ill patients is more of a sickeningly disgraceful feeling. ‘half of the 1,796 respondents believe that persons with mental health conditions should not be given any responsibility.’ this shows that many singaporeans think very low of mentally ill patients and that if duties are being tasks to them to do, they are not trusted and people do not expect them to get it done just because of their status of being mentally ill. Even though the society do not know the struggles of the mentally ill and how much support they are lacking from everyone else, they still judge them for their medical history and despite them saying that they have already recovered and episodes have not been occurring recently, everyone else would just ignore the fact that they are genuinely fine already and still see them as actively ill which is another reason why the society is not treated those mentally ill people as well as they should as they are not willing to give them a chance to feel like they belong and fit well as a singaporean but instead they would view and treat them differently.

Even though there are a huge group of people who are practically against the mentally ill, there are also another group of people who is willing to accept them and their differences wholeheartedly. ‘eight in 10 said they believe the best therapy for these persons is for them to be included in society.’ this shows that there are people who could identify and know a mentally ill patient and instead of having of mindset them eating medicine or being away from society is the best and only way for them to recover,

they know that including them into society and treating them as a normal person could take their minds away from their illness as they are interacting with people without mental illnesses and they are not being left alone to be overthinking their situation.

As a conclusion, i do believe that the way many people of the society treats being with mental illnesses is definitely without a doubt cruel but there are also minorities who are mature enough to put themselves into the shoes of the mental illness and treat them just like how they want to be treated.

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SINGAPORE - Even as more people are seeking outpatient treatment at the Institute of Mental Health (IMH), more than five in 10 respondents of a recent survey indicated they are unwilling to live with, live nearby or work with a person with a mental health condition.

The survey, which is the first of its kind by the National Council of Social Service (NCSS), also found that six in 10 people believe that mental health conditions are caused by a lack of self-discipline and willpower.

Another key finding from the survey conducted last year - half of the 1,796 respondents believe that persons with mental health conditions should not be given any responsibility.

But there were some encouraging notes in the findings, which were released on Saturday (Sept 8).

Seven in 10 respondents acknowledged that persons with mental health conditions experience stigma and discrimination in their daily lives, and eight in 10 said they believe the best therapy for these persons is for them to be included in society.

The findings highlight the misconceptions and stigma suffered by persons with mental health conditions, said NCSS deputy chief executive officer Tina Hung.

This will lead to them withdrawing from society and discouraging them from seeking help, added chief executive of IMH, Professor Chua Hong Choon.

"It's a vicious cycle - when they don't seek help, their condition deteriorates," Dr Chua added. "It is only when their condition worsens that they come to IMH and recovery will be more challenging then."

More people in Singapore have been seeking help for mental conditions such as depression, alcohol abuse and obsessive-compulsive disorder.

Last year, nearly 43,000 people went for outpatient treatment at IMH - a 22 per cent increase from the figure in 2010, according to previous reports.

And a Singapore Mental Health Study conducted in 2010 by IMH showed that one in eight adults here has experienced a mental health condition in their lifetime.

To combat stigma, a nationwide, five-year public education campaign was launched by NCSS on Saturday at the Mental Health Festival. The festival was organised by IMH to mark its 90th anniversary.

The Beyond The Label campaign, funded by the Tote Board Mental Health Strategic Initiative, will feature five Singaporeans aged 24 to 36 years old who are currently in recovery from various mental health conditions such as depression and schizophrenia, and have taken on the role as ambassadors for the campaign.

Their stories will be shown across Singapore, such as on public buses and at MRT stations, from September to November. Skits and other tools to kick-start conversations about mental health will also be used to help the public empathise with those with mental health conditions.

NCSS will also be working with partner groups to counter stigma towards mental health conditions.

Speaking at the launch on Saturday, Deputy Prime Minister Tharman Shanmugaratnam said that IMH - Singapore's only psychiatric hospital - has come a long way since it was founded as The Mental Hospital in Yio Chu Kang in 1923. Later, it was renamed Woodbridge Hospital in 1951, but the stigma still persisted.

"The stigma (back then) was very real and those with mental health conditions were living on the margins of society, and sometimes they were institutionalised for life. It was very tough for them, and also tough for the families," he said.

Since then, IMH has been renamed and relocated to Buangkok, and transitioned from an institutional care model to a community-based model focusing on early detection, rehabilitation as well as care and support in the community, he added.

"We have learnt a lot over the years, especially over the last 20 years, we've really come very far," he said.

DPM Tharman added that there are currently eight polyclinics offering mental health and dementia services, and 140 general practitioners have been trained to diagnose patients with mental health conditions.

He also urged Singaporeans to include those with mental health conditions in society, rather than shut them out.

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Many in Singapore unwilling to live or work with people with mental health conditions: Survey

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SINGAPORE - Even as more people are seeking outpatient treatment at the Institute of Mental Health (IMH), more than five in 10 respondents of a recent survey indicated they are unwilling to live with, live nearby or work with a person with a mental health condition.. Read more at straitstimes.com.

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there are many support network agencies and service in singapore that serves many different purposes and is beneficial to different groups of people. but what caught my eye is this agency for integrated care named 'Singapore Silver Pages'. their focus is to help seniors who are looking to age at home as they will need more healthcare and social services to help them stay well and safe as they age. what i really like about this page is that they have stories of certain elderlies and it helps other elderlies to somewhat understand more about what this agency does

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IN FOCUS

​​With more seniors looking to age at home, they will need more healthcare and social services to help them stay well and safe as they age. We share how the Community Networks for Seniors (CNS) sets out to deliver care and concern to our seniors.

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Drop us an email and we'll get back to you.

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Call Us

At Singapore Silver Line
Mon - Fri: 8.30am - 8.30pm
Sat: 8.30am - 4.00pm

1800-650-6060

Visit Us

Visit the AICare Link branch nearest to you.

Contact Us

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​​With more seniors looking to age at home, they will need more healthcare and social services to help them stay well and safe as they age. We share how the Community Networks for Seniors (CNS) sets out to deliver care and concern to our seniors. Drop us an email and we'll get back to you.

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from the article below, i learnt that there are

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The term psychological disorders is sometimes used to refer to what are more frequently known as mental disorders or psychiatric disorders.

Mental disorders are patterns of behavioral or psychological symptoms that impact multiple areas of life. These disorders create distress for the person experiencing the symptoms.

The DSM-5-TR lists hundreds of distinct conditions. Anxiety and depression are among the most common types of mental health conditions that people experience. While the DSM provides diagnostic information about such conditions, including the age at which they typically appear, it does not provide guidelines for treatment or predictions related to the course of illness.

While not a comprehensive list of every mental disorder, the following list includes some of the major categories of disorders described in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the fifth edition, text revision (DSM-5-TR). The DSM is one of the most widely used systems for classifying mental disorders and provides standardized diagnostic criteria.

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Neurodevelopmental Disorders

Neurodevelopmental disorders are those that are typically diagnosed during infancy, childhood, or adolescence. These psychological disorders include:

Intellectual Development Disorder

Sometimes called intellectual disability, this type of developmental disorder originates prior to the age of 18 and is characterized by limitations in both intellectual functioning and adaptive behaviors.

Limitations to intellectual functioning are often identified through the use of IQ tests, with an IQ score under 70 often indicating the presence of a limitation. Adaptive behaviors are those that involve practical, everyday skills such as self-care, social interaction, and living skills.

Global Developmental Delay

This diagnosis is for developmental disabilities in children who are under the age of five. Such delays relate to cognition, social functioning, speech, language, and motor skills.

It is generally seen as a temporary diagnosis applying to kids who are still too young to take standardized IQ tests. Once children reach the age where they are able to take a standardized intelligence test, they may be diagnosed with an intellectual development disorder.

Communication Disorders

These disorders are those that impact the ability to use, understand, or detect language and speech. The DSM-5 identifies four different subtypes of communication disorders: language disorder, speech sound disorder, childhood-onset fluency disorder (stuttering), and social (pragmatic) communication disorder.

Autism Spectrum Disorder

Autism is characterized by persistent deficits in social interaction and communication in multiple life areas as well as restricted and repetitive patterns of behaviors.

The DSM specifies that symptoms of autism spectrum disorder must be present during the early developmental period and that these symptoms must cause significant impairment in important areas of life including social and occupational functioning.

Attention-Deficit Hyperactivity Disorder (ADHD)

ADHD is characterized by a persistent pattern of hyperactivity and impulsivity and/or inattention that interferes with functioning and presents itself in two or more settings such as at home, work, school, and social situations.

The DSM-5 specifies that several of the symptoms must have been present prior to the age of 12 and that these symptoms must have a negative impact on social, occupational, or academic functioning.

Bipolar and Related Disorders

Bipolar disorder is characterized by shifts in mood as well as changes in activity and energy levels. The disorder often involves experiencing shifts between elevated moods and periods of depression. Such elevated moods can be pronounced and are referred to either as mania or hypomania.

Mania is characterized by a distinct period of elevated, expansive, or irritable mood accompanied by increased activity and energy. Periods of mania are sometimes marked by feelings of distraction, irritability, and excessive confidence.

When mania progresses, there is also the possibility of psychotic symptoms such as grandiose delusions and hallucinations. While mania occurs with bipolar I disorder, hypomania is a marker of bipolar II.

Hypomanic episodes are characterized by elevated, expansive, or irritable moods like manic episodes. However, hypomania is less severe and generally shorter in duration than mania.

Depressive Episodes

These episodes are characterized by feelings of a depressed or sad mood along with a lack of interest in activities. They may also involve feelings of guilt, fatigue, and irritability. During a depressive period, people with bipolar disorder may lose interest in activities that they previously enjoyed, experience sleeping difficulties, and even have thoughts of suicide.

Both manic and depressive episodes can be frightening for both the person experiencing these symptoms as well as family, friends, and other loved ones who observe these behaviors and mood shifts. Fortunately, appropriate and effective treatments, which often include both medications and psychotherapy, can help people with bipolar disorder successfully manage their symptoms.

Anxiety Disorders

Anxiety disorders are characterized by excessive and persistent fear, worry, anxiety and related behavioral disturbances. Fear involves an emotional response to a threat, whether that threat is real or perceived. Anxiety involves the anticipation that a future threat may arise. Types of anxiety disorders include:

Generalized Anxiety Disorder (GAD)

This disorderis marked by excessive worry about everyday events. While some stress and worry are a common part of life, GAD involves worry that is so excessive that it interferes with a person's well-being and functioning.

Social Anxiety Disorder

Social anxiety disorder is a fairly common psychological disorder that involves an irrational fear of being watched, judged, humiliated, and/or embarrassed. The anxiety caused by this disorder can have a major impact on an individual's life and make it difficult to function at school, work, and other social settings.

Specific Phobias

These phobias involve an extreme fear of a specific object or situation in the environment. Some examples of common specific phobias include fear of spiders, fear of heights, or fear of snakes.

The four main types of specific phobias involve natural events (thunder, lightning, tornadoes), medical (medical procedures, dental procedures, medical equipment), animals (dogs, snakes, bugs), and situational (small spaces, leaving home, driving).

Panic Disorder

This psychiatric disorder is characterized by panic attacks that may seem to strike out of the blue and for no reason at all. Because of this, people with panic disorder often experience anxiety and preoccupation over the possibility of having another panic attack.

People may begin to avoid situations and settings where attacks have occurred in the past or where they might occur in the future. This can create significant impairments in many areas of everyday life and make it difficult to carry out everyday routines.

Separation Anxiety Disorder

This condition is a type of anxiety disorder involving an excessive amount of fear or anxiety related to being separated from attachment figures. People are often familiar with the idea of separation anxiety as it relates to young children's fear of being apart from their parents, but older children and adults can experience it as well.

The person experiencing these symptoms may avoid moving away from home, going to school, or getting married in order to remain in close proximity to the attachment figure.

Trauma- and Stressor-Related Disorders

Trauma- and stressor-related disorders involve exposure to a stressful or traumatic event. These were previously grouped with anxiety disorders but are now considered a distinct category of disorders. Disorders included in this category include:

Acute Stress Disorder

Acute stress disorder is characterized by the emergence of severe anxiety for up to one month after exposure to a traumatic event. Some examples of traumatic events include natural disasters, war, accidents, and witnessing a death.

As a result, the individual may experience dissociative symptoms such as a sense of altered reality, an inability to remember important aspects of the event, and vivid flashbacks as if the event were reoccurring. Other symptoms can include reduced emotional responsiveness, distressing memories of the trauma, and difficulty experiencing positive emotions.

Adjustment Disorders

Adjustment disorders can occur as a response to a sudden change such as divorce, job loss, end of a close relationship, a move, or some other loss or disappointment. This type of psychological disorder can affect both children and adults and is characterized by symptoms such as anxiety, irritability, depressed mood, worry, anger, hopelessness, and feelings of isolation.

Post-Traumatic Stress Disorder (PTSD)

PTSD can develop after an individual has experienced exposure to actual or threatened death, serious injury, or sexual violence. Symptoms of PTSD include episodes of reliving or re-experiencing the event, avoiding things that remind the individual about the event, feeling on edge, and having negative thoughts.

Reactive Attachment Disorder

Reactive attachment disorder can result when children do not form healthy relationships and attachments with adult caregivers during the first few years of childhood. Symptoms of the disorder include being withdrawn from adult caregivers and social and emotional disturbances that result from patterns of insufficient care and neglect.

Dissociative Disorders

Dissociative disorders are psychological disorders that involve a dissociation or interruption in aspects of consciousness, including identity and memory. Dissociative disorders include:

Dissociative Amnesia

This disorder involves a temporary loss of memory as a result of dissociation. In many cases, this memory loss, which may last for just a brief period or for many years, is a result of some type of psychological trauma.

