Population Mental Health Promotion: Conceptual, policy and implementation perspectives

National Forum on the Role of Public Health

February 28, 2018

Professor Margaret Barry

WHO Collaborating Centre for Health Promotion Research National University of Ireland Galway

Ollscoil na hÉireann Gaillimh

Declarationofrealorpotentialconflictsofinterest

Presenter:MargaretBarry

Ihavenorealorpotentialconflictofinterestrelatedtothematerialthatisbeing

presentedtoday.

2

Overview •  Conceptualperspectives-concepts,principlesandframeworks

forpopulationmentalhealthpromotion•  Policyperspectives-embracingawhole-of-governmentand

whole-of-societyapproachtoimprovingpopulationmentalhealthandreducinginequities

•  Implementationperspectives-systemsandstructuresforsupportingeffectiveintersectoralaction;deliverymechanisms,skillsandcompetenciesforimplementingevidence-basedstrategies

Adopting a Public Health Approach ‘there is no health without mental health’

•  Treatmentapproachesontheirownarenotsufficienttoimprovepopulationmentalhealth(WHO,2002;2004;2013)o  needacomprehensivepublichealthapproachembracingpromotionand

preventionalongsidetreatmentandrecoveryo  cardiovasculardisease->addressingthe‘causesofthecauses’-preventionand

promotionalongsideimprovedandmoreaccessibletreatmentandrecovery

•  Paradigmchangeinthinkingaboutmentalhealtho  afocusonmentalhealthratherthansolelyonmentaldisordero  strategiesforcreatingthegreatestmentalhealthgainforthegreatestnumberof

peopleo  shiftfromadeficitmodelofillnesstothehealthpotentialofpeopleandtheir

everydaysettingsforliving

Ø  reframingthechallengeofimprovingmentalhealth

HEALTHY POPULATION

POPULATION AT RISK

OPTIMAL MANAGEMENT

AND CARE

TREATMENT AND RECOVERY OF

AVOIDABLE DISABILITY

DETECTION AND IDENTIFICATION

EARLY DIAGNOSIS AND INTERVENTION

REDUCE AVOIDABLE RISKS

BUILD RESILIENCE AND MAINTAIN

HEALTHY LIFESTYLE AND ENVIRONMENTS

PREVENTION OF DISORDERS AND

HEALTH PROBLEMS

HEALTH PROMOTION

POPULATIONS WITH DISORDERS

POPULATION WITH SYMPTOMS

Adapted from Building Capacity to Promote the Mental Health of Australians. 1996

A population health promotion perspective

Promoting population mental health and wellbeing

•  Promotingmentalhealthisacriticalstrategyinimprovingpopulationhealthandwellbeing,contributestosocialandeconomicdevelopmentandgreatersocialcohesion

•  Growingrecognitionoftheimportanceofpromotingpositivementalhealthandenhancingsocialandemotionalwellbeingacrossthelifecourse(WHO,2013)

•  MentalhealthiscreatedwherepeoplelivetheirlivesØ  broadeningourconceptandunderstandingofwhatconstitutesgood

mentalhealthandhowitcanbepromoted

Conceptualising Mental Health Mentalhealthmaybedefinedas:“astateofemotionalandsocialwell-beinginwhichtheindividualrealiseshisorherownabilities,canmanagethenormalstressesoflife,canworkeffectively,andisabletoplayaroleinhisorhercommunity“(WHO,1999)• Conceptofpositivementalhealth(Keyes,2002;Huppert,2005;Ryffetal.,2006)

o  subjectivewellbeingandlifesatisfactiono  positivefunctioning,engagementandsocialwellbeing

•  Keyes’conceptof‘flourishing’o  abilitiestodeveloppsychologically,physically,emotionally,intellectually,

sociallyandspirituallyØ indigenouswellnessframeworks

Evidence base for promoting mental health and wellbeing

•  Thepromotionofmentalhealthleadstolastingbenefitsfortheimprovedhealthandwellbeingofindividuals,theirfamiliesandsociety(WHO,2013)

