Concepts in mental health
Mental health is a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community. It is an integral component of health and well-being that underpins our individual and collective abilities to make decisions, build relationships and shape the world we live in. Mental health is a basic human right. And it is crucial to personal, community and socio-economic development.
Mental health is more than the absence of mental disorders. It exists on a complex continuum, which is experienced differently from one person to the next, with varying degrees of difficulty and distress and potentially very different social and clinical outcomes.
Mental health conditions include mental disorders and psychosocial disabilities as well as other mental states associated with significant distress, impairment in functioning, or risk of self-harm. People with mental health conditions are more likely to experience lower levels of mental well-being, but this is not always or necessarily the case.
Determinants of mental health
Throughout our lives, multiple individual, social and structural determinants may combine to protect or undermine our mental health and shift our position on the mental health continuum.
Individual psychological and biological factors such as emotional skills, substance use and genetics can make people more vulnerable to mental health problems.
Exposure to unfavourable social, economic, geopolitical and environmental circumstances – including poverty, violence, inequality and environmental deprivation – also increases people’s risk of experiencing mental health conditions.
Risks can manifest themselves at all stages of life, but those that occur during developmentally sensitive periods, especially early childhood, are particularly detrimental. For example, harsh parenting and physical punishment is known to undermine child health and bullying is a leading risk factor for mental health conditions.
Protective factors similarly occur throughout our lives and serve to strengthen resilience. They include our individual social and emotional skills and attributes as well as positive social interactions, quality education, decent work, safe neighbourhoods and community cohesion, among others.
Mental health risks and protective factors can be found in society at different scales. Local threats heighten risk for individuals, families and communities. Global threats heighten risk for whole populations and include economic downturns, disease outbreaks, humanitarian emergencies and forced displacement and the growing climate crisis.
Each single risk and protective factor has only limited predictive strength. Most people do not develop a mental health condition despite exposure to a risk factor and many people with no known risk factor still develop a mental health condition. Nonetheless, the interacting determinants of mental health serve to enhance or undermine mental health.
Mental health promotion and prevention
Promotion and prevention interventions work by identifying the individual, social and structural determinants of mental health, and then intervening to reduce risks, build resilience and establish supportive environments for mental health. Interventions can be designed for individuals, specific groups or whole populations.
Reshaping the determinants of mental health often requires action beyond the health sector and so promotion and prevention programmes should involve the education, labour, justice, transport, environment, housing, and welfare sectors. The health sector can contribute significantly by embedding promotion and prevention efforts within health services; and by advocating, initiating and, where appropriate, facilitating multisectoral collaboration and coordination.
Suicide prevention is a global priority and included in the Sustainable Development Goals. Much progress can be achieved by limiting access to means, responsible media reporting, social and emotional learning for adolescents and early intervention. Banning highly hazardous pesticides is a particularly inexpensive and cost–effective intervention for reducing suicide rates.
Promoting child and adolescent mental health is another priority and can be achieved by policies and laws that promote and protect mental health, supporting caregivers to provide nurturing care, implementing school-based programmes and improving the quality of community and online environments. School-based social and emotional learning programmes are among the most effective promotion strategies for countries at all income levels.
Promoting and protecting mental health at work is a growing area of interest and can be supported through legislation and regulation, organizational strategies, manager training and interventions for workers.
Mental health care and treatment
In the context of national efforts to strengthen mental health, it is vital to not only protect and promote the mental well-being of all, but also to address the needs of people with mental health conditions.
This should be done through community-based mental health care, which is more accessible and acceptable than institutional care, helps prevent human rights violations and delivers better recovery outcomes for people with mental health conditions. Community-based mental health care should be provided through a network of interrelated services that comprise:
- mental health services that are integrated in general health care, typically in general hospitals and through task-sharing with non-specialist care providers in primary health care;
- community mental health services that may involve community mental health centers and teams, psychosocial rehabilitation, peer support services and supported living services; and
- services that deliver mental health care in social services and non-health settings, such as child protection, school health services, and prisons.
The vast care gap for common mental health conditions such as depression and anxiety means countries must also find innovative ways to diversify and scale up care for these conditions, for example through non-specialist psychological counselling or digital self-help.
WHO response
All WHO Member States are committed to implementing the “Comprehensive mental health action plan 2013–2030", which aims to improve mental health by strengthening effective leadership and governance, providing comprehensive, integrated and responsive community-based care, implementing promotion and prevention strategies, and strengthening information systems, evidence and research. In 2020, WHO’s “Mental health atlas 2020” analysis of country performance against the action plan showed insufficient advances against the targets of the agreed action plan.
