MENTAL HEALTH PROMOTION

Suzanne F. Jackson, Ph.D.

Dalla Lana School of Public Health

University of Toronto

CPHA – May 28, 2014

CONTENTS Mental Health Promotion Risk factors, protective factors and

determinants of health “Flourishing” as concept Policy as focus for attention – key

policies Focus on Children and Families

WHY NOT FOCUS ON TREATMENT? “[T]he science of mental illness has

produced effective treatments for more ‘broken-down’ people; it remains ineffective for preventing more people from ‘breaking down.’” (Keyes and Lopez, 2002: 46)

Mental health problems cannot be brought under control by treating individuals one at a time (Nelson et al., 1996: 161).

4 out of 5 people are not mentally ill – but are they mentally healthy?

WHAT IS MENTAL HEALTH PROMOTION? “The process of enhancing the capacity

of individuals and communities to take control over their lives and improve their mental health.

[MHP] uses strategies that foster supportive environments and individual resilience while showing respect for culture, equity, social justice, interconnections and personal dignity.”

(Joubert et al, 1996)

By Evelyn Livia from Indonesia, 9 years old From a collection of drawings and stories from the WHO Global School Contest on Mental

Health (2001)

MENTAL HEALTH PROMOTION (CONT’D) 2 elements in definition:

Power – capacity to take control over one’s life & factors that affect one’s health

Resilience – ability to cope with adversity or stress

Go beyond focus on disease

MENTAL HEALTH PROMOTION (CONT’D)

Shifts the focus to the positive and is asset-based rather than negative or deficit-based.

Flourishing = optimal mental health (Keyes, 2002) Empowerment - people and communities

recognizing their personal strength and control through determining their own destinies, and having the resources to do so in a supportive environment.

Resilience - “the quality that allows an individual or group to function well despite the odds against them.” Two fundamental concepts associated with resiliency: risk and protective factors.

THROUGH CHILDREN’S EYES

Clarence, 18 years, Federated States of Micronesia

“… Being down, identifying why, doing something about it, and bouncing back can give a person a true sense of accomplishment and worth and strengthen his/her mental health in the process.”

From a collection of drawings and stories from the WHO Global School Contest on Mental Health (2001)

RISK FACTORS Risk factors increase likelihood & burden

of mental disease & arise from within individual, family, support networks, broader social & institutional environments e.g. Indiv - physical illness; poor social skillsFam/Supp – parental substance use;

marital disruption; work stress & unemployment;

Social & Inst - poverty & economic strain; violence & abuse; homelessness; discrimination & isolation

PROTECTIVE FACTORS Protective factors buffer a person in times of

adversity & moderate impact of stress – can be internal and/or external e.g. Indiv - optimism; attachment to family;

school/work achievement; problem-solving skills Family Supp - family harmony; strong, supportive

networks; community attachment Soc & Instit - healthy public policies;

community/institutional services The presence of more protective factors,

regardless of the number of risk factors, lowers the risk of developing mental health problems and disorders (Resnick et al 1997, cited in CAMH Guide 55+)

REASON TO FOCUS ON POLICY Need to work “upstream” Need to decrease risk factors, increase

protective factors & reduce inequities Focus on creating environments that

create mental HEALTH or enable people to “flourish”

Focus on social determinants of health that are not under jurisdiction of health sector

Multi-sector Collaboration and Policy are key tools at population level

MOST SIGNIFICANT DOH1. Social inclusion

Connectedness and social ties are protective at individual level

Social network can enhance coping Civic engagement can impact policy

2. Freedom from discrimination and violence

Individual, family & systemic violence

3. Access to economic resources Contributes to sense of personal

competence & worth Remove systemic inequities of access to

income

By Vetiana from Bulgaria, 6 years old From a collection of drawings and stories from the WHO Global School Contest on Mental

Health (2001)

From a collection of drawings and stories from the WHO Global School Contest on Mental Health (2001)

I’m so sad. I wish I had friends.Nobody likes me. I’m so lonely.Get away you mental kid! Hee! Hee!She’s a retard don’t let her play.What if that was you? Let her play. She’s a human being.She’s a stupid head. She does not know how to play!

I’m glad you are my friend. Please forgive them.Sorry for being mean with you. Will you be my friend?Sorry I said you’re a stupid head.

By Brittany from Samoa, 9 years old

• From a collection of drawings and stories from the WHO Global School Contest on Mental Health (2001)

EXAMPLES OF POLICIES Social Inclusion

Require community participation in healthy living & other major health strategies

Implement ‘Healthy School’ approach Freedom from Discrimination & Violence

Positive parenting programs Anti-bullying & anti-discrimination strategies in

school & workplaces Access to Economic Resources

Publicly subsidized high quality daycare Guaranteed annual income Increase in access to safe & affordable housing

RECS FROM NATIONAL THINK TANK ON MHP - 20081. Create a Vision for a comprehensive

Mental Health Strategy (built on an MHP framework)

2. Identify a clear single point of accountability and sustained leadership (including funding & collaboration between all levels)

3. Involve multiple sectors & stakeholders4. Clarify a strong Provincial/Territorial

role

RECS FROM NATIONAL THINK TANK ON MHP – 2008 - 25. Develop a common understanding of

concepts & language (by engaging the public, removing stigma, promoting community inclusion, addressing DOH)

6. Build on strengths (by mapping existing policies & programs & identifying gaps)

7. Create strong research, knowledge & data base (including indicators of positive mental health)

8. Build an effective, wellness-based mental health system

QUOTES FROM COREY KEYES Mental illness is indeed a burden to

society, but too little flourishing is just as serious as too much mental illness.

Loss of mental health precedes mental illness.

Promoting mental health is a “two-for-one” – you get lower rates of mental illness by promoting mental health, and you get lower rates of chronic disease.

CURRENT INTEREST IN MHP CAMH, DLSPH & TPH – Best Practices

Guides for Seniors 55+, Refugees, Children & Youth

CAMH, DLSPH, TPH – interest in indicators of positive mental health re programs

Pan-Canadian Committee on MHP – inventory of MHP programs across Canada, indicators of MHP, sharing approaches that work

PHAC – surveillance indicators re MHP City of Toronto – Measuring the Well-

Being of Children & Families in Toronto CPHA/CMHA – What is needed?

By Ming-qi from China, 7 years old From a collection of drawings and stories from the WHO Global School Contest on Mental

Health (2001)