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What is "Mental Health" to you? (C1 Class) 1/2

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What is "Mental Health" to you? (C1 Class) 1/2

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What is "Mental Health" to you? (C2 Class) 2/2

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What is "Mental Health" to you? (C2 Class) 2/2

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Now, let's compare.

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"state of mental well-being" to "contribute to community" and "a basic human right" that

"exists on a complex continuum" (from personal to universal).

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WHO fact sheet on mental health covering risks and protective factors, promotion and prevention, care and treatment, and WHO’s work in this area.

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Johns Hopkins Bloomberg School of Public Health

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The Realization of an Idea
by Dr. Wallace Mandell
The term mental hygiene has a long history in the United States, having first been used by William Sweetzer in 1843. After the Civil War, which increased concern about the effects of unsanitary conditions, Dr. J. B. Gray, an eminent psychiatrist, envisioned a community-based mental hygiene that would operate through education, social culture, religion and involvement in national life. In 1893, Isaac Ray, a founder of the American Psychiatric Association, provided a definition of the term mental hygiene as "the art of preserving the mind against all incidents and influences calculated to deteriorate its qualities, impair its energies, or derange its movements. The management of the bodily powers in regard to exercise, rest, food, clothing and climate, the laws of breeding, the government of the passions, the sympathy with current emotions and opinions, the discipline of the intellect-all these come within the province of mental hygiene." (Rossi, A., Some Pre-World War II Antecedents of Community Mental Health Theory and Practice. Mental Hygiene, 1962, 46, 78-98).

At the turn of the nineteenth century, Darwinian thinking dominated the biological and social sciences. Within the scientific community, mental deviations, i.e., extreme variations, were conceived as having a biological basis, primarily genetic, representing mutations that were unsuccessful adaptations for survival in the environments in which they appeared. This view provided little hope for recovery of the mentally deviant. Around 1900, some physicians and psychologists became convinced that deviant behavior was an expression of illnesses that lay at the other end of a continuum from mental health. Among leading thinkers of this period, G. Stanley Hall was convinced that early treatment might reduce both the severity and reoccurrence of mental illness. Adolph Meyerwas probably the single greatest proponent of this view. In 1906 he wrote on "The Problem of Aftercare and the Organization of Societies for the Prophylaxis of Mental Disorders" (Winters, E.E., The Collected Papers of Adolph Meyer, Vol. IV, Mental Hygiene. Baltimore, The Johns Hopkins Press, 1952).

By the 1890s, Meyer had become convinced by his experience with mental hospital patients that industrialization and urbanization were undermining human potential for continuous adaptability and constructive activity (Meyer 1921, quoted in Dreyer 1976). Meyer, combining the social reform ideology of the nineteenth century with his training as a physician, held that what man needed was a biologically sound idealism (Dreyer 1976). His concept of mental hygiene sprang from experience with the child study movement of the period. He proposed to apply those techniques to psychiatric hospital patients through study of their life histories, also including family and community factors. By 1908, these studies expanded Meyer's conception of mental hygiene to include reaching out into the community to prevent mental illness and preserve good mental health. Adolph Meyer, one of the founders of the mental hygiene movement in the United States, recalled that this new enterprise arose from "a mixture of humanitarian, fiscal and medical factors" (Meyer 1952).

Clifford Beers, after his release from an insane asylum, drafted the manuscript of his book A Mind That Found Itself, which included an agenda for mental hygiene societies. Under the sponsorship of William James and Adolph Meyer, the book was published in 1908. Beers called for the formation of a permanent voluntary health agency whose prime function would be to prevent the disease of insanity by providing information about it to the public. In the 1908 prospectus of the Connecticut Society for Mental Hygiene, the first in the nation, an article was included that committed it to "war against the prevailing ignorance regarding conditions and modes of living which tend to produce mental disorders." For this purpose the society set about to secure state legislation and appropriations, develop coordinated local programs to impregnate the schools and courts with the preventive view, and disseminate sound attitudes toward mental and emotional problems. Meyers wanted to move the mental hygiene movement, then focused on programs of intervention in social problems, to accept the necessity of basing its proposals on scientific research. He proposed a program of research based on the belief that the causes of mental illnesses were rooted in the interaction between biology and life history events. Meyers began a biographical or "life story" approach to studying mentally ill patients to provide a scientific knowledge base for mental hygiene efforts (Dreyer 1976).

