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Population Mental Health Promotion: Conceptual, policy and implementation perspectives
National Forum on the Role of Public Health
February 28, 2018
Professor Margaret Barry
WHO Collaborating Centre for Health Promotion Research National University of Ireland Galway
Ollscoil na hÉireann Gaillimh
Declarationofrealorpotentialconflictsofinterest
Presenter:MargaretBarry
Ihavenorealorpotentialconflictofinterestrelatedtothematerialthatisbeing
presentedtoday.
2
Overview • Conceptualperspectives-concepts,principlesandframeworks
forpopulationmentalhealthpromotion• Policyperspectives-embracingawhole-of-governmentand
whole-of-societyapproachtoimprovingpopulationmentalhealthandreducinginequities
• Implementationperspectives-systemsandstructuresforsupportingeffectiveintersectoralaction;deliverymechanisms,skillsandcompetenciesforimplementingevidence-basedstrategies
Adopting a Public Health Approach ‘there is no health without mental health’
• Treatmentapproachesontheirownarenotsufficienttoimprovepopulationmentalhealth(WHO,2002;2004;2013)o needacomprehensivepublichealthapproachembracingpromotionand
preventionalongsidetreatmentandrecoveryo cardiovasculardisease->addressingthe‘causesofthecauses’-preventionand
promotionalongsideimprovedandmoreaccessibletreatmentandrecovery
• Paradigmchangeinthinkingaboutmentalhealtho afocusonmentalhealthratherthansolelyonmentaldisordero strategiesforcreatingthegreatestmentalhealthgainforthegreatestnumberof
peopleo shiftfromadeficitmodelofillnesstothehealthpotentialofpeopleandtheir
everydaysettingsforliving
Ø reframingthechallengeofimprovingmentalhealth
HEALTHY POPULATION
POPULATION AT RISK
OPTIMAL MANAGEMENT
AND CARE
TREATMENT AND RECOVERY OF
AVOIDABLE DISABILITY
DETECTION AND IDENTIFICATION
EARLY DIAGNOSIS AND INTERVENTION
REDUCE AVOIDABLE RISKS
BUILD RESILIENCE AND MAINTAIN
HEALTHY LIFESTYLE AND ENVIRONMENTS
PREVENTION OF DISORDERS AND
HEALTH PROBLEMS
HEALTH PROMOTION
POPULATIONS WITH DISORDERS
POPULATION WITH SYMPTOMS
Adapted from Building Capacity to Promote the Mental Health of Australians. 1996
A population health promotion perspective
Promoting population mental health and wellbeing
• Promotingmentalhealthisacriticalstrategyinimprovingpopulationhealthandwellbeing,contributestosocialandeconomicdevelopmentandgreatersocialcohesion
• Growingrecognitionoftheimportanceofpromotingpositivementalhealthandenhancingsocialandemotionalwellbeingacrossthelifecourse(WHO,2013)
• MentalhealthiscreatedwherepeoplelivetheirlivesØ broadeningourconceptandunderstandingofwhatconstitutesgood
mentalhealthandhowitcanbepromoted
Conceptualising Mental Health Mentalhealthmaybedefinedas:“astateofemotionalandsocialwell-beinginwhichtheindividualrealiseshisorherownabilities,canmanagethenormalstressesoflife,canworkeffectively,andisabletoplayaroleinhisorhercommunity“(WHO,1999)• Conceptofpositivementalhealth(Keyes,2002;Huppert,2005;Ryffetal.,2006)
o subjectivewellbeingandlifesatisfactiono positivefunctioning,engagementandsocialwellbeing
• Keyes’conceptof‘flourishing’o abilitiestodeveloppsychologically,physically,emotionally,intellectually,
sociallyandspirituallyØ indigenouswellnessframeworks
Evidence base for promoting mental health and wellbeing
• Thepromotionofmentalhealthleadstolastingbenefitsfortheimprovedhealthandwellbeingofindividuals,theirfamiliesandsociety(WHO,2013)
• Compellingevidencethatmentalhealthpromotionandprimarypreventioninterventionso reduceriskfactorsformentalandbehaviouraldisorderso enhanceprotectivefactorsforgoodhealthandwellbeingo leadtolastingpositiveeffectsonarangeofsocial,economicandhealthoutcomes–>academicperformance,employment,socialfunctioningandphysicalhealth
• Convincingsocialandeconomiccaseforinvestinginthepromotionofpopulationmentalhealthandwellbeing
Policy Frameworks
MentalHealthActionPlan2013-2020(WHO,2013)“Theessentialroleofmentalhealthinachievinghealthforall”