Dissociative amnesia is much more than simple forgetfulness. Those who experience this disorder may remember some details about events but may have no recall of other details around a circumscribed period of time.

Dissociative Identity Disorder

Formerly known as multiple personality disorder, dissociative identity disorder involves the presence of two or more different identities or personalities in one person. Each of these personalities has its own way of perceiving and interacting with the environment.

People with this disorder experience changes in behavior, memory, perception, emotional response, and consciousness.

Depersonalization/Derealization Disorder

Depersonalization/derealization disorder is characterized by experiencing a sense of being outside of one's own body (depersonalization) and being disconnected from reality (derealization). People who have this disorder often feel a sense of unreality and an involuntary disconnect from their own memories, feelings, and consciousness.

Somatic Symptom Disorders

Formerly referred to as somatoform disorders, this category is now known as somatic symptom disorders. Somatic symptom disorders are a class of psychological disorders that involve prominent physical symptoms that may not have a diagnosable physical cause.

In contrast to previous ways of conceptualizing these disorders based on the absence of a medical explanation for the physical symptoms, the current diagnosis emphasizes the unusual thoughts, feelings, and behaviors that occur in response to these symptoms. Disorders included in this category are:

Somatic Symptom Disorder

Somatic symptom disorder involves a preoccupation with physical symptoms that make it difficult to function. This preoccupation with symptoms results in emotional distress and difficulty coping with daily life.

It is important to note that somatic symptoms do not indicate that individuals are faking their physical pain, fatigue, or other symptoms. In this situation, it is not so much the actual physical symptoms that are disrupting the individual's life as it is the extreme reaction and resulting behaviors.

Illness Anxiety Disorder

Illness anxiety disorder is characterized by excessive concern about having an undiagnosed medical condition. Those who experience this psychological disorder worry excessively about body functions and sensations are convinced that they have or will get a serious disease, and are not reassured, even when medical tests don't detect any illnesses.

Conversion Disorder

Conversion disorder involves experiencing motor or sensory symptoms that lack a compatible neurological or medical explanation. In many cases, a person develops the disorder after experiencing a real physical injury or stressful event, which then results in a psychological and emotional response.

Factitious Disorder

Factitious disorder used to have its own category, but it is now included under the somatic symptom and related disorders category of the DSM-5. A factitious disorder is when an individual intentionally creates, fakes, or exaggerates symptoms of illness. Munchausen syndrome, in which people feign an illness to attract attention, is one severe form of factitious disorder.

Feeding and Eating Disorders

Eating disorders are characterized by obsessive concerns with weight and disruptive eating patterns that negatively impact physical and mental health. Types of eating disorders include:

Anorexia Nervosa

Anorexia nervosais characterized by restricted food consumption that can lead to weight loss. Some people with anorexia are underweight, while others may be of average or above-average weight. Those who experience this disorder also have a preoccupation and fear of gaining weight as well as a distorted view of their own appearance and behavior.

Bulimia Nervosa

Bulimia nervosainvolves binge eating and then taking extreme steps to compensate for these binges. These compensatory behaviors might include self-induced vomiting, the abuse of laxatives or diuretics, or excessive exercise.

Rumination Disorder

Rumination disorder is marked by regurgitating previously chewed or swallowed food in order to either spit it out or re-swallow it. Rumination disorder can occur in infants, children, teens, and adults. It's also more common in people who have anxiety, depression, or another psychiatric disorder.

Pica involves craving and consuming non-food substances such as dirt, paint, or soap. Pica is more common among young children than adults, but it is also known to occur during pregnancy. A lack of nutrients may also trigger non-food cravings in some instances.

Binge Eating Disorder

Binge eating disorder involves episodes of binge eating where the individual consumes an unusually large amount of food during a short time period, such as a couple of hours.

People with binge-eating disorder often feel they have no control over their eating. Binge eating episodes are sometimes triggered by certain emotions such as feeling happy, anxious, or bored, or following stressful events.

Sleep-Wake Disorders

Sleep disorders involve an interruption in sleep patterns that leads to distress and affects daytime functioning. Examples of sleep disorders include:

Narcolepsy

Narcolepsy is a condition in which people experience an irrepressible need to sleep. People with narcolepsy may experience a sudden loss of muscle tone, also known as cataplexy.

They are also prone to hypnagogic hallucinations, which happen as someone falls asleep, and hypnopompic hallucinations, which happen as someone wakes up.

Insomnia Disorder

Insomnia disorder involves being unable to get enough sleep to feel rested. While all people experience sleeping difficulties and interruptions at some point, insomnia is considered a disorder when it is accompanied by significant distress or impairment over time.

Hypersomnolence

Hypersomnolence disorder is characterized by excessive sleepiness despite an adequate main sleep period. People with this condition may fall asleep during the day at inappropriate times such as at work and school.

Breathing-Related Sleep Disorders

Breathing-related sleep disorders are those that involve breathing anomalies-such as sleep apnea-that can occur during sleep. These breathing problems can result in brief interruptions in sleep that can lead to other problems including insomnia and daytime sleepiness.

Parasomnias

Parasomnia is a term that describes sleep disorders that feature unusual behaviors. Such disorders include sleepwalking, sleep terrors, sleep talking, and sleep eating.

Restless Legs Syndrome

Restless legs syndrome is a neurological condition that involves having uncomfortable sensations in the legs and an irresistible urge to move the legs in order to relieve the sensations. People with this condition may feel tugging, creeping, burning, and crawling sensations in their legs resulting in an excessive movement which then interferes with sleep.

Disruptive, Impulse Control and Conduct Disorders

Disruptive, impulse control and conduct disorders are those that involve an inability to control emotions and behaviors, resulting in harm to oneself or others.

These challenges with emotional and behavioral regulation are characterized by actions that violate the rights of others such as destroying property or physical aggression and/or those that conflict with societal norms, authority figures, and laws. These disorders include:

Kleptomania

Kleptomania involves an inability to control the impulse to steal. People who have kleptomania will often steal things that they do not really need or that have no real monetary value. Those with this condition experience escalating tension prior to committing a theft and feel relief and gratification afterwards.

Pyromania involves a fascination with fire that results in acts of fire-starting that endanger the self and others. People who struggle with pyromania purposefully and deliberately have set fires more than one time. They also experience tension and emotional arousal before setting a fire.

Intermittent Explosive Disorder

Intermittent explosive disorder is characterized by brief outbursts of anger and violence that are out of proportion to the situation. People with this disorder may erupt into angry outbursts or violent actions in response to everyday annoyances or disappointments.

Conduct Disorder

Conduct disorder is a condition diagnosed in children and adolescents under the age of 18 who regularly violate social norms and the rights of others. Children with this disorder display aggression toward people and animals, destroy property, steal and deceive, and violate other rules and laws. These behaviors result in significant problems in a child's academic or social functioning.

Oppositional Defiant Disorder

Oppositional defiant disorder begins prior to the age of 18 and is characterized by defiance, irritability, anger, aggression, and vindictiveness.

Depressive Disorders

The category of depressive disorders includes a number of conditions. They are all characterized by the presence of sad, empty, or irritable moods accompanied by physical and cognitive symptoms. They differ in terms of duration, timing, and causes. Some include:

Disruptive mood dysregulation disorder: A childhood condition characterized by extreme anger and irritability. Children display frequent and intense outbursts of temper.

Major depressive disorder: A condition characterized by loss of interest in activities and depressed mood which leads to significant impairments in how a person is able to function.

Persistent depressive disorder:This is a type of ongoing, chronic depression that is characterized by other symptoms of depression. While the symptoms are often less severe, they are longer lasting. Diagnosis requires experiencing a depressed mood on most days for a period of at least two years.

Other specified depressive disorder: This diagnosis is for cases when symptoms do not meet the criteria for the diagnosis of another depressive disorder, but they still create problems with an individual's life and functioning.

Premenstrual dysphoric disorder: This condition is a form of premenstrual syndrome (PMS) characterized by significant depression, irritability, and anxiety that begins a week or two before menstruation begins. Symptoms usually go away within a few days following bleeding.

Substance/medication-induced depressive disorder: This condition occurs when an individual experiences symptoms of a depressive disorder either while using alcohol or other substances or while going through withdrawal from a substance.

Depressive disorder due to another medical condition: This condition is diagnosed when a person's medical history suggests that their depressive symptoms may be the result of a medical condition. Medical conditions that may contribute to or cause depression include diabetes, stroke, Parkinson's disease, autoimmune conditions, chronic pain conditions, cancer, infections and HIV/AIDS.

Depressive disorders are all characterized by feelings of sadness and low mood that are persistent and severe enough to affect how a person functions.

The diagnostic criteria vary for each specific condition. For major depressive disorder, diagnosis requires an individual to experience five or more of the following symptoms over the same two-week period.

One of these symptoms must include either depressed mood or loss of interest or pleasure in previously enjoyed activities. Other symptoms can include:

Significant weight loss or gain

Decreased or increased appetite

Sleep disturbances (insomnia or hypersomnia)

Feelings of slowed physical activity or restlessness

Lack of energy or fatigue that lasts most or all of the day

Feelings of guilt or worthlessness

Difficulty thinking or concentrating

Preoccupation with death or thoughts of suicide

Treatments for depressive disorders often involve a combination of psychotherapy and medications.

Substance Use and Addictive Disorders

Substance-related disorders are those that involve the misuse of different substances such as cocaine, methamphetamine, opiates, and alcohol.

These disorders may include substance-induced conditions that can result in many associated diagnoses including intoxication, withdrawal, or the emergence of psychosis, anxiety, and delirium. Examples of substance-related disorders include:

Alcohol-related disorders: Theseinvolve the consumption of alcohol, one of the most widely used drugs in the United States.

Cannabis-related disorders: These disordersinclude symptoms such as using more marijuana than originally intended, feeling unable to stop it, and continuing to use it despite adverse effects in one's life.

Inhalant-use disorders: Theseinvolve inhaling fumes from things such as paints or solvents. As with other substance-related disorders, people with this condition experience cravings for the substance and find it difficult to control or stop engaging in the behavior.

Stimulant use disorder: Thisinvolves the use of stimulants such as meth, amphetamines, and cocaine.

Tobacco use disorder: This is characterized by symptoms such as consuming more tobacco than intended, difficulty cutting back or quitting, cravings, and experiencing adverse social consequences as a result of tobacco use.

Gambling Disorder

Neurocognitive Disorders

Neurocognitive disorders are characterized by acquired deficits in cognitive function. These disorders do not include those in which impaired cognition was present at birth or early in life. Types of cognitive disorders include:

Delirium is also known as acute confusional state. This disorder develops over a short period of time-usually a few hours or a few days-and is characterized by disturbances in attention and awareness.

Other Neurocognitive Disorders

Major and mild neurocognitive disorders have the primary feature of acquired cognitive decline in one or more areas including memory, attention, language, learning, and perception.

These cognitive disorders can be due to medical conditions including Alzheimer's disease, HIV infection, Parkinson's disease, substance/medication use, vascular disease, and others.

Schizophrenia Spectrum and Other Psychotic Disorders

Schizophrenia is a chronic psychiatric condition that affects a person's thinking, feeling, and behavior. It is a complex, long-term condition that affects less than 1% of people in the United States.

The DSM-5 diagnostic criteria specify that two or more symptoms of schizophrenia must be present for a period of at least one month.

One symptom must be one of the following:

Delusions: Beliefs that conflict with reality

Hallucinations: Seeing or hearing things that aren't really there

Disorganized speech: Words that do not follow the rules of language and may be difficult or impossible to understand

The second symptom may be one of the following:

Grossly disorganized or catatonic behavior: Confused thinking or bizarre behavior or movements

Negative symptoms: The inability to initiate plans, speak, express emotions, or feel pleasure

Diagnosis also requires significant impairments in social or occupational functioning for a period of at least six months. The onset of schizophrenia is usually in the late teens or early 20s, with men usually showing symptoms earlier than women. Earlier signs of the condition that may occur before diagnosis include poor motivation, difficult relationships, and poor school performance.

The National Institute of Mental Health suggests that multiple factors may play a role in the development of schizophrenia including genetics, brain chemistry, environmental factors, and substance use.

Obsessive-Compulsive and Related Disorders

Obsessive-compulsive and related disorders is a category of psychiatric conditions that include:

Each condition in this classification has its own set of diagnostic criteria.

Obsessive-Compulsive Disorder

The diagnostic criteria in the DSM-5 specify that in order to be diagnosed with obsessive-compulsive disorder, a person must experience obsessions, compulsions, or both.

Obsessions: Defined as recurrent, persistent thoughts, impulses, and urges that lead to distress or anxiety

Compulsions: Repetitive and excessive behaviors that the individual feels that they must perform to reduce anxiety or to prevent some dreaded outcome from occurring

Treatments for OCD usually focus on a combination of therapy and medications. Cognitive-behavioral therapy (CBT) or a form of CBT known as exposure and response prevention (ERP) are commonly used. Antidepressants such as Anafranil (clomipramine) or Prozac (fluoxetine) may also be prescribed to manage symptoms.

Personality Disorders

Personality disorders are characterized by an enduring pattern of maladaptive thoughts, feelings, and behaviors that can cause serious detriments to relationships and other life areas. Types of personality disorders include:

Antisocial Personality Disorder

Antisocial personality disorder is characterized by a long-standing disregard for rules, social norms, and the rights of others. People with this disorder typically begin displaying symptoms during childhood, have difficulty feeling empathy for others, and lack remorse for their destructive behaviors.

