Unit 4 Area of Study 2

1. Unit 4 Area of Study 2 What influences mental wellbeing?

2. Part 1 - Defining Mental Health • Dot point 1 - mental health as a continuum (mentally healthy, mental health problems, mental disorders) influenced by internal and external factors that can fluctuate over time

3. Mental Health as a Continuum • Mental health exists along a continuum. At the two extremes of this continuum are ‘Mentally healthy’ and ‘Mental disorder.’ • In the middle of the continuum is ‘Mental health problem’. • Mental Health: a state of wellbeing in which an individual realises his or her own abilities, can cope with the normal stresses of life, can work productively, and is able to make a contribution to his or her community. • Mental health problem:adversely affects the way a person thinks, feels and/or behaves, but typically to a lesser extent and of a shorter duration than a mental disorder. • Mental disorder:is a mental health state that involves a combination of thought, feelings and/or behaviours which are usually associated with significant personal distress and impair the ability to function effectively in everyday life. • The majority of people are considered ‘mentally healthy.’ Occasionally the stresses of life can become too much and a person may experience symptoms associated with a mental health problem. If the symptoms persist and get to a point where they impair a person’s ability to function cognitively, physically and socially, the person may be diagnosed with a mental disorder.

4. Mental Health as a Continuum

5. Internal and External Factors that Influence Mental Health • Mental health is influenced by a range of factors that fluctuate over time. These factors can come from internal sources or external sources. • Internal and external factors are identified and categorised using the ‘Biopsychosocial Framework.’ • Biopsychosocial framework: a way of describing and explaining how biological, psychological and social factors combine and interact to influence a person’s mental health. • INTERNAL FACTORS • Internal factors: influences that originate within a person. • Internal factors can be categorised as biological and psychological when using the biopsychosocial framework. • Biological factors refer to physical influences that are not under conscious control. • Psychological factors refer to influences associated with mental processes (cognition).

6. Internal and External Factors that Influence Mental Health • External factors:factors that originate outside a person. • External factors are categorised as social when using the biopsychosocial framework. • Social factors refer to any influences associated with social relationships and the environment. • Internal and external factors can combine and influence each other. Generally it is not just one type of factor that leads to a mental health problem or a mental disorder. • For example: being subject to trauma or abuse (social), having catastrophic thinking (psychological) and taking illicit drugs like marijuana (biological). When all three of these factors combine, they may form part of the diagnosis for the mental disorder ‘Schizophrenia.’

7. Biopsychosocial Framework

8. Underline the key knowledge. Eliminate obviously incorrect answers Exam question deconstruction

9. Part 1 - Defining Mental Health • Dot point 2 - the typical characteristics of a mentally healthy person, including high levels of functioning, social and emotional well-being and resilience to life stressors

10. Characteristics of Mentally Healthy People • People who are mentally healthy have some characteristics in common. They have high level functioning, positive social relationships, can manage their emotions and are resilient when faced with life stressors. • HIGH LEVEL FUNCTIONING • Functioning refers to how well an individual independently performs or operates in their environment. • Level of functioning relates to how well a person can adapt to changes in the following areas: • Interpersonal relationships • School and work/occupational settings • Leisure/ recreational activities • Daily living skills • Cognitive skills • Emotions • Mentally healthy people tend to have coping flexibility and can adapt to the challenges of living. They can cope effectively with living independently in everyday life, engage and cooperate with others, maintain relationships and are emotionally stable.

11. Characteristics of Mentally Healthy People HIGH LEVELS OF SOCIAL AND EMOTIONAL WELLBEING • Wellbeing refers to our sense of ‘wellness’ or how well we feel about ourselves and our lives. • Social wellbeing: based on the ability to have satisfying relationships and interactions with others. • A person with high social wellbeing is likely to be able to: • Develop and maintain healthy relationships • Socially interact with others in appropriate ways • Respect other individuals and their cultural differences • Resolve conflict with others • Feel confident when alone or with others • Emotional wellbeing: is based on the ability to control emotions and express them appropriately and comfortably. • A person with high emotional wellbeing is likely to be able to: • Develop awareness and understanding of their own emotions • Regulate emotions and control emotions when appropriate • Express emotions in a suitable manner • Identify emotions in others and empathise • Accept mistakes or setbacks and learn from them • Manage their stress reactions using appropriate coping skills • Take responsibility for their actions

12. Characteristics of Mentally Healthy People Resilience to life’s stressors • Being mentally healthy does not mean that a person never faces adversity. It refers to their ability to adapt or cope with the stressors that a person experiences over the course of their lifetime. • Resilience: is the ability to cope with and adapt well to life stressors and restore positive functioning. • Resilience is influenced by having supportive relationships as well as many other factors. A resilient person has skills and capacities that contribute to them maintaining positive social and emotional wellbeing. These include: • Communication skills • Emotional understanding • Social competence • Problem-solving skills • A sense of self-belief and confidence in oneself

13. Exam question deconstruction

14. Exam question deconstruction

15. Part 1 - Defining Mental Health • Dot point 3 - ethical implications in the study of, and research into, mental health, including informed consent and use of placebo treatments.