•  Compellingevidencethatmentalhealthpromotionandprimarypreventioninterventionso  reduceriskfactorsformentalandbehaviouraldisorderso  enhanceprotectivefactorsforgoodhealthandwellbeingo  leadtolastingpositiveeffectsonarangeofsocial,economicandhealthoutcomes–>academicperformance,employment,socialfunctioningandphysicalhealth

•  Convincingsocialandeconomiccaseforinvestinginthepromotionofpopulationmentalhealthandwellbeing

Policy Frameworks

MentalHealthActionPlan2013-2020(WHO,2013)“Theessentialroleofmentalhealthinachievinghealthforall”

• comprehensivestrategiesforpromotion,prevention,treatmentandrecoveryinawhole-of-governmentapproach• toprotectandpromotethementalwellbeingofallcitizens• responsibilityextendsacrossallsectorsandallgovernmentdepartments

Ø mainstreamingmentalhealthintopublichealth,povertyreduction,economicdevelopmentandsocialpolicies

Policy Frameworks •  TheHelsinkiStatementonHealthinAllPolicies(HiAP)&

FrameworkforCountryAction(WHO,2013)“HiAPisanapproachtopublicpoliciesacrosssectorsthatsystematicallytakesintoaccountthehealthimplicationsofdecisions,seekssynergies,andavoidsharmfulhealthimpactsinordertoimprovepopulationhealthandhealthequity”

Ø  accountabilityofpolicymakersforhealthimpactsatalllevelsofpolicy-making •  WHOShanghaiDeclaration(2016)–healthpromotionactions

toachievetheSustainableDevelopmentGoals(UN,2015)• ensuringhealthylivesandpromotingwellbeingacrossallagesisessentialtotheSDGs• SDG3.4–promotementalhealthandwellbeing

Policy Frameworks for Action •  Whole-of-governmentapproach

o  mentalhealthinallpoliciesapproach-cross-sectoralresponsibilityforaddressingthesocialdeterminantsofmentalhealthandaddressingmentalhealthinequities

o  priorityformorethanthementalhealthsector-policycoherence

•  Whole-of-societyapproacho  multisectoralpartnershipsidentifyingandcreatingsynergiestopromote

andenhancementalhealth-flourishingsocietyo  engagingnewactorsfromacrossdiversesectorssuchas;childcare,

education,welfare,community,youthservices,media,artsandculture,sports,urbandesign,localauthorities,environment,economicandsocialpolicies

Ø  participationofallofgovernmentandthewidercommunityincreatingthe

conditionsforpositivementalhealthandwellbeing

WHO&CalousteGulbenkianFoundation(2014)SocialDeterminantsofMentalHealth“Mentalhealthandmanycommonmentaldisordersareshapedtoagreatextentbythesocial,economic,andphysicalenvironmentsinwhichpeoplelive”• callsforactionstoimprovetheconditionsofdailylife• whole-of-governmentandwhole-of-societyapproach–comprehensiveanduniversalactionsacrossthelifecourse,multiplesectorsandlevelsØ policymakingatalllevelsofgovernanceandacrosssectorscanmakeapositivedifferencetomentalhealthoutcomes

Health Promotion action areas Build healthy public policy Create supportive environments Reorient health services Strengthen community action Develop personal skill combined into Health Promotion strategies

Systems policies environment organisation community person

Systems scale

Health Promotion Principles (participation, empowerment, equity, social justice)

Assessment

Plan

ning

Implementation

Eval

uatio

n

micro - macro

Health Promotion Socio-ecological Model (Ottawa Charter, WHO, 1986) The process of enabling people to increase control over their health and the determinants of health

Adoptingahealthpromotionapproach•  Buildinghealthypublicpolicy–puttingmentalheathpromotiononthe

policyagenda-health,economicandsocialpolicieso  multisectoralpolicydevelopment,legislation,regulation,organisationchangeo  policyandadvocacyskills;leadership,inter-governmentalaction

