Introduction to Mental Health

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While a significant proportion of the global burden of disease is caused by neuropsychiatric conditions, and the majority of these patients live in low-resource settings, most do not receive the treatment they need (Lund et al, 2012). Even though there are well-defined, cost-effective treatment strategies, work remains to be done in understanding how these treatments should be delivered, especially within a primary care context.

perhaps organize into:

pt-centred practice and communication
mental health and addictions
health care provider wellness

There is much disability below the diagnostic threshold.

common mental disorders: impairments weich, 1997)

account of 1/3 of work days lost due to illness, and 1/5 of general practice consultations.

SDQ parent and teacher report: 25 items of positive and negative

emotional symptoms
conduct problems
gyperactivity/inattention
peer relationship problems
prosocial behaviour

McMaster offers psychotherapy training (Nick Cates (sp)).

Primary Care

As many people have a family physician with whom they have a longstanding relationship, the trust that builds up means GPs are often the only confidential confidante patients have. Also GPs often know other family members and the relationships that are present.

GPs provide much of the care for anxiety, depression, personality disorders, and others. However, due to the years of training and experience required, GPs often do not provide psychotherapy, which also takes much time. Renumeration is an oft-cited barrier, and boundries for patients due to these concerns become important.

Psychiatrists tend to care for people with psychotic disorders or manic depression. ...

Shared care

In some settings, psychiatrists and other professionals are available to consult with GPs and their team regarding care of patients with mental illness. Timely access by GPs leads to improved integration of care.

Maintaining the point of care with GPs also means other physical concerns are less likely to be overlooked.

big barrier: how GP gets paid (fee for service) space allocation, expenses, etc

Development affects mental health; mental health affects development

epidemiology
assessing

There are conditions specific to children.

Forms of presentation can vary.

There can be substantial effects on development, and vice versa.

Family context is hugely important. Problems kids face can have a huge impact on the family, as family dynamics is very important too.

Outcomes are measured more in terms of school and developmental milestones.

Developmental Assessment

How parents were raised will affect how they raise their kids; ideally, a three generation history should be done

It is often best to meet the parents and children together, then kid alone, then parents alone

Epidemiology

0-2 years

delays, retardation, genetic syndromes
effects of prematurity or hospital stays
intereference from sensory or physical handicaps
early deprivation
attachment and interruption
non-organic failure to thrive
temperament variants

2-5 years

language disorders
ADHD
pervasive ...
....

5-12 years

learning disoerders
anxiety disorders
oppositional-defniant disorders
conduct dis
somatiform disorders

adolesecne

depressive
bipolar
schiz
substance abuse

late adolescence

personality disorders

Causes of Child and Adolescent Mental Health Concerns

Evaluation of Children

be cautious of the validity of children's story, as they can embellish
playing or drawing is useful in assessing and treating
don't compete with parents; work to support them in their role

Evaluation of Adolescents

evaluate current developmental status and prior negotion of other stages
explain role and confirm independence, separation, and confidentiality
if the parent is not ideal, it can sometimes be useful to see the person with a friend