Creating%20Caring%20Communities:%20Putting%20Mental%20Health%20on%20the%20Agenda - PowerPoint PPT Presentation

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Title: Creating%20Caring%20Communities:%20Putting%20Mental%20Health%20on%20the%20Agenda


1
Creating Caring Communities Putting Mental
Health on the Agenda
  • Dr. James Irvine
  • Health Promotion Summer School
  • Prairie Region Health Promotion Research Unit
  • Mental Health Promotion Identity, Culture and
    Power
  • August 2005

2
Mental Health
  • a state of balance between physical, mental,
    cultural, spiritual and other personal factors,
    and between the self, others and the environment

Sartorius
3
Positive Mental Health
  • A value in its own right contributes to the
    individuals well-being and quality of life and
    also contributes to society and the economy by
    increasing social functioning and social capital.
  • Jané-Llopis E, Barry M, Hosman C, Patel V.

4
Why the interest in mental health promotion?
  • Why the interest from health?
  • Why the interest from other sectors?

5
Increasing interest in populations mental health
  • Increasing awareness of mental disorders being
    common disabling
  • Economic consequences clearer
  • Links between physical mental health better
    appreciated
  • Links between education, labour, justice, etc
    mental health more understood
  • Increasing recognition of the link needed between
    economic social development

6
Mental Illness Impact
  • Neuropsychiatric disorders account for 13 of
    Global Burden of Disease (Moodle and Jenkins)
  • Predictions that by 2020, depression will be the
    2nd leading cause of disability in the world
  • Poor mental health also contributes to poor
    physical health
  • One in four persons will develop a mental or
    behavioural disorder throughout their lifetime.
    Prevalence 10 of adults (WHO)

7
Mental Illness Impact
  • 20 of adolescents under the age 18 suffer from
    developmental, emotional or behavioural problems
  • 1 in 8 has a mental disorder
  • from poor communities this increases to 1 in 5.
  • Economic costs substantial
  • 30-40 of workplace sickness absence is
    attributable to mental disorders (Jenkins)

8
Socio-economic Life Stress
  • Impact on Physical Health

9
Social Risk Factors
  • Adverse childhood experiences (ACE)
  • Lower childhood socio-economic status
  • Leads to increased
  • ? Cardiovascular risk
  • ? Lipids (cholesterol)
  • ? Insulin resistance
  • ? Obesity
  • Dong M et al Circulation 2004 Lawlor,
    Ebrahim, Smith. BMJ 2002

10
  • Mental health status is associated with risk
    behaviours at all stages of the life cycle.
  • Young people with depression and low self-esteem
    are linked with smoking, binge drinking, eating
    disorders and unsafe sex.
  • Vicious circle
  • Links between physical health and mental health
    are bidirectional

11
  • Malnourishment in infants increased risk of
    cognitive and motor deficits
  • Heart disease and cancer can increase risk of
    depression
  • Mood disorders can lead to increased risk of
    injuries, poor physical and role function
  • Learned helplessness, hopelessness and depression
    associated with decreased immunologic activity
    and increased risk of tumor growth and infections.

12
  • Many of the interventions designed to improve
    mental health will also promote physical health
    and vice versa.
  • (when mental health promotion is thought of in a
    broader sense than previously understood)

13
  • Promoting mental health has the potential to
    reduce a whole range of risk behaviours and their
    consequences such as loss of productivity, crime,
    drop-out from school, disrupted family
    relationships
  • (Moodle and Jenkins)

14
Similarities in the conditions for different
health and social outcomes
  • Same risk factors (low attachment to ones
    community, school, family and workplace parental
    alcohol and drug use family conflict
    inconsistent parenting marital instability) and
  • Absence of protective factors
  • Can result in
  • increased crime, drop out from school, increased
    risk of alcohol abuse, sexual activity,
    depression and suicide, drug addition

15
  • What we spend on policing and courts and jails is
    not available to be spent on affordable housing,
    school systems, or income security.
  • Feather

16
Mental Well-Being the foundation of a healthy
individual, family community
17
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18
The Health of the Population
  • Prerequisites
  • peace
  • shelter
  • education
  • food
  • income
  • stable ecosystem
  • sustainable resources
  • social justice and equity
  • Determinants
  • child development
  • working conditions
  • education
  • choices and coping
  • income and social status
  • physical environments
  • health services
  • social support network

19
Social, environmental economic determinants of
mental health
Risk Factors Protective Factors
  • Empowerment
  • Positive interpersonal interactions
  • Social participation
  • Social responsibility / tolerance
  • Social services
  • Social support / community network
  • Cultural integration
  • Isolation / alienation
  • Lack of education, transport, housing
  • Neighourhood disorganization
  • Peer rejection
  • Poor social circumstances
  • Poor nutrition
  • Poverty
  • Racial injustice / discrimination
  • Violence
  • Work stress
  • Unemployment
  • Access to drugs / alcohol
  • Displacement
  • War