•  Creatingsupportiveenvironments–social,physical,culturalandeconomicenvironmentso  mediatingstructures–homes,schools,workplaces,communitysettings,local

authoritieso  skillsofembeddingmentalhealthpromotionintoasystems-basedsettings

approach;partnershipworking

•  Reorientinghealthservices–embeddingmentalhealthpromotionandpreventionintomainstreamhealthserviceso  integratingmentalhealthpromotionandpreventionasacorepartofroutine

consultationsanduniversalprovisioninprimarycareandmentalhealthserviceso  organisationandstructureofhealthservicesandtrainingofthebroaderhealth

workforce

Adoptingahealthpromotionapproach

•  Strengtheningcommunityaction–communityengagementandparticipationo  empowermentofcommunitiesinidentifyingandaddressingmentalhealthneedsat

thecommunitylevelo  communitydevelopmentskills–communication,mobilisinglocalaction

•  Developingpersonalskills–enablingpersonalandsocialdevelopmento  socialandemotionalskillsdevelopmentacrossthelifecoursefromearlyyearsto

oldage–lifeskills,senseofcontrol,positivementalhealthliteracyo  implementingandscaling-upevidence-basedskillsdevelopmentinterventions

acrosssectors–antenatalcare,parenting,schools,communities,online

Ø  synergisticactionsacrossdifferentlevelsofintervention

Implementing Mental Health Promotion •  Workingacrosssectorstoimplementintersectoralactionsand

participatorypolicyprocesses•  Ensuringaccesstoresourcesandlifeopportunities

o  supportiverelationships,education,employment,income,housing,socialinclusion

•  Removingstructuralbarrierstogoodmentalhealtho  addressingsocialinequity,injustice,poverty,marginalisationand

discriminationthatdenyaccesstolifeopportunities

•  NCCsforPublicHealth(2017)PopulationMentalHealthPromotionforChildrenandYouth–collectionofpaperso  increaseunderstandingofpositivementalhealthasanessentialfocusfor

publichealthpracticeinCanadao  integratingmentalhealthpromotionintopublichealthpractice

NCCsforPublicHealth(2017)PopulationMentalHealthPromotionforChildrenandYouth

Evidence-based Actions •  Knowledgebaseoneffectiveprogrammesandpolicies

o  growingresearchandpracticebaseofeffectiveimplementationo  identifyingpriorityactionsor‘bestbuys’

•  Policiesandinterventionsforwhichthereisevidenceoftheircosteffectivenessandtheirfeasibilityintermsofculturalacceptabilityandcapacitytobedeliveredbyexistingsystems(Carteretal.,2000)

•  Interventionsthatcoverpopulationgroupsacrossthelifecourseandincludeactions,whichcanbedeliveredacrossdifferentsettingsanddeliveryplatforms

Evidence Syntheses •  WHOEvidenceBriefonImplementationofGlobalMentalHealthActionPlanintheEasternMediterraneanRegion.PromotionofMentalHealthandPrimaryPreventionofMentalDisorders:PrioritiesforImplementationBarry,Clarke&Petersen(2015)EMHJ21(6),424-432•  Barry,Clarke,Jenkins&Patel,V.(2013)–AsystematicreviewofinterventionsinLMICs… BMCPublicHealth,13:835•  Barry,M.M.andDowling,K.(2015)AReviewoftheEvidenceonEnhancingPsychosocialSkillsDevelopmentinChildrenandYoungPeople.ReportfortheIUHPE&PicardieRegionalHealthAgency,France•  Barry,Clarke,Morreale,&Field(2017)Reviewoftheevidenceontheeffectsofcommunity-basedprogramsonyoungpeople’ssocialandemotionalskills.AdolescentResearchReview•  Barry,M.M.andJenkins,R.(2007)ImplementingMentalHealthPromotion(2ndeditioninprogress)

DELIVERYPLATFORM• DeliveryChannel

Coresetofactions Evaluation Evidence

POPULATION

•  Legislation/regulation)

•  Laws&regulationtoreducedemandforalcoholuse[taxes,restrictionstoaccess,adbans,enforcementofBAClimits]

•  Lawstorestrictaccesstomeansofself-harm/suicide•  IntegratementalhealthintoOccupationalHealthand

Safetyregulations

•  Bestbuy

•  Bestbuy

•  Goodbuy

•  SufficientevidencefromHIC&LAMIC

•  SufficientevidencefromHIC&LAMIC

•  SufficientevidencefromHIC.PromisingevidencefromLMIC

•  Information/awareness

•  Masspromotionpublicawarenesscampaignstoimprovementalhealthliteracy&reducestigma