WHO’s “World mental health report: transforming mental health for all” calls on all countries to accelerate implementation of the action plan. It argues that all countries can achieve meaningful progress towards better mental health for their populations by focusing on three “paths to transformation”:
- deepen the value given to mental health by individuals, communities and governments; and matching that value with commitment, engagement and investment by all stakeholders, across all sectors;
- reshape the physical, social and economic characteristics of environments – in homes, schools, workplaces and the wider community – to better protect mental health and prevent mental health conditions; and
- strengthen mental health care so that the full spectrum of mental health needs is met through a community-based network of accessible, affordable and quality services and supports.
WHO gives particular emphasis to protecting and promoting human rights, empowering people with lived experience and ensuring a multisectoral and multistakeholder approach.
WHO continues to work nationally and internationally – including in humanitarian settings – to provide governments and partners with the strategic leadership, evidence, tools and technical support to strengthen a collective response to mental health and enable a transformation towards better mental health for all.
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The term “empathy” is used to describe a wide range of experiences. Emotion researchers generally define empathy as the ability to sense other people’s emotions, coupled with the ability to imagine what someone else might be thinking or feeling. Contemporary researchers often differentiate between two types of empathy: “Affective empathy” refers to the sensations and feelings we get in response to others’ emotions; this can include mirroring what that person is feeling, or just feeling stressed when we detect another’s fear or anxiety. “Cognitive empathy,” sometimes called “perspective taking,” refers to our ability to identify and understand other people’s emotions. Studies suggest that people with autism spectrum disorders have a hard time empathizing. Empathy seems to have deep roots in our brains and bodies, and in our evolutionary history. Elementary forms of empathy have been observed in our primate relatives, in dogs, and even in rats. Empathy has been associated with two different pathways in the brain, and scientists have speculated that some aspects of empathy can be traced to mirror neurons, cells in the brain that fire when we observe someone else perform an action in much the same way that they would fire if we performed that action ourselves. Research has also uncovered evidence of a genetic basis to empathy, though studies suggest that people can enhance (or restrict) their natural empathic abilities.
Having empathy doesn’t necessarily mean we’ll want to help someone in need, though it’s often a vital first step toward compassionate action.
For more: Read Frans de Waal’s essay on “The Evolution of Empathy” and Daniel Goleman’s overview of different forms of empathy, drawing on the work of Paul Ekman.
Empathy is a building block of morality—for people to follow the Golden Rule, it helps if they can put themselves in someone else’s shoes. It is also a key ingredient of successful relationships because it helps us understand the perspectives, needs, and intentions of others. Here are some of the ways that research has testified to the far-reaching importance of empathy. For more: Learn about why we should teach empathy to preschoolers.
Humans experience affective empathy from infancy, physically sensing their caregivers’ emotions and often mirroring those emotions. Cognitive empathy emerges later in development, around three to four years of age, roughly when children start to develop an elementary “theory of mind”—that is, the understanding that other people experience the world differently than they do. From these early forms of empathy, research suggests we can develop more complex forms that go a long way toward improving our relationships and the world around us. Here are some specific, science-based activities for cultivating empathy from our site Greater Good in Action: And here are some of the keys that researchers have identified for nurturing empathy in ourselves and others: For more: The Ashoka Foundation’s Start Empathy initiative tracks educators’ best practices for teaching empathy. The initiative gave awards to 14 programs judged to do the best job at educating for empathy. The nonprofit Playworks also offers eight strategies for developing empathy in children.
What Are the Pitfalls and Limitations of Empathy?
According to research, we’re more likely to help a single sufferer than a large group of faceless victims, and we empathize more with in-group members than out-group members. Does this reflect a defect in empathy itself? Some critics believe so, while others argue that the real problem is how we suppress our own empathy.
Empathy, after all, can be painful. An “empathy trap” occurs when we’re so focused on feeling what others are feeling that we neglect our own emotions and needs—and other people can take advantage of this. Doctors and caregivers are at particular risk of feeling emotionally overwhelmed by empathy.
In other cases, empathy seems to be detrimental. Empathizing with out-groups can make us more reluctant to engage with them, if we imagine that they’ll be critical of us. Sociopaths could use cognitive empathy to help them exploit or even torture people.
Even if we are well-intentioned, we tend to overestimate our empathic skills. We may think we know the whole story about other people when we’re actually making biased judgments—which can lead to misunderstandings and exacerbate prejudice.