Avoidant Personality Disorder

Avoidant personality disorder involves severe social inhibition and sensitivity to rejection. Such feelings of insecurity lead to significant problems with the individual's daily life and functioning.

Borderline Personality Disorder

Borderline personality disorder is associated with symptoms including emotional instability, unstable and intense interpersonal relationships, unstable self-image, and impulsive behaviors.

Dependent Personality Disorder

Dependent personality disorder involves a chronic pattern of fearing separation and an excessive need to be taken care of. People with this disorder will often engage in behaviors that are designed to produce care-giving actions in others.

Histrionic Personality Disorder

Histrionic personality disorder is associated with patterns of extreme emotionality and attention-seeking behaviors. People with this condition feel uncomfortable in settings where they are not the center of attention, have rapidly changing emotions, and may engage in socially inappropriate behaviors designed to attract attention from others.

Narcissistic Personality Disorder

Narcissistic personality disorder is associated with a lasting pattern of exaggerated self-image, self-centeredness, and low empathy. People with this condition tend to be more interested in themselves than in others.

Obsessive-Compulsive Personality Disorder

Obsessive-compulsive personality disorder is a pervasive pattern of preoccupation with orderliness, perfectionism, inflexibility, and mental and interpersonal control. This is a different condition than obsessive compulsive disorder (OCD).

Paranoid Personality Disorder

Paranoid personality disorder is characterized by a distrust of others, even family, friends, and romantic partners. People with this disorder perceive others' intentions as malevolent, even without any evidence or justification.

Schizoid Personality Disorder

Schizoid personality disorder involves symptoms that include being detached from social relationships. People with this disorder are directed toward their inner lives and are often indifferent to relationships. They generally display a lack of emotional expression and can appear cold and aloof.

Schizotypal Personality Disorder

Schizotypal personality disorder features eccentricities in speech, behaviors, appearance, and thought. People with this condition may experience odd beliefs or magical thinking as well as difficulty forming relationships.

A Word From Verywell

Various factors influence a person's risk of developing a psychological disorder, including biological, social, environmental, cultural, and economic factors. Factors such as social support and coping skills can have protective effects.

Some conditions are short-term, while others may be lifelong. Conditions can also change over time.

Psychological disorders can cause disruptions in daily functioning, relationships, work, school, and other important domains. However, with appropriate diagnosis and treatment, people can find relief from their symptoms and discover ways to cope effectively.

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Explore a List of Psychological Disorders From the DSM-5

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Psychological disorders are grouped into different categories in the DSM-5. Explore this list of different types of mental disorders and how they are categorized.

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The term psychological disorders is sometimes used to refer to what are more frequently known as mental disorders or psychiatric disorders.

Mental disorders are patterns of behavioral or psychological symptoms that impact multiple areas of life. These disorders create distress for the person experiencing the symptoms.

The DSM-5-TR lists hundreds of distinct conditions. Anxiety and depression are among the most common types of mental health conditions that people experience. While the DSM provides diagnostic information about such conditions, including the age at which they typically appear, it does not provide guidelines for treatment or predictions related to the course of illness.

While not a comprehensive list of every mental disorder, the following list includes some of the major categories of disorders described in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the fifth edition, text revision (DSM-5-TR). The DSM is one of the most widely used systems for classifying mental disorders and provides standardized diagnostic criteria.

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Neurodevelopmental Disorders

Neurodevelopmental disorders are those that are typically diagnosed during infancy, childhood, or adolescence. These psychological disorders include:

Intellectual Development Disorder

Sometimes called intellectual disability, this type of developmental disorder originates prior to the age of 18 and is characterized by limitations in both intellectual functioning and adaptive behaviors.

Limitations to intellectual functioning are often identified through the use of IQ tests, with an IQ score under 70 often indicating the presence of a limitation. Adaptive behaviors are those that involve practical, everyday skills such as self-care, social interaction, and living skills.

Global Developmental Delay

This diagnosis is for developmental disabilities in children who are under the age of five. Such delays relate to cognition, social functioning, speech, language, and motor skills.

It is generally seen as a temporary diagnosis applying to kids who are still too young to take standardized IQ tests. Once children reach the age where they are able to take a standardized intelligence test, they may be diagnosed with an intellectual development disorder.

Communication Disorders

These disorders are those that impact the ability to use, understand, or detect language and speech. The DSM-5 identifies four different subtypes of communication disorders: language disorder, speech sound disorder, childhood-onset fluency disorder (stuttering), and social (pragmatic) communication disorder.

Autism Spectrum Disorder

Autism is characterized by persistent deficits in social interaction and communication in multiple life areas as well as restricted and repetitive patterns of behaviors.

The DSM specifies that symptoms of autism spectrum disorder must be present during the early developmental period and that these symptoms must cause significant impairment in important areas of life including social and occupational functioning.

Attention-Deficit Hyperactivity Disorder (ADHD)

ADHD is characterized by a persistent pattern of hyperactivity and impulsivity and/or inattention that interferes with functioning and presents itself in two or more settings such as at home, work, school, and social situations.

The DSM-5 specifies that several of the symptoms must have been present prior to the age of 12 and that these symptoms must have a negative impact on social, occupational, or academic functioning.

Bipolar and Related Disorders

Bipolar disorder is characterized by shifts in mood as well as changes in activity and energy levels. The disorder often involves experiencing shifts between elevated moods and periods of depression. Such elevated moods can be pronounced and are referred to either as mania or hypomania.

Mania is characterized by a distinct period of elevated, expansive, or irritable mood accompanied by increased activity and energy. Periods of mania are sometimes marked by feelings of distraction, irritability, and excessive confidence.

When mania progresses, there is also the possibility of psychotic symptoms such as grandiose delusions and hallucinations. While mania occurs with bipolar I disorder, hypomania is a marker of bipolar II.

Hypomanic episodes are characterized by elevated, expansive, or irritable moods like manic episodes. However, hypomania is less severe and generally shorter in duration than mania.

Depressive Episodes

These episodes are characterized by feelings of a depressed or sad mood along with a lack of interest in activities. They may also involve feelings of guilt, fatigue, and irritability. During a depressive period, people with bipolar disorder may lose interest in activities that they previously enjoyed, experience sleeping difficulties, and even have thoughts of suicide.

Both manic and depressive episodes can be frightening for both the person experiencing these symptoms as well as family, friends, and other loved ones who observe these behaviors and mood shifts. Fortunately, appropriate and effective treatments, which often include both medications and psychotherapy, can help people with bipolar disorder successfully manage their symptoms.

Anxiety Disorders

Anxiety disorders are characterized by excessive and persistent fear, worry, anxiety and related behavioral disturbances. Fear involves an emotional response to a threat, whether that threat is real or perceived. Anxiety involves the anticipation that a future threat may arise. Types of anxiety disorders include:

Generalized Anxiety Disorder (GAD)

This disorderis marked by excessive worry about everyday events. While some stress and worry are a common part of life, GAD involves worry that is so excessive that it interferes with a person's well-being and functioning.

Social Anxiety Disorder

Social anxiety disorder is a fairly common psychological disorder that involves an irrational fear of being watched, judged, humiliated, and/or embarrassed. The anxiety caused by this disorder can have a major impact on an individual's life and make it difficult to function at school, work, and other social settings.

Specific Phobias

These phobias involve an extreme fear of a specific object or situation in the environment. Some examples of common specific phobias include fear of spiders, fear of heights, or fear of snakes.

The four main types of specific phobias involve natural events (thunder, lightning, tornadoes), medical (medical procedures, dental procedures, medical equipment), animals (dogs, snakes, bugs), and situational (small spaces, leaving home, driving).

Panic Disorder

This psychiatric disorder is characterized by panic attacks that may seem to strike out of the blue and for no reason at all. Because of this, people with panic disorder often experience anxiety and preoccupation over the possibility of having another panic attack.

People may begin to avoid situations and settings where attacks have occurred in the past or where they might occur in the future. This can create significant impairments in many areas of everyday life and make it difficult to carry out everyday routines.

Separation Anxiety Disorder

This condition is a type of anxiety disorder involving an excessive amount of fear or anxiety related to being separated from attachment figures. People are often familiar with the idea of separation anxiety as it relates to young children's fear of being apart from their parents, but older children and adults can experience it as well.

The person experiencing these symptoms may avoid moving away from home, going to school, or getting married in order to remain in close proximity to the attachment figure.

Trauma- and Stressor-Related Disorders

Trauma- and stressor-related disorders involve exposure to a stressful or traumatic event. These were previously grouped with anxiety disorders but are now considered a distinct category of disorders. Disorders included in this category include:

Acute Stress Disorder

Acute stress disorder is characterized by the emergence of severe anxiety for up to one month after exposure to a traumatic event. Some examples of traumatic events include natural disasters, war, accidents, and witnessing a death.

As a result, the individual may experience dissociative symptoms such as a sense of altered reality, an inability to remember important aspects of the event, and vivid flashbacks as if the event were reoccurring. Other symptoms can include reduced emotional responsiveness, distressing memories of the trauma, and difficulty experiencing positive emotions.

Adjustment Disorders

Adjustment disorders can occur as a response to a sudden change such as divorce, job loss, end of a close relationship, a move, or some other loss or disappointment. This type of psychological disorder can affect both children and adults and is characterized by symptoms such as anxiety, irritability, depressed mood, worry, anger, hopelessness, and feelings of isolation.

Post-Traumatic Stress Disorder (PTSD)

PTSD can develop after an individual has experienced exposure to actual or threatened death, serious injury, or sexual violence. Symptoms of PTSD include episodes of reliving or re-experiencing the event, avoiding things that remind the individual about the event, feeling on edge, and having negative thoughts.

Reactive Attachment Disorder

Reactive attachment disorder can result when children do not form healthy relationships and attachments with adult caregivers during the first few years of childhood. Symptoms of the disorder include being withdrawn from adult caregivers and social and emotional disturbances that result from patterns of insufficient care and neglect.

Dissociative Disorders

Dissociative disorders are psychological disorders that involve a dissociation or interruption in aspects of consciousness, including identity and memory. Dissociative disorders include:

Dissociative Amnesia

This disorder involves a temporary loss of memory as a result of dissociation. In many cases, this memory loss, which may last for just a brief period or for many years, is a result of some type of psychological trauma.

Dissociative amnesia is much more than simple forgetfulness. Those who experience this disorder may remember some details about events but may have no recall of other details around a circumscribed period of time.

Dissociative Identity Disorder

Formerly known as multiple personality disorder, dissociative identity disorder involves the presence of two or more different identities or personalities in one person. Each of these personalities has its own way of perceiving and interacting with the environment.

People with this disorder experience changes in behavior, memory, perception, emotional response, and consciousness.

Depersonalization/Derealization Disorder

Depersonalization/derealization disorder is characterized by experiencing a sense of being outside of one's own body (depersonalization) and being disconnected from reality (derealization). People who have this disorder often feel a sense of unreality and an involuntary disconnect from their own memories, feelings, and consciousness.

Somatic Symptom Disorders

Formerly referred to as somatoform disorders, this category is now known as somatic symptom disorders. Somatic symptom disorders are a class of psychological disorders that involve prominent physical symptoms that may not have a diagnosable physical cause.

In contrast to previous ways of conceptualizing these disorders based on the absence of a medical explanation for the physical symptoms, the current diagnosis emphasizes the unusual thoughts, feelings, and behaviors that occur in response to these symptoms. Disorders included in this category are:

Somatic Symptom Disorder

Somatic symptom disorder involves a preoccupation with physical symptoms that make it difficult to function. This preoccupation with symptoms results in emotional distress and difficulty coping with daily life.

It is important to note that somatic symptoms do not indicate that individuals are faking their physical pain, fatigue, or other symptoms. In this situation, it is not so much the actual physical symptoms that are disrupting the individual's life as it is the extreme reaction and resulting behaviors.

Illness Anxiety Disorder

Illness anxiety disorder is characterized by excessive concern about having an undiagnosed medical condition. Those who experience this psychological disorder worry excessively about body functions and sensations are convinced that they have or will get a serious disease, and are not reassured, even when medical tests don't detect any illnesses.

Conversion Disorder

Conversion disorder involves experiencing motor or sensory symptoms that lack a compatible neurological or medical explanation. In many cases, a person develops the disorder after experiencing a real physical injury or stressful event, which then results in a psychological and emotional response.

Factitious Disorder

Factitious disorder used to have its own category, but it is now included under the somatic symptom and related disorders category of the DSM-5. A factitious disorder is when an individual intentionally creates, fakes, or exaggerates symptoms of illness. Munchausen syndrome, in which people feign an illness to attract attention, is one severe form of factitious disorder.

Feeding and Eating Disorders

Eating disorders are characterized by obsessive concerns with weight and disruptive eating patterns that negatively impact physical and mental health. Types of eating disorders include:

Anorexia Nervosa

Anorexia nervosais characterized by restricted food consumption that can lead to weight loss. Some people with anorexia are underweight, while others may be of average or above-average weight. Those who experience this disorder also have a preoccupation and fear of gaining weight as well as a distorted view of their own appearance and behavior.

Bulimia Nervosa

Bulimia nervosainvolves binge eating and then taking extreme steps to compensate for these binges. These compensatory behaviors might include self-induced vomiting, the abuse of laxatives or diuretics, or excessive exercise.

Rumination Disorder

Rumination disorder is marked by regurgitating previously chewed or swallowed food in order to either spit it out or re-swallow it. Rumination disorder can occur in infants, children, teens, and adults. It's also more common in people who have anxiety, depression, or another psychiatric disorder.