16. Ethics • Research and studies into mental disorders involves participants who are particularly vulnerable. These participants have impaired psychological functioning and this can call into question their ability to provide consent. • There is a special section in the National Statement on Ethical Conduct in Human Research 2007 that describes the guidelines for conducting research with people with mental disorders. • Two particular issues that must be addressed relate to informed consent and the use of placebo treatments.

17. Informed Consent • Informed consent: participants must be informed of the true nature and purpose of a study, their rights as a participant and they must provide written consent and if they are under the age of 18, a parent or legal guardian must also provide written consent. • Participant consent must be voluntary and based on sufficient information and adequate understanding of both the proposed research and the consequences of participation in it. • A participant in mental health research should have the competence to give consent. • Competence means that the person understands all the information presented to them to make an informed decision about their participation. • The presence of a mental disorder has the potential to impair their ability to provide informed consent. • If the person has a mental disorder that is temporary or episodic, the researchers must endeavour to seek consent at a time when their symptoms do not interfere with their capacity to provide consent. • Researchers should also discuss with participants the possibility that their ability to participate in the study may deteriorate during the study and discuss the possibility of continuing in the study or withdrawing. • If a person is unable to provide informed consent, it can be obtained from a legal guardian or organisation authorised by law, even if the person is over the age of 18. However, the researchers must still provide all of the relevant information to the participant as well.

18. Placebo Treatments • Many studies (also known as ‘clinical trials’) into mental disorder involve testing new medications. When new medications are being tested, a placebo is used to measure the efficacy (effectiveness) of the medication. • Placebo:a substance or treatment that appears real and resembles the actual substance or treatment, but is neutral and has no known effect. • Commonly a placebo is a ‘sugar pill’ that is designed to look identical to the medication being tested. • When taking a placebo, the placebo effect may occur. • Placebo effect: changes in behaviour caused by the participant’s belief that they have been exposed to a treatment that will affect them in some way. • To counter placebo effect, participants take part in a single-blind procedure.

19. Placebo Treatments • Single-blind procedure:participants are unaware if they in the control (placebo) or experimental group. • When a new medication is being tested, there is always two groups. One group, the control group will take a placebo. The other group, the experimental group will be given the actual medication. • The results from both groups are compared and it would be assumed that any differences in the DV (measurements taken) are due to the effects of the IV (medication). • In most studies, a double-blind procedure is used.

20. Placebo Treatments • Double-blind procedure:both the experimenter and the participants are unaware which group (control or experimental) the participants have been allocated to. • The double-blind procedure eliminates any experimenter bias that may have influenced the results, instead of the IV (medication). • The placebo effect can relieve symptoms and can be long lasting. However, there are concerns over the use of placebo treatments, as it means that participants must stop taking their regular medication and are given nothing to replace it. • This may leave the person vulnerable to another episode of their mental disorder, which is potentially harmful. • Using a placebo also raises the issue of deception. The participants in the control group are deceived into believing they are taking the real medication. • Deception is acceptable within studies, as long as debriefing occurs at the end of the study and that it is approved by an ethics committee.

21. Dot point 3 - ethical implications in the study of, and research into, mental health, including informed consent and use of placebo treatments. Using the DP to predict the question Key terms = definitions Command terms = common structure How? What? When? Where? Why?

22. Part 2 - Factors that contribute to the development and progression of mental health disorders • Dot point 1 - the distinction between predisposing risk factors (increase susceptibility), precipitating risk factors (increase susceptibility and contribute to occurrence), perpetuating risk factors (inhibit recovery) and protective factors (prevent occurrence or re-occurrence)

23. 4P Factor Model • The 4P Factor Model describes four types of influences that contribute to the development and progression of mental health disorders. • The four factors, or P’s are: • Predisposing risk factors • Precipitating risk factors • Perpetuating risk factors • Protective risk factors

24. 4P Factor Model • Predisposing risk factor:increase susceptibility to a specific mental disorder. • Predisposing risk factors can occur at conception or early in life and shape the person’s personality. • Precipitating risk factor:increases susceptibility to and contributes to the occurrence of a specific mental disorder. • Precipitating risk factors are commonly known as triggers. These are events that occur shortly before the onset of a disorder and appear to have induced it. • Perpetuating risk factor:maintains the occurrence of a specific mental disorder and inhibits recovery. • Perpetuating risk factors are those that maintain the psychology problem and prevent resolution. • Protective risk factor:reduces or prevents the occurrence or re-occurrence of a mental disorder. • Protective factors are positive forces in a person’s life that help minimise the occurrence or re-occurrence of mental disorders.

