creating caring communities: putting mental health on the agenda dr. james irvine health promotion...
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Creating Caring Communities: Putting Mental Health on the Agenda
Dr. James Irvine
Health Promotion Summer SchoolPrairie Region Health Promotion Research Unit
Mental Health Promotion: Identity, Culture and PowerAugust 2005
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Mental Health a state of balance between
physical, mental, cultural, spiritual and other personal factors, and between the self, others and the environment
Sartorius
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Positive Mental Health
A value in its own right; contributes to the individual’s well-being and quality of life; and also contributes to society and the economy by increasing social functioning and social capital.
Jané-Llopis E, Barry M, Hosman C, Patel V.
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Why the interest in mental health promotion?
Why the interest from ‘health’?Why the interest from other
sectors?
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Increasing interest in population’s mental health
Increasing awareness of mental disorders being common & disabling
Economic consequences clearer Links between physical & mental health better
appreciated Links between education, labour, justice, etc &
mental health more understood Increasing recognition of the link needed between
economic & social development
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Mental Illness Impact
Neuropsychiatric disorders account for 13% of Global Burden of Disease; (Moodle and Jenkins)
Predictions that by 2020, depression will be the 2nd leading cause of disability in the world;
Poor mental health also contributes to poor physical health;
One in four persons will develop a mental or behavioural disorder throughout their lifetime. Prevalence ~10% of adults (WHO)
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Mental Illness Impact
20% of adolescents under the age 18 suffer from developmental, emotional or behavioural problems; 1 in 8 has a mental disorder; from poor communities this increases to 1 in 5.
Economic costs substantial 30-40% of workplace sickness absence is
attributable to mental disorders (Jenkins)
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Socio-economic & Life Stress
Impact on Physical Health
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Social Risk Factors Adverse childhood experiences (ACE) Lower childhood socio-economic status
Leads to increased: Cardiovascular risk Lipids (cholesterol) Insulin resistance Obesity
Dong M et al Circulation 2004; Lawlor, Ebrahim, Smith. BMJ 2002
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Mental health status is associated with risk behaviours at all stages of the life cycle. Young people with depression and low
self-esteem are linked with smoking, binge drinking, eating disorders and unsafe sex.
Vicious circle
Links between physical health and mental health are bidirectional
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Malnourishment in infants – increased risk of cognitive and motor deficits
Heart disease and cancer can increase risk of depression
Mood disorders can lead to increased risk of injuries, poor physical and role function
Learned helplessness, hopelessness and depression associated with decreased immunologic activity and increased risk of tumor growth and infections.
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Many of the interventions designed
to improve mental health will also
promote physical health and vice
versa.
(when mental health promotion is thought of in a
broader sense than previously understood)
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Promoting mental health has the potential to reduce a whole range of risk behaviours and their consequences such as loss of productivity, crime, drop-out from school, disrupted family relationships
(Moodle and Jenkins)
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Similarities in the conditions for different health and social outcomes
Same risk factors (low attachment to one’s community, school, family and workplace; parental alcohol and drug use; family conflict; inconsistent parenting; marital instability) and
Absence of protective factors
Can result in
increased crime, drop out from school, increased risk of alcohol abuse, sexual activity, depression and suicide, drug addition
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What we spend on policing and courts
and jails is not available to be spent on
affordable housing, school systems, or
income security.
Feather
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Mental Well-Being: the foundation of a healthy individual, family & community
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The Health of the Population
Prerequisites peace shelter education food income stable ecosystem sustainable resources social justice and
equity
Determinants child development working conditions education choices and coping income and social
status physical environments health services social support network
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Social, environmental & economic determinants of mental health
Isolation / alienation Lack of education, transport,
housing Neighourhood disorganization Peer rejection Poor social circumstances Poor nutrition Poverty Racial injustice /
discrimination Violence Work stress Unemployment Access to drugs / alcohol Displacement War
Empowerment Positive interpersonal
interactions Social participation Social responsibility /
tolerance Social services Social support / community
network Cultural integration
Williams, Saxena, McQueen
Risk Factors Protective Factors
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Societal or community-level characteristics: Culture, Language, Cohesion, Control
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Aboriginal Youth Suicide by Cultural Continuity Factors
0 20 40 60 80 100 120 140 160
Suicide Rate / 100,000
S elf-Government
Land Claims
Education
Health
Cultural Facilities
Y es No
Cultural Continuity Factors
Source: Chandler & Lalonde, 1998
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Post-Traumatic Stress Response
Popular explanations of health inequities of the
Aboriginal communities are limited (its more than
health behaviours, more than socio-economic),
The enduring impact of colonization and loss of
culture are identified as critical health issues –
concepts of historical and intergenerational trauma
need to be recognized
Mental health and social problems linked to social and
cultural disruption over the lifespan and across
generations
Mitchell, Maracle
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Post-Traumatic Stress Response
arises from external trauma and terrifying experiences that break a person’s sense of predictability, vulnerability, and control.