•  Goodbuy •  SufficientevidencefromHIC.InsufficientevidencefromLAMIC

COMMUNITY

•  Workplaces•  IntegratementalhealthintoworkplaceHealthand

Safetypractices•  Goodbuy

•  SufficientevidencefromHIC.PromisingevidencefromLAMIC

•  Schools

•  UniversalSocialEmotionalLearning(SEL)programmesadoptingwholeschoolapproaches

•  Targetedinterventionsforvulnerablechildren

•  Bestbuy

•  Bestbuy

•  SufficientevidencefromHIC&LAMIC

•  SufficientevidencefromHIC&LAMIC

•  Community

•  Preschooleducationandcommunity-basedparentingprogrammes

•  Multi-componentout-of-schoolyouthempowermentprogrammes

•  Economicand/orhealthempowermentprogrammesforfamilieslivinginpoverty

•  Parentingandfamilystrengtheningforschool-goingchildren(3-16years)

•  Goodbuy•  Goodbuy

•  Goodbuy

•  Goodbuy

•  SufficientevidencefromHIC&promisingevidencefromLAMIC

•  PromisingevidencefromLAMIC

•  PromisingevidencefromLAMIC•  SufficientevidencefromHIC&promising

evidencefromLAMIC

HEALTHCARE •  Primary

healthcare(includingcommunityoutreach)

•  Promoteinfant&maternalmentalhealth(inclparentingskills)aspartofroutineantenatalandpostnatalcareandhomevisitationprogrammes

•  Trainingprimaryhealthcareprovidersinopportunisticmentalhealthpromotionandpreventioninterventionsforadultsandolderpeople

•  Bestbuy

•  Goodbuy

•  SufficientevidencefromHIC&LAMIC

•  SufficientevidencefromHIC&promisingevidencefromLAMIC

Promising Interventions �

•  Interventionstofacilitatere-employment–Jobsprogramme/TyohonJobSearchprogrammeinFinland(Vuori&Silvonen,2005)

•  Urbanregeneration,housingimprovement,fuelpoverty•  Positiveageing–psychosocialinterventionstoreducesocial

isolation–volunteering,befriending,intergenerationalprogrammesandtargetedoutreach(Forsmanetal.,2011)

•  Community-basedpeersupportprogrammes(youthmentoring,Widow-to-Widowbereavementsupport)

•  Socialprescribing;supportedemploymentinitiatives–recoveryapproaches

Evidence-informed policy and practice •  Robustcaseforaction-highqualitycomprehensiveinterventions

carriedoutincollaborationwithparents,families,communitiesandservicescanproducemultipleandlastingpositivebenefitso  leadtoimprovementsnotonlyinmentalhealthbutalsoimprovedsocial

functioning,academicandworkperformanceandgeneralhealthbehaviouro  effectsareespeciallyevidentforthemostvulnerablegroupso  cost-effectiveinterventions-health,socialandeconomicbenefits

•  Policysupport–universalhealthcare,familysupport,preschoolandchildcaresupport,educationalandemploymentpolicies,welfare,socialinclusionandpovertyreduction

Ø  widerpublicpolicymeasurestoreducehealthandsocialinequitiesandpoverty

CapacityDevelopment •  Strengthenpublichealthcapacitytodeliveronpopulationmental

healthandwellbeing

•  Policy-decision-makersengageinmultisectoralpolicydevelopmentandimplementation

•  Practice-strengtheningeffectiveimplementationthroughpartnershipswithothersectorstoeffectsystemschange

•  Localcommunities-ensuringthattheconditionsthatcreateandprotectpositivementalhealthandwellbeingareaccessibletoall

CapacityDevelopment•  Structurestosupportmultisectoralpolicydevelopmentand

implementationo  politicalmandateforcross-sectoralactiono  commongovernancestructure–accountabilityo  operationalstructures-effectivedeliverymechanismso  infrastructure,resources,leadership,expertise,workforcedevelopment

•  Implementationsystemsandframeworksformultisectoralaction

o  mainstreamingsustainablementalhealthpromotionpoliciesandpracticesintostandardsupportandservicedelivery

o  creatingdeliverymechanismswithinexistingsystemsbasedoncollaborationandpartnerships

