Need for mental health intervention and strategies

Mental health interventions can encourage those with mental disorders to seek treatment.
Effective treatment can help a person heal and begin a healthier, happier life.
The main benefits of psychological interventions appear to center on promoting positive mood,
reducing depression, and fostering confidence in self-management (i.e. self-efficacy). For
example, Basler (1993), showed that the main effects of a cognitive-behavioral program were on
well-being (e.g., depression) and self-efficacy among people with AS. Similarly, evaluations of
the ASMP report positive effects on depression and self-efficacy (Lorig & Holman, 1993).
Hence, although levels of disability and pain may remain fairly stable, participants feel better
able to cope.
The effectiveness of psychological interventions is usually assessed over and above the effects of
medical interventions. Contrary to clinical trials, participants are not required to cease their
standard treatment for a wash-out period prior to entering the intervention. Washout periods
serve to increase the probability of finding a significant effect in clinical trials, while
maintenance of medication during an education intervention limits the potential for
improvement. A review of arthritis patient education studies (including psychologically based
interventions) (Hirano, Laurent, & Lorig, 1994) suggests that clinical studies of the effects of
medication alone demonstrate a 20–50% improvement on health status, whereas educational
interventions provide an additional 15–30% improvement.
Bronfenbrenner’s Model
American psychologist Urie Bronfenbrenner formulated the Ecological Systems Theory to
explain how social environments affect children’s development. This theory emphasizes the
importance of studying children in multiple environments, known as ecological systems, in the
attempt to understand their development.
According to Bronfenbrenner’s ecological systems theory, children typically find themselves
enmeshed in various ecosystems, from the most intimate home ecological system to the larger
school system, and then to the most expansive system which includes society and culture. Each
of these ecological systems inevitably interact with and influence each other in all aspects of the
children’s lives.
Bronfenbrenner’s theory identified four systems within which children exist that would combine
to have an impact upon how they grow and develop. He uses the terms microsystem,
mesosystem, exosystem and macrosystem.
 Microsystem
Factors located within the immediate environment of the child which interacts directly with the
child and has the greatest impact on them, such as people and events in the home.
 Mesosystem
Interconnections between the microsystems, such as between the family and teachers or
relationship between the child’s peers and the family.
 Exosystem
Those factors lie beyond the immediate environment of the child. For example, a child’s
experience at home may be influenced by their parent’s experience at work.
 Macrosystem: this includes larger societal factors such as cultural values and overall
economic conditions.
Through the various ecological systems, Bronfenbrenner’s theory demonstrates the diversity of
interrelated influences on child development. Awareness of the contexts that children are in can
sensitize us to variations in the way children may act in different settings.
For example, a child who frequently bullies smaller children at school may portray the role of a
terrified victim at home. Due to these variations, adults who are concerned with the care of a
particular child should pay close attention to his/her behavior in different settings, as well as to
the quality and type of connections that exist between these settings.
Socio-cultural approach to mental health
Much of the theory and practice of mental health, including psychiatry and mainstream
psychology, have emerged from Western cultural traditions and Western understandings of the
human condition. Notions of Cartesian dualism of body and mind, positivism, and reductionism
have been central to the development of mainstream mental health systems as they are widely
implemented today. While these relatively monocultural understandings of mental health have
provided powerful conceptual tools and frameworks for the alleviation of mental distress in
many settings, they have also been very problematic when applied to the context of non-Western
cultures without consideration of the complexity that working across cultures brings with it .
Tribe suggests that Western cultural approaches to health tend to be “predicated on a model that
focuses on individual intrapsychic experience or individual pathology, while other traditions may
be based more on community or familial processes.” From issues of over-representation of
particular cultural groups in mental health facilities to research that excludes cultural groups and
includes others, there are a number of areas at the intersection of mental health and culture that
need to be considered by the mental health professional if they wish to effectively engage with
all of the people that they work with
Cultural diversity across the world has significant impacts on the many aspects of mental health,
ranging from the ways in which health and illness are perceived, health seeking behavior,
attitudes of the consumer as well as the practitioners and mental health systems. As Hernandez et
al. suggest “culture influences what gets defined as a problem, how the problem is understood
and which solutions to the problem are acceptable.” Many of these considerations in cultural
diversity and mental health will be explored in the rest of the paper, an exploration of importance
in that while it may point to areas that need to be strengthened, it will also point to opportunities
that exist where new forms of engagement could be explored and the needs of people of diverse
cultures could be met more effectively and sustainably.
 Intersectionality
Intersectionality is an analytical framework for understanding how aspects of a person's social
and political identities combine to create different modes of discrimination and privilege.
Intersectionality identifies multiple factors of advantage and disadvantage. Examples of these
factors include gender, caste, sex, race, ethnicity, class, sexuality, religion, disability, weight, and
physical appearance. These intersecting and overlapping social identities may be both
empowering and oppressing.
“Intersectionality” is a term that was first coined in 1989 by Kimberlé Crenshaw. It recognizes
that each of us possess more than one identity – a combination of various identity markers.
Identity markers include our gender, sexuality, religion, age, caste, class, ability/disability, race,
ethnicity etc.These identity markers overlap with each other to create an “intersection” which
determines the unique ways in which each of our lives are shaped and the experiences we have.
If we want mental health care services to move towards becoming more inclusive and diverse for
all, it can only happen if service providers recognise that mental health is intersectional."
Intersectionality and Mental Health
Our mental health does not exist in isolation from the above identity markers. It is our
responsibility to acknowledge that our mental health is impacted by our identities of gender,
sexuality, caste, class, age, religion, and disability – and the unique life experiences and stressors
that accompany them.
For example, queer individuals may go through specific social disadvantages that heterosexual or
straight people would not experience.
“People living with psychosocial and/or physical disabilities may have unique life experiences of
discrimination and stigma that able-bodied people will not experience.As a result, when we talk
about mental health, we have to include these narratives of inequality, discrimination, erasure,
and violence that people with marginalized identity markers may experience. These unique and
specific stressors impact their emotional and physical health in unique ways too.
Coping mechanisms
Coping mechanisms are the strategies people often use in the face of stress and/or trauma to help
manage painful or difficult emotions. Coping mechanisms can help people adjust to stressful
events while helping them maintain their emotional well-being.
Significant life events, whether positive or negative, can cause psychological stress. Difficult
events, such as divorce, miscarriage, the death of a loved one, or the loss of a job, can cause most
people to feel grief or distress. But even events that are considered positive by many—getting
married, having a child, and buying a home—can lead to a significant amounts of stress. To
adjust to this stress, people may utilize some combination of behavior, thought, and emotion,
depending on the situation.
People may use coping mechanisms for stress management or to cope with anger, loneliness,
anxiety, or depression.
Coping mechanisms are the strategies people often use in the face of stress and/or trauma to help
manage painful or difficult emotions. Coping mechanisms can help people adjust to stressful
events while helping them maintain their emotional well-being.
Significant life events, whether positive or negative, can cause psychological stress. Difficult
events, such as divorce, miscarriage, the death of a loved one, or the loss of a job, can cause most
people to feel grief or distress. But even events that are considered positive by many—getting
married, having a child, and buying a home—can lead to a significant amounts of stress. To
adjust to this stress, people may utilize some combination of behavior, thought, and emotion,
depending on the situation.
People may use coping mechanisms for stress management or to cope with anger, loneliness,
anxiety, or depression.
Coping styles can be problem-focused—also called instrumental—or emotion-focused. Problem-
focused coping strategies are typically associated with methods of dealing with the problem in
order to reduce stress, while emotion-focused mechanisms can help people handle any feelings
of distress that result from the problem.
Further, coping mechanisms can be broadly categorized as active or avoidant. Active coping
mechanisms usually involve an awareness of the stressor and conscious attempts to reduce stress.
Avoidant coping mechanisms, on the other hand, are characterized by ignoring or otherwise
avoiding the problem.
Some coping methods, though they work for a time, are not effective for a long-term period.
These ineffective coping mechanisms, which can often be counterproductive or have unintended
negative consequences, are known as “maladaptive coping.” Adaptive coping mechanisms are
those generally considered to be healthy and effective ways of managing stressful situations.

