Mental health promotion: concepts and strategies for reaching the population

There have been many attempts to define mental health promotion. To date, there is no consensus in the field as to what it entails. While some understand it as a holistic concept including intervening at structural, societal and political levels to positively influence mental health, others conceptualise it basically as strategies with an individual focus to improve personal competencies. Many of these differences are related to the distinct understanding of the concepts of mental well‐being and positive mental health. The lack of clarity on the boundaries of mental health promotion has divided professionals and is a missed opportunity, as momentum is moving mental health promotion on to political agendas. In Europe, two important milestones for mental health, the WHO Ministerial Conference and the EC Green Paper on Mental Health, have moved mental health promotion into the political landscape, recognising positive mental health and mental well‐being as fundamental to the quality of life and productivity of Europeans and a contributor to sustainable development. Although proven efficacious, ad hoc implementation of mental health promotion programs alone is not sufficient to ensure improvement of the population's mental health. Co‐ordinated action that includes efficient ways to deliver such interventions in a sustainable way is essential. Two such delivery mechanisms in the search for efficiency are discussed in this paper: a) identifying co‐occurrence of mental and physical health problems in order to include mental health promotion components into existing health promotion interventions; and, b) supporting the inclusion of mental health indicators into sound public policy options in order to prove that efficacious policies in labour, education, environment, etc, also bring about positive mental health outcomes. To support the current interest to bring about positive mental health it is essential that evaluation of existing initiatives is put in place, as well as exploring more efficient ways for program delivery. Clearer concepts and understanding of mental health promotion's scope among practitioners would support the development of the field and the inclusion of mental health action across sectors.     

Exploration of joint working practices on anti‐social behaviour between criminal justice,mental health and social care agencies: A qualitative study

Although the police play an important role for people with mental health problems in the community, little is known about joint working practices between mental health, social care and police services. There is potential for tensions and negative outcomes for people with mental health problems, in particular when the focus is on behaviours that could be interpreted as anti‐social. This study explores perceptions about joint working between mental health, social care and police services with regard to anti‐social behaviour. We conducted a multi‐method sequential qualitative study in the UK collecting data between April 2014 and August 2016. Data were collected from two study sites: 60 narrative police logs of routinely gathered information, and semi‐structured interviews and focus groups with professionals from a range of statutory and third sector organisations (N = 55). Data sets were analysed individually, using thematic iterative coding before integrating the findings. We also looked at sequencing and turning points in the police logs. Findings mapped on a continuum of joint working practices, with examples more likely to be away from the policy ideal of partnership working as being central to mainstream activities. Joint working was driven by legal obligations and concerns about risk rather than a focus on the needs of a person with mental health problems. This was complicated by different perceptions of the police role in mental health. Adding anti‐social behaviour to this mix intensified challenges as conceptualisation of the nature of the problem and agreeing on best practice and care is open to interpretations and judgements. Of concern is an evident lack of awareness of these issues. There is a need to reflect on joint working practices, including processes and goals, keeping in mind the health and welfare needs of people with mental health problems.     

Current conceptualizations of mental health and mental health promotion

Health promotion is generally agreed to be underpinned by a set of principles which distinguish it from other disciplines and professions. This paper takes these principles as the starting point for a review of the literature of mental health promotion. The aim is to clarify the ways in which mental health and mental health promotion are currently conceptualized, in order to identify areas where health promotion can make a unique contribution to complement that of other interest groups. In the first section, it is suggested that current definitions of mental health are inadequate for health promotion practice in that they either equate health with the absence of illness or present a culturally skewed, individualized and 'expert'-led version of what it means to be mentally healthy. The second section then traces the implications of these definitions as they emerge from the literature relating to mental health promotion practice. The paper concludes with a discussion of some ways in which health promotion specialists might begin to develop a mental health promotion agenda which is more consistent with health promotion principles.     