Pica involves craving and consuming non-food substances such as dirt, paint, or soap. Pica is more common among young children than adults, but it is also known to occur during pregnancy. A lack of nutrients may also trigger non-food cravings in some instances.

Binge Eating Disorder

Binge eating disorder involves episodes of binge eating where the individual consumes an unusually large amount of food during a short time period, such as a couple of hours.

People with binge-eating disorder often feel they have no control over their eating. Binge eating episodes are sometimes triggered by certain emotions such as feeling happy, anxious, or bored, or following stressful events.

Sleep-Wake Disorders

Sleep disorders involve an interruption in sleep patterns that leads to distress and affects daytime functioning. Examples of sleep disorders include:

Narcolepsy

Narcolepsy is a condition in which people experience an irrepressible need to sleep. People with narcolepsy may experience a sudden loss of muscle tone, also known as cataplexy.

They are also prone to hypnagogic hallucinations, which happen as someone falls asleep, and hypnopompic hallucinations, which happen as someone wakes up.

Insomnia Disorder

Insomnia disorder involves being unable to get enough sleep to feel rested. While all people experience sleeping difficulties and interruptions at some point, insomnia is considered a disorder when it is accompanied by significant distress or impairment over time.

Hypersomnolence

Hypersomnolence disorder is characterized by excessive sleepiness despite an adequate main sleep period. People with this condition may fall asleep during the day at inappropriate times such as at work and school.

Breathing-Related Sleep Disorders

Breathing-related sleep disorders are those that involve breathing anomalies-such as sleep apnea-that can occur during sleep. These breathing problems can result in brief interruptions in sleep that can lead to other problems including insomnia and daytime sleepiness.

Parasomnias

Parasomnia is a term that describes sleep disorders that feature unusual behaviors. Such disorders include sleepwalking, sleep terrors, sleep talking, and sleep eating.

Restless Legs Syndrome

Restless legs syndrome is a neurological condition that involves having uncomfortable sensations in the legs and an irresistible urge to move the legs in order to relieve the sensations. People with this condition may feel tugging, creeping, burning, and crawling sensations in their legs resulting in an excessive movement which then interferes with sleep.

Disruptive, Impulse Control and Conduct Disorders

Disruptive, impulse control and conduct disorders are those that involve an inability to control emotions and behaviors, resulting in harm to oneself or others.

These challenges with emotional and behavioral regulation are characterized by actions that violate the rights of others such as destroying property or physical aggression and/or those that conflict with societal norms, authority figures, and laws. These disorders include:

Kleptomania

Kleptomania involves an inability to control the impulse to steal. People who have kleptomania will often steal things that they do not really need or that have no real monetary value. Those with this condition experience escalating tension prior to committing a theft and feel relief and gratification afterwards.

Pyromania involves a fascination with fire that results in acts of fire-starting that endanger the self and others. People who struggle with pyromania purposefully and deliberately have set fires more than one time. They also experience tension and emotional arousal before setting a fire.

Intermittent Explosive Disorder

Intermittent explosive disorder is characterized by brief outbursts of anger and violence that are out of proportion to the situation. People with this disorder may erupt into angry outbursts or violent actions in response to everyday annoyances or disappointments.

Conduct Disorder

Conduct disorder is a condition diagnosed in children and adolescents under the age of 18 who regularly violate social norms and the rights of others. Children with this disorder display aggression toward people and animals, destroy property, steal and deceive, and violate other rules and laws. These behaviors result in significant problems in a child's academic or social functioning.

Oppositional Defiant Disorder

Oppositional defiant disorder begins prior to the age of 18 and is characterized by defiance, irritability, anger, aggression, and vindictiveness.

Depressive Disorders

The category of depressive disorders includes a number of conditions. They are all characterized by the presence of sad, empty, or irritable moods accompanied by physical and cognitive symptoms. They differ in terms of duration, timing, and causes. Some include:

Disruptive mood dysregulation disorder: A childhood condition characterized by extreme anger and irritability. Children display frequent and intense outbursts of temper.

Major depressive disorder: A condition characterized by loss of interest in activities and depressed mood which leads to significant impairments in how a person is able to function.

Persistent depressive disorder:This is a type of ongoing, chronic depression that is characterized by other symptoms of depression. While the symptoms are often less severe, they are longer lasting. Diagnosis requires experiencing a depressed mood on most days for a period of at least two years.

Other specified depressive disorder: This diagnosis is for cases when symptoms do not meet the criteria for the diagnosis of another depressive disorder, but they still create problems with an individual's life and functioning.

Premenstrual dysphoric disorder: This condition is a form of premenstrual syndrome (PMS) characterized by significant depression, irritability, and anxiety that begins a week or two before menstruation begins. Symptoms usually go away within a few days following bleeding.

Substance/medication-induced depressive disorder: This condition occurs when an individual experiences symptoms of a depressive disorder either while using alcohol or other substances or while going through withdrawal from a substance.

Depressive disorder due to another medical condition: This condition is diagnosed when a person's medical history suggests that their depressive symptoms may be the result of a medical condition. Medical conditions that may contribute to or cause depression include diabetes, stroke, Parkinson's disease, autoimmune conditions, chronic pain conditions, cancer, infections and HIV/AIDS.

Depressive disorders are all characterized by feelings of sadness and low mood that are persistent and severe enough to affect how a person functions.

The diagnostic criteria vary for each specific condition. For major depressive disorder, diagnosis requires an individual to experience five or more of the following symptoms over the same two-week period.

One of these symptoms must include either depressed mood or loss of interest or pleasure in previously enjoyed activities. Other symptoms can include:

Significant weight loss or gain

Decreased or increased appetite

Sleep disturbances (insomnia or hypersomnia)

Feelings of slowed physical activity or restlessness

Lack of energy or fatigue that lasts most or all of the day

Feelings of guilt or worthlessness

Difficulty thinking or concentrating

Preoccupation with death or thoughts of suicide

Treatments for depressive disorders often involve a combination of psychotherapy and medications.

Substance Use and Addictive Disorders

Substance-related disorders are those that involve the misuse of different substances such as cocaine, methamphetamine, opiates, and alcohol.

These disorders may include substance-induced conditions that can result in many associated diagnoses including intoxication, withdrawal, or the emergence of psychosis, anxiety, and delirium. Examples of substance-related disorders include:

Alcohol-related disorders: Theseinvolve the consumption of alcohol, one of the most widely used drugs in the United States.

Cannabis-related disorders: These disordersinclude symptoms such as using more marijuana than originally intended, feeling unable to stop it, and continuing to use it despite adverse effects in one's life.

Inhalant-use disorders: Theseinvolve inhaling fumes from things such as paints or solvents. As with other substance-related disorders, people with this condition experience cravings for the substance and find it difficult to control or stop engaging in the behavior.

Stimulant use disorder: Thisinvolves the use of stimulants such as meth, amphetamines, and cocaine.

Tobacco use disorder: This is characterized by symptoms such as consuming more tobacco than intended, difficulty cutting back or quitting, cravings, and experiencing adverse social consequences as a result of tobacco use.

Gambling Disorder

Neurocognitive Disorders

Neurocognitive disorders are characterized by acquired deficits in cognitive function. These disorders do not include those in which impaired cognition was present at birth or early in life. Types of cognitive disorders include:

Delirium is also known as acute confusional state. This disorder develops over a short period of time-usually a few hours or a few days-and is characterized by disturbances in attention and awareness.

Other Neurocognitive Disorders

Major and mild neurocognitive disorders have the primary feature of acquired cognitive decline in one or more areas including memory, attention, language, learning, and perception.

These cognitive disorders can be due to medical conditions including Alzheimer's disease, HIV infection, Parkinson's disease, substance/medication use, vascular disease, and others.

Schizophrenia Spectrum and Other Psychotic Disorders

Schizophrenia is a chronic psychiatric condition that affects a person's thinking, feeling, and behavior. It is a complex, long-term condition that affects less than 1% of people in the United States.

The DSM-5 diagnostic criteria specify that two or more symptoms of schizophrenia must be present for a period of at least one month.

One symptom must be one of the following:

Delusions: Beliefs that conflict with reality

Hallucinations: Seeing or hearing things that aren't really there

Disorganized speech: Words that do not follow the rules of language and may be difficult or impossible to understand

The second symptom may be one of the following:

Grossly disorganized or catatonic behavior: Confused thinking or bizarre behavior or movements

Negative symptoms: The inability to initiate plans, speak, express emotions, or feel pleasure

Diagnosis also requires significant impairments in social or occupational functioning for a period of at least six months. The onset of schizophrenia is usually in the late teens or early 20s, with men usually showing symptoms earlier than women. Earlier signs of the condition that may occur before diagnosis include poor motivation, difficult relationships, and poor school performance.

The National Institute of Mental Health suggests that multiple factors may play a role in the development of schizophrenia including genetics, brain chemistry, environmental factors, and substance use.

Obsessive-Compulsive and Related Disorders

Obsessive-compulsive and related disorders is a category of psychiatric conditions that include:

Each condition in this classification has its own set of diagnostic criteria.

Obsessive-Compulsive Disorder

The diagnostic criteria in the DSM-5 specify that in order to be diagnosed with obsessive-compulsive disorder, a person must experience obsessions, compulsions, or both.

Obsessions: Defined as recurrent, persistent thoughts, impulses, and urges that lead to distress or anxiety

Compulsions: Repetitive and excessive behaviors that the individual feels that they must perform to reduce anxiety or to prevent some dreaded outcome from occurring

Treatments for OCD usually focus on a combination of therapy and medications. Cognitive-behavioral therapy (CBT) or a form of CBT known as exposure and response prevention (ERP) are commonly used. Antidepressants such as Anafranil (clomipramine) or Prozac (fluoxetine) may also be prescribed to manage symptoms.

Personality Disorders

Personality disorders are characterized by an enduring pattern of maladaptive thoughts, feelings, and behaviors that can cause serious detriments to relationships and other life areas. Types of personality disorders include:

Antisocial Personality Disorder

Antisocial personality disorder is characterized by a long-standing disregard for rules, social norms, and the rights of others. People with this disorder typically begin displaying symptoms during childhood, have difficulty feeling empathy for others, and lack remorse for their destructive behaviors.

Avoidant Personality Disorder

Avoidant personality disorder involves severe social inhibition and sensitivity to rejection. Such feelings of insecurity lead to significant problems with the individual's daily life and functioning.

Borderline Personality Disorder

Borderline personality disorder is associated with symptoms including emotional instability, unstable and intense interpersonal relationships, unstable self-image, and impulsive behaviors.

Dependent Personality Disorder

Dependent personality disorder involves a chronic pattern of fearing separation and an excessive need to be taken care of. People with this disorder will often engage in behaviors that are designed to produce care-giving actions in others.

Histrionic Personality Disorder

Histrionic personality disorder is associated with patterns of extreme emotionality and attention-seeking behaviors. People with this condition feel uncomfortable in settings where they are not the center of attention, have rapidly changing emotions, and may engage in socially inappropriate behaviors designed to attract attention from others.

Narcissistic Personality Disorder

Narcissistic personality disorder is associated with a lasting pattern of exaggerated self-image, self-centeredness, and low empathy. People with this condition tend to be more interested in themselves than in others.

Obsessive-Compulsive Personality Disorder

Obsessive-compulsive personality disorder is a pervasive pattern of preoccupation with orderliness, perfectionism, inflexibility, and mental and interpersonal control. This is a different condition than obsessive compulsive disorder (OCD).

Paranoid Personality Disorder

Paranoid personality disorder is characterized by a distrust of others, even family, friends, and romantic partners. People with this disorder perceive others' intentions as malevolent, even without any evidence or justification.

Schizoid Personality Disorder

Schizoid personality disorder involves symptoms that include being detached from social relationships. People with this disorder are directed toward their inner lives and are often indifferent to relationships. They generally display a lack of emotional expression and can appear cold and aloof.

Schizotypal Personality Disorder

Schizotypal personality disorder features eccentricities in speech, behaviors, appearance, and thought. People with this condition may experience odd beliefs or magical thinking as well as difficulty forming relationships.

A Word From Verywell

Various factors influence a person's risk of developing a psychological disorder, including biological, social, environmental, cultural, and economic factors. Factors such as social support and coping skills can have protective effects.

Some conditions are short-term, while others may be lifelong. Conditions can also change over time.

Psychological disorders can cause disruptions in daily functioning, relationships, work, school, and other important domains. However, with appropriate diagnosis and treatment, people can find relief from their symptoms and discover ways to cope effectively.

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Explore a List of Psychological Disorders From the DSM-5

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Psychological disorders are grouped into different categories in the DSM-5. Explore this list of different types of mental disorders and how they are categorized.

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From the article, I learnt that there are 5 types of mental illnesses.

Anxiety disorders, Mood disorders, Schizophrenia and psychotic disorders, dementia and eating disorders.
(Felicia)

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Mental illness is a common problem in the United States.

According to the Centers for Disease Control and Prevention (CDC), more than 43 million American adults suffer from mental illness. That accounts for 1 in 5 Americans 18 years and older. About 20 percent of children and teens also suffer from mental illness, according to the CDC.

Even if you don't have a diagnosed mental illness, it's likely you still will face mental health challenges in your life. Everyday situations can cause stress, anxiety, or other emotional impacts.

There are ways you can manage whatever mental health challenges come your way. Mental Health America's Tools 2 Thrive provide a guideline for how you can ease mental health burdens.

Why It's Important to Manage Mental Health

The COVID-19 pandemic has brought mental health to the forefront. The pandemic has caused a disruption in many people's lives. Challenges like lost jobs or decreased pay, the possibility of illness, and the loss of socializing all can cause emotional impacts.

