Focus on families: the public health priorities in Europe

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Focus on families the public health priorities
in Europe
Merja-Maaria Turunen Chief Physician, Porvoo
Hospital, Child Psychiatric Clinic, Finland
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Focus on families the public health priorities
in Europe

• Merja-Maaria Turunen
• Chief physician
• Childpsychiatric Unit
• Helsinki and Uusimaa Hospital District
• Porvoo Hospital

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Annual percent changes in cardiovascular
mortality in Europe between 1990 and 2002

• Age group 20-64 years
• men women
• Finland - 3,9 Ireland - 4,1
• Ireland - 3,6 Finland - 3,4
• UK - 3,5 UK - 3,2
• Bulgaria 1,0 Bulgaria 0,1
• Russia 5,7 Russia 4,3

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INFANT MORTALITY 2005

• Large inequalities in perinatal health
• late fetal mortality
• UK 5,5 Finland 2,0 ,Bulgaria 7,9
• neonatal mortality
• UK 3,4 Finland 2,1, Bulgaria 6,2
• infant mortality
• UK 5.0, Finland 3,0, Bulgaria 10,4

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WHAT IS MENTAL HEALTH

• Who a state of well-being in which the
  individual realises
• his or her abilities, can cope with the normal
  stresses
• of life, can work productively and fruitfully,
  and is able
• to make a contribution to his or her community.
• Mental health encompasses the abilities to
  develop
• emotionally, psychologically, intellectually,
  socially and
• spiritually (Barry and Jenkins, 2007). It
  includes concepts
• such as resilience, a sense of mastery and
  control,
• optimism and hope as well as our ability to
  initiate and
• sustain relationships and to play a part in our
  social
• world.

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WHY MENTAL HEALTH PROMOTION ?

• Emotional and behavioral problems are the highest
  cause of disability in children.
• Chilrens mental health problems are getting
  worse.
• Family, day care, school and peers are
  suffering.
• Problems impair all aspects of development.
• Mental health problems are major cause for social
  marginalisation
• Associated with adult mental health problems.
• High expenses in health, social services,
  education, criminal system.
• Treatment services are not meeting the needs.

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BROADER UNDERSTANDING OF MENTAL HEALTH

• Mental health is not only the concern of
  psychiatric specialists, it is a necessary
  underpinning for wider public health policies and
  interventions
• Mental health means more than psychiatric
  symptoms or disorders
• Physical health and mental health should not be
  seen as separate.
• Awarenss of the relevance of mental health means
  increased commitment and leads to effective
  action.

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EU high-level conferenceTogether for Mental
Health and Well-being, Brussels, 13 June 2008

• from a public health perspective, monitoring
  population mental health is vital
• it concerns the whole population
• is not only the concern for the proportion
  affected by mental ill health

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FINLAND HAS A STRONG TRADITION IN PREVENTION

• Existing structure of public well baby clinics
  since 1944
• Health visitors well accepted and respected
• All families attend well baby clinics
• It is part of being a good parent to use the
  services
• Awareness of mental health problems in children
  and national strategies to increase promotion of
  mental health instead on only focusing on
  physical health, vaccinations and developmental
  check ups.
• There is no health without mental health

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PARTNERSHIP

• Active participation/involvement
• Sharing of complementary expertise
• Shared decision making power
• Agreed aims and process
• Mutual respect and trust
• Open communication
• Negotiation

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EEPP personnel

• Cyprus Dr A Paradisiotou, Ms S Kyriakides, Ms Y
  Hadjipanayi, Ms S Vizacou
• Finland Prof T Tamminen, Dr K Puura, Dr M-M
  Turunen, Dr M Mäntymaa, Dr E Virta, Ms A-M Laine
• Greece Prof J Tsiantis, Prof T Dragonas, Ms E
  Layiou-Lignos, Dr K Papadopoulou
• UK Prof H Davis, Prof T Cox, Ms R Roberts, Mr C
  Day
• FRY Prof V Ispanovic, Dr N Rudic, Ms J
  Radosavlej, Ms A RadojKovic

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EEPP model education for health care nurses
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The aims of the course are to train Health
visitors to

• Work with parents in ways that support them,
  enhance their self-esteem, enable them to manage
  problems more effectively and improve their
  interaction with their children
• Adapt health visitors effectively to the helping
  role, while minimising the possible distorting
  effects of their own construction and views
• Know when and how to refer families who are
  beyond their remit to more specialist services

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SERVICE COMPONENTS

• Antenatal promotional interview
• Postnatal promotional interview
• Assessment of need (Needs checklist)
• Continuing help via home visiting or visits at
  the well baby clinic for those who were assessed
  to be in need

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TOPICS IN ANTENATAL INTERVIEW

• Mothers feelings of her current pregnancy
• Mothers expectations of the baby
• Changes happening to the family
• Support available
• Fears
• Support that might alleviate the fears