Starting early: promoting the mental health of women and girls throughout the life span

The importance of mental health in the promotion of lifelong health among men and women alike cannot be overstated. However, mental health remains under-addressed within general public health and community health programs. In this report, we focus primarily on the mental health of women and discuss risk factors that can affect the well-being of women throughout the life span. The literature reviewed demonstrates a strong relationship between social and environmental risk factors, such as abuse and family dysfunction in childhood, to health risk behaviors and poor mental health in adulthood. We concluded that adverse childhood experiences (ACEs) and poor adult mental health could contribute to cycles of intergenerational transmission of risks leading to poor mental and physical health in children of ACEexposed parents. Also, we argue that public health communities can make a difference in women's lifelong health by improving early recognition and treatment of mental health concerns, seeking opportunities to prevent exposures to known risk factors in childhood, and developing targeted parenting interventions. Promoting healthy psychological states and coping mechanisms before, during, and after exposure to adverse events throughout life is also critical. Perhaps such efforts will help to reduce or even break cycles of risk exposure specifically for women and their children. Finally, existing prevention activities and opportunities for promoting the mental health of girls and women are discussed. Ultimately, this report challenges the women's health and public health communities to take action because mental health can have a serious impact on lifelong well-being.     

精神卫生与社会发展整合的理论与实践

许多中低收入国家对精神卫生区别对待,将其作为一种专业性的卫生政策。尽管全球精神卫生工作取得重大进展,但与之有关的政策和实践与社会发展整合的程度有限,并且往往落后于全球更广义的卫生发展。这种差距的出现是由于忽略了社会发展对精神卫生服务的影响,而这种影响既可能是积极的,也可能是消极的。本文旨在分析当前精神卫生需要克服的一系列理论和实践挑战,探索富有成效的社会发展和精神卫生整合的政策。从理论角度出发,本文力求证明社会发展与精神卫生模式之间存在兼容性,能力方法可以为精神卫生和社会发展整合提供框架。然而,近期有关幸福能力导向的言论一直在讨论精神卫生所带来的潜在危害性后果。有关政策和实践部分,本文建议采用横向和纵向整合战略。横向战略需要精神卫生与初级卫生保健相结合,精神卫生服务的提供与服务包的扩展更加统一。纵向整合是指精神卫生与其它相关政策领域（尤其是社会、经济和政治领域）之间的结合。精神卫生的实证研究强调了社会发展理论的诸多方面可以在某种形式上对其实践产生影响：一是避免那些受心理疾病影响或存在患病风险的弱势人群遭到排斥;二是强调了执行过程是成功政策的重要组成部分;三是通过聚焦个人,尽力避免社会发展中的不均衡。     

Diagnostic dissonance and negotiations of biomedicalisation: mental health practitioners’ resistance to the DSM technology and diagnostic standardisation

Previous research demonstrates that biomedicalisation and diagnostic processes are intertwined in American mental health care, but few studies examine practitioners’ negotiations. This study examines how Mental Health Practitioners (MHPs) negotiate the Diagnostic and Statistical Manual (DSM), diagnosis, standardisation and biomedicalisation‐in‐practice. Feminist grounded theory analysis of 42 semi‐structured interviews with licensed adolescent MHPs reveals accounts of discursive, everyday resistance to the DSM technology and standardisation, which I regard as key aspects of biomedicalisation. Findings demonstrate MHPs seemingly practice what I term diagnostic dissonance: a deep conflict between their professional theoretical orientations and the biomedical model legitimated in the DSM technology and insurers’ diagnostic standardisation. MHPs enact dissonance by undermining the DSM, working around standardisation and by coding the social. Coding the social refers to the employment of V‐codes – illegitimate secondary diagnoses – which convey social and relational conditions of mental distress. MHPs’ contestations of the DSM and standardisation are responses to a healthcare infrastructure that decontextualises mental health. Practitioner resistance to biomedicalisation‐in‐diagnosis is important because the biomedicalisation of mental health takes focus away from the social and relational conditions and solutions to individual and community health and illness.     