Mentally: negative beliefs about themselves and the
world,
Emotionally: cycles of denial and anxiety
Physically: sleep disturbances, anxiety, nightmares,
flashbacks
Behaviourally: avoidance, isolation, drinking, drugging,
increasingly aggressive.
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PTSR is a useful model for understanding and addressing health inequities:
Provides a social / historical context for what has been incorrectly viewed as individual/cultural weaknesses, or illness,
Confirms holistic understanding of well-being and cultural renewal
Compassionately validates stress responses as appropriate human reaction to trauma;
Offers access to proven psycho-educational and therapeutic approaches
Points to use of group/community models for collective mourning, support and healing.
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Mental Health Promotion
Enhances positive mental health Contributes to the reduction of risk
behaviours such as tobacco, alcohol, and drug misuse, unsafe sex
Reduction of social and economic problems such as drop out from school, crime, absenteeism from work and intimate partner violence
Reduction of rates, severity of, mortality from physical and mental illness.
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How do we approach mental health
promotion?
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Diet
Sexual Activity
Drugs
Smoking
Early Childhood Development
Social Supports
Unemployment
Education
Poverty
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Principles of Health Promotion
Health education Policy analysis Community development and
organization Health advocacy Legislation
World Health Organization (1984)
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Ottawa Charter for Health Promotion
Building Healthy Public Policy Creating supportive environments Strengthening community action Developing personal skills Reorienting health services
World Health Organization (1986)
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Key Population Health Promotion Ideas
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Meaningful participation
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Meaningful Participation
Participation by local people is
recognized as having the greatest
and most sustainable impact when
solving local problems and setting
local norms
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Multi-sector collaboration and partnerships
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The health sector has to pick up the pieces resulting from poor mental health, but it has little effect on the determinants of mental wellbeing
Expand the traditional view about who ‘owns’ mental health promotion, and who actually does, or can, promote mental health in most populations. Moodle/Jenkins
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Finding ways to shift emphasis from a sector-by-sector approach to a broader and more cohesive problem approach
Community as the focus!
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Partnerships Within communities Between communities Within health organizations
Mental health promotion & health promotion
Treatment and promotion services Between health organizations With other sectors
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Conditions for success: Intersectoral action for Population Health
Seek shared values and interest; alignment of purpose; common vision
Ensure political support Engage key partners Ensure horizontal and vertical linking Invest in alliance building Focus on concrete objectives and visible results Ensure leadership, accountability and rewards are
shared among partners Build stable teams of people skilled
transformative action adapted from FPT Adv C on PH
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Housing
Good housing acts as a mitigating factor against the negative effects of low SE status on health and well-being (Dunn, 2002).
Community focus versus jurisdictional
“if jurisdiction is your starting point, you’re not going to solve anything…Start from a
community issues standpoint, set aside jurisdictional and policy issues, and commit
some resources to it. You’ll see things happen” (Hanselmann, Gibbins)
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Intersectoral partnerships
Individuals and organizations in business and industry, housing, local gov’t, sports, recreation, arts and culture, education, and justice already are promoting and in some cases demoting mental health
May not be aware of the effect they have on mental health and can be further encouraged to either expand their health promoting work, or reduce the health damaging effects of their work
Challenge is to work out how to create effective partnerships with these indiv and organizations.
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Take action on a variety of determinants
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Multiple StrategiesMultiple Levels
Reduce individual, socio-economic, and environmental risk factors, and
Promote protective factors
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Supportive environments to reduce inequities & remove barriers
Making healthy choices, easier choices.