In 1908, William Welch, dean of the Johns Hopkins Medical School, was present at the founding meeting of the National Committee for Mental Hygiene. He became its vice president in that year and later, in 1923, its president. In 1912 Thomas W. Salmon became the medical director of the National Committee. Under these auspices, he compiled statistics about mental illness for the United States. The Surgeon General of the United States Army became interested in the problem of psychiatric casualties in response to data on this problem in the peacetime army compiled by Pearce Bailey Sr., chief of neurology, psychiatry and psychology in the Office of the Surgeon General. Salmon worked with Welch on the problem of psychiatric casualties during World War I. During World War I, the National Committee for Mental Hygiene turned its attention to mental health problems in the armed services. American psychiatrists were able to detect and treat "shell-shock" casualties with success rates believed to be superior to those of other countries (Strecker, E.A., Military Psychiatry: World War I, in One Hundred Years of American Psychiatry. New York, Columbia U. Press, 1944, 385-418). Based on these experiences, William H. Welch and Witcliffe Rose included mental hygiene as part of the course of studies in their prospectus proposing the founding of the Johns Hopkins School of Hygiene and Public Health to the General Education Board of the Rockefeller Foundation in 1915.

In line with the thinking about the emerging role of local departments of public health, in 1915 Meyer envisioned community mental hygiene districts in which the services of schools, playgrounds, churches, law enforcement agencies and other social agencies would be coordinated by mental health personnel to prevent mental disorders and to foster sound mental health (Meyer, A., Organizing the Community for the Protection of its Mental Life. Survey, 1915, 34, 557-560).

Apparently Welch was looking for a leader for the mental hygiene activity and considered offering the position of professor of Mental Hygiene to Salmon in 1918. However, Salmon was not interested (Lemkau 1961). Despite the lack of a professor, social and mental hygiene were included in areas of study for candidates for the degree of Doctor of Public Health in 1920 (Preliminary Announcement, School of Hygiene and Public Health, Baltimore, Johns Hopkins Press, 1981.)

C.E.A. Winslow, professor of Public Health at Yale, was also concerned to include mental hygiene in public health education. He described mental hygiene in 1933 as "an organized community response to a recognized community need; and it lays its prime emphasis on the detection and the control of those incipient maladjustments with which the physician qua physician never comes into contact, unless specific community machinery and far-flung educational facilities are provided for the purpose." (Winslow, C. A. E., The mental hygiene movement and its founder, in National Committee on Mental Hygiene, The Mental Hygiene Movement, Garden City, NY, Country Life Press, 1938, pp. 303-17.)

The first International Congress on Mental Hygiene convened in 1933. Included in the purpose statement there was the idea that it was necessary to determine "how best to care for and treat the mentally sick, to prevent mental illness, and to conserve mental health" (in National Committee for Mental Hygiene, The Mental Hygiene Movement). By World War II, the mental hygiene movement had expanded to the ideas that 1) maladjustments that are not psychiatric but that bring the child into conflict with the law are of concern to mental health; 2) even slight deviations from harmony with the environment in the social world of the school and nursery are close to the roots of ultimate difficulties that produce mental disorder; 3) institutional programs should be encouraged that are favorable to the creation of a mentally healthy environment; 4) community forces should be coordinated to supply mentally health environments; and 5) mental health principles should be integrated into the practices of social work, nursing, public health administration, education, industry and government.

The mental hygiene movement, as it was called, was criticized in some medical circles for its lack of an objective scientific basis for its proposals and its "unscientific" focus on sociological factors as being the key to the prevention of mental illness and preservation of health. The mental hygiene movement was torn by differences between psychiatrists devoted to treating the mentally ill through biological means and mental hygienists attempting to promote mental health by changing societal institutions.

In an attempt to increase the scientific basis for mental hygiene activities, a mental hygiene study unit with full-time personnel was established at Johns Hopkins in 1934 (Dr. Ruth Fairbank, psychiatrist; Dr. Bernard Cohen, statistician; and Miss Elizabeth Green, social worker) (Lemkau 1961) to be the urban counterpart of a rural study carried out in Williamson County, Tennessee. In this first study, in the Eastern Health District of Baltimore City, all cases of mental disturbance, illness or retardation were identified from agency records and self reports of symptoms and were analyzed in terms of age, sex, geographic location and socioeconomic status.

