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  • Kevin Humphreys

Mental Health vs Mental Illness - what's the difference and is it all just made up?



What’s the reality of Mental Illness? Almost half of us will experience a mental illness at some stage in our lives. So, if it’s not you, at least one person in your immediate family or circle of friends has or will experience mental illness.


Before we go any further, I want you to do something. Allow yourself to see what’s written here differently to how you normally read an article like this. In a future piece I’ll explore this concept further, but for now I want you to read this article through the prism of these words from the late Wayne Dyer:


“When you change the way you look at things, the things you look at change”.

The aim of this article is to outline the difference between mental illness and mental health plus provide factual information about the prevalence of mental illness both inside and outside military life.


You can choose how you read it. In the words of Mark Twain, it can be just another set of ‘lies, damned lies and statistics’ or you can adopt Wayne Dyer’s view and change the way you look at it to see that every number represents a person, a human, a life. Almost certainly, the numbers below represent someone you know in your immediate family or your circle of friends.


Mental Health vs Mental Illness


Mental health and mental illness are talked about a lot more now than years gone by. That’s a great thing if we understand what we’re talking about.


According to the World Health Organization, mental health is “a state of well-being in which every individual realises his or 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 or his community.”


Mental health is about how well a person is. Someone may have good mental health, poor mental health or mental ill-health. It’s not binary, it’s holistic and it’s a spectrum. Mental ill-health is not the same as mental illness though.


Mental Illness can be defined as ‘a clinically diagnosable disorder that significantly interferes with a person’s cognitive, emotional or social abilities’. The illnesses include numerous disorders such as anxiety, affective, psychosis and substance use.[1] Mental illness and mental disorder mean the same thing.


Just as mental health is a spectrum, mental illness isn’t simply binary either. It’s possible to recover from many mental illnesses or at least greatly reduce severity of symptoms. With this in mind, it’s most practical to think of mental health and mental illness in terms of a continuum.


Mental Health Continuum


In Canada, suicide is the second leading cause of death for 15-34 year olds[2]. Their Mental Health Commission has created a continuum model (below) to articulate the varying degrees of mental health and mental illness. It’s an excellent tool for self-reflection of symptoms and commonality of language, allowing instant understanding if you or someone else is green, yellow, amber or red.



Now that we understand what mental illness is and we’ve got examples of symptoms showing illness and ill-health, let’s take three points of reference across the globe to compare prevalence. I don’t have research for Asia and most of Europe (yet) so it’s a western world view as we look at Australia, United Kingdom (UK) and the United States of America (US).


Australia


Firstly, Australia. The Australian Government’s Institute of Health and Welfare provides the following information about mental illness downunder[4]:

  • Nearly 1 in 2 (46%) people experience a mental disorder in their lifetime.

  • 1 in 5 (20%) people experience a mental or behavioural disorder in any given 12-month period.

  • 1 in 6 females and 1 in 8 males experience depression in their lifetime.

  • 1 in 3 females and 1 in 5 males experience an anxiety condition in their lifetime.

Regarding suicide:

  • There were 3,139 deaths by suicide in 2020, representing a rate of 12.1 per 100,000 of population.

  • 3 in 4 (76%) of these deaths were males.

  • Despite the prevalence of male suicide deaths, more females attempt suicide than males, and females are twice as likely to be admitted to hospital for self-harm (with and without suicidal intent).

  • Suicide is the leading cause of death for 15-44 year olds.

  • It’s estimated over 65,000 people attempt suicide each year.


When we look specifically at Australian military personnel:[5]

  • Ex serving females are 102% more likely (ie, twice as likely) to die by suicide than the general population.

  • Permanent and reserve force males are about half as likely to die by suicide compared to the general population.

  • Ex serving males are around 24% more likely to die by suicide than the general population.

  • Ex serving males who separate voluntarily have a similar rate of suicide to the general population.

  • Ex serving males who separate for involuntary medical reasons have higher rates of suicide than males who separate voluntarily.


United States of America


Next up is the US. Here are adult statistics from the National Institute of Mental Health (NIMH)[6][7]. They’re the lead federal agency for research on mental disorders in the land of stars and stripes.

  • 1 in 5 (21%) had a mental illness.