Parental perceptions of feeding practices in five European countries: an exploratory study

OBJECTIVE: To gain an insight into parental perceptions of infant feeding practices in five European countries. DESIGN: An exploratory investigation using focus group discussions. Various aspects addressed included social and cultural setting for the consumption of food, infant feeding practice and behaviour, consumer health awareness and sources of information, and attitudes towards a healthy infant diet. SETTING: Focus group participants were recruited from centres in five countries, Germany, Italy, Scotland, Spain and Sweden, with three focus groups being conducted in each centre. SUBJECTS: A total of 108 parents with infants up to the age of 12 months participated in focus group discussions across these centres. METHODS: Focus groups were conducted with participants from centres in five countries. RESULTS: The majority of parents in this study chose to initiate breastfeeding and prepare infant food at home. Parents did not strictly adhere to infant feeding guidelines when introducing complementary foods into their infant's diets. There were cross-cultural differences in sources of information on infant feeding practice with the paediatrician in Germany, Italy and Spain. The health visitor in Scotland and the child welfare clinics in Sweden were the most popular sources. CONCLUSIONS: A number of cultural differences and similarities in attitudes towards infant feeding practice were revealed. This makes European wide approaches to promoting healthy infant feeding difficult as different infant feeding practices are influenced not only by parental perceptions but also by advice from health professionals and feeding guidelines. Further data need to be available on parents' attitudes and beliefs towards infant feeding practice to investigate further the rationale for differing beliefs and attitudes towards infant feeding practice. SPONSORSHIP: EU Fifth Framework QLRT 2002 02606.     

Pregnancy and infant health: progress toward the 1990 objectives

Assuring all infants a healthy start in life and enhancing the health of their mothers are goals of the Public Health Service's health promotion and disease prevention initiative. The 13 priority objectives selected for the pregnancy and infant health area of the initiative focus on lowering infant, neonatal, and perinatal mortality rates, reducing the number of low-birth-weight infants, improving the health care of pregnant women and infants through regionalized perinatal care systems and comprehensive primary care services, encouraging early prenatal care and healthy lifestyles in pregnancy, and targeting the factors and populations associated with health risk. Although considerable progress has been made in this century in lowering the infant mortality rate, infants continue to die at a higher rate than members of any other age category under 60 years, and black infants die at almost twice the rate of white infants. To lower these high mortality rates, the private, public, and voluntary sectors have cooperated in new approaches to perinatal and infant health that have already produced some encouraging results. Recent data, for example, indicate that the priority objective of universal screening of newborns for treatable metabolic disorders has already been achieved and that the target for neonatal and infant mortality rates could be reached earlier than 1990. Substantial challenges, however, lie ahead if the current racial and ethnic differentials evident in the rates for prenatal care registration, low-birth-weight babies, and maternal and infant mortality are to be eliminated.     

Social networks,stress and health-related quality of life

Although evidence suggests that social networks reduce the risk of mortality and are negatively associated with severe mental disability, little is known about their relationship to everyday functioning and health-related quality of life (HRQoL). In addition, the importance of social networks in the presence of chronic stress remains unclear. We examined the association between social networks and aspects of mental functioning (mental health, vitality and role-emotional functioning) and the relationship between social networks and mental functioning in the presence of stressors. Multiple linear and logistic regression models were used to examine data in 47,912 middle-aged and older healthy women. The Medical Outcomes Study Short-form Health Survey measured dimensions of quality of life. We observed strong associations between levels of social networks and multivariate-adjusted quality of life scores, particularly in potentially high stress situations. Compared to the most socially integrated, women who were socially isolated had reductions in mental health and vitality scores of 6.5 and 7.4 points, respectively and a 60% increased risk of limitation in role-emotional functioning. Social networks are positively associated with mental functioning in women. This association is strongest for women reporting high levels of home and work stressors.     

