Drug & Alcohol Recovery and Education Centre

What is a mental illness?

About one in five Australians will experience a mental illness, and most of us will experience a mental health problem at some time in our lives. Mental illness is a general term that refers to a group of illnesses, in the same way that heart disease refers to a group of illnesses and disorders affecting the heart. A mental illness is a health problem that significantly affects how a person feels, thinks, behaves, and interacts with other people. It is diagnosed according to standardised criteria. A mental health problem also interferes with how a person thinks, feels, and behaves, but to a lesser extent than a mental illness.

Mental health problems are more common and include the mental ill health that can be experienced temporarily as a reaction to the stresses of life. Mental health problems are less severe than mental illnesses, but may develop into a mental illness if they are not effectively dealt with. Mental illnesses cause a great deal of suffering to those experiencing them, as well as their families and friends. Furthermore, these problems appear to be increasing. According to the World Health Organization, depression will be one of the biggest health problems worldwide by the year 2020.

What are the Causes?

The causes of psychiatric illness and drug and alcohol abuse are complex. The evidence that people with mental illness are more likely to abuse alcohol and other drugs, or that those who abuse alcohol and other drugs are more likely to develop some form of mental illness, indicates that the causes are likely to be complex.

This is outlined in the statements below:

• drug use can cause psychiatric symptoms and mimic psychiatric syndromes
• drug use can initiate or worsen a psychiatric disorder
• drug use can mask psychiatric symptoms and syndromes
• drug withdrawal can cause psychiatric symptoms and mimic psychiatric disorders
• psychiatric behaviours can mimic drug use problems
• drug and alcohol abuse can make side effects from medication worse, and more likely to occur.

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What are the Symptoms?

The symptoms that a person with dual diagnosis (having both a mental health issue and a substance misuse issue) displays are identified in two parts which sometimes makes it common for one diagnosis to be missed. First are the symptoms associated with any major psychiatric disorder, such as schizophrenia, bipolar mood disorder, or personality disorder (the Mental Health Information Service has fact sheets on all of these). Second are the issues associated with abuse of alcohol and other drugs.

These are listed below:

• significant impairment or distress resulting from use
• failure to fulfil roles at work, home, or school
• persistent use in physically hazardous situations
• ongoing legal problems related to use
• continued use despite relationship or financial problems.

Drug/alcohol abuse may or may not involve physiological dependence or tolerance. The symptoms that do indicate dependency or addiction are as follows:

• compulsion and preoccupation with obtaining a drug or drugs
• loss of control over use (losing track of how much has been consumed or feeling unable to stop using)
• continued use despite negative consequences
• tendency for relapse after period of abstinence
• drug induced behaviour e.g. aggression, irritability, changes in thinking or mood.

The main symptom is increased tolerance and withdrawal. This means the same amount of the drug or alcohol has less effect, and the person can tolerate greater amounts without feeling the effects. Withdrawal symptoms occur after physiological dependence has been established and the person cannot acquire the drug or alcohol, or stops taking it for some reason.

What can I do to help myself?

• learn to recognise personal 'high-risk' situations and apply specific coping skills and strategies to avoid drinking or using
• avoid environments where substance abuse occurs, e.g. parties where people are likely to drink heavily, friends who are heavy drinkers
• join a self-help group where you can talk to others about their experiences and provide mutual support
• enlist the support of family and friends

What is the Impact of Dual Diagnosis?

The impact of having two diagnoses, one of mental illness and one of substance abuse, means that a person often experiences more severe and chronic medical, social and emotional problems than if they were to have just one. They are vulnerable not only to an alcohol and/or drug relapse but also a relapse of their mental health problems.The occurrence of either of these is likely to affect the other in a negative way. Treatment and relapse prevention must therefore be specifically catered to the person, and will often take longer, come across more obstacles, and progress only gradually.

What kind of treatment is available?

Mental health services primarily evolved to address single disorders. However many treatments for specific illnesses can be adapted to address other problems. Treatment for people with dual diagnosis may be more effective if the two diagnoses are dealt with at the same time as the two are often related (e.g. drug use to cope with symptoms of mental disorder).