Grounding techniques
Grounding is a practice that can help you pull away from flashbacks, unwanted memories, and
negative or challenging emotions.
Grounding techniques are exercises that may help you refocus on the present moment to distract
yourself from anxious feelings.
While there’s little research explaining how grounding techniques work, the techniques represent
a common strategy for managing PTSD and anxiety.
Grounding techniques use tools such as visualization and senses including sight, hearing, and
smell to help distract you from a variety of possible feelings and thoughts.
During a panic attack or traumatic flashback, your emotions can take over your thoughts and
physical responses. Focusing on the present through grounding techniques can help interrupt
your body’s response and return your brain and feelings to a place of safety.
Some of the common grounding techniques that can be practiced are:
 Breathe deeply
Slowly inhale, then exhale. If it helps, you can say or think “in” and “out” with each breath. Feel
each breath filling your lungs and note how it feels to push it back out.
 Take a short walk
Concentrate on your steps — you can even count them. Notice the rhythm of your footsteps and
how it feels to put your foot on the ground and then lift it again.
 Move your body
Do a few exercises or stretches. You could try:
jumping jacks
jumping up and down
jumping rope
jogging in place
stretching different muscle groups one by one
Pay attention to how your body feels with each movement and when your hands or feet touch the
floor or move through the air.
How does the floor feel against your feet and hands? If you jump rope, listen to the sound of the
rope in the air and when it hits the ground.
 Recite something
Think of a poem, song, or book passage you know by heart. Recite it quietly to yourself or in
your head.
If you say the words aloud, focus on the shape of each word on your lips and in your mouth. If
you say the words in your head, visualize each word as you’d see it on a page.
 Practice self-kindness
Repeat kind, compassionate phrases to yourself:
“You’re having a rough time, but you’ll make it through.”
“You’re strong, and you can move through this pain.”
“You’re trying hard, and you’re doing your best.”
Say it, either aloud or in your head, as many times as you need.