Adolph Meyer proposed a young physician, Paul Lemkau, whom he had trained as a psychiatrist at Johns Hopkins, to continue the work on the precedent-setting Baltimore Study of Chronic Illness at the School of Hygiene and Public Health. In 1936, further data were gathered and analyzed by the Lemkau, Tietze and Cooper team (Cohen and Fairbank, American Journal of Psychiatry 1937-38; Lemkau, Tietze, Cooper, 1940-41). This study was pioneering in that it included data on the extent of mental illness in a defined population sample using both survey methods and institutional records. Working with Dr. A. W. Freeman, Lemkau became convinced that epidemiological study of the prevalence of mental disorders was possible.
Clinical psychiatrists of that period rejected symptom inventories as an inadequate basis for determining the prevalence of disorder (Kleiman and Weisman). Lemkau believed, accordingly, that mental hygiene would have its foundation in research based on the treatment of individual patients. He held that theories could be formulated from this clinical research that would serve as a basis for preventive programs directed toward whole populations.

Working with Meyer, Lemkau had developed a deep commitment to the view that mental disorders had a biological basis, and a conviction that life events were the precipitants of illness. These events, identified by the life history method, would provide the database for a theory on which prevention programs could be based. Meyer had envisioned the nation divided into mental hygiene districts in which psychiatrists would catalyze friendships and cooperation among teachers, playground workers, charity organizations, ministers and physicians, to help individuals and families maintain their mental health by teaching people constructive tolerance for individual differences. In 1941, Lemkau presented the first course at the School of Public Health, relating the material arising from personality development research to public health practice. Working with the faculty teaching public health practice to future health commissioners, he became convinced that the expanding public health system would provide the institutional opportunity to bring mental hygiene to the population. As he envisioned it, mental health practitioners in public health would use the tools of epidemiology and biostatistics to diagnose the mental health needs of the population while mental health education could produce effects analogous to immunization for mental disorders.

World War II intervened, and in 1941 Lemkau entered the Army and was assigned to Walter Reed Hospital. He continued to direct the mental hygiene study and teach at the School of Hygiene in the evenings. This led to efforts to integrate wartime psychiatric experiences into public health. Working with psychiatric casualties convinced Lemkau that early detection of mental disorders and early treatment could reduce the duration of episodes of mental illness. He observed that individuals provided with rapid short-term treatment at front-line psychiatric clinics were less likely to develop enduring neurotic disorders. Weaving these strands of experience together, Lemkau conceived the idea of locating mental hygiene activities in local health departments close to community sources of stress. He envisioned a psychiatric clinic located in each local health department. Health department psychiatric outpatient clinics would heal the sick and also prevent future disorders (Lemkau 1955). Based on his war experience, he believed that the damaged personality could be changed in outpatient treatment by the verbal reconstruction of improperly assimilated past stressful experiences. For those individuals who had sustained injury leading to a chronic mental condition, clinic treatment would return them to efficient living through education to replace missing functions. The observation that "personality tends to recover from mental disease when the etiologic agents such as stress have been removed" (p. 8) suggested that the psychiatric clinics should also work to decrease stressors in the community uncovered during the course of treatment.

Lemkau propagated the concept that mental health could be promoted by health department psychiatric clinics through educating the population about how individuals might process stressful experiences more healthfully. Training in appropriate processing would produce personalities that could better withstand stress (Lemkau, Pasamanick and Cooper 1953). He believed that the promotion of resilient early personality development was complementary to the traditional public health activity of protecting the brain from damage, and would therefore fit well with the work of public health agencies.

At a meeting of the nation's public health officers in 1948, and later as part of the committee charged with designing the new National Institute of Mental Health after passage of the National Mental Health Act, Lemkau was able to promote the idea that mental hygiene and public health belonged together. This concept was expressed in his 1949 book, Mental Hygiene and Public Health. In 1949 the Maryland State Health Department invited Lemkau to be the director of a new Division of Mental Health. Four years of experience in that position convinced him that, while the mental hygiene clinics must continue to promote activities preventing psychogenic mental illness, other agencies charged with combating extreme poverty and providing public education would reach larger segments of the population. Since these agencies were not staffed by mental health personnel, mental health personnel would have to influence these farther-reaching agencies by means of epidemiologic studies that would convince them to establish policies and programs promoting mental health. He observed that professionals operating psychiatric clinics within local health departments tended to isolate themselves from other personnel, continuing to deliver traditional outpatient psychiatric services (Mental Hygiene and Public Health, 1955 edition). He saw the need for specially trained mental health professional personnel who would work from the public health department as a base. He called for experimentation in expanding mental health professionals' roles to include education and consultation to health and other agency personnel. Mental health personnel would need new skills, including those required for changing public attitudes through mass media, for providing in-service education to human services personnel, and for consultation with community leaders and community groups.

