Mental Health Promotion

1. Mental Health Promotion Suzanne F. Jackson, Ph.D. Dalla Lana School of Public Health University of Toronto CPHA – May 28, 2014

2. Contents • Mental Health Promotion • Risk factors, protective factors and determinants of health • “Flourishing” as concept • Policy as focus for attention – key policies • Focus on Children and Families

3. Why not focus on Treatment? • “[T]he science of mental illness has produced effective treatments for more ‘broken-down’ people; it remains ineffective for preventing more people from ‘breaking down.’” (Keyes and Lopez, 2002: 46) • Mental health problems cannot be brought under control by treating individuals one at a time (Nelson et al., 1996: 161). • 4 out of 5 people are not mentally ill – but are they mentally healthy?

4. What is Mental Health Promotion? “The process of enhancing the capacity of individuals and communities to take control over their lives and improve their mental health. [MHP] uses strategies that foster supportive environments and individual resilience while showing respect for culture, equity, social justice, interconnections and personal dignity.” (Joubert et al, 1996)

5. By Evelyn Livia from Indonesia, 9 years old • From a collection of drawings and stories from the WHO Global School Contest on Mental Health (2001)

6. Mental Health Promotion (cont’d) • 2 elements in definition: • Power – capacity to take control over one’s life & factors that affect one’s health • Resilience – ability to cope with adversity or stress • Go beyond focus on disease

7. Mental Health Promotion (cont’d) • Shifts the focus to the positive and isasset-based rather than negative or deficit-based. • Flourishing = optimal mental health (Keyes, 2002) • Empowerment - people and communities recognizing their personal strength and control through determining their own destinies, and having the resources to do so in a supportive environment. • Resilience- “the quality that allows an individual or group to function well despite the odds against them.” Two fundamental concepts associated with resiliency: risk and protective factors.

8. through children’s eyes Clarence, 18 years, Federated States of Micronesia “… Being down, identifying why, doing something about it, and bouncing back can give a person a true sense of accomplishment and worth and strengthen his/her mental health in the process.” From a collection of drawings and stories from the WHO Global School Contest on Mental Health (2001)

10. Risk Factors • Risk factors increase likelihood & burden of mental disease & arise from within individual, family, support networks, broader social & institutional environments e.g. • Indiv - physical illness; poor social skills • Fam/Supp – parental substance use; marital disruption; work stress & unemployment; • Social & Inst - poverty & economic strain; violence & abuse; homelessness; discrimination & isolation

11. Protective Factors • Protective factors buffer a person in times of adversity & moderate impact of stress – can be internal and/or external e.g. • Indiv - optimism; attachment to family; school/work achievement; problem-solving skills • Family Supp - family harmony; strong, supportive networks; community attachment • Soc & Instit - healthy public policies; community/institutional services • The presence of more protective factors, regardless of the number of risk factors, lowers the risk of developing mental health problems and disorders (Resnick et al 1997, cited in CAMH Guide 55+)

13. Reason to Focus on Policy • Need to work “upstream” • Need to decrease risk factors, increase protective factors & reduce inequities • Focus on creating environments that create mental HEALTH or enable people to “flourish” • Focus on social determinants of health that are not under jurisdiction of health sector • Multi-sector Collaboration and Policy are key tools at population level

14. Most significant DOH • Social inclusion • Connectedness and social ties are protective at individual level • Social network can enhance coping • Civic engagement can impact policy • Freedom from discrimination and violence • Individual, family & systemic violence • Access to economic resources • Contributes to sense of personal competence & worth • Remove systemic inequities of access to income

15. By Vetiana from Bulgaria, 6 years old • From a collection of drawings and stories from the WHO Global School Contest on Mental Health (2001)

16. From a collection of drawings and stories from the WHO Global School Contest on Mental Health (2001) • By Brittany from Samoa, 9 years old • From a collection of drawings and stories from the WHO Global School Contest on Mental Health (2001)

17. Examples of Policies • Social Inclusion • Require community participation in healthy living & other major health strategies • Implement ‘Healthy School’ approach • Freedom from Discrimination & Violence • Positive parenting programs • Anti-bullying & anti-discrimination strategies in school & workplaces • Access to Economic Resources • Publicly subsidized high quality daycare • Guaranteed annual income • Increase in access to safe & affordable housing

19. Recs from National Think Tank on MHP - 2008 • Create a Vision for a comprehensive Mental Health Strategy (built on an MHP framework) • Identify a clear single point of accountability and sustained leadership (including funding & collaboration between all levels) • Involve multiple sectors & stakeholders • Clarify a strong Provincial/Territorial role

20. Recs from National Think Tank on MHP – 2008 - 2 • Develop a common understanding of concepts & language (by engaging the public, removing stigma, promoting community inclusion, addressing DOH) • Build on strengths (by mapping existing policies & programs & identifying gaps) • Create strong research, knowledge & data base (including indicators of positive mental health) • Build an effective, wellness-based mental health system

21. Quotes from Corey Keyes • Mental illness is indeed a burden to society, but too little flourishing is just as serious as too much mental illness. • Loss of mental health precedes mental illness. • Promoting mental health is a “two-for-one” – you get lower rates of mental illness by promoting mental health, and you get lower rates of chronic disease.

22. Current Interest in MHP • CAMH, DLSPH & TPH – Best Practices Guides for Seniors 55+, Refugees, Children & Youth • CAMH, DLSPH, TPH – interest in indicators of positive mental health re programs • Pan-Canadian Committee on MHP – inventory of MHP programs across Canada, indicators of MHP, sharing approaches that work • PHAC – surveillance indicators re MHP • City of Toronto – Measuring the Well-Being of Children & Families in Toronto • CPHA/CMHA – What is needed?

23. By Ming-qi from China, 7 years old • From a collection of drawings and stories from the WHO Global School Contest on Mental Health (2001)