WHO Collaborating Centre on Health, Psychosocial and Psychobiological factors, Belgium

1. The scope of Mental Health Promotion / Mental Disorder Prevention Conceptual boundaries under debate WHO Collaborating Centre on Health, Psychosocial and Psychobiological factors, Belgium Institut Wallon pour la Santé Mentale (Walloon Institute for Mental Health), Belgium Ligue Bruxelloise Francophone pour la Santé Mentale (French-Speaking League for Mental Health), Belgium

2. Question To what extent does the broadening of mental health field have an impact on: • The practice of care givers and professionals involved in the mental health field? • The general population, MH Services users and carers? • Policy makers, MHP / MDP Policies ?

3. The mental health field Diseases

4. Care givers: How to cure? How to keep in life? Prevention: Primary: How to decrease the incidence? Secondary: How to avoid complications ? Tertiary: How to avoid relapses? Policies: Public health Mortality Morbidity prevalence The mental health field Diseases

5. Broadening of the Mental Health field • WHO definition of the health: The health is not only a lack of illness But also a complete physical, mental and social state of well being

6. The mental health field Functionnal Diseases

7. WHO Concepts Invalidity Deficiency Handicap Care givers Skills Abilities Prevention: Physical: ie How to maintain a right to sexuality and pregnancy with a mental handicap? Psychologic: ie How to develop or refind skills and abilities with a mental disorder? Social: ie How to keep citizenship with mental problems? Policies: Rigths and protection Forensic psychiatry Privation of liberty Protection toward others The mental health field Functionnal Diseases

8. The mental health field Functionnal Diseases Adverse effects

9. Fields: Iatrogenic Drugs Environmental Care givers: The best care and cure? Evidence Based Medecine Practice Based Evidence Value Based Evidence Family therapy Prevention: Risk factors Mediators Protective behaviors for health Policies: Food and drugs quality Environmental nuisances The mental health field Functionnal Diseases Adverse effects

10. The mental health field Ill being Functionnal Diseases Adverse effects

11. Fields: Life events Stress Distress Care givers: Copings Resilience Quality of Life Prevention: Work Pauperisation War and refugies Immigrants and transcultural psychology Policies: Well being at work Discriminations Poverty The mental health field Ill being Functionnal Diseases Adverse effects

12. The mental health field Ill being Functionnal Diseases Adverse effects Safety

13. Care givers Health behaviors attitudes Perceived safety Coping with violence Prevention Violence In the city At school How to live in a world Multi cutural Multi ethnic Multi religious? Policies Perceived safety in the city: Fighting against offenders Illegal drugs Maffia and traffic with human people Lightening in the street ¨Presence of security stewards or policy in the street…. The mental health field Ill being Functionnal Diseases Adverse effects Safety

14. And why not? HAPPINESS Ill being Functionnal Diseases Adverse effects Safety

15. Indeed • Happiness, for instance, is in the US constitution a fundemental right of a citizen…

16. Debate • What is the impact of the broadening of the Mental Health field on • Psychosocial workers? • The general population and on services users and carers? • The relations with policy makers? • General concluding statement • Action point or recommendation

17. The broadening of the MH field in general + - The broadening of MH field makes it difficult to define. The use of 'Mental well-being' includes: 1° 'Social determinants of (mental) health' environmental, social, economic, cultural and other factors that can engender or favour the development of mental health problems or pathologies; 2° Subjectivity of individuals who must be able to enjoy good mental health and to feel that it is good For some years, the broadening of MH field has given more importance to the field in general, for the general population, health care professionals and policy makers alike.

18. The broadening of the MH field for psychosocial professionals - + 1° Lack of an unambiguous vocabulary shared by all the approaches and disciplines in MH, as well as by policy makers and programmes managers. Conceptual extension of the MH field allows for the inclusion of the subjectivity of individuals  The main focus of attention of MH professionals must go beyond the ‘pathology’ and must include as a higher priority the dimension of their relationship with the patient 2° Lack of visibility and comprehensibility of the MH field. First-line health care professionals have difficulty with MHP and MDP projects, because of little knowledge of the existing resources. They generally have also difficulty dealing with mental health problems, which can delay the diagnosis and amplify the problems.

19. The broadening of the MH fieldfor the general population, service users and carers - + 1° The awareness and image of the MH field that are common among the general public, non-specialised health professionals or in the media generate additional questions in terms of MHP and MDP As ‘Mental Well-Being’ allows for the inclusion of the subjectivity of individuals, the accountability of MH Services users is facilitated. This involvement is in itself a priority of the Mental Health Action Plan, and it is also an opportunity when it comes to the effectiveness of MHP / MDP programmes 2° Lack of visibility and comprehensibility of the MH field among the general public, MH Services users and non-specialised health care professionals. While individuals are generally aware of the resources in the field of physical health (doctors, general hospitals, etc.), they know little or nothing about the services, projects and structures in the MH field.

20. The broadening of the MH fieldfor policy makers - 1° According to more wide-ranging definitions, MH could concern the majority of ministerial departments No overall vision of the work being done in the field. Very many specific prevention projects, but they are not part of a general and concerted approach to the field, and they do not sufficiently take into account the social determinants of (mental) health within the framework of MHP / MDP 2° Observable political vacuum in relation to certain sub-issues which can only partially be included within the MH field, such as handicaps, school dropout, conflicts connected with multi-ethnic cohabitation... and of which the social determinants extend beyond this field (social precarity, well-being in the workplace, etc.