• comprehensivestrategiesforpromotion,prevention,treatmentandrecoveryinawhole-of-governmentapproach• toprotectandpromotethementalwellbeingofallcitizens• responsibilityextendsacrossallsectorsandallgovernmentdepartments
Ø mainstreamingmentalhealthintopublichealth,povertyreduction,economicdevelopmentandsocialpolicies
Policy Frameworks • TheHelsinkiStatementonHealthinAllPolicies(HiAP)&
FrameworkforCountryAction(WHO,2013)“HiAPisanapproachtopublicpoliciesacrosssectorsthatsystematicallytakesintoaccountthehealthimplicationsofdecisions,seekssynergies,andavoidsharmfulhealthimpactsinordertoimprovepopulationhealthandhealthequity”
Ø accountabilityofpolicymakersforhealthimpactsatalllevelsofpolicy-making • WHOShanghaiDeclaration(2016)–healthpromotionactions
toachievetheSustainableDevelopmentGoals(UN,2015)• ensuringhealthylivesandpromotingwellbeingacrossallagesisessentialtotheSDGs• SDG3.4–promotementalhealthandwellbeing
Policy Frameworks for Action • Whole-of-governmentapproach
o mentalhealthinallpoliciesapproach-cross-sectoralresponsibilityforaddressingthesocialdeterminantsofmentalhealthandaddressingmentalhealthinequities
o priorityformorethanthementalhealthsector-policycoherence
• Whole-of-societyapproacho multisectoralpartnershipsidentifyingandcreatingsynergiestopromote
andenhancementalhealth-flourishingsocietyo engagingnewactorsfromacrossdiversesectorssuchas;childcare,
education,welfare,community,youthservices,media,artsandculture,sports,urbandesign,localauthorities,environment,economicandsocialpolicies
Ø participationofallofgovernmentandthewidercommunityincreatingthe
conditionsforpositivementalhealthandwellbeing
WHO&CalousteGulbenkianFoundation(2014)SocialDeterminantsofMentalHealth“Mentalhealthandmanycommonmentaldisordersareshapedtoagreatextentbythesocial,economic,andphysicalenvironmentsinwhichpeoplelive”• callsforactionstoimprovetheconditionsofdailylife• whole-of-governmentandwhole-of-societyapproach–comprehensiveanduniversalactionsacrossthelifecourse,multiplesectorsandlevelsØ policymakingatalllevelsofgovernanceandacrosssectorscanmakeapositivedifferencetomentalhealthoutcomes
Health Promotion action areas Build healthy public policy Create supportive environments Reorient health services Strengthen community action Develop personal skill combined into Health Promotion strategies
Systems policies environment organisation community person
Systems scale
Health Promotion Principles (participation, empowerment, equity, social justice)
Assessment
Plan
ning
Implementation
Eval
uatio
n
micro - macro
Health Promotion Socio-ecological Model (Ottawa Charter, WHO, 1986) The process of enabling people to increase control over their health and the determinants of health
Adoptingahealthpromotionapproach• Buildinghealthypublicpolicy–puttingmentalheathpromotiononthe
policyagenda-health,economicandsocialpolicieso multisectoralpolicydevelopment,legislation,regulation,organisationchangeo policyandadvocacyskills;leadership,inter-governmentalaction
• Creatingsupportiveenvironments–social,physical,culturalandeconomicenvironmentso mediatingstructures–homes,schools,workplaces,communitysettings,local
authoritieso skillsofembeddingmentalhealthpromotionintoasystems-basedsettings
approach;partnershipworking
• Reorientinghealthservices–embeddingmentalhealthpromotionandpreventionintomainstreamhealthserviceso integratingmentalhealthpromotionandpreventionasacorepartofroutine
consultationsanduniversalprovisioninprimarycareandmentalhealthserviceso organisationandstructureofhealthservicesandtrainingofthebroaderhealth
workforce
Adoptingahealthpromotionapproach
• Strengtheningcommunityaction–communityengagementandparticipationo empowermentofcommunitiesinidentifyingandaddressingmentalhealthneedsat
thecommunitylevelo communitydevelopmentskills–communication,mobilisinglocalaction