Williams, Saxena, McQueen
20
  • Societal or community-level characteristics
  • Culture,
  • Language,
  • Cohesion,
  • Control

21
Aboriginal Youth Suicide by Cultural Continuity
Factors
Cultural Continuity Factors
Source Chandler Lalonde, 1998
22
Post-Traumatic Stress Response
  • Popular explanations of health inequities of the
    Aboriginal communities are limited (its more than
    health behaviours, more than socio-economic),
  • The enduring impact of colonization and loss of
    culture are identified as critical health issues
    concepts of historical and intergenerational
    trauma need to be recognized
  • Mental health and social problems linked to
    social and cultural disruption over the lifespan
    and across generations
  • Mitchell, Maracle

23
Post-Traumatic Stress Response
  • arises from external trauma and terrifying
    experiences that break a persons sense of
    predictability, vulnerability, and control.
  • Mentally negative beliefs about themselves and
    the world,
  • Emotionally cycles of denial and anxiety
  • Physically sleep disturbances, anxiety,
    nightmares, flashbacks
  • Behaviourally avoidance, isolation, drinking,
    drugging, increasingly aggressive.

24
PTSR is a useful model for understanding and
addressing health inequities
  • Provides a social / historical context for what
    has been incorrectly viewed as individual/cultural
    weaknesses, or illness,
  • Confirms holistic understanding of well-being and
    cultural renewal
  • Compassionately validates stress responses as
    appropriate human reaction to trauma
  • Offers access to proven psycho-educational and
    therapeutic approaches
  • Points to use of group/community models for
    collective mourning, support and healing.

25
Mental Health Promotion
  • Enhances positive mental health
  • Contributes to the reduction of risk behaviours
    such as tobacco, alcohol, and drug misuse, unsafe
    sex
  • Reduction of social and economic problems such as
    drop out from school, crime, absenteeism from
    work and intimate partner violence
  • Reduction of rates, severity of, mortality from
    physical and mental illness.

26
  • How do we approach mental health promotion?

27
Poverty
Sexual Activity
Education
Drugs
Diet
Unemployment
Smoking
Social Supports
Early Childhood Development
28
Principles of Health Promotion
  • Health education
  • Policy analysis
  • Community development and organization
  • Health advocacy
  • Legislation
  • World Health Organization (1984)

29
Ottawa Charter for Health Promotion
  • Building Healthy Public Policy
  • Creating supportive environments
  • Strengthening community action
  • Developing personal skills
  • Reorienting health services
  • World Health Organization (1986)

30
Key Population Health Promotion Ideas
31
Meaningful participation
32
Meaningful Participation
  • Participation by local people is recognized as
    having the greatest and most sustainable impact
    when solving local problems and setting local
    norms

33
Multi-sector collaboration and partnerships
34
  • The health sector has to pick up the pieces
    resulting from poor mental health, but it has
    little effect on the determinants of mental
    wellbeing
  • Expand the traditional view about who owns
    mental health promotion, and who actually does,
    or can, promote mental health in most
    populations. Moodle/Jenkins

35
  • Finding ways to shift emphasis from a
    sector-by-sector approach to a broader and more
    cohesive problem approach
  • Community as the focus!

36
  • Partnerships
  • Within communities
  • Between communities
  • Within health organizations
  • Mental health promotion health promotion
  • Treatment and promotion services
  • Between health organizations
  • With other sectors

37
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38
Conditions for success Intersectoral action for
Population Health
  • Seek shared values and interest alignment of
    purpose common vision
  • Ensure political support
  • Engage key partners
  • Ensure horizontal and vertical linking
  • Invest in alliance building
  • Focus on concrete objectives and visible results
  • Ensure leadership, accountability and rewards are
    shared among partners
  • Build stable teams of people skilled
    transformative action
  • adapted from FPT Adv C on PH

39
Housing
  • Good housing acts as a mitigating factor against
    the negative effects of low SE status on health
    and well-being (Dunn, 2002).
  • Community focus versus jurisdictional
  • if jurisdiction is your starting point, youre
    not going to solve anythingStart from a
    community issues standpoint, set aside
    jurisdictional and policy issues, and commit some
    resources to it. Youll see things happen
    (Hanselmann, Gibbins)

40
Intersectoral partnerships
  • Individuals and organizations in business and
    industry, housing, local govt, sports,
    recreation, arts and culture, education, and
    justice already are promoting and in some cases
    demoting mental health
  • May not be aware of the effect they have on
    mental health and can be further encouraged to
    either expand their health promoting work, or
    reduce the health damaging effects of their work
  • Challenge is to work out how to create effective
    partnerships with these indiv and organizations.

