There is continual debate at national and international levels about definitions of mental health and mental health promotion.
A formula produced by Albee and Ryan Finn (1993) is commonly referred to and has been adapted by the Health Education Authority (HEA) (1997) in the following way to focus on mental health as opposed to mental illness:
Coping Skills + Self Esteem + Social Support
Mental Health =
Organic Factors + Stress + Exploitation
Mental health results from increasing the factors above the line, protective influences, and decreasing those below it, provoking influences.
The most recent description used by HEA for the 1998 World Mental Health Day campaign is “Mental health is the emotional and spiritual resilience which enables us to enjoy life and to survive pain, disappointment and sadness. It is a positive sense of well-being and an underlying belief in our own and others’ dignity and worth.”
MacDonald and O’Hara (1998), in the SHEPS position paper on mental health promotion, have further adapted the formula to include ten elements of mental health:
Environmental Quality + Self Esteem + Emotional Processing
+ Self Management Skills + Social Participation
Mental Health =
Environmental Deprivation + Emotional Abuse
+ Emotional Negligence + Stress + Social Exclusion
Their view is that mental health is fundamentally about social conditions and processes that either promote or demote mental health in our culture, rather than about individual mental states.
• Main health promotion messages
In line with the debate and contention around what constitutes mental health, mental health promotion is also challenged with problems of definition. Does it, for example, focus on positive well-being or prevention of ill health?
There appears to be some level of agreement, however, about the interdependence between individuals, organisations and governments, and the need for a broad and integrated approach with a focus on social and economic conditions. This is highlighted in the Green Paper Our Healthier Nation which has identified mental health as one of four national priorities.
A major challenge identified by the government is how to improve the health of the least well-off and reduce the inequalities in the health of the population. The new policy framework for public health focuses on partnerships and contracts and aims to tackle the underlying causes of ill health, including poverty, poor housing, unemployment and a polluted environment.
At a more local level, Harding and Naidoo (1997) in their report The Health of Women in Greater Bristol refer to some of the major factors influencing the health status of women, adding that the interaction between the factors is complex and variable. It is evident, however, that women’s health is fundamentally affected by factors such as employment, housing, transport and leisure facilities.
Striking in women’s own accounts of their health concerns is the importance of mental health issues and the detrimental impact of exclusion and vulnerability on mental health. If their health is to be improved it is therefore necessary to look towards broader social policies which affect social, economic and physical environments in which people live.
Mental health promotion can therefore be described as working to promote the capacity for mental health at various levels:
- strengthening individuals or increasing emotional resilience, e.g. life skills training, parenting courses, building self esteem
- strengthening communities, e.g. community safety initiatives, after-school child care clubs, anti-bullying schemes, awareness raising campaigns
- reducing structural barriers to mental health, e.g. access to employment schemes, pre-school education, fiscal policies to reduce inequality.
• Brief statistics about the size of the issue/problem
Statistics refer to the incidence of mental ill health and the cost to the nation of people not being able to work due to mental illness and the cost of service provision for people with mental health problems.
One in four adults in any one year will experience some form of mental health problem and one in seven of us, regardless of age, is dealing with a mental health issue at any one time.
People may well be experiencing mental distress, however, and not be recorded as a statistic in any research.
• Research demonstrating effectiveness of health promotion interventions and rationale for approaches used.
Problems cited in undertaking a review of the effectiveness of mental health promotion interventions include the lack of formal evaluations of many projects and programmes. Linked to this are the problems of using traditional research designs in the complex field of mental health (as discussed above) and the timescale needed for mental health promotion.
The following interventions are known to be effective and have been edited from the Executive Summary of an extensive review commissioned by the HEA and carried out in collaboration with the NHS Center for Reviews and Dissemination (1997).
- Interventions with children in schools on self-concept, self-esteem and coping skills
- Interventions with children experiencing divorce
- Participation in outdoor pursuits helps young people develop their self-concept
- Exercise in pregnancy for teenagers has a positive effect on mental health
- Social network support for first time mothers leads to mental health gains
- General health promotion programmes involving the community in a participatory manner on healthy living provide evidence of mental health gains
- Preparation programmes to cope with life changes, such as marriage, can be useful
- Both brief and extensive interventions after divorce reduce mental health problems
- Job search interventions are effective
- Health visitors can provide support to reduce post-natal depression
- Group approaches in community settings can reduce depression in older women
- Interventions focusing either on the provision of social support or development of coping skills in carers can have a positive effect
- Exercise in older adults has a positive effect on mental health
- Pre-retirement interventions are effective
- Supportive interventions for widows and widowers are effective.