Lemkau began an active study of the options for organization of mental health services at the national, state and local levels. Lemkau supported decentralized mental health services, with the responsibility for coordination of treatment and prevention services resting within the local health department, whether or not psychiatric hospitalization services were joined with preventive services at the state level. He proposed regionalization of public mental health services and the use of traveling clinics to improve the delivery of care to the mentally ill. Lemkau also supported the development of strong, independent, nongovernmental, voluntary mental health organizations as a political constituency to support the development of public mental health services. He saw these voluntary organizations, when they maintained their character as representatives of the people, as the most effective means for educating the public. He was aware that voluntary groups want more rapid program development than public agencies, but maintained that these sometimes stressful differences between official and non-government organizations were to the general benefit of society.

Lemkau took leave from the School of Public Health to serve as the first Director of Mental Health Services for the New York City Community Mental Health Board. The second edition of Mental Hygiene and Public Health, published in 1955, filled an important need by offering a systematic approach to organizing mental health services in a society increasingly demanding those services. Published in 12 languages, it had worldwide influence. Lemkau used the Mental Hygiene Division of the School of Public Health to create a model and personnel for his approach. The expansion of the teaching of Mental Hygiene under the auspices of the National Institute of Mental Health led to the formal designation of the division as the Department of Mental Hygiene as a regular part of the School of Hygiene and Public Health in 1963.

His work provided a firm foundation for mental hygiene and public health; it endures in mental health services throughout the world and in the Department of Mental Health at the Johns Hopkins Bloomberg School of Public Health.

Dr. Mandell wrote this article in 1995 during his tenure as department chair (1993 - 1997).

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Origins of Mental Health | Johns Hopkins Bloomberg School of Public Health

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by Dr. Wallace Mandell The term mental hygiene has a long history in the United States, having first been used by William Sweetzer in 1843. After the Civil War, which increased concern about the effects of unsanitary conditions, Dr. J. B.

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What's like being a Mental Patient in the 20th century

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What's like being a Mental Patient in the 20th century

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Asylums and their patient treatment.

What about today?

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What It Was Like to Be a Mental Patient In the 1900s

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The Yellow Wallpaper by Charlotte Perkins Gilman (1892)

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The Yellow Wallpaper by Charlotte Perkins Gilman (1892)

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Hysteria, Post-partum depression, "lockdown" treatment, isolation.

Note: National Library of Medicine is the source of the post.

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By the American Psychiatric Association

Homosexuality as Mental Disorder by DSM-III

Social vs Medical

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by the World Health Organization

Following the DSM line.

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web services to get programmatic access to ICD-11

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We love Ted-Ed videos. But do you agree with the perspective of the video on depression? Is it perhaps too "medical"?

Which are our own views on depression?

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An alternative take on depression by Dr. Gabor Mate

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An alternative take on depression by Dr. Gabor Mate

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Depression as the outcome of childhood anxiety and fear. Not solemnly biological.

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This Is The  Root Of Your Depression and Anxiety | Dr. Gabor Mate

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Depression as "Deep rest", a condition that calls for resting body and mind from situations that don't work out for you.

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Depression is a Call to "Deep Rest"  - Jim Carrey quotes Jeff Foster

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Why do we misdiagnose male depression?

Is society at fault?

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How depression can look different for men

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Depression in men may be masked by unhealthy coping behaviors, so it often goes undiagnosed and can have devastating consequences when untreated.

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Depression as a privilege?

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Anxiety and Depression Humor | Netflix Is A Joke

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Celebrity life might not be as amazing as it seems

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WebMD lists a number of brave celebrities who admit to having depression and struggling with sadness.

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Why do we insist on replying "I'm fine" when we're not?

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"I'm Fine" - Learning To Live With Depression | Jake Tyler | TEDxBrighton

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Benzodiazepines and pharmaceuticals companies 

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Benzodiazepines and pharmaceuticals companies 

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Are pills the magic potion against anxiety & depression?

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Watch Take Your Pills: Xanax | Netflix Official Site

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A cure for some and a curse for others, widely prescribed anti-anxiety medication is examined by patients and experts in this revealing documentary.

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Pop culture's take on anxiety and depression

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Annabelle Psychology | Singapore's Leading Psychologists

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Following many teen suicides making the news in 2010, rock band Rise Against took to music to comment on mental health. Frontman Tim McIlrath said about the song, "The message is: It can get better, it does get better, give it a chance to get better, don't end your life prematurely."

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System Of A Down - Chop Suey! (Official HD Video)

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A mental disorder is characterized by a clinically significant disturbance in an individual's cognition, emotional regulation, or behaviour. It is usually associated with distress or impairment in important areas of functioning. There are many different types of mental disorders. Mental disorders may also be referred to as mental health conditions. The latter is a broader term covering mental disorders, psychosocial disabilities and (other) mental states associated with significant distress, impairment in functioning, or risk of self-harm. This fact sheet focuses on mental disorders as described by the International Classification of Diseases 11th Revision (ICD-11).