• Developingpersonalskills–enablingpersonalandsocialdevelopmento socialandemotionalskillsdevelopmentacrossthelifecoursefromearlyyearsto
oldage–lifeskills,senseofcontrol,positivementalhealthliteracyo implementingandscaling-upevidence-basedskillsdevelopmentinterventions
acrosssectors–antenatalcare,parenting,schools,communities,online
Ø synergisticactionsacrossdifferentlevelsofintervention
Implementing Mental Health Promotion • Workingacrosssectorstoimplementintersectoralactionsand
participatorypolicyprocesses• Ensuringaccesstoresourcesandlifeopportunities
o supportiverelationships,education,employment,income,housing,socialinclusion
• Removingstructuralbarrierstogoodmentalhealtho addressingsocialinequity,injustice,poverty,marginalisationand
discriminationthatdenyaccesstolifeopportunities
• NCCsforPublicHealth(2017)PopulationMentalHealthPromotionforChildrenandYouth–collectionofpaperso increaseunderstandingofpositivementalhealthasanessentialfocusfor
publichealthpracticeinCanadao integratingmentalhealthpromotionintopublichealthpractice
NCCsforPublicHealth(2017)PopulationMentalHealthPromotionforChildrenandYouth
Evidence-based Actions • Knowledgebaseoneffectiveprogrammesandpolicies
o growingresearchandpracticebaseofeffectiveimplementationo identifyingpriorityactionsor‘bestbuys’
• Policiesandinterventionsforwhichthereisevidenceoftheircosteffectivenessandtheirfeasibilityintermsofculturalacceptabilityandcapacitytobedeliveredbyexistingsystems(Carteretal.,2000)
• Interventionsthatcoverpopulationgroupsacrossthelifecourseandincludeactions,whichcanbedeliveredacrossdifferentsettingsanddeliveryplatforms
Evidence Syntheses • WHOEvidenceBriefonImplementationofGlobalMentalHealthActionPlanintheEasternMediterraneanRegion.PromotionofMentalHealthandPrimaryPreventionofMentalDisorders:PrioritiesforImplementationBarry,Clarke&Petersen(2015)EMHJ21(6),424-432• Barry,Clarke,Jenkins&Patel,V.(2013)–AsystematicreviewofinterventionsinLMICs… BMCPublicHealth,13:835• Barry,M.M.andDowling,K.(2015)AReviewoftheEvidenceonEnhancingPsychosocialSkillsDevelopmentinChildrenandYoungPeople.ReportfortheIUHPE&PicardieRegionalHealthAgency,France• Barry,Clarke,Morreale,&Field(2017)Reviewoftheevidenceontheeffectsofcommunity-basedprogramsonyoungpeople’ssocialandemotionalskills.AdolescentResearchReview• Barry,M.M.andJenkins,R.(2007)ImplementingMentalHealthPromotion(2ndeditioninprogress)
DELIVERYPLATFORM• DeliveryChannel
Coresetofactions Evaluation Evidence
POPULATION
• Legislation/regulation)
• Laws®ulationtoreducedemandforalcoholuse[taxes,restrictionstoaccess,adbans,enforcementofBAClimits]
• Lawstorestrictaccesstomeansofself-harm/suicide• IntegratementalhealthintoOccupationalHealthand
Safetyregulations
• Bestbuy
• Bestbuy
• Goodbuy
• SufficientevidencefromHIC&LAMIC
• SufficientevidencefromHIC&LAMIC
• SufficientevidencefromHIC.PromisingevidencefromLMIC
• Information/awareness
• Masspromotionpublicawarenesscampaignstoimprovementalhealthliteracy&reducestigma
• Goodbuy • SufficientevidencefromHIC.InsufficientevidencefromLAMIC
COMMUNITY
• Workplaces• IntegratementalhealthintoworkplaceHealthand
Safetypractices• Goodbuy
• SufficientevidencefromHIC.PromisingevidencefromLAMIC
• Schools
• UniversalSocialEmotionalLearning(SEL)programmesadoptingwholeschoolapproaches
• Targetedinterventionsforvulnerablechildren
• Bestbuy
• Bestbuy
• SufficientevidencefromHIC&LAMIC
• SufficientevidencefromHIC&LAMIC
• Community
• Preschooleducationandcommunity-basedparentingprogrammes
• Multi-componentout-of-schoolyouthempowermentprogrammes
• Economicand/orhealthempowermentprogrammesforfamilieslivinginpoverty
• Parentingandfamilystrengtheningforschool-goingchildren(3-16years)
• Goodbuy• Goodbuy
• Goodbuy
• Goodbuy
• SufficientevidencefromHIC&promisingevidencefromLAMIC
• PromisingevidencefromLAMIC
• PromisingevidencefromLAMIC• SufficientevidencefromHIC&promising
evidencefromLAMIC
HEALTHCARE • Primary
healthcare(includingcommunityoutreach)
