Pengurusan

Kesihatan
Mental
Dr Hasniah Binti Husin
(MMC 49520; NSR 134656)
Pakar Psikiatri HKL/HSel
8 Oktober 2019
Mahkamah Moot, Tingkat 2,
Institut Sosial Malaysia
PROLOGUE &
BRIEF CV

2
 Outline
• Overview of mental health
– Pengenalan kepada kesihatan mental
• Mental Health Issues:
– Proses fisiologi kesihatan mental
– Isu-isu berkaitan dengan kesihatan mental
• Mental Health tactics & tips
– Kaedah praktikal mengendalikan kesihatan
mental.
Overview of mental health
"Health is a state of complete physical, mental
and social well-being and not merely the
absence of disease or infirmity” (WHO, 2016)
is defined as a state of well-being in which every
individual realizes his/her own potential, can
cope with the normal stresses of life, can work
productively and fruitfully, and is able to make
a contribution to her/his community.
WHY MENTAL HEALTH AT IS SO
IMPORTANT?
 Overview

• Globally, more than 300 million people suffer from

depression, the leading cause of disability, with many
of these people also suffering from symptoms of
anxiety.
• In Malaysia, prevalence of mental health
problem in adults (age >16yo) 29.2% (2015) vs
10.7% (1996)
In 2016, 21.7 million people are of working age
(defined by DOSM as individual aged between
15 to 64 years old) out from 31.7 million of
total Malaysian population.
• A recent WHO-led study estimates that depression and
anxiety disorders cost the global economy US$ 1 trillion each
year in lost productivity.
• 67.2 days loss of working days in 2017 = estimated cost
of RM2.27 million lost per organisation per year,
• 50.2 per cent of Malaysian employees have at least one
dimension of work-related stress
AIA vitality 2018 survey-A total of 117 organisations of different sizes and sectors participated in the
survey this year, representing a combined workforce of 11,551 employees
Type of work
Type of work
Unemployment is a well-recognized risk factor for
mental health problems, while returning to, or
getting work is protective.

2x risk for depression, 3 x increase suicide

risk, 70% of schizophrenic patients
• Workplaces that promote
mental health and support
people with mental
disorders are more likely to
reduce absenteeism,
increase productivity and
benefit from associated
economic gains.

• A negative working
environment may lead to
physical and mental health
problems, harmful use of
substances or alcohol,
absenteeism and lost
productivity.
A healthy workplace can be described as one where
workers and managers actively contribute to the
working environment by promoting and protecting
the health, safety and well-being of all employees &
Address mental health problems regardless of cause.
 Interventions and good practices
• implementation and enforcement of health
and safety policies and practices, including
• identification of distress,
• harmful use of psychoactive substances and
illness
• providing resources to manage them;
 Interventions and good practices
• informing staff that support is available;
• involving employees in decision-making,
conveying a feeling of control and
participation;
 Interventions and good practices
• support a healthy work-life balance
• programmes for career development of
employees; and
• recognizing and rewarding the contribution of
employees.
How to support people with
mental disorder at work?
• Many of the initiatives may help:
• flexible hours,
• job-redesign,
• addressing negative workplace dynamics, &
• supportive and confidential communication with
management can help people with mental
disorders continue to or return to work.
• Organizations have a responsibility to support
individuals with mental disorders in either
continuing or returning to work.
 Challenges

• Because of the stigma

associated with mental
disorders, employers need to
ensure that
– individuals feel supported
– able to ask for support in
continuing with or returning to
work
– provided with the necessary
resources to do their job.
• Access to evidence-based treatments has
been shown to be beneficial for depression
and other mental disorders.
Mental Health Issues & Mental
Illness
 Have you ever found yourself in a
situation where..
• Your to-do list seems endless
• Deadlines are near
• You are screaming inside ‘I feel so stressed!’….
• But what is stress really, and how does it
affect us?
• Is stress always a bad thing?
 What is stress?
• A multi-dimensional concept & may be defined based on
language and organizational perspectives.
• In terms of language, Latin word, stringere, refers to ‘draw
tight’, to describe hardships and/or affliction (Cartwright &
Cooper, 1997).
It often occurs when individuals’ physical and emotional do not
match or cannot handle their job demands, constraints and/or
opportunities

Eustress: Distress:
• defined as individuals who • defined as individuals who
have experienced moderate have experienced high
and low stress levels stress level.
• Able to meet job demands • not able to fulfil job
and this may help them to demands and this may
increase positive work life motivate them to decrease
(e.g., satisfaction and quality of work life (e.g.,
positive moral values). dissatisfaction and negative
moral values)
 Situational / adverse event:
occupational stress =job stress and/or work stress.