In 2019, 1 in every 8 people, or 970 million people around the world were living with a mental disorder, with anxiety and depressive disorders the most common (1). In 2020, the number of people living with anxiety and depressive disorders rose significantly because of the COVID-19 pandemic. Initial estimates show a 26% and 28% increase respectively for anxiety and major depressive disorders in just one year (2). While effective prevention and treatment options exist, most people with mental disorders do not have access to effective care. Many people also experience stigma, discrimination and violations of human rights.

Anxiety Disorders

In 2019, 301 million people were living with an anxiety disorder including 58 million children and adolescents (1). Anxiety disorders are characterised by excessive fear and worry and related behavioural disturbances. Symptoms are severe enough to result in significant distress or significant impairment in functioning. There are several different kinds of anxiety disorders, such as: generalised anxiety disorder (characterised by excessive worry), panic disorder (characterised by panic attacks), social anxiety disorder (characterised by excessive fear and worry in social situations), separation anxiety disorder (characterised by excessive fear or anxiety about separation from those individuals to whom the person has a deep emotional bond), and others. Effective psychological treatment exists, and depending on the age and severity, medication may also be considered.

Depression

In 2019, 280 million people were living with depression, including 23 million children and adolescents (1). Depression is different from usual mood fluctuations and short-lived emotional responses to challenges in everyday life. During a depressive episode, the person experiences depressed mood (feeling sad, irritable, empty) or a loss of pleasure or interest in activities, for most of the day, nearly every day, for at least two weeks. Several other symptoms are also present, which may include poor concentration, feelings of excessive guilt or low self-worth, hopelessness about the future, thoughts about dying or suicide, disrupted sleep, changes in appetite or weight, and feeling especially tired or low in energy. People with depression are at an increased risk of suicide. Yet, effective psychological treatment exists, and depending on the age and severity, medication may also be considered.

Bipolar Disorder

In 2019, 40 million people experienced bipolar disorder (1). People with bipolar disorder experience alternating depressive episodes with periods of manic symptoms. During a depressive episode, the person experiences depressed mood (feeling sad, irritable, empty) or a loss of pleasure or interest in activities, for most of the day, nearly every day. Manic symptoms may include euphoria or irritability, increased activity or energy, and other symptoms such as increased talkativeness, racing thoughts, increased self-esteem, decreased need for sleep, distractibility, and impulsive reckless behaviour. People with bipolar disorder are at an increased risk of suicide. Yet effective treatment options exist including psychoeducation, reduction of stress and strengthening of social functioning, and medication.

Post-Traumatic Stress Disorder (PTSD)

The prevalence of PTSD and other mental disorders is high in conflict-affected settings (3). PTSD may develop following exposure to an extremely threatening or horrific event or series of events. It is characterised by all of the following: 1) re-experiencing the traumatic event or events in the present (intrusive memories, flashbacks, or nightmares); 2) avoidance of thoughts and memories of the event(s), or avoidance of activities, situations, or people reminiscent of the event(s); and 3) persistent perceptions of heightened current threat. These symptoms persist for at least several weeks and cause significant impairment in functioning. Effective psychological treatment exists.

Schizophrenia

Schizophrenia affects approximately 24 million people or 1 in 300 people worldwide (1). People with schizophrenia have a life expectancy 10-20 years below that of the general population (4). Schizophrenia is characterised by significant impairments in perception and changes in behaviour. Symptoms may include persistent delusions, hallucinations, disorganised thinking, highly disorganised behaviour, or extreme agitation. People with schizophrenia may experience persistent difficulties with their cognitive functioning. Yet, a range of effective treatment options exist, including medication, psychoeducation, family interventions, and psychosocial rehabilitation.

Eating Disorders

In 2019, 14 million people experienced eating disorders including almost 3 million children and adolescents (1). Eating disorders, such as anorexia nervosa and bulimia nervosa, involve abnormal eating and preoccupation with food as well as prominent body weight and shape concerns. The symptoms or behaviours result in significant risk or damage to health, significant distress, or significant impairment of functioning. Anorexia nervosa often has its onset during adolescence or early adulthood and is associated with premature death due to medical complications or suicide. Individuals with bulimia nervosa are at a significantly increased risk for substance use, suicidality, and health complications. Effective treatment options exist, including family-based treatment and cognitive-based therapy.

