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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. Mental Health.

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Creating caring communities putting mental health on the agenda l.jpg

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


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Mental Health Agenda

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

Sartorius


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Positive Mental Health Agenda

  • A value in its own right; contributes to the individual’s 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.


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Why the interest in mental health promotion? Agenda

Why the interest from ‘health’?

Why the interest from other sectors?


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Increasing interest in population’s mental health Agenda

  • 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


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Mental Illness Impact Agenda

  • 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)


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Mental Illness Impact Agenda

  • 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)


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Socio-economic & Life Stress Agenda

Impact on Physical Health


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Social Risk Factors Agenda

  • 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


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  • 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


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  • 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.


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Similarities in the conditions for different health and social outcomes

  • Same risk factors (low attachment to one’s 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


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Prerequisites family & community

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

The Health of the Population


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Isolation / alienation family & community

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

Empowerment

Positive interpersonal interactions

Social participation

Social responsibility / tolerance

Social services

Social support / community network

Cultural integration

Social, environmental & economic determinants of mental health

Risk Factors Protective Factors

Williams, Saxena, McQueen


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Aboriginal Youth Suicide by family & communityCultural Continuity Factors

Cultural Continuity

Factors

Source: Chandler & Lalonde, 1998


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Post-Traumatic Stress Response family & community

  • 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


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Post-Traumatic Stress Response family & community

  • arises from external trauma and terrifying experiences that break a person’s 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.


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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.


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Mental Health Promotion health inequities:

  • 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.



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Poverty health inequities:

Sexual Activity

Education

Drugs

Diet

Unemployment

Smoking

Social Supports

Early Childhood Development


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Principles of Health Promotion health inequities:

  • Health education

  • Policy analysis

  • Community development and organization

  • Health advocacy

  • Legislation

    World Health Organization (1984)


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Ottawa Charter for Health Promotion health inequities:

  • Building Healthy Public Policy

  • Creating supportive environments

  • Strengthening community action

  • Developing personal skills

  • Reorienting health services

    World Health Organization (1986)



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Meaningful participation health inequities:


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Meaningful Participation health inequities:

  • Participation by local people is recognized as having the greatest and most sustainable impact when solving local problems and setting local norms



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  • 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


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  • Partnerships approach to a broader and more cohesive problem approach

    • Within communities

    • Between communities

    • Within health organizations

      • Mental health promotion & health promotion

      • Treatment and promotion services

    • Between health organizations

    • With other sectors


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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


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Housing Health

  • 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, you’re not going to solve anything…Start from a community issues standpoint, set aside jurisdictional and policy issues, and commit some resources to it. You’ll see things happen” (Hanselmann, Gibbins)


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Intersectoral partnerships Health

  • Individuals and organizations in business and industry, housing, local gov’t, 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.



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Multiple Strategies HealthMultiple Levels

  • Reduce individual, socio-economic, and environmental risk factors, and

  • Promote protective factors


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Supportive environments to reduce inequities & remove barriers

Making healthy choices,

easier choices.


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Creating supportive environments barriers

  • Policy

  • Economic development

  • Social action

  • Community schools

  • Early childhood supports


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Creating Supportive Environments barriers

  • 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


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Government Healthy Public Policy barriers

  • The way services are provided

  • Environmental policy

  • Policy on housing, transportation, etc

  • Economic policy

  • Taxation policy

  • Social policy


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Healthy Policy is also for you & I barriers

  • School boards

  • Recreation centers

  • First Nations Band councils

  • Municipal governments

  • Committees and organizations

  • Families

  • Workplaces



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Capacity building barriers

  • Increased awareness & knowledge

  • Skill development

  • Knowing how to access resources

  • Developing social networks

  • Learning from others




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Evidence based decision making barriers

Not only doing things right,

but the right things.


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Four crucial settings for intervention empowering, collaborative and participatory manner is central to mental health promotion activity.

  • Home,

  • School,

  • Workplace, and

  • Community.

    Jané-Llopis/Barry MM


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Home empowering, collaborative and participatory manner is central to mental health promotion activity.

  • 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


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School empowering, collaborative and participatory manner is central to mental health promotion activity.

  • 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 children’s lives.

    • Establishes connections between school and family life, encourages creativity as well as academic abilities, and promotes self-esteem and self-confidence of children.


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Workplace empowering, collaborative and participatory manner is central to mental health promotion activity.

  • Unemployment

  • Work stress

    • Noise, overload, time pressures

    • Repetitive tasks

    • Interpersonal conflicts

    • Job insecurity

    • Low sense of control

    • Balance with personal life


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Community empowering, collaborative and participatory manner is central to mental health promotion activity.

  • 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


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Support Multi-outcome interventions empowering, collaborative and participatory manner is central to mental health promotion activity.

  • 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.


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Addressing the determinants empowering, collaborative and participatory manner is central to mental health promotion activity.

  • 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 isn’t worse


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Solutions? empowering, collaborative and participatory manner is central to mental health promotion activity.

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.


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David’s Population Health Traps empowering, collaborative and participatory manner is central to mental health promotion activity.

Macro Avoidance

Micro Paralysis


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Many Small Steps empowering, collaborative and participatory manner is central to mental health promotion activity.


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“Almost anything you do will seem insignificant, but it is very important that you do it anyway”

Mahatma Ghandi


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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.


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Other sources of further information: that by working together we can change the world?

  • Moodle R and Jenkins R. Mental health promotion. I’m from the government and you want me to invest in mental health promotion. Well why should I? Promotion and Education 2005; S-2:37-41.

  • 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/Reports/Reports_other.htm


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Dr. James Irvine that by working together we can change the world? Professor, Dept of Family Medicine, U of SMedical Health Officer, Population Health Unit, Northern Health AuthoritiesBox 60002nd Floor, Lac La Ronge Indian Band Office,LaRonge, Sk S0J [email protected]


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