  • 1 in 3 (31%) aged 18-25 years experienced a mental illness. For those aged 26-49 years, the rate was 1 in 4 (25%).

  • Mental illness was higher among females (26%) compared to males (16%).

  • Mental illness was highest among those reporting two or more races (35.8%), followed by White adults (22.6%). Prevalence of mental illness was lowest among Asian adults (13.9%).

  • Anxiety disorder was higher for females (23.4%) than for males (14.3%).

  • 1 in 3 adults (31.1%) experience an anxiety disorder at some time in their lives.

  • An estimated 21.0 million people (8.4% of all U.S. adults) had at least one major depressive episode.

  • Major depressive episodes were higher among females (10.5%) compared to males (6.2%).

  • Major depressive episodes were highest among individuals aged 18-25 (17.0%).

  • An estimated 3.6% had PTSD.

  • PTSD Prevalence was higher for females (5.2%) than for males (1.8%).


When it comes to suicide, the Center for Disease Control and Prevention (CDC) WISQARS Leading Causes of Death Reports[8] found that in 2019:

  • 130 people died by suicide each day.

  • Suicide was the second leading cause of death between the ages of 10 and 34, and the fourth leading cause of death between the ages of 35 and 44.

  • There were nearly two and a half times as many suicides (47,511) as there were homicides (19,141).


United Kingdom


And how about the UK? Information for the Union Jack comes from Mental Health First Aid – England:[9]

  • Depression is one of the leading causes of disability worldwide and a major contributor to suicide and coronary heart disease.

  • 1 in 4 (24%) females and 1 in 8 (13%) males in England are diagnosed with depression in their lifetime.

  • Depression often co-occurs with other mental health issues.

  • Females are twice as likely to be diagnosed with anxiety compared to males.

  • In 2018 there were 6,154 suicides (17 per day) in Great Britain, this represents approximately 11.0 per 100,000 of population (almost 250% more than died in road accidents).

  • It’s estimated up to 150,000 people attempt suicide each year.

  • 3 in 4 (75%) of deaths by suicide are males even though more females attempt suicide than males.

  • Drug and alcohol misuse increase the risk of suicide attempts and completions.


Regarding the UK Armed Forces: [10]

  • 4,214 or 2.7% of UK armed forces personnel were assessed with a mental disorder in 2018/19.

  • In 2016/17, over 24,000 ex-service personnel used primary care NHS therapeutic services in England, a 15.4% increase on the previous year.

  • Stigma is a frequently reported barrier to help-seeking. Armed forces personnel fear differential treatment from unit leaders, being labelled ‘weak’ or ‘malingerers’, or becoming ‘non-deployable’.

  • Up to 71% of military personnel who experience mental ill health don’t seek professional help.

  • Although reported mental health issues doubled in the UK armed forces between 2005-2014, only 1 in 20 ex-service personnel experiencing symptoms of mental ill health sought help.

  • 84% of ex-service personnel reporting psychological issues did not access professional help.

  • 62% of males and 46% of females in the UK armed forces were identified as drinking hazardous amounts of alcohol.

  • Service personnel are 2-5 times more likely to be dependent on alcohol than the general population.

  • Ex-service personnel with mental health issues, particularly PTSD, often present with comorbid problems of anger and aggression.

  • Male suicide rates over the last 20 years are:

  • 10 per 100,000 in the Army

  • 8 per 100,000 in the Naval service

  • 5 per 100,000 in the RAF

  • In 2017, the suicide rate among males aged 16—59 years in the UK armed forces was 9 per 100,000, compared to 19 per 100,000 in the UK general population.

  • The risk of suicide for males aged 24 or younger who have left the armed forces is between two and three times higher than for males the same age who haven’t served in the military.

  • Ex-service personnel who identify as LGBT+ are more likely to have suicidal thoughts, and attempt suicide, than those who do not identify as LGBT+.

  • Adjustment disorders accounted for 30% of all mental disorders in the armed forces in 2018/19.

  • Rates of adjustment disorders in the UK armed forces were significantly higher than for all other mental disorders between 2007/8 and 2015/16.