• Promoteinfant&maternalmentalhealth(inclparentingskills)aspartofroutineantenatalandpostnatalcareandhomevisitationprogrammes
• Trainingprimaryhealthcareprovidersinopportunisticmentalhealthpromotionandpreventioninterventionsforadultsandolderpeople
• Bestbuy
• Goodbuy
• SufficientevidencefromHIC&LAMIC
• SufficientevidencefromHIC&promisingevidencefromLAMIC
Promising Interventions �
• Interventionstofacilitatere-employment–Jobsprogramme/TyohonJobSearchprogrammeinFinland(Vuori&Silvonen,2005)
• Urbanregeneration,housingimprovement,fuelpoverty• Positiveageing–psychosocialinterventionstoreducesocial
isolation–volunteering,befriending,intergenerationalprogrammesandtargetedoutreach(Forsmanetal.,2011)
• Community-basedpeersupportprogrammes(youthmentoring,Widow-to-Widowbereavementsupport)
• Socialprescribing;supportedemploymentinitiatives–recoveryapproaches
Evidence-informed policy and practice • Robustcaseforaction-highqualitycomprehensiveinterventions
carriedoutincollaborationwithparents,families,communitiesandservicescanproducemultipleandlastingpositivebenefitso leadtoimprovementsnotonlyinmentalhealthbutalsoimprovedsocial
functioning,academicandworkperformanceandgeneralhealthbehaviouro effectsareespeciallyevidentforthemostvulnerablegroupso cost-effectiveinterventions-health,socialandeconomicbenefits
• Policysupport–universalhealthcare,familysupport,preschoolandchildcaresupport,educationalandemploymentpolicies,welfare,socialinclusionandpovertyreduction
Ø widerpublicpolicymeasurestoreducehealthandsocialinequitiesandpoverty
CapacityDevelopment • Strengthenpublichealthcapacitytodeliveronpopulationmental
healthandwellbeing
• Policy-decision-makersengageinmultisectoralpolicydevelopmentandimplementation
• Practice-strengtheningeffectiveimplementationthroughpartnershipswithothersectorstoeffectsystemschange
• Localcommunities-ensuringthattheconditionsthatcreateandprotectpositivementalhealthandwellbeingareaccessibletoall
CapacityDevelopment• Structurestosupportmultisectoralpolicydevelopmentand
implementationo politicalmandateforcross-sectoralactiono commongovernancestructure–accountabilityo operationalstructures-effectivedeliverymechanismso infrastructure,resources,leadership,expertise,workforcedevelopment
• Implementationsystemsandframeworksformultisectoralaction
o mainstreamingsustainablementalhealthpromotionpoliciesandpracticesintostandardsupportandservicedelivery
o creatingdeliverymechanismswithinexistingsystemsbasedoncollaborationandpartnerships
CapacityDevelopment• Organizationalcapacityandhumanresourcestoachievepriority
actions• Workforcedevelopment–knowledgeandskillsmix
o skillsofintersectoralworking,leadership,partnerships,advocacy,o mobilisingandengagingindividuals,communitiesandothersectorso bridgingthegapbetweenpublichealthandmentalhealthspecialists
• Newresearchparadigmso innovativeresearchapproachestocaptureandmeasuresystemschangeo supportfortransdisciplinaryandtranslationalresearchØ thenecessaryknowledge,skillsandabilitiesintranslatingpolicy,theoryand
researchintoeffectiveaction
DevelopingCompetenciesforMentalHealthPromotion
• Internationalliteratureonhealthpromotioncompetencieso Australia,Canada,NewZealandandanumberofEuropeancountrieso progressinidentifyingasetofskills,knowledge,attitudesandabilitiesthat
areuniquetohealthpromotion
• Internationalcollaborationtoidentifydomainsofcorecompetencyinhealthpromotion– IUHPE,SOPHE,CDCandinternationalleadersinthefield
• GalwayConsensusConferenceStatementonDomainsofCoreCompetencyinHealthPromotion(Allegranteetal.,2009;Barryetal.,2009)
• Barry,MM;Battel-Kirk,B;Davison,H;Dempsey,C;Parish,R;Schipperen,M;Speller,V;Zanden,vander,G;Zilnyk,A.(2012).TheCompHPProjectHandbooks.InternationalUnionforHealthPromotionandEducation(IUHPE),Paris
• Barry,M.M.,Battel-Kirk,B.andDempsey,C.(2012).TheCompHPCoreCompetenciesFrameworkforHealthPromotioninEurope.HealthEducation&Behavior,39(6):648-662.
