Areas of Social Work Practice I (Health Care): Medical and Psychiatric Social Work, their Evolution, Roles and Functions; Mental Health and Disease, with Schizophrenia, Mood Disorders, Neurotic, Stress-Related and Somatoform Disorders Mapped to DSM-5-TR and ICD-11, Child and Adolescent Mental Health, and Mental Health Legislation

The World Health Organization defines mental health as a state of well-being in which a person realises their own abilities, can cope with the normal stresses of life, can work productively and is able to contribute to their community; it is more than the absence of disorder. India's National Mental Health Survey of 2015–16, conducted by NIMHANS, estimated the current prevalence of mental morbidity among adults at about 10.6 per cent and the lifetime prevalence at about 13.7 per cent, and found a treatment gap ranging from about 70 to 92 per cent across disorders. Common mental disorders (depression and anxiety) and substance use disorders account for most of the burden; severe mental disorders such as schizophrenia and bipolar disorder are less common but more disabling.

Etiology is multifactorial. Biological factors include genetic vulnerability (the risk of schizophrenia is far higher in children and siblings of affected persons), brain chemistry (the dopamine hypothesis of schizophrenia; serotonin and noradrenaline in mood disorders), brain structure, and physical illness and substance use. Psychological factors include early adversity, trauma, learned patterns of thinking and coping styles. Social factors include poverty, unemployment, discrimination, violence, migration, social isolation and disasters. The stress-vulnerability (diathesis-stress) model joins them: a predisposition is triggered into illness by stress, which is why social workers address stressors and supports as part of treatment and relapse prevention. Normal and abnormal behaviour, and the criteria for distinguishing them, are treated in Unit II.

Schizophrenia usually begins in late adolescence or early adulthood and affects roughly one per cent of people over their lifetime. Its positive symptoms are delusions (fixed false beliefs, such as persecution), hallucinations (most often hearing voices), disorganised speech and grossly disorganised or catatonic behaviour; its negative symptoms are reduced emotional expression (flat affect), avolition (lack of motivation), alogia (poverty of speech), anhedonia and asociality. DSM-5-TR requires two or more of the five characteristic symptoms for a significant part of a month, at least one of them delusions, hallucinations or disorganised speech, with continuous signs of disturbance for at least six months. Management combines antipsychotic medication (clozapine for treatment-resistant illness) with psychosocial interventions: psychoeducation, family intervention, social skills training, vocational rehabilitation and community-based support. Research by George Brown and colleagues showed that high "expressed emotion" in families, criticism, hostility and emotional over-involvement, predicts relapse, and family psychoeducation that reduces it lowers relapse rates.

Mood disorders disturb emotional state for extended periods. Major depressive disorder, in DSM-5-TR, requires at least five of nine symptoms (depressed mood, loss of interest or pleasure, change in weight or appetite, sleep disturbance, psychomotor agitation or slowing, fatigue, feelings of worthlessness or guilt, poor concentration, and recurrent thoughts of death or suicide) for at least two weeks, one of them being depressed mood or loss of interest. Persistent depressive disorder (formerly dysthymia) is a chronic, milder depression lasting at least two years in adults. Bipolar I disorder involves at least one manic episode, a week or more of elevated or irritable mood with increased energy, decreased need for sleep, grandiosity, pressured speech and risky behaviour; bipolar II disorder involves hypomanic episodes and major depressive episodes, without full mania. Management includes antidepressants, mood stabilisers such as lithium, electroconvulsive therapy in severe cases, psychotherapies such as cognitive-behavioural and interpersonal therapy, and, for the social worker, suicide risk assessment, family work and help with work, debt and relationships.

The syllabus's "neurotic disorders", "stress related disorders" and "somatoform disorders" follow the tenth revision of the International Classification of Diseases, whose block F40–F48 was titled "Neurotic, stress-related and somatoform disorders", and DSM-IV, which had a "somatoform disorders" class. The current classifications have dropped the term "neurosis" and regrouped these conditions. The American Psychiatric Association's DSM-5 (2013) and its text revision DSM-5-TR (2022) use separate chapters: anxiety disorders (panic disorder, agoraphobia, generalised anxiety disorder, social anxiety disorder, specific phobia, separation anxiety disorder); obsessive-compulsive and related disorders (OCD, body dysmorphic disorder, hoarding disorder); trauma- and stressor-related disorders (post-traumatic stress disorder, acute stress disorder, adjustment disorders and, added in DSM-5-TR, prolonged grief disorder); dissociative disorders; and somatic symptom and related disorders (somatic symptom disorder, illness anxiety disorder, conversion disorder, also called functional neurological symptom disorder, and factitious disorder). The World Health Organization's ICD-11, adopted in 2019 and in effect from 1 January 2022, has its own groupings: anxiety or fear-related disorders; obsessive-compulsive or related disorders (which include hypochondriasis); disorders specifically associated with stress (post-traumatic stress disorder, complex post-traumatic stress disorder, prolonged grief disorder and adjustment disorder); dissociative disorders; and bodily distress disorder, which replaces most of the old somatoform category.

These disorders are common in primary care and in social work caseloads. Management usually combines psychological therapies, cognitive-behavioural therapy with exposure for anxiety and OCD, trauma-focused therapies for PTSD, with medication where needed, and attention to the social context: violence at home, work stress, debt and bereavement. For somatic symptom and bodily distress disorders, the social worker helps the patient and family to move from repeated investigations towards understanding the link between distress and bodily symptoms, without dismissing the suffering as "imaginary".

Child and adolescent mental health problems include the neurodevelopmental disorders, intellectual disability, autism spectrum disorder, attention-deficit/hyperactivity disorder and specific learning disorder; disruptive behaviour disorders such as oppositional defiant and conduct disorder; anxiety and depression, which often begin in adolescence; eating disorders; substance use; self-harm and suicide; and the effects of abuse, neglect and trauma. Early identification matters, and India's programmes include the Rashtriya Bal Swasthya Karyakram (2013), which screens children for developmental delays and disabilities, and the Rashtriya Kishor Swasthya Karyakram (2014) for adolescent health, including mental health. Social workers work with schools, families and child protection services, and apply the Rights of Persons with Disabilities Act 2016, which lists intellectual disability, autism spectrum disorder, specific learning disabilities and mental illness among its 21 conditions.

Mental health law in India has moved from custody to rights. The Indian Lunacy Act 1912 was replaced by the Mental Health Act 1987, which in turn was replaced by the Mental Healthcare Act 2017, in force from 29 May 2018 and designed to comply with the UN Convention on the Rights of Persons with Disabilities. The 2017 Act gives every person a right to access mental healthcare and treatment from services run or funded by government; recognises the capacity of persons with mental illness to make decisions about their treatment; provides for advance directives and nominated representatives; sets up Central and State Mental Health Authorities and Mental Health Review Boards; protects rights to dignity, confidentiality, community living and freedom from cruel treatment, prohibiting chaining; and prohibits electroconvulsive therapy without anaesthesia and muscle relaxants, allowing it for a minor only with the guardian's informed consent and the prior permission of the Mental Health Review Board. Section 115 provides that a person who attempts suicide shall, unless proved otherwise, be presumed to have severe stress and shall not be tried and punished, and places a duty on the government to provide care, treatment and rehabilitation. The Bharatiya Nyaya Sanhita, which replaced the Indian Penal Code from 1 July 2024, does not carry over the general offence of attempted suicide. Policy includes the National Mental Health Programme (1982), the District Mental Health Programme, the National Mental Health Policy (2014), the Tele-MANAS helpline (2022) and the National Suicide Prevention Strategy (2022).