Promoting Mentally Healthy Cities for the Future

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Promoting Mentally Healthy Cities for the Future

• Shona Sturgeon
• President
• World Federation for Mental Health
• sturgeon_at_humanities.uct.ac.za

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Definition

• A healthy city is defined by a process, not an
  outcome. A healthy city is one that is
  continually creating and improving the physical
  and social determinants and expanding the
  community resources that enable people to
  mutually support each other in performing all the
  functions of life and in developing to their
  maximum potential.
• A healthy city places the health and well- being
  of its citizens at the heart of its
  decision-making

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Definition

• Well-being refers to mental health
• Mental health is defined as
• a state of well-being in which the individual
  realizes his or her own 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 own community. (WHO
  2001)

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Role of NGOs in cities

• To be effective, city decision making must be
  holistic and integrated, with all stakeholders
  involved
• NGOs have a vital role in empowering communities
  to engage with the city on broad issues of mental
  health/well-being and ensure that the voice of
  users of mental health services are heard
• The Healthy Cities movement and the World
  Federation for Mental Health share many common
  goals

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World Federation for Mental Health

• The only world-wide, multi-disciplinary,
  grassroots advocacy and public education non
  governmental organization concerned with all
  aspects of mental health/well being
• Its broad membership base facilitates
  collaboration among governments, NGOs,
  researchers, mental health practitioners and
  consumers
• It provides the framework to enable mental health
  issues to be examined from every perspective

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WFMHs Goals

• To heighten public awareness about the importance
  of mental health, and to gain understanding and
  improve attitudes about mental disorders
• To promote mental health and prevent mental
  disorders
• To improve the care, treatment and recovery of
  people with mental disorders

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Impact of mental disorders

• Mental disorders responsible for 12-15 of the
  worlds total disablity - more than
  cardiovascular diseases and twice that of cancer
• Impact on daily life accounts for over 30 of all
  years lived with disability
• One in four people will develop one or more
  mental/behavioural disorders in their life-time.
• One in four families has one member suffering
  from a mental or behavioural disorder
• Balanced care required services available in an
  accepting community with hospital support when
  needed
•  

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Mental disorders vs physical disorders

• Services for mental illness should be equitable
  with those for physical illness
• Anti-discriminatory programmes required to
  promote tolerant communities which accept people
  with mental illnesses
• Promotion of mental health and prevention of
  mental illness share many determinants
• Mentally healthy individuals create mentally
  healthy communities

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Determinants of mental health

• Risk factors
• Poverty/economic instability
• Isolation and alienation/peer rejection
• Lack of education, housing and transport
• Poor nutrition
• Early life disadvantage/child abuse
• Work stress /unemployment
• Displacement
• Racial discrimination
• Poor working conditions/unemployment
• Violence
• Access to drugs and alcohol

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Determinants of mental health

• Protective factors
• Secure attachments
• Family social support
• Positive interpersonal interactions
• Integration of ethnic minorities
• Empowerment
• Social participation
• Social services
• Social support
• Community networks

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Role of NGOs

• Need to ensure that the structure and management
  of the city promotes mental health
• NGOs concerned with mental health can play vital
  role in mobilizing community advocacy and empower
  people to
• articulate their needs to city management
• hold the city accountable for service delivery
• NGO-city partnerships facilitate the delivery of
  mental health promotion programmes

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City structure can promote mental health

• Public buildings culturally appropriate,
  accessible and people friendly
• Transport system appropriate (public system)
  accessable and affordable e.g. Curitiba
• City structure facilitates community life e.g.
  markets
• City and social services equally accessible to
  all
• Provide safe space for recreation
• City design sensitive to crime/violence e.g.
  defensible space

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City management can promote mental health

• City educational and social services can partner
  with private sector and NGOs in providing mental
  health promotion programmes
• Evidence based mental health promotion programmes
  contribute to a healthy community
• Evidence based mental health promotion programmes
• Early childhood programmes, e.g. Prenatal and
  Infancy Home Visiting Programme - impacts on
  child abuse, conduct disorders and substance
  abuse. (Olds, 1997 Olds, 2002 Olds et al.,
  1998).
•  
• Parent training programmes, e.g. The Incredible
  Years (Weber-Stratton and Reid, 2003)
• Triple P Positive Parenting Programme
  (Sanders et al., 2002)- improved parent-child
  interaction.
• The Perry Preschool Project - improved
  cognitive development and reduced conflict with
  the law (Schweinhart and Weikart, 1997).
•  

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City management can promote mental health

• Community-based programmes e.g. Communities that
  Care (CTC) - prevention of violence and
  aggression ( Hawkins et al., 2002).
• Poverty alleviation programmes (Chowdhury and
  Bhuiya, 2001),
• Adult literacy programmes (Cohen, 2002)
• Substance abuse programmes (Bang and Bang,
  1991 Wu et al., 2002).
• School based programmes , targeting
  problem-solving skills, substance abuse,
  bullying, aggression.
• I Can Problem Solve (Sure, 1997),
• Improving Social Awareness-Social
  Problem-Solving programme ( (Bruene-Butler et
  al., 1997),
• The Good Behaviour Game (Kellam et el., 1994)

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City management can promote mental health

• Linking the Interests of Families and Teachers
  (LIFT) Programme (Reid et al., 1999),
• Seattle Social Development Project (Hawkins
  et al., 1991)
• Positive Youth Development Programme (Caplan
  et al., 1992).
• Work based programmes, targeting unemployment,
  mastery, job satisfaction, and depression. E.g.
  the JOBS Programme (Caplan et al.,1989 Vinokur
  et al., 2000),
• The Care Giver Support Programme (Heaney et
  al., 1995).
• Elderly, targeting general well being, e.g.
  using exercise (Li et al., 2001), befriending
  (Stevens and van Tilburg, 2000)

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Conclusion

• WFMH can contribute to mentally healthy cities
  movement through its network of members
• NGOs concerned with mental health can empower
  communities to make their needs known
• Mental health promotion programmes form an
  essential component of the healthy cities movement