Women and Mental Health: Two Traditions of Feminist Research

Gender differences in mental health have been the focus of much research and debate in several academic disciplines. This paper reviews the literature regarding the socio-cultural dimensions of women's mental health in the United States. Feminist scholarship on mental health has followed two lines of inquiry. The first, a social causation approach, examines the features of women's lives that enhance or undermine well-being. The social constructionist perspective involves critical analyses of methodology and conceptions of mental health and illness. This body of literature suggests that the findings of gender differences in mental health are artifactual and focuses on the sexism of psychiatry. Although these bodies of work have remained largely distinct and have been criticized as contradictory, both are important ingredients of a general feminist perspective on mental health. Feminist therapy is used as a model for a synthesis of approaches.     

Women and mental health: two traditions of feminist research.

Gender differences in mental health have been the focus of much research and debate in several academic disciplines. This paper reviews the literature regarding the socio-cultural dimensions of women's mental health in the United States. Feminist scholarship on mental health has followed two lines of inquiry. The first, a social causation approach, examines the features of women's lives that enhance or undermine well-being. The social constructionist perspective involves critical analyses of methodology and conceptions of mental health and illness. This body of literature suggests that the findings of gender differences in mental health are artifactual and focuses on the sexism of psychiatry. Although these bodies of work have remained largely distinct and have been criticized as contradictory, both are important ingredients of a general feminist perspective on mental health. Feminist therapy is used as a model for a synthesis of approaches.     

Training and career paths in primary prevention

Increasingly, undergraduate and graduate students as well as mid-career professionals are deciding to pursue careers focused on the primary prevention of mental disorders and the promotion of mental health. Although there are several training and career options available to prospective students of prevention, a compendium of prevention resources is not readily available. This article is intended to help prospective students find training programs, and other sources of information, that focus on prevention. The disciplines of public health, community psychology, social work, and education are reviewed with regard to their respective training options in prevention, and sources of further information are offered.     

Promoting mental health as an essential aspect of health promotion

This paper advocates that mental health promotion receive appropriate attention within health promotion. It is of great concern that, in practice, mental health promotion is frequently overlooked in health promotion programmes although the WHO definitions of health and the Ottawa Charter describe mental health as an integral part of health. It is suggested that more attention be given to addressing the determinants of mental health in terms of protective and risk factors for both physical and mental conditions, particularly in developing countries. Examples of evidence-based mental health programmes operating in widely diverse settings are presented to demonstrate that well designed interventions can contribute to the well-being of populations. It is advocated that particular attention be given to the intersectorial cooperation needed for this work.     

‘My special time’: Australian women's experiences of accessing a specialist perinatal and infant mental health service

Women who have few social supports, poor health and a history of stressful life events are at risk of poor mental health during the perinatal period. Infants of parents whose parenting capacity is compromised are also at risk of adverse outcomes. Specifically, poor perinatal mental health can impact maternal–infant attachment. To identify women at risk of poor perinatal mental health, psychosocial assessment and depression screening in the antenatal and early postnatal periods are recommended. This qualitative study is part of a larger mixed methods study, which explored two specialist perinatal and infant mental health (PIMH) services in New South Wales (Australia). Eleven women who had accessed and been discharged from a PIMH service participated in either face‐to‐face or telephone interviews. Data were transcribed verbatim and analysed thematically. One overarching theme, ‘my special time’ and three sub‐themes, ‘there is someone out there for me’, ‘it wasn't just a job’ and ‘swimming or stranded: feelings about leaving the service’, were identified. The themes describe the women's experiences of being a client of a PIMH service. Overall, women reported a positive experience of the service, their relationship with the clinician being a key component. Findings from this study highlight the importance of the relational aspect of care and support; however, women need self‐determination in all therapeutic processes, including discharge, if recovery and self‐efficacy as a mother are to be gained. Importantly, further research is needed about how clinicians model a secure base and how mothers emulate this for their infants.     

Partnership for mental health promotion

Given the conceptual shift from a focus on primary prevention to mental health promotion, this article suggests that mental health promotion activities not be conducted in mental health agencies but in those human service systems involved with the normal processes of living. The major thesis of this article is that a partnership between the mental health system and the other human service agencies is essential. This requires a clear delineation and differentiation of roles to be performed by the mental health professional.     