  • In 2018/19, PTSD accounted for 7% of all mental disorders diagnosed in UK armed forces personnel, with the highest percentages in the Army and Royal Marines.

  • In 2018/19, PTSD risk increased by 170% for service personnel previously deployed to Iraq and/or Afghanistan.

  • Diagnosis of PTSD in the UK armed forces remained low at around 2 in 1000 personnel in 2018/19.

  • A study of 100 women caring for a partner with service-related PTSD found: 45% misused alcohol, 39% had depression, 37% had anxiety, and 17% showed symptoms of PTSD.

Summary


Rates of mental illness and suicide are universally lower than the general population whilst the uniform is still on. This means there are protective factors whilst serving that help to keep us well. However, after service ends the likelihood of mental illness and the rate of suicide skyrockets for certain cohorts compared to the general population.


Despite rates of mental illness being higher in females than males across virtually every metric, males account for 3 in 4 suicides. There is no single simple answer for this dichotomy as suicide is an incredibly complex problem. However, what is clear is that males are far less likely to put their hand up to seek help and that needs to change.


We military types are more complicated than we like to admit. The rigours of combat only account for a portion of our ailments and troubles after we leave service. The impact of the workplace, loss of tribe, loss of purpose, loss of identity and loss of routine all play significant and often underrated parts in our overall state of mental health. For many, they are the real issues leading to mental illness and for some, suicide.


The Mental Health Continuum model gives good insight into some of the cognitive, behavioural and social issues associated with mental ill-health and mental illness. Clearly, someone who is non-compliant, easily enraged, frequently binge drinking and withdrawn should not be in the cockpit. They need help however, that doesn’t mean they should be banned from the cockpit forever. Again though, that’s the topic for another article.


Hopefully, by now you’ll see that mental illness is all around us. It is I believe, normal, manageable and recoverable for the vast majority of people. There are countless examples of Presidents, Prime Ministers, Generals, pilots and aircrew, Olympic athletes, academics and more who have all experienced mental ill-health and mental illness, yet had extraordinary careers and positive impacts on the world. Admitting there’s a problem and then accepting the help needed are essential steps in navigating the journey ahead. It may mean a grounding and accepting some hard truths until wings level again, but that’s ok. It’s certainly better than the alternative.


Importantly, help is available in many different forms. The first is talking to friends, family or a general medical practitioner. There are numerous other avenues as well, be it via phone, text, online chat or more. Some of these are military centric such as Open Arms in Australia, which is an organisation specifically created to provide counselling support to military personnel and their families.


Here are some helpful numbers (country specific dialling):


Australia

  • Emergency: 000

  • Open Arms: 1800 011 046 / 1800 142 072 (anonymous)

  • Lifeline: 13 11 14

Canada

  • Emergency: 911

  • Member Assistance Program: 1-800-268-7708

  • Suicide Prevention Service: 1-833-456-4566

New Zealand

  • Emergency: 111

  • 1737: 1737

  • Lifeline Aotearoa: 0508 828 865

UK

  • Emergency: 999

  • Combat Stress: 0800 138 1619

  • Samaritans: 116 123

USA

  • Emergency: 911

  • Veterans Crisis Line: 1-800-273-8255

  • Suicide Prevention Lifeline: 988 (available across the US from July 16, 2022)

References: [1] https://www.aihw.gov.au/reports/australias-health/mental-health [2] https://www.canada.ca/en/department-national-defence/services/benefits-military/health-support/mental-health/suicide-and-suicide-prevention-in-the-caf.html [3] https://theworkingmind.ca/continuum-self-check [4] https://www.aihw.gov.au/reports/australias-health/mental-health [5] https://www.aihw.gov.au/reports/veterans/serving-and-ex-serving-adf-suicide-monitoring-2021/contents/about [6] Statistics for a given 12 month period. Either 2019 or 2020. [7] https://www.nimh.nih.gov/health/statistics/mental-illness [8] https://www.cdc.gov/injury/wisqars/index.html [9] https://mhfaengland.org/mhfa-centre/research-and-evaluation/mental-health-statistics [10] https://mhfaengland.org/mhfa-centre/research-and-evaluation/mental-health-statistics/#armed-forces


This article was published in Issue 3 of Antares: The World of Military Aviation.