Physiological stress Psychological stress

• is often seen as physiological • is often seen as an
reaction of the body emotional reaction
(headache, migraine, (irritability and frustration,
abdominal pain, lethargic, tension, sadness, anger,
backache, chest pain, fatigue,
anxiety, nervousness,
heart palpitation, sleep
hostility, burnout,
disturbance and muscle ache,
as well as changes in eating, depression)
drinking, sleeping and smoking
habits)
 What is the challenge?
• Stress is key for survival, but too much stress can be
detrimental.
• Emotional stress that stays around for weeks or months
• It can weaken the immune system
• Causing high blood pressure, fatigue, depression, anxiety and
even heart disease.
• In particular, too much epinephrine can be harmful to your
heart
 Duration of stress
• Acute Stress
• Episodic acute stress
• Chronic stress
 Stress vs Mental Illness
• Distinction between ‘pressure’, ‘stress’ & ‘mental
health problems’
• Everyone feels under pressure sometimes but not
everyone suffers the adverse effects of stress or a
mental health problem
• Ability to work under pressure varies according to
what is happening in rest of one’s life
 Stress & Mental Illness
• Can worsen biological vulnerability, worsen
symptoms, and cause relapses
• Often associated with negative events, but positive
events and experiences may be stressful as well.
• Stress caused by not having enough to do.
– When people with co-occurring disorders have nothing
purposeful or interesting to do, they tend to have worse
symptoms and are more prone to using substances.
TYPES OF
MENTAL
ILLNESS
 CLASSIFICATION: ICD-10
Mental and behavioural disorders (F00-F99)
– F00-F09Organic, including symptomatic, mental disorders
– F10-F19Mental and behavioural disorders due to psychoactive substance
use
– F20-F29Schizophrenia, schizotypal and delusional disorders
– F30-F39Mood [affective] disorders
– F40-F48Neurotic, stress-related and somatoform disorders
– F50-F59Behavioural syndromes associated with physiological disturbances
and physical factors
– F60-F69Disorders of adult personality and behaviour
– F70-F79Mental retardation
– F80-F89Disorders of psychological development
– F90-F98Behavioural and emotional disorders with onset usually occurring
in childhood and adolescence
– F99Unspecified mental disorder
Delusions: False beliefs/thoughts win no basis in Blunted (or flat) Affect: Decreased emotional
reality expressiveness, unresponsive immobile facial appearance,
Hallucinations: Disturbances of sensory perception reduced eye contact and body language.
(hearing, seeing or feeling things not there) Alogia: Reduced speech. Responses are detached and
Disorganized Thinking/Speech: Jumping from speech is not fluid.
topic to topic, responding to questions with unrelated Avolition: Lacking motivation, spontaneity, initiative.
answers or speaking incoherently Sitting for lengthy periods or ceasing to participate in work
or daily activities.
Disorganized Behavior: Problems in performing
Anhedonia: Lacking Pleasure or interest in activities
directed daily activities. that were once enjoyable.
Catatonic Behavior: Lowered environmental Attention Deficit: Difficulty in concentrating
awareness, unresponsiveness, rigid posture, resistance
to movement or instructions and inappropriate
postures.
Perbezaan Kemurungan dan Mania
KEMURUNGAN MANIA

Emosi • Sedih, resah, rasa bersalah, kurang memberi tindakbalas • Rasa gembira keterlaluan
emosi, putus harapan, helpless • Mudah marah (irritable)
Fikiran • Kerap kritik/salahkan diri sendiri, risau, & pessimis • “Grandiose”: yakin bahawa
• Mudah lupa/ keliru, kurang tumpuan, sukar buat beliau seorang yang penting,
keputusan kaya, hebat dsb nya.

• Rasa orang lain memandang negatif terhadap beliau • Fikiran amat laju

• Berfikir tentang kematian, bunuh diri • Hilang pertimbangan

Tingkahl • Kerap menangis, mengasingkandiri, mengabaikan • Banyak bercakap

aku tanggungjawab, hilang minat terhadap penampilan diri, • Tidak perlukan tidur
hilang motivasi
• Nafsu seks berlebihan
• Tingkahlaku sosial melampau

Fizikal • Kepenatan, kurang tenaga, kurang atau terlebih tidur, • Terlalu banyak tenaga
kurang atau terlebih makan, sembelit, hilang atau • Banyak bergerak
bertambah berat badan, haid tak teratur, hilang minat
terhadap seks, kerap sakit badan

Apr 2019 MH mx @ ISM 47

 US Institute of Mental Health)
Apr 2019 MH mx @ ISM 48
 Factors affecting mental health