Creating a robust public health infrastructure for physical activity promotion

The essential role of physical activity both as an independent protective factor against numerous common chronic diseases and as a means to maintain a healthy weight is gaining increasing scientific recognition. Although the science of physical activity promotion is advancing rapidly, the practice of promoting physical activity at a population level is in its infancy. The virtual absence of a public health practice infrastructure for the promotion of physical activity at the local level presents a critical challenge to control policy for chronic disease, and particularly obesity. To translate the increasing evidence of the value of physical activity into practice will require systemic, multilevel, and multisectoral intervention approaches that build individual capability and organizational capacity for behavior change, create new social norms, and promote policy and environmental changes that support higher levels of energy expenditure across the population. This paper highlights societal changes contributing to inactivity; describes the evolution and current status of population-based public health physical activity promotion efforts in research and practice settings; suggests strategies for engaging decision makers, stakeholders, and the general public in building the necessary infrastructure to effectively promote physical activity; and identifies specific recommendations to spur the creation of a robust public health infrastructure for physical activity.     

What would the Ottawa Charter look like if it were written today?

The Ottawa Charter has been a phenomenal influence guiding the development of the concept of health promotion, and in shaping public health practice in the past 20 years. The world has changed somewhat since 1986 in many ways that could not have been anticipated by those drafting the Charter. Substantial social and economic changes have occurred, and continue to occur. These include the globalization of trade, the invention and development of the internet and mobile communications, as well as the emergence of new threats to health such as HIV/AIDS. Such profound changes require adaptations to established health promotion strategies and the development of new strategies. This paper considers the origins, describes changes and suggests adaptations to the five strategies of the Ottawa Charter - build healthy public policy; create supportive environments for health; strengthen community actions; develop personal skills; and reorient health services - that now routinely provide the framework for consideration of any major public health challenge.     

HEALTH PROMOTION: CAN IT REDRESS THE HEALTH EFFECTS OF SOCIAL DISADVANTAGE?

Social disadvantage is an entrenched feature of contemporary New Zealand society and has a deleterious influence on health. Traditional health promotion activities, with their focus on the individual, have had only a limited impact. The World Health Organization is fostering a new approach to health promotion based on the Ottawa Charter, the two most important strategies being: building healthy public policy and strengthening community action. The new health promotion has great potential, especially with its emphasis on ‘empowerment’, but as yet only indirect evidence supports the effectiveness of this approach. Several current New Zealand community-based initiatives hold promise for the future and three of these are discussed. The greatest challenge is to ensure that the ‘empowering’ approach to health promotion continues to be developed by Area Health Boards and that this type of health promotion becomes a major priority at all levels of society. As social scientists, we need to support this approach and assist in the production of evidence to show whether it is capable of redressing the health effects of social disadvantage.     

Re-thinking recovery in post-conflict settings: Supporting the mental well-being of communities in Colombia

ABSTRACT

Addressing mental health needs is a central focus of the Colombian Government’s framework for socio-political reconstruction following over 60 years of conflict. Informed by WHO standards, country efforts utilise biopsychosocial models that prioritise individual psychological and psychiatric conditions. However, increasing scrutiny of the deployment of Western approaches to mental health and recovery in the global south suggests a need to explore the best route to improving mental health outcomes. Our research contributes to these debates through a qualitative study of local understandings of mental health recovery related concepts among internally displaced persons in Colombia. Analysis of focus groups with 40 internally displaced men and women established definitions for emotional distress and recovery as parallel processes linked to the fracture and rebuilding of social worlds and family life. Definitions were shaped heavily by cultural, political, economic and legal contexts of everyday survival, often linked to experiences of structural and symbolic forms of violence. We conclude that a locally informed mental health recovery model that stretches beyond individual experiences of mental ill-health to promote ideas of collective social change would be best suited to addressing mental health needs of internally displaced groups in Colombia. Implications for practice are discussed.