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Creating supportive environments
Policy Economic development Social action Community schools Early childhood supports
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Creating Supportive Environments
High/Scope Perry Preschool Project Targeted 3-4 year old children from
impoverished backgrounds
Cost $1000 per child
Cost-benefit - $7,000 to $8,000 per child
Barnett WS. AJ Orthopsych 1993
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Government Healthy Public Policy
The way services are provided Environmental policy Policy on housing, transportation,
etc Economic policy Taxation policy Social policy
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Healthy Policy is also for you & I
School boards Recreation centers First Nations Band councils Municipal governments Committees and organizations Families Workplaces
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Capacity building and empowering practices
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Capacity building
Increased awareness & knowledge
Skill development Knowing how to access
resources Developing social networks Learning from others
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Actions that focus on the health of the population
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Focus upstream on taking action earlier
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Evidence based decision making
Not only doing things right, but the right things.
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The delivery of mental health
promotion programs in an
empowering, collaborative and
participatory manner is central to
mental health promotion activity. (Barry M)
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Four crucial settings for intervention
Home, School, Workplace, and Community.
Jané-Llopis/Barry MM
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Home
During the first period of life,
there is more development in
mental, social, and physical
functioning than in any other
period across the lifespan
UNICEF, 2002
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School Enormous potential – no other setting where
such a large proportion of children can be reached
WHO “Child-friendly schools” promotes sound psychosocial environment; encourages tolerance and equality between genders, ethinic,
religious and social groups. Promotes active involvement and co-op; avoids use of physical
punishment; does not tolerate bullying. Supporting and nurturing environment; providing education
which responds to the reality of the children’s lives. Establishes connections between school and family life,
encourages creativity as well as academic abilities, and promotes self-esteem and self-confidence of children.
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Workplace Unemployment Work stress
Noise, overload, time pressures
Repetitive tasks Interpersonal conflicts Job insecurity Low sense of control Balance with personal life
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Community
Change is more likely to come about when the people it affects are involved in the change process.
Participation by local people is recognized as having the greatest and most sustainable impact when solving local problems and setting local norms
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Support Multi-outcome interventions
One of remaining problems is the categorical approach to mental, social, educational, behavioural and legal problems.
Many of these problems have commonalities that can be addressed simultaneously and that impact on many areas of functioning.
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Addressing the determinants
Partner - Who can we work with, to do it better together?
Advocate - What needs to be done at policy legislative
level?
Cheerlead - Encouraging and not getting in the way.
Enable - What we do directly to change the determinants
Mitigate - Picking up some of the pieces, so it isn’t worse
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Solutions?
Will be found in:.. thinking, planning and working...
across sectors and levels of government from multiple perspectives, including social,
psychological, justice, education, and economic, from prevention and promotion through to
treatment and care, using the expertise of many disciplines and engaging communities as partners in
potential solutions.
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David’s Population Health Traps
Macro Avoidance
Micro Paralysis
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Many Small Steps
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“Almost anything you do will seem insignificant, but it is very important that you do it anyway”
Mahatma Ghandi
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Why would a small group of dedicated individuals believe that by working together we
can change the world?
Because throughout history, it is the only thing that ever
has.
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Other sources of further information: Moodle R and Jenkins R. Mental health promotion. I’m
from the government and you want me to invest in mental health promotion. Well why should I? Promotion and Education 2005; S-2:37-41.
Jané-Llopis E, Barry M, Hosman C, Patel V. Mental health promotion works: a review. Promotion and Education; 2005; ProQuest Nursing Journals, supplement 2: 9-25
Sask Health. Supporting mental well-being and decreased substance use and abuse. 2005
McCubbin M, Labonte R, Sullivan R, Dallaire B. Mental health is our collective wealth – a discussion paper. Submitted to Federal/Provincial/Territorial Advisory Network on Mental Health. Accessed online: http://www.spheru.ca/www/html/Reports/Reports_other.htm
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Dr. James IrvineProfessor, Dept of Family Medicine, U of S
Medical Health Officer, Population Health Unit, Northern Health Authorities
Box 60002nd Floor, Lac La Ronge Indian Band Office,
LaRonge, Sk S0J 1L0