Apr 2019 MH mx @ ISM 49

 Kombinasi Faktor-
faktor
• Penyebab Umum Penyakit
Mental
– Faktor Pre-dispos atau sedia-ada
(keturunan, perwatakan)
– Faktor Pencetus (Stres, ketidak-
seimbangan fungsi saraf, peristiwa
hidup yang amat memberi
tekanan)
– Faktor Pengekal (tiada rawatan
teratur, tiada sokongan sosial)
Apr 2019 MH mx @ ISM 50
 Stress vulnerability model
• Help in understanding the causes of
psychiatric disorders, how psychiatric
disorders and addiction can influence each
other, and how co-occurring disorders can be
managed and treated together.
 Stress vulnerability model
• By addressing these factors people can reduce
symptoms and relapses and improve the
course of their co-occurring disorders.
• Severity and course of a co-occurring mental
health disorder can be improved by reducing
biological vulnerability and increasing
resiliency against stress
 Vulnerability
• Refers to our basic susceptibility to mental health disorders
• Biologically vulnerable to certain psychiatric disorders
• Determined early in life by a combination of factors including
– genetics,
– prenatal nutrition and stress,
– birth complications, and
– early experiences in childhood (such as abuse or the loss of a parent)
• Biological vulnerability to developing an addiction: they are
more likely to develop alcohol or drug abuse or dependence
 Factors influenced the Model
• Alcohol and drug use
– Using alcohol or drugs can increase a person’s pre-
existing biological vulnerability to a psychiatric
disorder.
– Trigger a psychiatric disorder and lead to more
severe symptoms and other impairments.
– They tend to be highly sensitive to even small
amounts of alcohol and drugs
• Medication use
 Factors influenced the Model
• Coping skills
– Relaxation skills for dealing with stress and
tension
– Social skills for connecting with people, dealing
with conflict, and getting support
– Coping skills for managing persistent symptoms
such as depression, anxiety, and sleeping
problems
 Factors influenced the Model
• Social support
– Helping people solve challenging problems
– Supporting people in using coping strategies to deal with
symptoms and substance-use urges
– Being open and willing to discussing and resolving
personal disagreements, misunderstandings, and areas of
conflict that could otherwise lead to stress
– Letting people know that they are important and cared
about
– Supporting the person in pursuing personally meaningful
goals & activities
 Reducing Biological Vulnerability
• Taking medication:
– Helping to correct the imbalances in
neurotransmitters believed to cause psychiatric
disorders.
– The symptoms of a psychiatric disorder can be
lowered and the chances of having a relapse can
also be reduced.
 Reducing Biological Vulnerability
• Avoiding alcohol or drug use.
• Can reduce biological vulnerability in two
ways.
– Because substances affect the brain
– Using substances can interfere with the corrective effects
of medication on vulnerability.
Increasing Resiliency against Stress
• Developing effective coping skills for
managing stress and persistent symptoms
• Getting involved in meaningful activities that
structure one’s time and reduce the stress of
having nothing to do
• Building socially supportive relationships that
help one manage the mental health disorder
and maintain sobriety
Mental Health: tactics & tips
How to recognize people who
needs help?
 Warning Signs
• An increase in
unexplained absences
or sick leave.
• Poor performance.
• Poor-time-keeping.
• Increased use of
alcohol, drugs, tobacco
or caffeine.
• Frequent headaches
and backaches.
 Warning Signs
• Withdrawal from social
contact.
• Poor judgement /
indecision.
• Constant tiredness or
low energy.
• Unusual displays of
emotion, e.g. frequent
irritability or
tearfulness.
 Warning Signs
• Working slowly
• Missing deadlines
• Difficulty concentrating
• Appearing numb or
emotionless
 Warning Signs
• Withdrawing from work
activity
• Overworking
• Forgetting directives,
procedures and
requests
• Having difficulty with
work transitions or
changes in routines
Support system
 Time Management
URGENT LESS URGENT

IMPORTANT

LESS IMPORTANT
HOW TO RELAX
5 USEFUL TIPS
 Deep Breathing Technique
• In one minute count your breathing
• Take a straw
• Control your breathing
 DBT:
Useful when you
are anxious,
worried, fearful…
Progressive Muscle Relaxation
 TEKNIK PENGALIHAN PERHATIAN
(Distraction techniques)
• Cth:
– Mengira dlm kepala/menyanyi dlm hati
– Perhatikan keadaan sekeliling (melihat tingkap,
perhatikan org lain,perabot/bangunan)
– Berjalan perlahan
– Berbual dgn org lain
– Bawa aktiviti yg boleh dibawa kemana2 (sudoku,
majalah)
– Perbualan kendiri yg positif
Imagery techniques
ANY QUESTION
 References
• https://www.who.int/mental_health/in_the_
workplace/en/
(updated in september 2017)
• National Health Morbidity Survey 2016
• Department of Statistic Malaysia
• Mukhtar Firdaus, Tian Po Oei. Terapi Kognitif
Tingkah Laku bagi rawatan anzieti. Penerbit
Universiti Putra Malaysia
• Pictures: courtesy to Google
Any question?

THANK YOU FOR YOUR ATTENTION