25. The 4P Factor Model aligns with the Biopsychosocial Framework to identify factors that contribute to the progression of mental disorders. 4P Factor Model

26. Exam question deconstruction

27. Exam question deconstruction

28. Part 2 - Factors that contribute to the development and progression of mental health disorders • Dot point 2 - the influence of biological risk factors including genetic vulnerability to specific disorders, poor response to medication due to genetic factors, poor sleep and substance use

29. Biological Risk Factors • The biopsychosocial framework identifies risk factors that influence mental disorders. As mentioned previously they align with the 4P Factor Model. • Biological risk factors include: • Genetic vulnerability to specific disorders (predisposing risk factor) • Poor response to medication due to genetic factors (perpetuating risk factor) • Poor sleep and substance use (precipitating risk factor)

30. Genetic Vulnerability to Specific Disorders • Inheriting genes from a parent may increase the risk of developing a mental disorder. This is known as genetic vulnerability. • Genetic vulnerability: having a risk for developing a mental disorder due to one or more factors associated with genetic inheritance. • Mental disorders are more prevalent in people who have a genetic relative with a mental disorder. • For example: a person with a parent diagnosed with schizophrenia has a 17% chance of also developing schizophrenia. If both parents have schizophrenia the risk of their offspring developing it rises to 48%. • Genetic factors contribute to a person’s susceptibility to the mental disorder, but they do not directly cause the mental disorder. Many other factors are also involved.

31. Poor response to medication due to genetic factors • Medications are commonly used to treat mental disorders. They are used in conjunction with therapy and are monitored closely. Medications can cause side effects and these can be more intense in some people. • Poor response to medication:means having little to no reduction in the number or severity of symptoms despite taking medication as prescribed. • For example: up to 45% of people with depression have a poor response to anti-depressant medications. • Our genes determine how our bodies process medications and this can vary from person to person. Variations in genes may affect the absorption, distribution, metabolism or elimination of particular medication. • Other factors such as a person’s age, sex, body weight, race, diet and other co-existing disorders or drugs/medications being taken will also affect a person’s response to medication.

32. Poor Sleep • Poor sleep quantity and quality is associated with a range of mental disorders. It can be a risk factor that contributes to the development of the disorder or the mental disorder may cause the poor sleep. • Poor sleep relates to difficulties getting to sleep and maintaining sleep. • For example: insomnia is very common among people diagnosed with depression.

33. Substance Use • Substance use:refers to the use or consumption of legal or illegal drugs or other products. • The active ingredients in these drugs can trigger the onset of a mental disorder. • For example: taking marijuana can trigger the onset of schizophrenia. • Taking drugs can increase the risk factor of developing a mental disorder, however, the mental disorder can also cause the person to abuse or increase intake of substances such as drugs.

34. Part 2 - Factors that contribute to the development and progression of mental health disorders • Dot point 3 - the influence of psychological risk factors including rumination, impaired reasoning and memory, stress and poor self-efficacy

35. Psychological Risk Factors • The biopsychosocial framework identifies risk factors that influence mental disorders. As mentioned previously they align with the 4P Factor Model. • Psychological risk factors include: • Rumination • Impaired reasoning and memory • Stress • Poor self-efficacy

36. Rumination • Rumination: involves repeatedly thinking about or dwelling on undesirable thoughts and feelings, such as problems or bad moods, without acting to change them. • Obsessing about undesirable thoughts, such as work or relationships can prolong a mental disorder. • For example: replaying negative thoughts over and over will maintain the mental disorder ‘Depression.’ Rumination can increase the severity of depression and impede recovery. • People who ruminate have difficulty problem-solving. They can focus too long on the problem itself and this leads them to feel like they cannot overcome the problem.

37. Impaired reasoning and memory • Mental illness can prevent people from thinking rationally. Impairments to cognitive functioning can impact both reasoning and memory. • Impairments in reasoning and memory may significantly affect a person’s day-to-day functioning, maintaining and prolonging the mental disorder. • Reasoning:involves goal-directed thinking in which inferences are made or conclusions are drawn from known or assumed facts or pieces of information.

38. Impaired reasoning and memory • Impaired reasoning has varying degrees and tends to centre on probabilistic reasoning. Probabilistic reasoning is when a person makes a judgement on how likely something is to occur or be true. • When a person has a mental disorder, this may mean that they jump to conclusions that are false more frequently and it may also create delusions. Delusions are fixed, false beliefs that are held with absolute certainty, even when there is strong factual evidence against it. • Impaired reasoning can also cause a decrease in the functioning of verbal fluency, language processing and interpretation of social situations.