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POSTNATAL INTERVIEW

• About four weeks after delivery
• How mother was adapting to the changes in their
  lives
• Issues about being a parent, about the baby, the
  couple relationship
• Social network
• Future expectations
• Worries and problems

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THE NEEDS CHECKLIST

• CHILD
• Premature, Small for Dates Physical Concern
  Constant Crying
• PREGNANCY Unwanted, Other Concerns (e.g. young
  mother)
• IN THE MOTHER-CHILD RELATIONSHIP Lack of Feeling
  for the Baby Problems in Interaction.
• IN THE FAMILY Adversity in Mothers Childhood
• Maternal Physical Illness Psychological/Psychiatr
  ic Problems Maternal Substance Abuse
• Adversity in Fathers childhoodPaternal
  Physical Illness Psychological/Psychiatric
  Problems Paternal Substance Abuse
• Parental Marital/Partner Discord
• Criminality
• 4 or More Children
• Isolation/Lack of Social Support
• IN THE ENVIRONMENTPoverty Debt Unemployment
  Housing Problems Cleanliness Overcrowding
  Environmental Problems (e.g. threat).
• LIFE EVENTSMajor Recent Life Events.

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Preventive Intervention early interaction

• Assessment of interaction eye-contact,
  baby-talk, handling, reciprocity
• Supporting positive interaction
• Change by modelling, open wondering, and by
  speaking for the baby
• Concrete help to mothers when needed

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Early promotion project in Finland

• Clear message mental health and support of
  parents and early relationships are part of
  health visitors work
• There are effektive methods
• Problems still exist with the pressures in work
  and constantly new demands and tasks from
  specialist health services to primary health.

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EVALUATION OF EARLY INTERVENTION EEPP- PROJECT

• The outcome research showed in Finland decrease
  by 50 of mothers postnatal depression in the
  intervention group
• The level of health visitors skills in
  recognising the psychosocial problems in the
  family was high in Finland
• The training motivated health visitor to work
  with problems in partnership very useful in
  most problems where change of behaviour is
  needed.

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EVALUATION IN HELSINKI EEPP MODEL EDUCATION HAS
HELPED THE PHCPS TO (1)

• improve their skills in counselling and
  supporting parents with small children
• use their knowledge in a more structured and
  conscious way
• change their working model and routines more
  flexible
• notice risk factors in families more adequately
• deal more effectively with families with severe
  problems

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EEPP model education helped the health visitors
in Helsinki (2)

• assist parents in finding their own ways in
  problem solving
• assist parents in finding their own strengths as
  parents
• increase their professional self-esteem
• improve their working capacity with less burn
  out symptoms
• increase enjoyment of their work

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EEPP in Finland

• Major publich health intervention of the decade
• 3500 health visitors trained
• The ministery of social and health included the
  material in the well baby clinics protocols as
  part of regular service
• Screening and recognising postnatal depression
  now routine in well baby clinics

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FOCUS ON FAMILIES-NEW CHALLENGES FOR PARENTING
AND SERVICES

• Conduct disorder
• Early interaction and attachment
• Day care and schools as context for health and
  pathological development
• Bullying and violence among and to children need
  to be redefined
• Violence in the families
• Distorted and unhealthy image of reality portraid
  in mediaviolence, body image, shaming and
  disrespect
• Urgent need to study, understand and intervene
  on childrens behaviour in the net

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PUBLIC HEALTH CUTS ACROSS POLICIES AND SERVICES

• Families operate in many services for their
  health needs not just with medical professions
• Different stake holders need to commit to finding
  solutions in partnership making each their
  expertise and skills available.
• PHCP can be central in the coordination of
  different services for the family with unique
  direct access to both the physical and
  psychosocial arenas with accepted tradition in
  home visiting.
• The health care workforce needs to understand
  the role they could play in mental health
  promotion and in prevention.

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ONE CANNOT SPEED UP DEVELOPMENT FROM OUTSIDE

• There is a historical bases in what we do and
  processes cannot be changed quickly. Destroying
  goes quicker than building.
• Changes cost always need for more careful
  analyses.
• Quality of leadership will redirect itself to
  quality in the services.
• Looking back helps appreciate what can be done in
  10 to 20 years.

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Useful links

• Mental Health in the EU
• Key Facts, Figures, and Activities
• A Background Paper
• provided by the SUPPORT-project
• European Pact for Mental Health and
  Well-being Luxembourg 2008
• Davis, H. Tsiantis, J. et al.(2005).
  Special issue the European Early Promotion
  Project (EEPP). International Journal of Mental
  Health Promotion
• Juha Lavikainen, Tom Fryers and Ville Lehtinen
  (Eds.) 2006
• Improving Mental Health Information in Europe
• Health-EU portal

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