It has been recommended that during treatment administration, both conditions need to be regarded as primary, without one being seen as the cause of the other. Some of the treatment options available (dependent on the severity of symptoms) are as follows:

• drugs prescribed by a psychiatrist can be tailored to reduce side effects and control symptoms of mental illness.
• Honest discussion of prescribed and recreational drug use can be a good first step in controlling overall drug use
• counselling and psychotherapy involves working with a therapist on developing inner strengths, capabilities, resources and potential. It looks at developing personal strategies to reduce drug use
  cognitive-behaviour therapy uses a number of strategies to change behaviour. These might include changes in thinking about drug use, rewards for positive changes and strategies to help reduce drug use. This therapy doesn’t look at why the person is using
• working towards the person wanting to stop abusing and helping people to recognise the greater benefits in changing behaviour. It focuses on increasing the use of internal resources.

WATERSHED HAS EXPERIENCE AND EXPERTISE IN TREATING CLIENTS WITH THIS DUAL DIAGNOSES.

In 2011, Watershed won the "Mental Health Matters' Award for Excellence in this area.

Are mental illnesses incurable and lifelong?

When treated appropriately and early, many people recover fully and have no further episodes of illness. For others, mental illness may recur throughout their lives and require ongoing treatment. This is the same as many physical illnesses, such as diabetes and heart disease. Like these other long-term health conditions, mental illness can be managed so that individuals live life to the fullest. Although some people become disabled as a result of ongoing mental illness, many who experience even very major episodes of illness live full and productive lives.

Are people born with a mental illness?

No. A vulnerability to some mental illnesses, such as bipolar mood disorder, can run in families. But other people develop mental illness with no family history.
Many factors contribute to the onset of a mental illness. These include stress, bereavement, relationship breakdown, physical and sexual abuse, unemployment, social isolation, and major physical illness or disability. Our understanding of the causes of mental illness is growing.

Can anyone develop a mental illness?

Yes. In fact, as many as one in five Australians may develop a mental illness at some stage in their lives. Everyone is vulnerable to mental health problems. Many people feel more comfortable with the notion of having 'a nervous breakdown' rather than a mental illness. However, it is important to talk openly about mental illness, as this reduces the stigma and helps people to seek early treatment.

Are people with mental illness usually dangerous?

No. This false perception underlies some of the most damaging stereotypes. People with a mental illness are seldom dangerous. Even people with the most severe mental illness are rarely dangerous when receiving appropriate treatment and support.

Should people with a mental illness be isolated from the community?

No. Most people with a mental illness recover quickly and do not even need hospital care. Others have short admissions to hospital for treatment. Improvements in treatment over recent decades mean that most people live in their communities, and there is no need for the confinement and isolation that was commonly used in the past. A very small number of people with mental illness need hospital care, sometimes against their will but this is uncommon.

What is one of the biggest problems for people with mental illness?

Stigma. One of the biggest obstacles for people recovering from mental illness is confronting the negative attitudes of other people. These often mean that people with mental illness face isolation and discrimination just for having an illness. Positive and hopeful attitudes of family, friends, service providers, employers, and other members of the community toward people with mental illness are critical to ensuring quality of life for people with mental illness and supporting recovery the signs and symptoms of different types of mental illness

What can be done about the stigma of mental illness?

• Think about mental illnesses like any other illness or health condition and bring them into the open. 
• Talk about mental illness openly with everyone you meet - it is surprising how many people are affected by mental illness, particularly the highly prevalent disorders of depression and anxiety. 
• Educate the community to overcome negative stereotypes based on misconceptions. 
• Promote mental health and healthy attitudes through childhood and adult life. 
• Support the development of resilience: learn ways to deal with stress in relationships, situations, and events. 
• Assist friends and family with a mental illness to obtain care and treatment as early as possible. 
• Ensure high quality support and treatment services are provided to people with mental illness to promote recovery. 
• Actively support the families and carers of people who have mental illness, who also experience the confusion, distress, and stigma that can accompany mental illness. 
• Address discrimination in every area of life, including employment, education, and the provision of goods, services, and facilities. 
• Encourage research into mental illness to assist understanding of how these illnesses affect people and can be prevented and/or effectively treated. 

People that can help include:

• Your general practitioner. 
• Your community health centre. 
• Your community mental health centre.
• For information on services, check the Community Help and Welfare Services and 24-hour emergency numbers in your local telephone directory.
• For immediate counselling assistance, contact Lifeline on 13 11 14. Lifeline can also supply you with contacts, further information and help. 
• For those with a mental illness and a drug or alcohol problem, Watershed can help.

Other useful sources of information about mental illness are: 

• SANE Australia www.sane.org 
• Mental Illness Fellowship of Australia www.mifa.org.au 
• The public area of the Royal Australian and New Zealand College of Psychiatrists www.ranzcp.org 
• Auseinet www.auseinet.com 
• Australian Government's HealthInsite www.healthinsite.gov.au

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