41
Take action on a variety of determinants
42
Multiple Strategies Multiple Levels
  • Reduce individual, socio-economic, and
    environmental risk factors, and
  • Promote protective factors

43
Supportive environments to reduce inequities
remove barriers
Making healthy choices, easier choices.
44
Creating supportive environments
  • Policy
  • Economic development
  • Social action
  • Community schools
  • Early childhood supports

45
Creating Supportive Environments
  • High/Scope Perry Preschool Project
  • Targeted 3-4 year old children from impoverished
    backgrounds
  • Cost 1000 per child
  • Cost-benefit - 7,000 to 8,000 per child
  • Barnett WS. AJ Orthopsych 1993

46
Government Healthy Public Policy
  • The way services are provided
  • Environmental policy
  • Policy on housing, transportation, etc
  • Economic policy
  • Taxation policy
  • Social policy

47
Healthy Policy is also for you I
  • School boards
  • Recreation centers
  • First Nations Band councils
  • Municipal governments
  • Committees and organizations
  • Families
  • Workplaces

48
Capacity building and empowering practices
49
Capacity building
  • Increased awareness knowledge
  • Skill development
  • Knowing how to access resources
  • Developing social networks
  • Learning from others

50
Actions that focus on the health of the population
51
Focus upstream on taking action earlier
52
Evidence based decision making
Not only doing things right, but the right
things.
53
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54
  • The delivery of mental health promotion programs
    in an empowering, collaborative and participatory
    manner is central to mental health promotion
    activity. (Barry M)

55
Four crucial settings for intervention
  • Home,
  • School,
  • Workplace, and
  • Community.
  • Jané-Llopis/Barry MM

56
Home
  • During the first period of life, there is more
    development in mental, social, and physical
    functioning than in any other period across the
    lifespan
  • UNICEF, 2002

57
School
  • Enormous potential no other setting where such
    a large proportion of children can be reached
  • WHO Child-friendly schools
  • promotes sound psychosocial environment
  • encourages tolerance and equality between
    genders, ethinic, religious and social groups.
  • Promotes active involvement and co-op avoids use
    of physical punishment does not tolerate
    bullying.
  • Supporting and nurturing environment providing
    education which responds to the reality of the
    childrens lives.
  • Establishes connections between school and family
    life, encourages creativity as well as academic
    abilities, and promotes self-esteem and
    self-confidence of children.

58
Workplace
  • Unemployment
  • Work stress
  • Noise, overload, time pressures
  • Repetitive tasks
  • Interpersonal conflicts
  • Job insecurity
  • Low sense of control
  • Balance with personal life

59
Community
  • Change is more likely to come about when the
    people it affects are involved in the change
    process.
  • Participation by local people is recognized as
    having the greatest and most sustainable impact
    when solving local problems and setting local
    norms

60
Support Multi-outcome interventions
  • One of remaining problems is the categorical
    approach to mental, social, educational,
    behavioural and legal problems.
  • Many of these problems have commonalities that
    can be addressed simultaneously and that impact
    on many areas of functioning.

61
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62
Addressing the determinants
  • Partner - Who can we work with, to do it better
    together?
  • Advocate - What needs to be done at policy
    legislative level?
  • Cheerlead - Encouraging and not getting in the
    way.
  • Enable - What we do directly to change the
    determinants
  • Mitigate - Picking up some of the pieces, so it
    isnt worse

63
Solutions?
  • Will be found in..
  • thinking, planning and working...
  • across sectors and levels of government
  • from multiple perspectives, including social,
    psychological, justice, education, and economic,
  • from prevention and promotion through to
    treatment and care,
  • using the expertise of many disciplines
  • and engaging communities as partners in potential
    solutions.

64
Davids Population Health Traps
  • Macro Avoidance
  • Micro Paralysis

65
Many Small Steps
66
Almost anything you do will seem insignificant,
but it is very important that you do it anyway
  • Mahatma Ghandi

67
  • Why would a small group of dedicated individuals
    believe that by working together we can change
    the world?
  • Because throughout history, it is the only thing
    that ever has.

68
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69
Other sources of further information
  • Moodle R and Jenkins R. Mental health promotion.
    Im from the government and you want me to invest
    in mental health promotion. Well why should I?
    Promotion and Education 2005 S-237-41.
  • Jané-Llopis E, Barry M, Hosman C, Patel V. Mental
    health promotion works a review. Promotion and
    Education 2005 ProQuest Nursing Journals,
    supplement 2 9-25
  • Sask Health. Supporting mental well-being and
    decreased substance use and abuse. 2005
  • McCubbin M, Labonte R, Sullivan R, Dallaire B.
    Mental health is our collective wealth a
    discussion paper. Submitted to Federal/Provincial/
    Territorial Advisory Network on Mental Health.
    Accessed online http//www.spheru.ca/www/html/Rep
    orts/Reports_other.htm

70
Dr. James Irvine Professor, Dept of Family
Medicine, U of S Medical Health Officer,
Population Health Unit, Northern Health
Authorities Box 6000 2nd Floor, Lac La Ronge
Indian Band Office, LaRonge, Sk S0J
1L0 James.Irvine_at_mcrrha.sk.ca
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