Mindfulness
Mindfulness is the psychological process of purposely bringing one’s attention to experiences
occurring in the present moment without judgment.
Mindfulness has been around for thousands of years in various religious and secular traditions,
such as Hinduism, Buddhism, yoga, and other non-religious meditations.
Mindfulness is essentially maintaining a moment-by-moment awareness of our thoughts,
feelings, bodily sensations, and surrounding environment, through a gentle and nurturing lens.
We do not necessarily need to be sitting on the floor with our legs crossed or even meditating at
all in order to practice mindfulness.
Several studies have shown that practicing mindfulness increases positive emotions while
decreasing negative emotions (Keng et al., 2011). Practicing mindfulness allows us to identify
our emotions while they are happening and allows us the time that we need to separate our
emotions from what is happening around us, from what is triggering our emotions. This helps us
to take a step back rather than snapping at someone when we are feeling angry or upset.
Part of mindfulness practice is to notice the emotions and thoughts that arise in us, without
judgement, and without trying to change them. We just notice our thoughts and feelings and
allow them to pass through.
We don’t think about the day that we just had at work or the awkward conversation we are
anticipating later on – and if we do find ourselves thinking about these things, we don’t tell
ourselves off or get frustrated, we simply let it go, with the knowledge that we can deal with that
later.
Below are a few examples that you can incorporate in simple ways;
 When you are in the shower, take a moment to just stand under the stream of water and
feel the temperature of it. Feel the way the water hits your shoulders. Just breathe.
 When you are sitting on the bus, plant your feet flat on the floor and roll them from your
heels to your toes, feel the floor beneath your feet, feel the bus rumble as it moves along
the street. Feel the seat beneath you, supporting your weight, against your back. Just
breathe.
 When you are driving, feel the steering while in your hands, squeeze it and then loosen
your grip, feel the seat as it supports your weight, your feel as they balance on the pedals.
Just breathe.
 When you get into bed at night, or when you wake up in the morning, do a body scan.
Start at your toes, feel as they wiggle and you roll your ankles. Move your awareness up
your calves, over your knees, up your thighs and over your hips and stomach, up to your
chest, feel your chest rise and fall as you breathe, move up to your shoulders, down your
arms, feel your fingers wiggle. Back up to your neck, your chin, cheeks, ears, eyes, and
finally to the roots of your hair on your scalp. Do you feel tightness anywhere? Do you
feel stiffness in your shoulders? Are you clenching your jaw? Just breathe.

Self Care in Mental Health – A conceptual Model

There are a number of definitions of self-care produced by different authorities at

different times – the World Health Organisation for example has produced three much-
cited definitions (in 1983, 1998 and 2009). The WHO 1998 definition is:

‘Self-Care is what people do for themselves to establish and maintain health, and to
prevent and deal with illness. It is a broad concept encompassing hygiene (general and
personal), nutrition (type and quality of food eaten), lifestyle (sporting activities, leisure
etc), environmental factors (living conditions, social habits, etc.) socio-economic factors
(income level, cultural beliefs, etc.) and self-medication.’

Different definitions include or emphasise different aspects of self-care. A discussion of

the different definitions of self-care has been published (Webber et al. Self-Care in
Health: We can define it, but should we also measure it? SelfCare 2013 4(5): 101-106).
The range of definitions of self-care, together with the broad and disparate activities that
are part of self-care, can lead to definitions of this sort becoming unwieldy for practical
purposes.

What is needed for practical implementation of self-care is a description of the all the
elements positioned from the individual’s point of view. ISF therefore proposes that a
framework for self-care can conveniently be visualised and organised around seven
‘pillars’ or ‘domains’:
 1. Health literacy – includes: the capacity of individuals to obtain, process and
understand basic health information and services needed to make appropriate
health decisions
2. Mental Wellbeing – includes: knowing your body mass index (BMI), cholesterol
level, blood pressure; engaging in health screening.
3. Physical activity – practicing moderate intensity physical activity such as
walking, cycling, or participating in sports at a desirable frequency.
4. Healthy eating – includes: having a nutritious, balanced diet with appropriate
levels of calorie intake.
5. Risk avoidance or mitigation – includes: quitting tobacco, limiting alcohol use,
getting vaccinated, practicing safe sex, using sunscreens.
6. Good hygiene – includes: washing hands regularly, brushing teeth, washing food.
7. Rational and responsible use of products, services, diagnostics and medicines –
includes: being aware of dangers, using responsibly when necessary.

Self-care is also usually the first treatment response to everyday health conditions and common
ailments. Overall, an estimated 70% to 95% of all illnesses are managed without the intervention
of a doctor. Knowing when to consult a healthcare professional is a self-care skill under pillar 1
(health literacy) and pillar 2 (self-awareness).

Self-care is therefore the fundamental level of health care in all societies and should be seen as a
major public health resource. Yet self-care is often unrecognised and underappreciated, leading
to comparisons with the invisible majority part of an iceberg below the surface, or to a
hippopotamus in those countries in latitudes less familiar with icebergs.