Mental health promotion and public mental health: moving forward in Europe

EMIP Czech Republic [email protected]

Mental health promotion and public mental health: moving

forward in Europe

Dr Lynne Friedli

EMIP National Workshop

Prague, Czech Republic

22nd November 2005


Summary

•The EMIP project

•Mental health promotion in Europe

•Public mental health and mental health promotion

•Risk and protective factors

•Effective interventions

•Measuring success

•Public debate and engagement


EMIP National Workshops

•Mapping: what is the present situation for mental health promotion and prevention? For example, in relation to policy, practice, services, resources, training

•Opportunities: what are the factors that support progress in mental health promotion? For example supporting policies (in all sectors), stakeholders, initiatives and networks

•National profile: strategic vision for the future development of mental health promotion and prevention


EMIP National Reports

•National mental health data•Policy context: existing mental health and other policies relevant to promoting mental health•Strengths and weaknesses in the position of mental health promotion and prevention•Opportunities and barriers •Key priorities for action•Progress on developing a National Mental Health Action Plan


European policy environment

•WHO European declaration and action plan (Helsinki)•EU Green paper•MINDFUL (Stakes, Finland)•IMHPA (University of Nijmegen) http://www.imhpa.net/index.php?id=8

•Monitoring positive mental health (Bilbao)

•Quality of life/economics of well-being (ESS Wave 3)

•Holistic, ecological, sustainable, environmental, ethical

•WHO Health assets

http://www.imhpa.net/index.php?id=8

http://www.imhpa.net/index.php?id=8


Public mental health or mental health for all

promoting mental health for the whole population

preventing mental health problems

improving quality of life

for people with mental

health problems

improved mental health; reduced incidence of mental health problems


Public mental health

Addressing the wider determinants of mental health

• Whole populations

• Individuals at risk

• Vulnerable groups

• Key settings

How people feel is a significant public health

indicator

“the science, art and politics of creating a mentally healthy society”


What is mental health?

Physical health and well-beingFeeling

Thinking

“The heart has its reasons….” Pascal

“much depends on dinner” Margaret Visser


mental health: how we

think and feel

genetic inheritancechildhood adversity

povertysocial exclusion

inequalitybehaviour relationships parenting education

employment physical health

quality of life crime

Mental health: cycles of impact

It’s all in the mind, but it’s written on the body….


Mental Health

PovertyExclusionDiscriminationInequality

Physical Health

“We haven’t lost faith, we’ve simply transferred it from God to the medical profession” George Bernard Shaw


Sources of support for people with

mental health problemsDiagnosis

Treatment

Family, friends & neighboursEmploym

ent

HousingLeisur

e

Faith Communities

Education

Sports

Self help & support groups


Intervention approacheshe worked hard for respect but he could not find it. There was in the world a great shortage of respect and Chanu was among the famished (Monica Ali, Brick Lane)

Strengthening protective

factors

Reducing risk factors

•Strengthening individuals•Strengthening communities•Reducing structural barriers


Strengthening protective factors

• Psycho-social, life and coping skills e.g. self-expression, self-esteem, learning new skills, stress or anger management, relaxation, efficacy

• Social support as a buffer against adverse life events e.g. building social contacts, self-help groups, drop in, home visits, mentoring, time banks, volunteering

• Access to resources and services which protect mental health e,g, benefit uptake, supported employment, access to mainstream services


GDP and Life Satisfaction (from nef)A Challenge to the Political Status Quo

GDP and Life Satisfaction 1973 - 2002

0%

20%

40%

60%

80%

100%

120%

140%

160%

180%

200%

1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001

Life Satisfaction

GDP


The visioncivic life

relationships

well-being economy

parenting

friendshipsocial networks

environment

work/life balance

education

lifelong learning

sustainability

engagement

mutuality

What would policy look like if the goal was well-being?

local democracy

community assets


Health Assets & Health Needs

Healthy Diseased

HealthyDiseased

Less Healthy

Less Diseased

EpidemiologySaluto-genesis

Risk managementOpportunity Management

(from Dominic Harrison 2005)


Community assetsstrengthening communities e.g. building capacity, control,

engagement, inclusion

•know how•creativity•resilience•resourcefulness•tradition•intergenerational solidarity•cohesion

•equity•control•safety•participation•local democracy•social networks•mutuality

•cultural assets•lifelong learning•built and natural environment•access to resources•public spaces


Pathways ofImpact:

Mental health impact

Mental health promotion

health

Human capitalIdentity

capital

Social capital

Economic capital


What works in different domains?

• feelings: confident, understood, respected, empowered, safe

• skills: life skills, relaxation, help seeking, keeping fit, accessing information

• meaningful activity: employment, volunteering, education, leisure, creativity, spiritual growth

• social support: self-help groups, opportunities for friendship, faith communities

• access to resources: paid work, adequate welfare benefits, appropriate services

• influence: opportunities to participate, being consulted, shared decision making, advocacy


What demonstrates that living in a community promotes

mental health?• Access to resources: who doesn’t have access?• Feeling safe: who doesn’t feel safe?• Good place to live: who doesn’t agree?• Influence local decisions: who doesn’t have a

say?• Feeling supported: who is isolated?• Hopeful about the future: who isn’t hopeful?• Feeling valued: what makes people feel valued?• Feeling respected: what makes people feel

respected?• Being involved: who isn’t involved and why?• Knowing where to get help: who doesn’t know?


Moving forward for mental health promotion

public debate and engagement

connecting and mainstreaming

policy and emerging

ideas

evidence and indicators


The five fruit and vegetables of mental health

• Valuing yourself and others• Talking about your feelings• Keeping physically active• Eating well• Drinking in moderation• Keeping in touch with friends/loved ones • Caring for others• Getting involved/making a contribution• Taking a break• Learning new skills• Doing something creative• Seeking Help

Individuals

Communities

Policy


Notes for policy makers ….

• How people feel is a significant public health indicator

• Include ‘mental health impact’ in decision making

• Quality of life may be a more important indicator of success than symptom reduction

• It’s all in the mind, but it’s written on the body

• Modify services, not people

• Curing illness doesn’t necessarily result in health


notes for us all ….

Keep on making waves –

without which

no tide can turn……

Documents

Mental health promotion and public mental health: moving forward in Europe