Going Upstream Mental health promotion as suicide prevention? Building a framework for LGBTI Populations Atari Metcalf, Evaluation Manager, Inspire Foundation & Board Director, Suicide Prevention Australia MindOUT Symposium | October 2012. Outline.
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GoingUpstreamMental health promotionas suicide prevention? Building a framework for LGBTI PopulationsAtari Metcalf, Evaluation Manager, Inspire Foundation & Board Director, Suicide Prevention AustraliaMindOUT Symposium | October 2012
MindOUT Symposium October 2012
Upstream – determinants (macro, environmental level – gov’t policy & legislation, social and economic resources)
Midstream – risk & protective factors (behavioural & individual prevention programs)
Downstream – treatment, crisis intervention (clinical research and practice)
The World Health Organisation describes ‘mental health’ as a state of complete mental, spiritual and social wellbeing where: “every individual realizes [their] own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to [their] community”.
Similarly, VicHealth define ‘mental health’ as:
“…the embodiment of social, emotional and spiritual wellbeing. Mental health provides individuals with thevitality necessary for active living, to achieve goals and to interact with one another in ways that are respectful and just. (VicHealth 1999).
The Melbourne Charter for Mental Health Promotion: “Mental health promotion is a strategic and sustainable approach to eliminating or minimising those factors which give rise to distress and loss of wellbeing and introducing and maximisingthose which create thecircumstances in which all can flourish. It is also important in the process of recovery from illness or episodes of illness.”
The Melbourne Charter asserts that mental health and wellbeing are:
The Melbourne Charter affirms that mental health and wellbeing are:
The Melbourne Charter believes that mental health and wellbeing are:
The role of Mental Health Promotion is twofold, working to prevent suicide in both direct and indirect ways:
…factors that typically operate at the environmental (system, social or community) level and affect the likelihood that people will be exposed to a disease or condition or, when exposed, the likelihood of their developing the condition.
Examples: poverty, access to healthcare, employment opportunities, education and housing; socially inclusive societies that value diversity
Actions: reducing exposure to social and contextual risk through structural changes such as improved access to economic resources, housing, and legislative reforms to protect human rights; improved visibility and recognition of LGBTI people
…increase the likelihood that a mental health problem will develop and/or increase susceptibility to suicide
Single risk factors often have only a minimal effect on their own but may combine to have a strong interactive effect, and exposure to multiple risk factors over time has a cumulative effect (Kazdin & Kagan 1994).
Examples: AOD use, mental illness, bereavement/exposure to suicide, experiences of trauma violence, discrimination, abuse, exclusion and family conflict, access to means, ‘hopelessness’
Actions: reducing exposure to, or mitigating risk, by building protective factors. Addressing homophobia, transphobia and continued stigma surrounding intersex is critical. Stop. Think. Respect. Campaign and Proud Schools are recent examples.
Figure 14. Relationships between homophobic abuse, self-harm and suicide (Hillier et al. 2011)
Protective factors build resilience in the face of adversity and moderate the impact of stress and transient symptoms/events on wellbeing. They can be truly protective, reducing the exposure to risk, or they may be compensatory, reducing the effect of risk factors (Rutter 1985).
Examples: social connection, supportive family & peer relationships, adaptive coping skills, self-determination, efficacy and resiliency, sense of belonging and self-esteem, optimism and hopefulness
Actions: supporting parents and families; peer education and support programs (particularly around ‘coming out’), opportunities to engage and participate in the community
Figure 21. Rates of attempted suicide in young people when supported or rejected by family (Hillier et al. 2011)
Writing Themselves in Again 3 also found:
Some groups are considered more ‘at risk’ than others:
Ultimately: contribute to improved mental health and wellbeing and the prevention of suicide via a sustainable and comprehensive approach
The Melbourne Charter states that population-based approaches for promoting mental health and wellbeing and preventing mental illness work by:
Key social determinants of MH & Themes for Action
Population Groups & Health Promotion Action Areas \ Methods
Settings for Action