Disruptive behaviour and dissocial disorders

40 million people, including children and adolescents, were living with conduct-dissocial disorder in 2019 (1). This disorder, also known as conduct disorder, is one of two disruptive behaviour and dissocial disorders, the other is oppositional defiant disorder. Disruptive behaviour and dissocial disorders are characterised by persistent behaviour problems such as persistently defiant or disobedient to behaviours that persistently violate the basic rights of others or major age-appropriate societal norms, rules, or laws. Onset of disruptive and dissocial disorders, is commonly, though not always, during childhood. Effective psychological treatments exist, often involving parents, caregivers, and teachers, cognitive problem-solving or social skills training.

Neurodevelopmental disorders

Neurodevelopmental disorders are behavioural and cognitive disorders, that? arise during the developmental period, and involve significant difficulties in the acquisition and execution of specific intellectual, motor, language, or social functions.

Neurodevelopmental disorders include disorders of intellectual development, autism spectrum disorder, and attention deficit hyperactivity disorder (ADHD) amongst others. ADHD is characterised by a persistent pattern of inattention and/or hyperactivity-impulsivity that has a direct negative impact on academic, occupational, or social functioning. Disorders of intellectual development are characterised by significant limitations in intellectual functioning and adaptive behaviour, which refers to difficulties with everyday conceptual, social, and practical skills that are performed in daily life. Autism spectrum disorder (ASD) constitutes a diverse group of conditions characterised by some degree of difficulty with social communication and reciprocal social interaction, as well as persistent restricted, repetitive, and inflexible patterns of behaviour, interests, or activities.

Effective treatment options exist including psychosocial interventions, behavioural interventions, occupational and speech therapy. For certain diagnoses and age groups, medication may also be considered.

Who is at risk from developing a mental disorder?

At any one time, a diverse set of individual, family, community, and structural factors may combine to protect or undermine mental health. Although most people are resilient, people who are exposed to adverse circumstances - including poverty, violence, disability, and inequality - are at higher risk. Protective and risk factors include individual psychological and biological factors, such as emotional skills as well as genetics. Many of the risk and protective factors are influenced through changes in brain structure and/or function.

Health systems and social support

Health systems have not yet adequately responded to the needs of people with mental disorders and are significantly under resourced. The gap between the need for treatment and its provision is wide all over the world; and is often poor in quality when delivered. For example, only 29% of people with psychosis (5) and only one third of people with depression receive formal mental health care (6).

People with mental disorders also require social support, including support in developing and maintaining personal, family, and social relationships. People with mental disorders may also need support for educational programmes, employment, housing, and participation in other meaningful activities.

WHO response

WHO's Comprehensive Mental Health Action Plan 2013-2030 recognizes the essential role of mental health in achieving health for all people. The plan includes 4 major objectives:

to strengthen effective leadership and governance for mental health;

to provide comprehensive, integrated and responsive mental health and social care services in community-based settings;

to implement of strategies for promotion and prevention in mental health; and

to strengthen information systems, evidence, and research for mental health.

WHO's Mental Health Gap Action Programme (mhGAP) uses evidence-based technical guidance, tools and training packages to expand services in countries, especially in resource-poor settings. It focuses on a prioritized set of conditions, directing capacity building towards non-specialized health-care providers in an integrated approach that promotes mental health at all levels of care. The WHO mhGAP Intervention Guide 2.0 is part of this Programme, and provides guidance for doctors, nurses, and other health workers in non-specialist health settings on assessment and management of mental disorders.

References

(1) Institute of Health Metrics and Evaluation. Global Health Data Exchange (GHDx), ( https://vizhub.healthdata.org/gbd-results/, accessed 14 May 2022).

(2) Mental Health and COVID-19: Early evidence of the pandemic's impact. Geneva: World Health Organization; 2022.

(3) Charlson, F., van Ommeren, M., Flaxman, A., Cornett, J., Whiteford, H., & Saxena, S. New WHO prevalence estimates of mental disorders in conflict settings: a systematic review and meta-analysis. Lancet. 2019;394,240-248.

(4) Laursen TM, Nordentoft M, Mortensen PB. Excess early mortality in schizophrenia. Annual Review of Clinical Psychology, 2014;10,425-438.

(5) Mental health atlas 2020. Geneva: World Health Organization; 2021

(6) Moitra M, Santomauro D, Collins PY, Vos T, Whiteford H, Saxena S, et al. The global gap in treatment coverage for major depressive disorder in 84 countries from 2000-2019: a systematic review and Bayesian meta-regression analysis. PLoS Med. 2022;19(2):e1003901. doi:10.1371/journal.pmed.1003901.