39. Impaired reasoning and memory • The type of mental disorder will also influence impairments in memory. Short term, long term, episodic, semantic and procedural memories can all be affected by mental disorders. • Generally, the memory impairment will relate to forgetting information. This can be especially important if it is episodic memories and the person suffering from a mental disorder may not be able to provide relevant details about their history to medical professionals and others.

40. Stress • The level of stress and a person’s ability to cope are key risk factors that contribute to a person developing a mental disorder. • Major life events such as losing a job or the breakdown of a relationship, increases the likelihood of a person developing a mental disorder. • If a person is already vulnerable to developing a mental disorder, the level of stress they encounter might only need to be low for it to be enough to trigger the onset of the mental disorder.

41. Poor self-efficacy • Self-efficacy: refers to an individual’s belief in their capacity to execute behaviours necessary to succeed in a specific situation or accomplish a specific task. • Low or poor self-efficacy is a good predictor of low mental health and high self-efficacy is a good predictor of high mental health. • Self-efficacy is situation specific. Some people may have high self-efficacy in some aspects of their life, such as their work, but low self-efficacy in other areas, such as personal relationships. • Self-efficacy is not about self-worth (self esteem), it is about how competent we feel. In some areas of life we feel extremely competent and in others we feel inadequate. • A person with poor self-efficacy in most aspects of their life will be more vulnerable to stress and rumination, which may contribute to the development of mental disorders.

42. Part 2 - Factors that contribute to the development and progression of mental health disorders • Dot point 4 - the influence of social risk factors including disorganised attachment, loss of a significant relationship and the role of stigma as a barrier to accessing treatment

43. Social risk factors • The biopsychosocial framework identifies risk factors that influence mental disorders. As mentioned previously they align with the 4P Factor Model. • Social risk factors include: • Disorganised attachment • Loss of a significant relationship • Stigma

44. Disorganised Attachment • Attachment: refers to the emotional bond which forms between an infant and another person, usually the primary caregiver such as their mother and father. • Most infants form a secure attachment with their primary caregiver and this allows them to develop into independent people who are capable of forming positive relationships. • An unhealthy attachment formed early in life is a risk factor for developing a mental disorder. • Disorganised attachment:a type of attachment that is characterised by inconsistent or contradictory behaviour patterns in the presence of a primary caregiver.

45. Disorganised Attachment • A child with a disorganised attachment will behave towards their primary caregiver in an ambivalent or odd manner. • Behavioural characteristics of disorganised attachment include • Contradictory behaviour pattern • Undirected, misdirected, incomplete and interrupted movements • Asymmetrical movements, mistimed movements, anomalous postures • Freezing, stilling, and slowed movements and expressions • Apprehension regarding the parent • Disorganisation or disorientation • In adulthood, people with a disorganised attachment find it difficult to form close relationships, open up to others or to seek out help or other forms of social support. They have difficulty trusting people and managing stress. These behaviours influence the development of mental disorders.

46. Loss of a significant relationship • A significant relationship is a relationship perceived by an individual as being of considerable importance to them. • Significant relationships include: • Parents • Siblings • Friends • Bosses • Pets • Intimate partners • The loss of a significant other usually results in grief. • Grief is the total reaction to the experience of loss, comprising a mix of thoughts, feelings and behaviours. • Two common reactions in grief are sadness and separation anxiety. • Coping mechanisms with grief can sometimes include increased alcohol, smoking or drug use. • People who are vulnerable to developing a mental disorder are at greater risk when they lose a significant relationship. • Depression and substance use disorders are most likely to develop.

47. Stigma as a barrier to treatment • There are many services available in Australia to help with treatment and management of mental disorders. However, about two thirds of people do not seek or have access to treatment. A large number of these people are homeless or unemployed, limiting their access to treatment. • Many people avoid seeking treatment due to the stigma that surrounds mental disorders. • Stigma:means a mark or sign of shame, disgrace or disapproval typically associated with a particular characteristic or attribute that sets a person apart, such as skin colour, cultural background, a disability or a mental disorder. • People with mental disorders can be treated in a negative manner, or are stigmatised. • Stigmatisation is a form of discrimination.

48. Stigma as a barrier to treatment • Stigma involves a person being labelled. In terms of mental disorders, these labels are generally negative and derogatory. • Labels can include name calling such as ‘psycho’, ‘nuts’, ‘crazy’ or ‘schizo.’ • Stigma hampers the prevention of mental disorders, the promotion of mental wellbeing and the provision of effective treatment and care. • Two common types of stigma are: social stigma and self-stigma. • Social stigma: refers to any aspect of an individual’s identity that is devalued in a social context. • Self-stigma:refers to the stigmatising views that individuals hold about themselves • The influence of stigma leads to a person not seeking treatment, which will perpetuate their mental disorder.

49. Exam question deconstruction

50. Exam question deconstruction