"Mental health-related issues and concerns have affected everybody worldwide in the context of the crisis," says Jennifer Beckjord, PsyD, senior director of clinical services at UPMC Western Psychiatric Hospital. "I don't know if one person has gone through this without feeling some anxiety or loneliness or experiencing some mental health-related challenge."

Mental Health America created its toolkit to provide some simple steps for people to manage their mental health. People can follow some of these steps to try to relieve what they're feeling at any time.

"It doesn't necessarily need to take a crisis to benefit from resilience-related resources or coping skills," Dr. Beckjord says.

How Can I Improve My Mental Health?

The Mental Health America toolkit includes six ways you can manage mental health challenges that come your way.

Own your feelings: Are you angry, sad, stressed, anxious, irritable, or something else? Don't ignore the emotions that you're feeling. The first step to overcoming negative thoughts or feelings is to recognize and identify them, then take action. You can cope by writing out your thoughts, talking to someone you trust, or seeking professional help.

Find the positive: Experiencing a loss is common, whether it's a loved one, a job, or a relationship. In difficult times, it can help to focus on the positives to recover from the emotional impact of your loss.

Eliminate toxic influences: Many different sources can cause problems - drugs and alcohol, social media, and even people in our lives. Identifying the influences that are causing us pain and then working to eliminate or manage them can ease our mental burden.

Create a routine: A healthy body and a healthy mind can go hand in hand. Try to control what you can by creating a routine of diet, exercise, social interaction, and more.

Support others: Everyone faces mental challenges at some point, and other people may need help getting through theirs. Try to be there for the people in your life who may need some help. Listen to them and try to help.

Connect with others: Loneliness can be a heavy burden, but there are ways you can prevent it. Connecting with others, whether it's in person or through technology, can help provide a lift.

One or more of these steps can help you manage your own mental challenges. But if you still are having a difficult time, seeking professional help is another option.

For more information, call UPMC Western Psychiatric Hospital at 412-624-2100.

Sources

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UPMC HealthBeat: Everyday Ways to Manage Your Mental Health

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Mental illness is a common problem in the United States. According to the Centers for Disease Control and Prevention (CDC), more than 43 million American adults suffer from mental illness. That accounts for 1 in 5 Americans 18 years and older. About 20 percent of children and teens also suffer from mental illness, according to the CDC.

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Common views towards people who have mental illnesses (felicia

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Common views towards people who have mental illnesses (felicia

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Teens in Singapore do not understand the severity of having an mental illness.
46.2 percent of the respondents said they would be embarrassed if they had a mental illness between the ages of 14 to 18. However, this is usually the age where people start developing mental illnesses. Yet they say, they would be ashamed/embarrassed to even talk to an adult,confront parents. This is the stereotype that singapore has accumulated. Even though the rate of people developing mental illnesses are 1 in 6 people. This is such a huge number yet we still have these thought about mental patient/ illnesses.

The environment that you’re in, plays a huge part in developing mental illnesses. Constant bullying is one of the triggering factors. People usually bully because they are jealous or they go with the majority or they are too insecure about some parts of their body and is trying to cover it.

I think this is a pressing problem because when the person is medically diagnosed as mentally ill, they do not dare to go and find professional help and tend to brush off the feeling. Therefore this is how the issues worsen.

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'Crazy, weird, scary': Survey unveils negative labels youths associate with mental illness

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SINGAPORE - Researchers have called for regular and compulsory education on mental health for youths, in the wake of a study that found a large proportion of this group having misconceptions of mental illness. Almost half (44.5 per cent) of 940 teenage students polled attached negativ

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Some issues families face are that some families may not have the money to seek professional help. Therefore, hard to cure.
Some types of illness can cause big changes in the family’s routines, activities and finances. Different people in your family will react differently to these changes.

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When you, your partner or someone in your family has a mental illness, it can cause stress and worry for everyone. Mental illness affects people, couples and families in different ways but you can get information and help to support your family in many ways.

How mental illness can affect couples

Many relationships have their ups and downs but if one or both people in a relationship is experiencing mental health problems, it can bring additional challenges. You might find that living day-to-day with a mental illness, or with a partner who has a mental illness, can affect your relationship in different ways. While conflict is a normal part of a healthy relationship, if you find that you and your partner are arguing more often than usual, it might help you both to find support and guidance through counselling or other relationship support services such as courses. Violence in a relationship is never acceptable.

Call Relationships Australia on 1300 364 277 for telephone counselling. They help people in Victoria who are isolated geographically or through other circumstances.

See the page ' Relationship support services ' for a range of relationship support services available.

Relationship break-ups and mental illness

It is always sad and stressful when couples break up, but if one or both of the people in the couple has a mental illness, it may prove additionally stressful.

If you are worried about your own mental health in the midst of a break‑up the best place to start is by making sure you are taking care of yourself. Are you getting enough sleep, eating healthy food and drinking enough water? Try to exercise every day, even just by going for a walk. Talk to trustworthy friends and family about your worries.

You can also talk to your doctor about it; tell them you are worried about how your break‑up is or might affect your wellbeing, your ability to work or care for yourself or your children. A counselling session or two can really help clarify things for you as well.

If you are worried about your relationship and not sure what to do, see what support resources are available to help you.

How mental illness can affect families

When you or someone in your family has a mental illness, it can affect everyone. Some types of illness can cause big changes in the family's routines, activities and finances. Different people in your family will react differently to these changes.

There are training courses for people caring for or living with a family member with a mental illness. Training has a good track record for helping the whole family. It is not just about how to care for the person who is ill, but also about how you can manage your own health and stress levels. Ask your doctor about local or online courses you can access.

Parenting while experiencing mental illness

Parenting can be challenging as well as rewarding. If you or your partner has a mental illness, it can increase the challenges for your family.

If your children are under three years old, you can get support at an Early Parenting Centre. They can help with getting your little one to sleep, feeding, discipline, and your own health and wellbeing. If you are outside of Melbourne, ask your doctor to refer you to a centre.

If your children are over three years old, your healthcare team can direct you towards services in your area that might suit you and your family. Ask your doctor, counsellor, nurse or another healthcare professional where you can get support.

Crisis plans for you and your children

It is a good idea to have a plan ready in case you or someone in your family experiences a sudden or rapid deterioration in their mental health. Make a list of people you can ring for support. Make sure the people who support you have each other's contact details too.

If your children are old enough to use the phone, keep the numbers somewhere they will be able to find them if they need to. Have a chat with them about what a crisis such as this could look like. Let them know that they can call someone they trust whenever they feel worried - about you or themselves.

Parenting a child or young person experiencing mental illness

Mental illness often appears in someone's teens or early twenties, so it is common for someone to be living with their parents when their issues become apparent. The most common mental illnesses are anxiety disorders and depression.

Parent-child relationships can be complex, and if your child is experiencing mental illness, caring for them can be difficult at times. It is very important to do your best to balance taking care of them with allowing them to be in charge of their own healthcare.

It is also really important to remember to take care of yourself - taking time out regularly, getting enough sleep, eating healthily and exercising. You can support others much better when you are healthy and rested.

You may find that your child's mental health issues are beyond your ability to care for on your own. If this is the case, you can speak with your doctor or your child's case worker about more intensive treatment and support options. Read more about Hospitals, clinics and residential options.

Resources for young people with a mental illness

There are a number of online counselling and information websites set up specifically for young people, including:

Youthbeyondblue aims to empower young people aged 12-25, their friends and those who care for them to respond to anxiety and depression.

provides online counsellors, practical information, tools and support to young people with mental illnesses.

provides a telephone helpline and drop-in centres around Australia, as well as information and places to engage online.

Becoming an official carer

If you are spending a lot of time caring for someone in your family who is experiencing mental illness, you or someone in your family might be eligible for financial support via Centrelink's carer payment. Check the eligibility requirements with Centrelink.

Other support for family carers can be found at:

Family violence and mental illness

Having mental illness very rarely leads to a person being violent. SANE has a good factsheet on this topic.

Having someone you love act violently towards you or someone in your family will always have a negative effect on your mental health. It is not uncommon for people who are subject to violence at home to suffer from depression.

Family or domestic violence is almost always done by men towards women. Therefore, support services for family violence are mainly aimed at women and their children.

There is also help for men who are victims of family violence by their partners - male or female. A good place to start is Domestic Violence Resource Centre Victoria.

For information about family violence and support, see our factsheets on:

Where to get help

Your GP (doctor)

SANE Helpline, call 1800 18 SANE (7263)

SuicideLine, call 1300 651 251

Lifeline, call 13 11 14

Kids Help Line, call 1800 55 1800

Mensline Australia, call 1300 789 978

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When you, your partner or someone in your family has a mental illness, it can cause stress and worry for everyone. Mental illness affects people, couples and families in different ways but you can get information and help to support your family in many ways.

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Opinion on how people suffering from these conditions are treated in society (Felicia)

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Opinion on how people suffering from these conditions are treated in society (Felicia)

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I disagree on how society treat these people. They are also human beings like us. They too have feelings, thought and are allowed to make decisions. Let’s think back. The main cause of mental disorders are the environment we grow up in. These type of environments are typically formed by the personality of the person. Toxic person means toxic environment. I feel that everyone should just lI’ve together in harmony. Push aside all our differences and connect with our similarities. That’s the first step to a nontoxic World. The outcome of our society is the decisions people make. Majority of this world do The wrong things believing it’s right. What has our morality become? Personally I believe morality should not be taught in school as ephemeral everyone is born, they are given some type of morality by the high above. The rest is just learnt from other. This is actually called the monkey see monkey do action. Are we not given a choice to do what is logical? Yes we are. But we are so peer pressured into dong the wrong things. This is why good and wrong are mixed up.

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from this video i understand more about the different mental illnesses such as bipolar depression dementia etc !

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Categories of mental disorders | Behavior | MCAT | Khan Academy

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from this article , i can say that teenagers nowadays are more proned to mental illnesses due to stresses from exams and studies

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Last year, a Primary 5 pupil fell 17 floors from his bedroom window on the day he was supposed to take his exam papers home.

He had never fared poorly in his examinations from Primary 1 to 4, and scored an average of 70 marks.

His mother would cane him on his palm "lightly" for every mark he fell short of her stipulated standard of 70 per cent.

But he failed his Higher Chinese and mathematics in his latest mid-year exam. Out of 100 marks, he scored 50 for English, 53.8 for Chinese and 57.5 for science.

This case shows what too much stress can lead to.

BE THERE FOR THEM
We need to be there for teenagers when they are hurt emotionally, when they are sad and when they are celebrating.
ASSOCIATE PROFESSOR JOHN WONG, head of the National University Hospital's psychological medicine department.

Primary schoolchildren may complain of headaches, and chest and abdominal pain.

They may be more clingy, emotional, demanding or con- frontational. And they may also be more regressive in their play and behaviour.

Meanwhile, teenagers may be more withdrawn from social and family interactions.

They may also be more tearful, sad, irritable or rebellious.

Some could have problems sleeping, or sleep too much, and seem tired in the daytime.
*Source: Dr Vicknesan Marimuttu of the KK Women's and Children's Hospital's psychological medicine department. Helplines
*Institute of Mental Health's Mental Health Helpline (24 hours) Call 6389-2222

*Samaritans of Singapore (24 hours) Call 1800-221-4444

*Singapore Association for Mental Health Call 1800-283-7019

*Care Corner Counselling Centre (Mandarin) Call 1800-353-5800

Stress can trigger anxiety, depression and self-harming behaviour, and cause sleep problems, social withdrawal, angry outbursts and obsessive-compulsive behaviours.

Experts have observed a rise in the number of stressed-out children and youth in Singapore. While the demands of school are often blamed, the stress often stems from multiple sources.

Some have trouble making friends or being accepted by their peers, and face family problems or have high personal expectations.

The NurtureSG committee, a taskforce formed to promote the physical and mental health of children, suggested steps that included training students to look out for peers in distress and setting up a workgroup to study suicidal and self-harming behaviours in children and youth.

The Health Promotion Board said last month it would enhance the training for pre-school educators so that they can help build emotional resilience in young children.

"There has been an increase in the number of teens who present at KK Women's and Children's Hospital (KKH) with stress and emotional problems," said Dr Vicknesan Marimuttu, a consultant at the child and adolescent mental wellness service of the hospital's psychological medicine department. "Most of them are between 13 and 16 years old."

Increased awareness of mental health services as well as efforts to move away from the stigmatisation of seeking help could have led to the rise, said Dr Marimuttu.

Young people may also not be getting adequate support from their parents, who are busy with work.
SCHOOL STRESS IS A BIG THING
Associate Professor John Wong, head of the National University Hospital's psychological medicine department, said a Primary 6 pupil told him last August that he was stressed because he had to score at least 245 for the PSLE.

His mum wanted him to aim for that score as it was the cut-off point for a good neighbourhood school and she had promised him a laptop.

"The child is not psychologically mature to know he wants 245, but he wants a computer," said Prof Wong.

"His mum wanted to motivate him. But she didn't tell him she'd still be happy with a 240 score."

Academic and social pressures tend to pile up in school. In Singapore, many children attend tuition, enrichment classes or sports activities on top of a long school day.

They do homework when they reach home, leaving little "me" time, and often do not have enough time to sleep.

School is a big stressor because they spend most of their time there, doctors said.

During the Education Ministry's budget debate last week, Mr Lim Biow Chuan (Mountbatten) asked if some schools were setting the bar too high for non-national examinations. And Dr Intan Azura Mokhtar (Ang Mo Kio GRC) called for an end to streaming students into normal and express classes.