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Facts sheet on mental disorders: key facts, depression, dementia, health and support and WHO response

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A social experiment on mental health stigma

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A social experiment on mental health stigma

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A Social Experiment on Mental Health Stigma | Beyond the Label

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Mental Health in Asian countries: the Aokigahara Forest in Japan

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Mental Health in Asian countries: the Aokigahara Forest in Japan

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Note: The Logan Paul controversy

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Aokigahara (青木ヶ原, 'Blue Tree Meadow'), also known as the Sea of Trees, is a forest on the northwestern flank of Mount Fuji on the island of Honshu in Japan, thriving on 30 square kilometres (12 sq mi) of hardened lava laid down by the last major eruption of Mount Fuji in 864 CE. The western edge of Aokigahara, where there are several caves that fill with ice in winter, is a popular destination for tourists and school trips. Parts of Aokigahara are very dense, and the porous lava rock absorbs sound, contributing to a sense of solitude that some visitors attribute to the forest.

The forest has a historical reputation as a home to : ghosts of the dead in Japanese mythology. At least since the 1960s, Aokigahara has become associated with suicide, eventually becoming known in English by the nickname "the Suicide Forest", and gaining a reputation as one of the world's most-used suicide sites. Because of this, signs at the head of some trails urge suicidal visitors to think of their families and contact a suicide prevention association.

The forest floor mostly consists of volcanic rock. Designated trails lead to several tourist attractions such as the Narusawa Ice Cave, Fugaku Wind Cave and Lake Sai Bat Cave which are three larger lava caves near Mount Fuji, the ice cave being frozen year-round.

Aokigahara has been falsely portrayed as a place where navigational compasses go haywire. Needles of magnetic compasses will move if placed directly on the lava, aligning with the rock's natural magnetism, which varies in iron content and strength by location. However, a compass behaves as expected when held at a normal height. The Japan Ground Self-Defense Force has conducted its ranger courses including navigation training in the forest since 1956.

Flora and fauna

Mammals include the Asian black bear, small Japanese mole, bats, mice, deer, fox, boar, wild rabbit, Japanese mink and Japanese squirrel. Birds include great tit, willow tit, long-tailed tit, great spotted woodpecker, pygmy woodpecker, bush warbler, Eurasian jay, Japanese white-eye, Japanese thrush, brown-headed thrush, Siberian thrush, Hodgson's hawk-cuckoo, Japanese grosbeak, lesser cuckoo, black-faced bunting, oriental turtle dove, and common cuckoo.

There are ground beetles and other insects, including many species of butterflies, even in the forest interior Argynnis paphia, Chrysozephyrus smaragdinus, Celastrina argiolus, Celastrina sugitanii, Curetis acuta, Favonius jezoensis, Neptis sappho, Parantica sita and Polygonia c-album are found.

The forest has a variety of conifers and broadleaf trees and shrubs including: Chamaecyparis obtusa, Cryptomeria japonica, Pinus densiflora, Pinus parviflora, Tsuga sieboldii, Acer distylum, Acer micranthum, Acer sieboldianum, Acer tschonoskii, Betula grossa, Chengiopanax sciadophylloides (as Acanthopanax sciadophylloides a.k.a. Eleutherococcus sciadophylloides), Clethra barbinervis, Enkianthus campanulatus, Euonymus macropterus, Ilex pedunculosa, Ilex macropoda, Pieris japonica, Prunus jamasakura, Quercus mongolica var. crispula, Rhododendron dilatatum, Skimmia japonica f. repens, Sorbus commixta (as Sorbus americana ssp. japonica) and Toxicodendron trichocarpum (as Rhus trichocarpa). The dominant tree species between 1,000 and 1,800 metres of altitude is Tsuga diversifolia and from 1,800 to 2,200 metres is Abies veitchii.

Aokigahara is sometimes referred to as the most popular site for suicide in Japan. In 2003, 105 bodies were found in the forest, exceeding the previous record of 78 in 2002. In 2010, the police recorded more than 200 people having attempted suicide in the forest, of whom 54 completed the act. Suicides are said to increase during March, the end of the fiscal year in Japan. As of 2011, the most common means of suicide in the forest were hanging or drug overdose. In recent years, local officials have stopped publicizing the numbers in an attempt to decrease Aokigahara's association with suicide.

The rate of suicide has led officials to place a sign at the forest's entry urging suicidal visitors to seek help and not take their own lives. Annual body searches have been conducted by police, volunteers, and journalists since 1970.

