Mental health difficulties

Not everyone with mental health difficulties needs specialised psychological therapy with PTS. For those with mild to moderate symptoms, community options such as counselling, social prescription, fitness programs, or volunteering may be equally effective or more effective – and faster to access. If this is the case, you should check out our Community Services section for options in your area. If you’re not sure, read the sections below to learn more about mental health. You can also talk to your GP to work out which service might be best for you.

What is mental health?

Mental health is an important component of overall health and wellbeing for everyone, it is understood that we can all move between poor and satisfactory wellbeing throughout life due to many biological, psychological and social factors. It is also recognised that people can experience long-term difficulties which greatly impact their quality of life and daily functioning. This experience may be classed as clinical, leading to diagnosis, treatment and reasonable adjustments in society.

Mental health difficulties are common in Northern Ireland highlighted by the statistics below.

• One in six adults experience common mental health difficulties (Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2014. – NHS England Digital)
• 159,726 people over the age of 16 experience emotional and mental health conditions (Northern Ireland Census 2021)

Mental health difficulties can look and feel very different across people, and for the same person over time, which highlights the importance of gaining an awareness of how difficulties present in our own lives.

Thankfully, there are skills which we can acquire and practical methods which we can implement to help manage distress and improve quality of life.

What causes mental health difficulties?

Research has not provided a definite answer for what causes mental health difficulties, however it is understood that many biological, psychological and social factors interact to influence periods of distress and resilience.

Some factors linked to distress include a family history of mental health conditions, personality, substance use, medication effects, stressful life circumstances, physical health difficulties, relationship difficulties, adverse childhood experiences, abuse, neglect, discrimination, poverty, unemployment, bereavement, loss and traumatic events marked by extreme fear, danger or violation.

Depression

Depression describes the experience of persistent low mood across long periods of time which impacts on daily living and reduces quality of life. Symptoms can vary across people however, common symptoms can be grouped across physical, psychological and behavioural categories as outlined below.

Physical	Psychological	Behavioural
Fatigue Feeling physically unwell changes in appetite and sleep	Lacking motivation Concentration difficulty Loss of enjoyment and interest Negative thoughts about oneself, others, the world and future Feeling intensely sad, guilty, frustrated, incompetent, hopeless or numb	Difficulty with concentration and motivation, starting and completing tasks Using substances to escape and cope Withdrawal from previous activities, and socialising with others

Anxiety

Anxiety describes the experience of unease and a level of fear which significantly impacts our day-to-day functioning. Anxiety operates to protect us, alerting us to danger and preparing our body to respond for survival. However, if our anxiety is severe, chronic or unpredictable it may be problematic hindering how we function daily and our quality of life. With any type of anxiety it is common to experience the physical, psychological and behavioural symptoms outlined below.

Physical	Psychological	Behavioural
Sleep difficulties Increased heartrate and palpitations, tight chest and throat, shallow breathing Muscle tension, shaking, pins and needles Headaches, dizziness, nausea Extreme hot and cold temperatures, sweating	Extreme fear, nervousness and unease Scanning for and predicting threats in the environment Obsessive and hypothetical thoughts considering ‘what if’ and worst case scenarios	Worrying and reassurance seeking Avoidance of things and situations expected to trigger anxiety Withdrawal from previous activities, and socialising with others

Below are specific anxiety conditions which are treated within healthcare services:

Generalised Anxiety describes enduring anxiety characterised by continual worry over many different things, where distressing situations are repeatedly considered.

Panic describes the regular experience of sudden and extreme anxiety which is unpredictable, all-consuming, and compromises the body. Panic can feel like losing control and can be mistaken for medical emergencies. Many people isolate, avoid and worry in attempts to prevent the reoccurrence of panic attacks.

Phobias describe a consistent and intense fear-reaction to specific items or situations. Therefore, the trigger is avoided which hinders daily functioning and quality of life.

Social Anxiety describes an extreme fear related to aspects of socialising or social situations.

Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder (OCD) describes the experience of having unpleasant and unwanted thoughts on a recurring basis (obsessions) and carrying out instinctive or habitual behaviours to reduce distress in the short-term (compulsions).

We all experience intrusive thoughts which appear randomly and shock us due to unpleasant themes- violence and harm, illness and contamination, inappropriate relationships, conflicting values.

OCD develops when intrusions become relentless and individuals form beliefs that having a thought can lead to serious consequences or influence real-world events. Further, people can worry significantly about what their obsessions mean in relation to their identity, leading people to question who they are and what they stand for.

The methods used to avoid intrusions, minimise distress and a sense of responsibility can be consuming, taking a lot of energy and time. Compulsions can be external, something we physically do that is obvious to others, or internal something we complete in our mind which is hidden.

Symptoms of OCD vary across people and over time, however the common physical, psychological and behavioural symptoms are outlined below.

Physical	Psychological	Behavioural
Sleep difficulties Increased heartrate and palpitations, tight chest and throat, shallow breathing Muscle tension, shaking, pins and needles Headaches, dizziness, nausea Extreme hot and cold temperatures, sweating	Intrusive feelings, urges, thoughts, memories and images Feelings of fear, guilt, shame, and disgust Persistent doubt and intolerance of uncertainty Strong sense of responsibility to prevent bad things from happening Concentration difficulties	Worry and reassurance seeking Avoidance of things and situations perceived to trigger anxiety and increase the likelihood of intrusions occurring Compulsive behaviour e.g. counting, washing, checking, inflexible routine, specific orders, repeating phrases, replacement of thoughts and feelings

Post-Traumatic Stress Disorder

Post-Traumatic Stress Disorder (PTSD) describes the body and mind’s long-term response to a single or series of traumatic events.  A traumatic event is any situation which poses serious threat to an individual’s life, safety or sense of self. PTSD can surface for people who are directly impacted by traumatic events, and those who witness traumatic events. Research demonstrates that not everyone who experiences a traumatic event develops PTSD however, the factors associated with prevention and onset are not yet clear.

In Northern Ireland, 60% of people surveyed experienced 1+ traumatic events (The Fundamental Facts Report 2023)

Symptoms of PTSD vary across people, however it is common to experience the physical, psychological and behavioural symptoms outlined below.

Physical	Psychological	Behavioural
Sleep difficulties and insomnia Frequently startled or dissociated Increased heartrate and palpitations, tight chest and throat, shallow breathing Muscle tension, shaking, pins and needles Headaches, dizziness, nausea Extreme hot and cold temperatures, sweating	Memory and concentration difficulty Reliving the event e.g.  Intrusive thoughts, vivid flashbacks and nightmares Intense prolonged anxiety, fear and stress Feeling sadness, guilt, shame and anger Hypervigilance – alert to potential threat Numbness, sense of loss, distorted identity Beliefs that you cannot trust the world or others- it is not safe	Using substances to escape and cope Over activity, withdrawal and isolation Aggressive, destructive, unpredictable behaviour Avoidance of memories, feelings and reminders of the traumatic event Acting to protect safety Interpersonal difficulties

 Urgent help 

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