• Battle-Kirk,B.,Barry,M.M.,vanderZanden,Contu,P.,Gallardo,C.,Martinez.,Speller,V.,Debenedetti,S.(2014).OperationalisingandpilotingtheIUHPEEuropeanaccreditationsystemforhealthpromotion(2014)GlobalHealthPromotion,doi:10.1177/1757975914545386
• Furtherdetailsavailableat:http://www.iuhpe.org/index.php/en/the-accreditation-system
DomainsofCoreCompetencies• Ethicalvaluesandprinciplesforhealthpromotionincludeabelief
inequityandsocialjustice,respectfortheautonomyandchoiceofbothindividualsandgroups,andcollaborativeandconsultativewaysofworking
• KnowledgeBase-thecorecompetenciesrequirethatahealth
promotionpractitionerdrawsonamultidisciplinaryknowledgebaseofthecoreconcepts,principles,theoryandresearchofhealthpromotionanditsapplicationinpractice
DomainsofCoreCompetencies• EnableChange-enableindividuals,groups,communitiesand
organisationstobuildcapacityforhealthpromotionactiontoimprovehealthandreducehealthinequities
• Advocatewith,andonbehalf,ofindividuals,communitiesandorganisationstoimprovehealthandwell-beingandbuildcapacityforhealthpromotionaction
• Mediatethroughpartnership-workcollaborativelyacrossdisciplines,sectorsandpartnerstoenhancetheimpactandsustainabilityofhealthpromotionaction
• Communication-communicatehealthpromotionactioneffectively,usingappropriatetechniquesandtechnologiesfordiverseaudiences
• Leadership-contributetothedevelopmentofasharedvisionandstrategicdirectionforhealthpromotionaction
DomainsofCoreCompetencies• Assessment-conductassessmentofneedsandassetsinpartnership
withstakeholders,inthecontextofthepolitical,economic,social,cultural,environmental,behaviouralandbiologicaldeterminantsthatpromoteorcompromisehealth
• Planning-developmeasurablehealthpromotiongoalsandobjectivesbasedonassessmentofneedsandassetsinpartnershipwithstakeholders
• Implementation-implementeffectiveandefficient,culturallysensitive,andethicalhealthpromotionactioninpartnershipwithstakeholders
• EvaluationandResearch-useappropriateevaluationandresearchmethods,inpartnershipwithstakeholders,todeterminethereach,impactandeffectivenessofhealthpromotionaction
CapacityDevelopmentforPopulationMentalHealth
• Developingmentalhealthpromotionpoliciesthatwilldeliveronimprovedmentalhealthatapopulationlevelo creatinganenablingpolicystructureforcomprehensiveanduniversal
actionsonacross-sectoralbasiso policyanddecision-makers–engageinmultisectoralpolicyanalysis,
developmentandimplementation
• Advancingresearchtosupporteffectiveactiono strengtheningandexpandingtheevidencebase–upstreaminterventionso investinginimplementationresearcho monitoringthestatusanddeterminantsofpositivementalhealthata
populationlevel
CapacityDevelopmentforPopulationMentalHealth
• Strengtheningeffectiveimplementationo systemsandsupportstructuresformultisectoralactiono deliverymechanismsforembeddingmentalhealthpromotionpractices
intomainstreamsupportandservicedeliveryinasustainablemanner
• Investinginmentalhealthpromotionpracticeo aligningcapacitytodeliveronpopulationmentalhealtho scaling-upandintegratingpopulationlevelactionsbasedoncross-sectoral
planninganddelivery
• Developingworkforcecapacityo baseofmultidisciplinaryknowledge,skillsandvalueso workinginpartnershipwithothersectorstoeffectsystemschangeo mobilisingpublicengagement
SustainableActionensuringthattheconditionsthatcreateandpromotepopulationmentalhealthand
wellbeingareaccessibletoall
structures
systems
science
skills
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