The site's popularity has been attributed to Seichō Matsumoto's 1961 novel Nami no Tō ( Tower of Waves). However, the history of suicide in Aokigahara predates the novel's publication, and the place has long been associated with death; may have been practiced there into the nineteenth century, and the forest is reputedly haunted by the of those left to die.

References in media

Aokigahara has been referred to in several media, including anime and manga, films, literature, music, and video games.

The 2015 film The Sea of Trees with Matthew McConaughey, Ken Watanabe and Naomi Watts also tells a story happening there, as does the 2016 horror film .

During late 2017 and early 2018, the Logan Paul suicide forest controversy began with a YouTube video showing the Aokigahara forest, in which Paul showed the body of a suicide victim on camera, that shocked many viewers and brought widespread condemnation.

It was the subject of a BBC Radio 4 production (first broadcast 10 September 2018) in which four poets traveled to Aokigahara to write and record poetry in the forest.

The poets Arai Takako, Jordan A. Y. Smith, Osaki Sayaka, and Yotsumoto Yasuhiro co-authored a bilingual (Japanese/English) anthology of the poems and short writings on Aokigahara, titled Sea of Trees: Poetic Gateways to Aokigahara (ToPoJo Excursions, 2019).

An American playwright of Japanese ancestry, Kristine Haruna Lee, wrote and staged a play, Suicide Forest, in New York City in March 2019. It addressed suicide in America and Japan, referencing the Aokigahara Forest.

References

1. Harrington, Patrick (22 January 2017). "Hiking in a Forest Born Out of Mount Fuji's Lava". The New York Times. p. TR8.

2. ^ "Intruders tangle 'suicide forest' with tape". Asahi Svhimbun. 3 May 2008. Archived from the original on 6 May 2008.

3. ^ Tani, Saburō (1988). Rangers - The Strongest Combatants of the Ground Self Defense Force (in Japanese). Fusosha Publishing. pp. 45-60. ISBN 978-4594002350.

4. ^ Koike, Shinsuke; Hazumi, Toshihiro (2008). "Notes on Asiatic black bears denning habits in the Misaka Mountains, central Japan" (PDF). Ursus. 19 (1): 80-84. doi:10.2192/1537-6176(2008)19[80:NOABBD]2.0.CO;2.

5. ^ Tsuchiya, Kimiyuki; Suzuki, Hitoshi; Shinohara, Akio; Harada, Masashi; Wakana, Shigeharu; Sakaizumi, Mitsuru; Han, Sang-Hoon; Lin, Liang-Kong; Kryukov, Alexei P (2000). "Molecular phylogeny of East Asian moles inferred from the sequence variation of the mitochondrial cytochrome b gene". Genes & Genetic Systems. 75 (1): 17-24. doi:10.1266/ggs.75.17.

6. ^ "Aokigahara "sea of trees" walking course". Charm of Mt Fuji. Yamanashi Tourism Organization.

7. ^ Kitahara, Masahiko; Watanabe, Maki (2003). "Diversity and rarity hotspots and conservation of butterfly communities in and around the Aokigahara woodland of Mount Fuji, central Japan". Ecological Research. 18 (5): 503-522. doi:10.1046/j.1440-1703.2003.00574.x.

8. ^ Kitahara, Masahiko; Masahiko, Mitsuko; Kobayashi, Takato (2008). "Relationship of butterfly diversity with nectar plant species richness in and around the Aokigahara primary woodland of Mount Fuji, central Japan". Biodiversity and Conservation. 17 (11): 2713-2734. doi:10.1007/s10531-007-9265-4.

9. Lah, Kyung (19 March 2009). "Desperate Japanese head to 'suicide forest'". CNN.com/Asia. Especially in March, the end of the fiscal year, more suicidal people will come here because of the bad economy. It's my dream to stop suicides in this forest, but to be honest, it would be difficult to prevent all the cases here.

10. ^ "Japan's harvest of 69 death". The Independent. London. 24 October 2000. Archived from the original on 24 April 2008.

11. ^ Hadfield, Peter (16 June 2001). "Japan struggles with 69 soaring death toll in Suicide Forest". The Sunday Telegraph. London.

12. ^ Collins-Hughes, Laura (4 March 2019). "A Family Divide Haunts Heart-Rending 'Suicide Forest'". The New York Times.

External links

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Aokigahara (青木ヶ原, 'Blue Tree Meadow'), also known as the Sea of Trees, is a forest on the northwestern flank of Mount Fuji on the island of Honshu in Japan, thriving on 30 square kilometres (12 sq mi) of hardened lava laid down by the last major eruption of Mount Fuji in 864 CE.

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