Stress is not necessarily a problem but a challenge, said Prof Wong. "Minimal stress may not motivate a child aged seven to 18, but some stress can facilitate his learning. It's when it exceeds his capacity that it becomes a problem."
BUT DON'T JUST BLAME SCHOOL
While academic stress can be a problem in the pressure-cooker education system here, social issues are a big stressor for teens.

Dr Chua Siew Eng, a specialist in psychiatry and consultant at Raffles Counselling Centre, cited the case of a 16-year-old boy who had been seeing a cardiologist for his heart palpitations that surfaced whenever he had a panic attack.

The boy had complained of feeling anxious for an entire year. His anxiety worsened during situations such as speaking up in class and ordering food at the canteen.

He slept poorly and criticised himself for not performing well. This led to fatigue and poor concentration, said Dr Chua. The boy was diagnosed with social anxiety disorder.

Another often-overlooked factor is that each child has his own expectations, said Prof Wong.

A child will want to achieve something that his parents want or he may form his own expectations based on the incentives or how his siblings have performed.

"As a result, stress occurs. It's not the fault of the school or the curriculum," added Prof Wong.
CHILD'S TEMPERAMENT IS KEY
"It's okay for parents to motivate their child but don't use a blunt approach," said Prof Wong.

A child's temperament is something he is born with and it may result in him reacting differently to situations. "Those who are happy- go-lucky tend to be more resilient," he said.

"For those who are more sensitive and fragile, their parents and teachers must understand their temperament and make sure they do not get rushed."

Rather than have unrealistic expectations of their child, parents should find out his interests and capabilities, he said.

Parents may also not think through their demands and expectations to make sure these are attainable. As a result, he added, they do not know why their child is depressed or overwhelmed.

"As parents, we may miss opportunities to validate them and recognise their efforts," said Prof Wong.

"I learnt from a youth social worker that we need to be there for teenagers when they are hurt emotionally, when they are sad and when they are celebrating."

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More children and teens are stressed out

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Last year, a Primary 5 pupil fell 17 floors from his bedroom window on the day he was supposed to take his exam papers home. He had never fared poorly in his examinations from Primary 1 to 4, and scored an average of 70 marks.

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it may affect other family member's mental health , and they may not be able to afford the treatments hence the patient may not be able to recover

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Abstract

Background

Mental illness may cause a variety of psychosocial problems such as decreased quality of life of the patient's family members as well as increased social distance for the patient and the family caring for the patient. Psychosocial challenges are enhanced by the stigma attached to mental illness, which is a problem affecting not only the patient but also the family as a whole. Coping mechanisms for dealing with mentally ill patients differ from one family to another for a variety of reasons.

The aim of the study was to determine the psychosocial problems of mental illness on the family including the coping strategies utilized by family members caring for a person with mental illness.

Method

A qualitative study was conducted, involving four focus group discussions and 2 in-depth interviews of family members who were caring for patient with mental illness at Temeke Municipality, Dar es Salaam. Purposive sampling procedure was used to select participants for the study. Audio-recorded interviews in Swahili were conducted with all study participants. The recorded interview was transcribed and qualitative content thematic analysis was used to analyse the data.

Results

Financial constraints, lack of social support, disruption of family functioning, stigma, discrimination, and patients' disruptive behaviour emerged as the main themes in this study. Acceptance and religious practice emerged as the major coping strategies used by family members.

Conclusion

Familial care for a person with mental illness has its advantages, yet it has multiple social and psychological challenges. Coping strategies and skills are important for the well-being of the caregiver and the patient. Addressing these psychosocial challenges requires a collaborative approach between the health care providers and government so that the needs of the family caregivers and those of the patients can be addressed accordingly.

Keywords: Relatives, Mental illness, Psychosocial problems, Caregiver

Background

Globally, it is estimated that 450 million people are affected by mental disorders at any one time. These include 121 million people with depression, 24 million with schizophrenia and 37 million with dementia [ 1]. Mental illness accounted for about 12.3 % of the global burden of disease in 2001 and it is estimated that by 2020 unipolar depressive disorders will be the second most important cause of disability [ 2]. The burden of caring for mentally ill patients falls on the family members who provide all necessary support.

Evidence from developing countries is scarce; some countries show a higher prevalence of psychiatric patients living with families. In Uganda for example, the Uganda National Health Statistics (UNHS) of 2005/06 reports that of all households with disabled members, 58 % had at least one person with a mental disorder. To date, Tanzania lacks established statistics on families affected by mental illness.

Most mentally ill patients normally consult traditional healers and the reasons for not attending health facilities still remains unclear [ 3]. Beliefs regarding the cause of mental illness may be one of the reasons for not seeking healthcare. Most family members view mental illness not as disease, but as a curse; a product of both witchcraft and evil spirits of which the patient himself is counted as the main contributor [ 4]. It is likely that mental illness is severely underreported resulting in many untreated patients. However, in all cases, family members bear much of the burden of the patient's mental illness and this affects them psychologically and socially [ 5].

Psychosocial problems

Mental illness may cause a variety of psychosocial problems such as decreased quality of life for the patient's family members, as well as increased social distance for the patient and the family caring for the patient. The family members who care for relatives with mental illness report feeling stigmatized as a result of their association with the mentally ill [ 6].

Persons with serious mental illnesses often engage in behaviours that are frightening, troublesome, disruptive, or at least annoying, and many relatives are obliged to control, manage, or tolerate these behaviours [ 7]. Thus, psychiatric professionals often view the family members of a patient as people of support because they can act as informants regarding the patient and they can act as co-therapists at home [ 8]. The family members need to be in an optimal social and psychological state. It is reported that reduced function of one family member contributes to the burden of other members and this in turn leads to other family members assuming a critical attitude towards the patient [ 9]. Such criticism can in some cases lead to a relapse of the patient's illness or to the family feeling overwhelmed by the patient's disruptive behaviour [ 6, 10].

Social support is important for the wellbeing of the family affected by mental illness. A research finding reveals that families should assume major roles in supporting relatives with mental illness; and collaborative plans should include strategies to assist family members and consumers in dealing with stigma [ 11]. There is a relationship between caregivers' social support and stigma associated with relative with mental illness. For example, in a study investigating the links between stigma, depressive symptoms and coping amongst caregivers, it was found that stigma may erode the morale of family caregivers and result in withdrawal from potential supporters [ 12]. This argument supports the situation of families affected by mental illness in Tanzania as many families with mentally ill members hide the patient to avoid stigma and being socially discriminated. It is not known what psychosocial problems affect family members caring for their relative with mental illness in Tanzania.

Family coping and adaptation

Coping differs from one family to another for a variety of reasons. In developed countries, some researchers have emphasized coping as a key concept for the study of adaptation and mental health [ 13, 14]. However, the effects of age, duration of illness, living arrangements and other contextual factors on the coping styles of family caregivers, and on the recovery or rehabilitation of persons with mental illness are important factors to be considered [ 14].

In this case, family caregivers have to learn and understand the patient's characteristics and behaviour. Coping with symptoms such as delusions, hallucinations, inappropriate behaviours, and violence may often require lengthy, complex, and distressing negotiations. Over-burdened caregivers employ less effective coping strategies, report more frequent physical and mental health problems and use services more often [ 15].

In the Tanzanian context, however, it is unclear how family members cope with the mental illness of their relatives.

It is important to know how the family struggles to cope with the stressful situation so as to be able to help the family with mental illness. This study examined the psychosocial problems and coping strategies of families living with a person with mental illness within Temeke Municipality, Dar es Salaam.

Methods

Study design

The study used an explorative qualitative approach. Information was obtained from individual families living with mentally ill persons regarding the problems and coping strategies utilized.

Setting

The study was conducted in Dar es Salaam, which is the largest commercial city in Tanzania. The city has a population of more than four million and has diverse socio-cultural characteristics as a result of significant rural to urban migration. This region consists of a mixture of tribes mainly from southern Tanzania.

Sample size and sampling procedure

Fourteen participants were recruited using purposive sampling on the clinic days at Temeke Municipal Hospital in the Outpatient Clinic of Mental Health and Drug Abuse. Family members escorting the patient with mental illness to the clinic and who met the criteria were asked to participate in the study. Temeke Municipal Hospital does not admit psychiatric patients; therefore those patients who need admission are referred to Muhimbili National Hospital, which is also situated within Dar es Salaam. Sampling was done to the point at which no new information was obtained from participants and redundancy was achieved, referred to as data saturation. During the interview we identified two participants who seemed to be reserved, and were not active participants. We interviewed them separately after the Focus Group Discussions in order to obtain their views and experiences.

Selection criteria

Participants were selected according to the following criteria:

1. Caregiver living with relative who had been suffering from mental illness for more than 6 months.

2. Caregiver is 18 years or older

3. Caregiver is the main caretaker.

He/she was explained briefly the nature of the study before being asked to participate. All who agreed to participate were asked to provide contact information to decide on an appropriate day for the interview.

Ethical approval

Ethical clearance was obtained from the Muhimbili University of Health and Allied Sciences Ethics and Publication Committee. Further permission and approval was obtained from the Temeke Municipal Medical Officer in charge. Before the interview started, the informants were given a full explanation of the data collection procedure. Each participant was fully informed and understood the nature of the study and voluntarily agreed to participate. The written consent form was read, understood, and signed by the participants. Those who were not able to write were requested to provide verbal consent. However, all were able to read and write and therefore signed the consent form. Participants were informed that they could continue to use the health service as usual. Confidentiality was guaranteed by maintaining anonymity of all caregivers who participated in the study. Freedom to withdraw from the study at any time was ensured.

Data collection

Four focus group discussions (FGD) and two in-depth interviews were carried out due to the fact that more detailed information was needed in order to get the psychosocial problems and coping strategies of families caring for patients with mental illness. Data were collected through audio-taped interviews, which lasted for 55 to 60 min for focus groups discussions and 30 to 45 min for in-depth interviews. Four FGDs were conducted at the hospital. Each FGD consisted of 3-4 members. The aim was to get at least 6-8 people but it was not possible for a variety of reasons including problems with transportation There was no categorization of the group participants. Both sexes were mixed during the interview and they were from different areas of the Dar es Salaam region. The in-depth interviews were conducted in the participants' home environments. This provided an opportunity for the researcher to observe the living situation of the caregiver and the patient. The participants in this category were identified during the interview as those who were not actively sharing their views in the group discussions. They were then asked to participate in an interview in their home environment.

Data collection was guided by the following five structured questions.

1. What is the experience of caring for your mentally ill relative?

2. What problems do you face when caring for the mentally ill relative?

3. How do other relatives help you to care for the mentally ill relative?

4. What are the attitudes and views of the people around you concerning caring for a person with mental illness?

5. How do you cope with such problems?

The structured questions were followed by specific probing questions in order to obtain more information or clarification. The discussions and interviews were conducted in Kiswahili, the national language which was easily understood by all informants. During group discussions, the principal investigator moderated the discussion while a research assistant was taking notes, operating the audio recorders and taking care of any interruptions. Observations of non-verbal reactions were collected during and after the discussion. Field notes were blended with the recorded data during analysis.

Data analysis

Content thematic analysis was used in order to gain a deeper and clearer understanding and a formation of themes. Audiotaped focus group discussions and in-depth interviews were transcribed verbatim in the original Kiswahili language. The principal investigator transcribed the audiotaped data by typing directly into the computer using the Microsoft Word program. This helped the researcher to correlate the tone of the informants in the sentence with the feelings and emotions, which were of importance to the analysis. In the process of transcription, the informants' words were captured as closely as possible. To make sure that the data were transcribed correctly, the transcripts were checked against the audiotape and then reviewed by a person who was also proficient in Kiswahili. Interview notes and ideas were jotted down and the transcripts were read several times so that the researcher could be immersed in the data.

The unit of analysis was the themes expressed in the text about social and psychological problems found in families caring for persons with mental illness. Iterative reading of the interview transcripts was done. Pens, highlighters and memos were used during analysis. Different colours were used to highlight the patterns in the text, which corresponded to the preconceived category derived from the study objectives. In both margins of the hard copies of the transcripts, the patterns were jotted down in a crystallised meaning (condensed meaning) which were then transferred to a different sheet of paper for further analysis. Memos were used to summarize the patterns of the condensed meaning before transferring to the master sheet. To identify the source of data in the memo and in the text, identification numbers of informants were used when transferring the condensed meaning to the master sheet, so that the source could be easily traced and accessed. On this sheet of paper, coding schemes were developed with the abstracted categories and themes. Different categories, condensed meaning units, or codes were compared for underlying meanings and relationship at the interpretation level, which formed the themes (Table ).

Table 1

The problem which I get is that I can't even chop onions in public, I always do that in the locked room, and all knives and everything are hidden in the cupboard

Doing thing in hidden places to avoid physical attack

Fearing physical attack

Fear of being attacked

Problems in Managing patient's symptoms

There is a day he can really succeed to kill, if not him to kill, himself may be killed, because I can prevent when attempting to hurt me, unfortunately hurts himself.

Expressing fear of patient to kill or to be killed

Unpredictable patient's behaviour

Patient's safety

Field notes were also analysed separately whereby the patterns and categories were compared to those from the FGDs and in-depth interviews.

The two lists of categories were generated and compared and adjustments were made to the words used in the labelling of the categories. Transcripts were read again alongside with the list of the categories to ensure that the interviews had been transcribed. All the transcripts were then coded according to the list of categories and the coded sections of the transcripts were collected and then sorted. Verbatim examples were used as evidence for each theme and categories.