In the same year (1997) the NHS CRD undertook a review of mental health promotion in high risk groups. These included:
- living in poverty
- exhibiting behavioural difficulties
- experiencing parental separation or divorce
- living in families experiencing bereavement
Adults – undergoing divorce or separation
- at risk of depression in pregnancy
- experiencing bereavement
- long-term carers of people who are highly dependent.
Effective interventions identified for these groups included:
- high-quality pre-school and nursery education for children from disadvantaged communities
- school-based social skills training for children with behavioural problems
- cognitive skills training and emotional support following the death of a parent and for children of separating parents
- social support visits and training in child care skills for new parents
- home-based social support during pregnancy for socially disadvantaged women
- cognitive behaviour therapy and job-searching and problem-solving skills for the unemployed
- respite care and some forms of psycho-social support for long-term carers.
Virtually all these programmes have a focus on the individual level of intervention and do not address activity at the organisation or government policy level.
Community Action For Mental Health (1998) is a recent publication by the HEA describing twenty one innovative local projects working with a variety of groups, aimed at strengthening social networks and helping to create opportunities for participation and involvement. These programmes have a focus on collective action and making changes at a community and structural level, whilst at the same time having an impact on individuals’ sense of identity and self-worth.
• Web sites and other useful information
Health Education Authority (HEA) promotes sustainable improvements in health, particularly among disadvantaged groups. It researches the need for, and effectiveness of, health promotion measures; tests out new approaches to health promotion; advises the UK government on health promotion solutions to public health problems; and works with partners across a range of sectors to bring about social and behavioural changes that contribute to better health for all.
Contact details: Tel.0171 2225300 Fax. 0171 4138900
Center for Mental Health Promotion and Research, University of Central England, working to establish a national mental health promotion network in the UK.
Contact details: Tel. 0121 3315497 Fax. 0121 3316360
Young Minds, the children’s mental health charity, works to promote an alliance of individuals and organisations across the sectors of education, health, social services and youth justice, to work together to promote the mental health of children and young people
Its projects include a bi-monthly magazine, parents information service, training, library and information service, publications and consultancy service.
Contact details: Tel. 0171 3368445 Fax. 0171 3368446
National Association for Mental Health, the mental health charity in England and Wales, works for a better life for people diagnosed, labelled or treated as mentally ill.
It does this through campaigning, community development, training, publishing (including OPEN Mind magazine), and a comprehensive information service. Mind draws on the expertise of people with direct experience as providers and users of mental health services.
Contact details: Tel. 0181 5192122 Fax. 0181 5221725
The Sainsbury Centre for Mental Health is to improve the quality of life for people with severe mental health problems by enabling the development of excellent mental health services which are valued by users, carers and professionals.
It seeks to achieve this by influencing policy and practice through a coordinated programme of research and evaluation, communication, and development and training.
Contact details: Tel. 0171 8278385 Fax. 0171 4039482
Educational Forum for Mental Health is based at the University of York and runs seminars and conferences on a broad range of topics including autism, services for people with learning disabilities, mental health of children, eating disorders, mental health of the elderly, community mental health services, child abuse, alcoholism and so on.
Contact details: Tel. 01484 532102 Fax. 01484 425699
The Clifford Beers Foundation (The European Centre for Mental Health Promotion) is an international charity registered in the UK, to promote the protection and preservation of good mental health of persons irrespective of gender, race, colour, creed or place of residence and to advance education for the public benefit in all matters relating to mental illness/disorder and to take the steps necessary to protect and preserve good mental health.
Contact Details: Tel/Fax. 01785 246668
Website: http:/ /www.soc.staffs.ac.uk/~cmtrmk/cbfl.htm
Tilford S, Delaney F & Vogels M, (1997) Effectiveness of mental health promotion interventions: a review. Health Promotion Effectiveness Reviews No 4. Health Education Authority.
HEA (1998) World Mental Health Day Campaign Guide 1998 Health Education Authority.
MacDonald G, O’Hara K, (1998) Ten Elements of Mental Health, its Promotion and Demotion: Implications for Practice Society of Health Education and Health Promotion Specialists (SHEPS)
Department of Health (1998) Our Healthier Nation Department of Health, Government, UK
Harding T & Naidoo J, (1997) The Health of Women in Greater Bristol Faculty of Health and Social Care, University of the West of England
HEA (1997) Mental Health Promotion: a Quality Framework. Health Education Authority.
Speller V, (1997) Groundwork – Effective Health Promotion No 1 Mental Health Promotion The Wessex Institute, University of Southampton.
NHS Centre for Reviews and Dissemination (1997) Mental health promotion in high risk groups Effective Health Care 3:3 NHS CRD
HEA (1998) Community Action For Mental Health Health Education Authority.