Mental health is a process that enables people to realise their abilities, deal with life’s challenges and stresses, enjoy life, work productively and contribute to their communities. Mental health is a positive sense of emotional and spiritual well-being that respects the importance of culture, equity, social justice, personal dignity and diversity. Mental health also refers euphemistically to mental problems, illnesses or disorders and services for treating them.
Mental health problems are psychological or emotional reactions that may lead temporarily to unusual behaviour but do not interrupt established routines and activities.
A mental illness or disorder is more serious and involves medically diagnosed conditions. Its symptoms may include hallucinations (a sense of something that does not exist), delusions (firm but false beliefs), highly inappropriate or violent behaviour, sadness, depression, anxiety, addiction or suicide attempts.
Types of mental illness
Mental illness includes mood disorders like bipolar, depressive or anxiety disorders, cognitive (reasoning) disorders, personality disorders, schizophrenia and other psychotic disorders, eating disorders and substance-related disorders.
Rates of mental illness
Mental illness is extremely common. In any 12-month period, more than 20% of people in New Zealand are likely to experience some form of mental illness; 47% of New Zealanders are likely to experience a form of mental illness at some point in their lives. The Dunedin longitudinal study suggests an even higher lifetime prevalence, given that 83% of the cohort had experienced mental illness and/or addiction by age 38.
Suicide is a significant health challenge. In 2011 New Zealand’s male and female suicide rates were around the middle of the range for OECD countries, but both youth rates were second-highest. Increased risk of suicide is often linked with mental illness. Serious mental disorders and risk of suicide are most common among people who have few educational qualifications or low household incomes. Often they are Māori or Pasifika, females, younger people, urban dwellers or people with an existing mental disorder. Gay, lesbian, bisexual, transgender, queer and intersex people experience higher levels of mental health distress, and are at more risk of suicide, than the heterosexual population. Anxiety disorders, major depression and eating disorders are more common among women. Substance-use disorders (such as alcohol and drug addictions) are more common among men. People with experience of mental illness make up 35% of those on the sickness benefit, and 27% of those on the invalid’s benefit.
Beliefs about mental illness
In all eras and cultures people have explained mental health and illness in their own way. Mental illness has been explained in terms of supernatural, natural, biological or psychological causes. In pre-colonial times Māori held a supernatural view and distinguished between the insane (pōrangi, pōrewarewa, haurangi, pōtētē), the demented (wairangi, karearea), the intellectually disabled (karakiraki, pororirori) and people who were possessed by spirits (apa, mate kikokiko).
In contemporary western society mental illness is believed to be influenced by a combination of biological, psychological and social factors.
Mental health and the law
Every year in New Zealand about 4,000 people are committed to treatment under compulsory-detention, assessment and treatment orders on the grounds of mental disorder. Balancing the liberty, safety and welfare of these individuals and their families, their caregivers and the public calls for complex medical and legal decisions.
Mental health of prisoners
Those sentenced to prison have higher rates of substance abuse and other forms of mental illness than the general population. While they are not imprisoned because they are mentally ill, their high levels of drug dependency, traumatic brain injury, fetal alcohol syndrome and other mental health conditions may contribute to the behaviours that result in the imprisonment. A survey of prisoners in 2015 indicated that 62% of respondents had been diagnosed with a mental health or substance abuse disorder in the last 12 months. They were three times more likely to be diagnosed with a mental health disorder in the preceding year than the general population. This research prompted the allocation of more resources to mental health services for those in New Zealand prisons.