Results

Characteristics of informants

A total of fourteen family caregivers (informants), whose age ranged from 35 to 60 years, were interviewed. Five informants were men and nine were female. Four informants identified as Christian and ten identified as Muslim. Most of the informants had gone to primary school and a few had received secondary level education. Five informants were housewives, that is, they were married with no source of income except that of their husbands while five participants were petty traders' i.e. were doing small business (Table ).

Table 2

Characteristics of patients

The informants who participated were caring for ill relatives with different types of mental illness including schizophrenia, bipolar disorders, autistic disorders and epilepsy with psychosis. The duration of relatives' illness ranged from 7 months to 27 years. All the caregivers were living with the patient in the same household and most of them were parents.

Themes identified

After analysis, seven main themes emerged from the data.

Financial constraints

Financial constraints were a concern for almost all participants. They said they had limited time to work in order to earn money because most of their time was spent caring for their relative. The amount of money earned from limited working time was used to help care for the relative, such as buying bus fare to the hospital, purchasing medications, and other activities for the patient.

Cost for transport

Most informants expressed concerns about financial strain caused by increased cost for patient care, which was coupled with decreased working hours. Most of the participants were living a considerable distance from the hospital, they had to travel either by taxi or by public transport for patient follow-up. This caused most caregivers to have multiple financial crises with the small amount of money they had. For psychotic patients, some used to take taxi but the easiest and most accessible transport was public buses ( daladala). The most important concern was how to get the money for the transport. Some failed completely to come to the hospital for more than two or more months and other caregivers sometimes used their other relatives to collect the medication at the clinic as reported by one of the respondents caring for her elder sister with schizophrenia:

" Like that day I sent my brother-in-law, and told him; take this patient's register book because you are going there, I don't have the bus fare for going to the hospital just to collect the medicine." (46 year old sister).

Cost for medication

In addition to cost of transportation, it was revealed that shortage of medicine in the hospital compromised the treatment system of the patient. Medication was expressed as a major contributor to a patient's improvement. For example, the informants whose ill relative used more than two types of medication were rarely getting the second medication from the hospital and consequently had to purchase it in private pharmacies. As a result of lack of money, they used only one type of medication due to the carer's inability to buy the second drug. This was reported by an informant caring for his son with schizophrenia:

"......and when you come the next month, you are told; again, we don't have this type of drug, so you are given the only one, okay! Then the patient uses the one type of drug because no money to buy the second drug." ( 58 years old father).

The psychotropic medications are normally provided free of charge by the government hospital. However, not all are available in the government pharmacies and thus patients need to buy from private pharmacies. In this case patients reported that drugs were so expensive that those who managed to buy them had to sacrifice other household needs so that the patient could get the drug to prevent the disruptive behaviour:

"My main problem is money to buy the drug. They (doctors) have changed the medication, just imagine, a single monthly dose now costs forty thousand shillings (40,000/=) and she uses three different types of drugs......we ought to abandon other household issues to buy the medication because if she does not use the drugs for two or three consecutive days, you find that no peace at home". ( 51 years old mother).

This theme occurred even in patients using one type of drug. Some informants expressed that even if the patient had one type of drug which was not available at the hospital, the patient had to wait until they get the money to buy it. This was expressed as a causative risk factor for frequent relapse of patients' symptoms as a result of inappropriate dosage regimen.

The informants expressed that their relative's disruptive behaviour needed to be prevented by regular use of medicine. Lack of money for transportation and medication for the patients was suggested to be the main impediment to the patient improvement.

Disruption of family functioning

Family functioning is the ability of the family to continue with daily activities despite an internal or external threat. Most participants expressed disturbances in their normal routine as a result of having a mentally ill person in the household as explained below:

Lack of family harmony

Resilience in the family was also affected by the patient's disruptive or by family members disagreeing about the management of the mentally ill relative. One caregiver expressed concern about her husband by saying:

"...........He uses abusive language to my son because his is mentally ill but he does not show such behaviour to the children. We always quarrel for that reason " (50 years old mother).

Other informants revealed that a frequent source of misunderstanding revolved around how to find solutions to the patient's problems. It was revealed that one parent/member may seek out help from a traditional healer for treatment while the other may seek out spiritual treatment. However, most caregivers resolved to seek out professional treatment.

Disruptive behaviuor of patients

Problems in managing patients' symptoms

Participants had difficulties in managing patients' symptoms. They expressed concern that there was no one else who would be able to handle the unpredictable behaviour of the patient. They were the only one who had learned how to handle the patients' behaviour; therefore, they had to remain at home to protect the patient and other people from patient's uncontrolled behaviour. The majority expressed fear of being attacked by the patient as well as concern for safety of the patient as elaborated below:

"I have got many problems with my patient because, he is very strong and fat and his intention is to kill me and his father. The problem which I get is that I can't even chop onions in public, I always do that in the locked room, and all knives and everything are hidden in the cupboard." ( 51 years old mother).

Some other informants expressed that they had to be modest and humble when talking with the patients. They revealed that some family members do not bother to learn about the patients' behaviour and how to handle him or her when agitated. Thus leaving care of the patient to the main caregiver despite the dangers to that person.

Conflict with neighbours

The caregivers revealed that their relatives' uncontrolled behaviour such as temper tantrums, shouting in public, insulting people and neighbours and hitting people had caused them to have difficulty in forming and maintaining good social relationships. Some caregivers had been blamed for their relative's behaviour in court of law causing endless misunderstanding between family with the ill relative and the neighbourhood family. One informant reported that:

"When you make jokes of him several times, then, he becomes aggressive suddenly attacks you even stabbing you if in access with a knife; I have been arrested by police about two times to answer cases." (42 years old father).

It was said that most people do not know the nature of the mental illness and think that the person was pretending. Most of the family members tried to illuminate that their ill relative is not pretending and that he/she is suffering from mental illness.

Stigma and discrimination

Many caregivers described people around them having negative attitudes toward their mentally ill relative. Most informants reported that the relative was more stigmatized than the caregivers themselves and that when they hear or see their ill relative being ostracized, they feel guilty and are psychologically disturbed. However, the experience of societal stigma and discrimination is worsened by negative attitudes from close relatives towards the caregivers, thus creating an increased distance among them and the community at large. Negative attitudes from close relatives were explained to occur on different occasions such as when using public transportation and at other social gatherings. One participant whose ill relative had cannabis induced psychosis complained that his neighbours shunned his son from social events:

"Because even if he sees them sitting and chatting, and if he decides to go there to sit with them, you find that they all stand up and start leaving away. They perceive him as insane and can't chat with them." (38 years old mother).

Some highlighted that stigma was present among family members. This was apparent after the onset of illness. This seemed to be an unbearable burden to the caregiver as everything is left to him/her.

"Stigma is present even among us, because, you find that initially, you will be with your family and the society in general, but when the problem happens, none of your relative will come to know your progress with the patient." (38 year old mother).

Stigma was said to be caused by lack of knowledge about the nature of mental illness. The caregivers expressed their belief that education regarding mental illness should be provided to people in order to prevent stigma and discrimination. Most caregivers had demonstrated interest in understanding the origins of mental illness and some had even obtained brochures from some mental health facilities with respect to their relative's condition. Patients were said to be more stigmatized than the caregiver probably due to awkward behaviour. However, caregivers were blamed for causing the ill relative to be in that situation to begin with.

Coping and adaptation

Coping and adaptation are one of the important aspects to be applied when caring for a patient with chronic mental illness. Different types of coping and adaptation were reported by the participants.

Acceptance and faith were two of the most frequently cited strategies for coping. Caregivers had learned to accept and reconcile the disability or deviant behaviour in the mentally ill relative so as to avoid the dissatisfaction and disappointment that could have resulted from the patient's bizarre behaviour.

"You need to accept, no way, that is your child, whether your relative, your family member. .......where would you ask help? That is your gift from Almighty God, you have to accept." (58 years old father).

Some family caregivers took a positive step by utilizing problem solving strategies to address their relatives' psychological, emotional and practical needs. Most family members brought their ill relative to the hospital after consulting different areas especially from traditional healers.

"So, it is the hospital services we are continuing with until now. It gives me hope and satisfaction I and the patient will never go to the traditional healer again" (60 years old mother).

Other family caregivers sought religious support as the only means of hope and encouragement. They said that their religious practice gave them peace of mind and helped them to endure the caregiving situation. They believed that praying was also likely to reduce the suffering of their ill relative as well, thus making their faith indispensable to continued caregiving of the relative, irrespective of their distressing behaviour.

"Whenever the aggressive behaviour of my son begins, I immediately enter into my room, lock the door, kneel down and pray for Almighty God; Oh God! Help me to touch the Cross until my time of death!" (50 years old mother).

Some caregivers displayed signs of despair due to the difficult life situation caused by the patient's critical demands coupled with unrealistic daily income. They had no means of coping or adapting to manage their situation either due to persistent bizarre behaviour by the patient or their own lack of energy. However, they still had hopes due to their faith;

"That's why sometimes you speak rudely to me, and I answer rudely to you as well. What respect do I expect from you I wonder! I always provide care for you so what! It is merely my faith which makes me to be here." (46 years old sister).

Love, patience, and knowledge of the problem were other coping strategies mentioned by the family caregivers as important for difficult situations. However, none of the caregivers had abandoned his/her relative but most showed signs of desperation.

Discussion

This study has offered insight into the social and psychological problems of caring for mentally ill patients on families' caregivers. Feelings and coping strategies experienced by family caregivers were revealed in the study. This study found that the main challenges faced by caregivers of mentally ill relatives were lack of social support, stigma, and conflict caused by the patients. Similar findings were reported in rural Ghana where caregivers reported financial difficulties, social exclusion, depression, and inadequate time for other social responsibilities as their main challenges [ 16].

The financial constraints found in this study corroborate findings from other studies that explored the relationship between mental illness and poverty [ 17]. In this study, it has been found that people with mental illness are often unable to generate income and that they often have to rely on the financial support of family members to meet basic living needs and to pay for any health expenditure associated with mental illness. Thus, family members may have to set aside a significant amount of their time to care for an ill family member. This can diminish caregivers' chances to get or keep a job or earn income, which further increases the risk of poverty and poor mental health of the patient. This finding also shows similar financial burden as reported by a study conducted in Nigeria that explored relatives caring for schizophrenic patients [ 18]. However, our study did not explore the level of burden and its associations with caregivers' educational level, age of patient, employment status of patients and global rating of difficulty in coping with caregiving.

In Mtwara region, the report from BasicNeeds in 2009 revealed that the shortage of psychotropic drugs resulted in substitution of patients' usual medicine with alternative ones that were not as effective. In our research, the shortage of drugs was reported to decrease the credibility of health facilities, which are the main source of support for many families with mentally ill members. As such there is a need to improve mental health services including adequate provision of antipsychotic medication so that caregivers can continue getting them at the hospital free of charge as the policy stipulates.

Our findings demonstrate that there is a need for social support for the benefits of the family affected by mental illness. This unity helps to prevent stigma against the mentally ill patient in the family and the community at large. In the United State (US) research findings reports that families assume major roles in supporting relatives with mental illness [ 10]. The report in USA is inconsistent with these findings probably because of different cultural background of Tanzania and USA. However, education on the nature of mental illness can also be a problem, which calls for more emphasis on community awareness of mental illness in Tanzania. A qualitative study conducted in Thailand to explore the lived experience of Thai family caregivers found that extended family was a major source of support to caregivers physically, financially and emotionally [ 19]. This is not the case in this study because the caregiving was described to be occurring in a more nuclear family unit which resulted in decreased support to the family caregivers and may be due to the fact that the study was conducted in an urban setting. In essence, neighbours and the community are important components of social support. This research suggests that a strong social support system is critical for the improvement of mentally ill patients. However, a lack of this important component has hampered efforts to improve mentally ill patients' condition and is the drawback to the psychosocial rehabilitation of chronic mentally ill patients. This argument is supported by findings from India which revealed several reasons for difficulties encountered by patients cared for at home [ 20]. The most important way to improve the social support system in Tanzania is to integrate mental health into the primary health care system [ 21]. In primary health care practice, family members with their mentally ill relative can access the health facilities easily and with low costs. Although mental health is addressed in the National Health policy of 2007, the pace of progress is too slow to cater to the increasing burden and demand of mental health care in the local setting. The government's support is essential not only in improving primary mental health care but also in ensuring adequate provision of free treatment and free medication. Nevertheless, effort is needed by the government to increase the number of training institutions in order to create more mental health professionals.

Our study reported stigma as one of the biggest social challenges affecting families caring for patients with mental illness. Similar studies have shown that stigma may erode the morale of family caregivers and results in withdrawal of potential supporters [ 11, 15]. The report supports the finding in this study that some caregivers lose the support of their close relatives as well as other sources of social support after the onset of their relative's mental illness. However, a longitudinal study is required to establish a causal relationship between the stigma and the loss of social support for families caring for relatives with mental illness. Due to the fact that participants were concerned about their caregiving obligations in this research, there is a significant need for education of the general population about the causes, presentation, and treatment of mental disorders. Although stigma and discrimination is a socially and culturally influenced phenomenon [ 3], increased education and understanding among the general population may decrease the stigma experienced by people who have a mental illness, their caregivers, and their families. Stigma is acknowledged globally as one of the major problems to the success of community mental healthcare and it prevents a person from being fully integrated into society. In Zambia, research found that stigma could be reduced if people with mental health problems were treated in primary health care settings rather than in mental or district hospitals [ 22]. In Tanzania, most health care facilities in the local setting have not yet incorporated mental health into their basic health care packages; this could aid in reducing stigma. Furthermore, research suggests that the media plays a pivotal role in the stigmatization of mental illness and therefore could also play a role in the de-stigmatization process [ 23]. Media should be effectively utilized to improve the general population's understanding of mental disorders.

Family functioning has been affected by caring for patients with mental illness. There is change in the role of family members as the parents become involved or more consumed by patient's needs. The patient has many needs which must be fulfilled by the caregivers at the same time that they must engage in daily tasks to earn an income. This increases fact increases the overall burden on the caregivers. A large quantitative study in Australia reported that higher levels of the burden of care were associated with lower levels of family functioning, which in turn were associated with higher levels of anxiety, depression and perceptions of poor health [ 24]. Our findings also demonstrated that there was a low level of family functioning that was associated with patient's uncontrolled behaviour. The results of this research would further suggest that families affected by mental illness feel less cohesive and perceive themselves to be less connected to one another and less bonded as a unit than the normative family. In addition, the families of the mentally ill felt dissatisfied with the functioning of their family. This gives an impression that individual families should maintain their roles and relationships, thereby enabling the caregivers to maintain equilibrium. Any occurrence of mental illness of a family member which needs caring at home results in psychological and emotional disturbances for the whole family [ 25]. In relation to the conceptual approach of family caregiving [ 26], these family beliefs and relationships can be of great importance to understanding caregiving problems and any socio-cultural factors influencing family care of people with mental illness. However, it is also important to examine further and distinguish between the availability of social support resources and the actual use of that resource to strengthen family functioning.

Violence and threatening behaviour displayed by patients in this study would seem to be the result of insufficient symptom management. Proper management is of importance not only to the family caregiver but to all people who come into contact with the patient. This research has found that families are perplexed by violent patients. This is because many violent patients fail to see their behaviour as threatening and may actually perceive the family to be threatening. This threatening behaviour of patients comes at the cost of family caregivers who are often required to pay fines for destroyed property or pay compensation for injury caused by the patient. This phenomenon demoralizes the caregivers and further increases the stigma of mental illness. Information in regards to approach and management of violence are required when interacting with the mentally ill person.

Coping strategies are an important aspect of caring for a patient with mental illness. In this study caregivers have shown a narrow range of strategies for dealing with patients' disruptive behaviours. Acceptance and praying are one of the most cited coping strategies. Some researchers have revealed different ways of coping with distressing situations including cognitive, behavioural and avoidance strategies [ 14, 27]. This is not the case in our study as most of them were engaged in caring activities, even though with difficulties.

A research study which specifically examined differences in coping strategies among caregivers of different age, ethnic, gender, and education groups found some evidence that older people were more religious than younger adults [ 27]. In their study, religious coping seemed to focus more on informal activities, especially informal beliefs, rather than on more formal religious activities. This is consistent with the findings in this study although we did not consider gender, age, ethnic and education background. Praying as one of the coping mechanism in our study, is similar to the findings from studies in Thai family caregivers [ 19]. However, there is a difference in religious beliefs in that Thai families were predominately Buddhist compared to mostly Christian and Muslim participants in Tanzania. In this research, both Christians and Muslims had developed a habit of praying as a way to deal with caregiving situation. Findings suggest that different consultation is sought as a way of finding solutions or treatments for their loved one. Some were advised to seek treatment from traditional healers but when they found no relief, they turned back to God and sought hospital services. Most were satisfied with the hospital treatment after individual effort to seek information concerning the illness of their loved ones (cognitive coping). Maladaptive coping strategies were not described although though some did shown signs of desperation in caring for their ill relatives as they were tired and did not know what to do to make their ill relative feel better.

Limitation of the study

There are several limitations in this research. Firstly, the sample was too small with few participants in each FGD. This might have an effect in a normal interaction during the interview and consequently contributed to limited information. Secondly, the FGD groups were not homogenous which might have affected the freedom of expression among the participants.

Thirdly, only one primary caregiver and who spent most of the time with the patient was recruited. There could be variety in the types of problems associated with caregiving amongst different caregivers, due to different family roles and perceptions of caregiving. Finally, the study was hospital-based which means the findings are not generalizable to a community-based sample.

Conclusion

Family caregiving for persons with mental illness has its advantages, yet it has multiple social and psychological challenges for both family caregivers and mental health professionals. Coping strategies and skills are important to the well-being of the caregiver and the patient.

Tackling of these problems needs a collaborative approach between health care providers and the government so that the needs of the caregiver and the family in general can be addressed.

Replication of the study with a larger sample based on age, gender, education background, occupation will be useful for further enriching the knowledge base of the phenomenon and in providing a foundation for future research in clinical practice.

Ethics approval and consent to participate

Ethical clearance was obtained from the Muhimbili University of Health and Allied Sciences Ethics and Publication Committee. Further permission and approval was obtained from the Temeke Municipal Medical Officer in charge. Before the interview started, the informants were given a full explanation of the data collection procedure. Each participant was fully informed and understood the nature of the study and voluntarily agreed to participate. The written consent form was read, understood, and signed by the participants.

Consent for publication

The participants were informed that the findings of the study would be published in different journals and that their names would not appear in the publications. The participants agreed and signed the consent form.

Acknowledgement

Much appreciation goes to the Ministry of Health and Social welfare for financial support for this study. A lot of thanks go to Dr. Edith M. Tarimo and Ms Renee for the important role she played in editing the manuscript, Mr. Joel Ambikile Seme helped in data collection and conducting interviews. Finally, thanks go to Temeke Municipal Hospital where the study was conducted.

Funding

The research was funded by Ministry of Health and Social welfare of Tanzania.

Abbreviations

FGDs

Focus Group Discussions

MUHAS

Muhimbili University of Health and Allied Sciences

UBS

Uganda Bureau of Statistics

UNAIDS

The Joint United Nation Programme for HIV/AIDS

UNHS

Uganda National Health Services

WHO

World Health Organization

Footnotes
Competing interest
The authors declare that they have no competing interests.
Authors' contributions
MKI did all the work from research proposal development, data collection and analysis, and report writing. KIYM supervised the whole work from proposal development, ensuring proper data collection instruments, relevant data analysis method, and adherence to ethical issues and paper writing skills. LK was involved in the step by step process of data analysis and formation of themes. All authors read and approved the final manuscript.
Authors' information
MKI is the Assistant Lecturer at Muhimbili University of Health and Allied Sciences. He has Masters of Science (MSc) in Mental Health and Psychiatric Nursing. MKI teaches mental health for both undergraduate and postgraduate students at the university.

References

1. WHO. The World Health Report, Mental Health: New Understanding, New Hope. Geneva: WHO; 2001.

2. Mathers CD, Loncar D. Updated Projection of Global Mortality and Burden of Disease, 2002-2030: Data source, Methods and Results. WHO; 2006.

7. Shankar J, Muthuswamy SS. Support Needs of Family Caregivers of of People Who Experience Mental Ilnnes and the Role of Mental Health services. Fam Soc J Contemp Soc Serv. 2007;88(2):302-310.

12. Wintersteen RT, Wintersteen LB, Mupedziswa R. Zimbabwean Families of the Mentally 111 : Experiences and Support Needs. J Soc Dev Afr. 1995;10(1):89-106.

16. Ae-ngibise KA, Christian V, Doku K, Asante KP, Owusu-agyei S. The experience of caregivers of people living with serious mental disorders: a study from rural Ghana. Glob Health Action. 2015;1:1-9. [ PMC free article] [ PubMed]

20. Sheth HC. Common Problems in Psychosocial Rehabilitation. Int J Psychosoc Reahabilitation. 2005;10(1):53-60.

21. WHO. Integrating mental health into primary care A Global Perspective. Geneva: WHO Press; 2008.

24. Edwards B, Higgins DJ, Gray M, Zmijewski N, Kingston M. The Nature and Impact Caring for Family Members with a disability in Australia. Melbourne, Victoria: Australian Institute of Family Studies; 2008.

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The psychosocial problems of families caring for relatives with mental illnesses and their coping strategies: a qualitative urban based study in Dar es Salaam, Tanzania

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Mental illness may cause a variety of psychosocial problems such as decreased quality of life of the patient's family members as well as increased social distance for the patient and the family caring for the patient. Psychosocial challenges are ...

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no i do not agree . people in this society should not be looking at them in a different way , they should be treated equally and not seen as crazy or attention seeking . even if they were born this way , it should not give anyone any excuse to treat them differently .

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ncss , imh and samhealth

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Across the country and around the world, there are a number of organizations dedicated to helping people who struggle with mental health disorders and their families to better understand the nature of their illnesses and connect with treatment that will assist them with managing symptoms.
National Alliance on Mental Illness (NAMI)

The National Alliance on Mental Illness (NAMI) is a nonprofit organization dedicated to connecting mental health patients and their families with the resources they need to better understand the nature of the illnesses, share their stories, and connect with others who are also living with a mental health disorder. They offer:

Analysis of a range of issues about or related to mental illness and/or brain disorders

Access to current mental health research and data

A place for people living with mental health issues and their caregivers to share their stories

A forum for people living with mental illness and their families to speak out and connect with others

Opinion on mental health policy and policies that impact mental health treatment, patients, and their families

The National Alliance on Mental Illness began in 1979 when a small group of families first began meeting to support one another and share their experiences living with mental illness. It has since grown into a grassroots advocacy organization with hundreds of affiliates staffed by volunteers who work to increase awareness of the issues facing people living with mental illness and support people in their journey toward balance through treatment.

NAMI is dedicated to giving a voice to the millions of people and their families who are living with a mental health disorder and helping patients to improve their lives through treatment and reduced stigma. They recognize that improved quality of life for people living with mental illness comes through support and treatment and believe that no mental health symptoms should be an obstacle to a person's ability to live a balanced and meaningful life. Their goal is to advocate for people impacted by mental health issues and work to ensure that all who need it can connect with treatment that will help them thrive.

NAMI offers a number of services and programs to patients living with mental health disorders and their families as well as those who would like to positively impact the mental health community. These programs include:

NAMI also advocates for public policy changes that empower families living with mental health disorders, sponsors public awareness events, provides educational services on mental health disorders and related issues, and maintains their toll-free NAMI helpline (800-950-NAMI) to provide information and support to people in need. Families and their loved ones living with mental health symptoms are encouraged to call weekdays between 10 am and 6 pm Eastern time, connect with them online, or seek out a local affiliate for support and information.

The National Institute of Mental Health (NIMH) is focused on researching the nature of all mental health disorders to better understand the impact on patients, and thus create new and effective treatments. NIMH also provides open access to its findings as well as a wealth of mental health information on its site. From anxiety disorders and personality disorders to suicide prevention and autism spectrum disorders as well as other mental health-related topics, NIMH is a premiere resource for families impacted by mental health disorders.

The World Health Organization was initially conceived in 1945 by diplomats who were meeting to form the United Nations. Just three years later, on April 7, 1948, the WHO Constitution was created, and this day is now celebrated as World Health Day around the globe.

In addition to addressing the medical needs of low-income countries, WHO has long been focused on educating governments about the nature of mental health disorders and helping them to understand that there are treatment options and medications available - and that incarcerating patients is not the answer, a common practice in many countries to this day. Unfortunately, even with the knowledge that there are mental health treatment options available, many countries simply did not - and do not - have the resources to provide their residents with the treatment necessary to heal.

To address this issue, WHO created their Division of Mental Health in the 1970s. A regional adviser was appointed in each of the six WHO regional offices, and soon the Division's network of 10 collaborating centers grew to more than 100 across 80 countries.

In 1999, WHO continued its work on worldwide mental health reform by collaborating with the European Commission to increase awareness of mental health issues and working to connect patients with appropriate care.

Additionally, in the 1990s, WHO created a research measurement tool known as disability-adjusted life-years (DALYs). It is this tool that allows researchers to quantify the loss associated with untreated mental illness, or the burden of disease, by calculating the number of years lived with disability (YLD) and the number of years lost due to mental illness (YLL). This tool not only allows researchers to better assess the impact of mental health disorders but also aids in the effective planning and management of programs dedicated to helping mental health patients and their families.

The mission of the World Health Organization is to increase the services made available to people struggling with mental health disorders, neurological disorders, and substance abuse and addiction around the world, with a special focus on aiding patients living in low- and middle-income countries. With the right intervention, medication, and treatment, WHO asserts that tens of millions of people could be treated for various disorders, including depression and schizophrenia, and ultimately maintain balance and wellness.

The World Health Organization has a number of active core projects that are serving to close the gap between the need for mental health services and access to treatment. These include:

Mental Health Atlas: This project focuses on the collection of worldwide data on mental health-related topics, including financing of mental health treatment, how treatment is provided, medications available, information systems in use, mental health-related policies, and more. The data was first collected in 2001 and updated in 2005, 2011, and 2014.

WHO-AIMS: The World Health Organization Assessment Instrument for Mental Health Systems is a tool for gathering information about the mental health system of an area with the goal of making improvements to that system and creating a baseline that will facilitate positive change.

Mental Health in Emergencies: This project focuses on providing mental health services to people in areas struck by crises, including natural disaster, war, terrorism, refugees, and others.

The research and support as well as access to mental health information provided by these and other mental health organizations are important resources for families struggling with mental health disorders. Learning how to manage mental health symptoms and how to live a life of balance is possible through comprehensive mental health treatment.

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3 Organizations and Agencies That Focus on Mental Health

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Across the country and around the world, there are a number of organizations dedicated to helping people who struggle with mental health disorders and their families to better understand the nature of their illnesses and connect with treatment that will assist them with managing symptoms. The National Alliance on Mental Illness (NAMI) is a nonprofit organization dedicated to connecting mental health patients and their families with the resources they need to better understand the nature of the illnesses, share their stories, and connect with others who are also living with a mental health disorder.