CapacityDevelopment•  Organizationalcapacityandhumanresourcestoachievepriority

actions•  Workforcedevelopment–knowledgeandskillsmix

o  skillsofintersectoralworking,leadership,partnerships,advocacy,o  mobilisingandengagingindividuals,communitiesandothersectorso  bridgingthegapbetweenpublichealthandmentalhealthspecialists

•  Newresearchparadigmso  innovativeresearchapproachestocaptureandmeasuresystemschangeo  supportfortransdisciplinaryandtranslationalresearchØ  thenecessaryknowledge,skillsandabilitiesintranslatingpolicy,theoryand

researchintoeffectiveaction

DevelopingCompetenciesforMentalHealthPromotion

•  Internationalliteratureonhealthpromotioncompetencieso  Australia,Canada,NewZealandandanumberofEuropeancountrieso  progressinidentifyingasetofskills,knowledge,attitudesandabilitiesthat

areuniquetohealthpromotion

•  Internationalcollaborationtoidentifydomainsofcorecompetencyinhealthpromotion–  IUHPE,SOPHE,CDCandinternationalleadersinthefield

•  GalwayConsensusConferenceStatementonDomainsofCoreCompetencyinHealthPromotion(Allegranteetal.,2009;Barryetal.,2009)

•  Barry,MM;Battel-Kirk,B;Davison,H;Dempsey,C;Parish,R;Schipperen,M;Speller,V;Zanden,vander,G;Zilnyk,A.(2012).TheCompHPProjectHandbooks.InternationalUnionforHealthPromotionandEducation(IUHPE),Paris

•  Barry,M.M.,Battel-Kirk,B.andDempsey,C.(2012).TheCompHPCoreCompetenciesFrameworkforHealthPromotioninEurope.HealthEducation&Behavior,39(6):648-662.

•  Battle-Kirk,B.,Barry,M.M.,vanderZanden,Contu,P.,Gallardo,C.,Martinez.,Speller,V.,Debenedetti,S.(2014).OperationalisingandpilotingtheIUHPEEuropeanaccreditationsystemforhealthpromotion(2014)GlobalHealthPromotion,doi:10.1177/1757975914545386

•  Furtherdetailsavailableat:http://www.iuhpe.org/index.php/en/the-accreditation-system

DomainsofCoreCompetencies•  Ethicalvaluesandprinciplesforhealthpromotionincludeabelief

inequityandsocialjustice,respectfortheautonomyandchoiceofbothindividualsandgroups,andcollaborativeandconsultativewaysofworking

•  KnowledgeBase-thecorecompetenciesrequirethatahealth

promotionpractitionerdrawsonamultidisciplinaryknowledgebaseofthecoreconcepts,principles,theoryandresearchofhealthpromotionanditsapplicationinpractice

DomainsofCoreCompetencies•  EnableChange-enableindividuals,groups,communitiesand

organisationstobuildcapacityforhealthpromotionactiontoimprovehealthandreducehealthinequities

•  Advocatewith,andonbehalf,ofindividuals,communitiesandorganisationstoimprovehealthandwell-beingandbuildcapacityforhealthpromotionaction

•  Mediatethroughpartnership-workcollaborativelyacrossdisciplines,sectorsandpartnerstoenhancetheimpactandsustainabilityofhealthpromotionaction

•  Communication-communicatehealthpromotionactioneffectively,usingappropriatetechniquesandtechnologiesfordiverseaudiences

•  Leadership-contributetothedevelopmentofasharedvisionandstrategicdirectionforhealthpromotionaction

DomainsofCoreCompetencies•  Assessment-conductassessmentofneedsandassetsinpartnership

withstakeholders,inthecontextofthepolitical,economic,social,cultural,environmental,behaviouralandbiologicaldeterminantsthatpromoteorcompromisehealth

•  Planning-developmeasurablehealthpromotiongoalsandobjectivesbasedonassessmentofneedsandassetsinpartnershipwithstakeholders

•  Implementation-implementeffectiveandefficient,culturallysensitive,andethicalhealthpromotionactioninpartnershipwithstakeholders

•  EvaluationandResearch-useappropriateevaluationandresearchmethods,inpartnershipwithstakeholders,todeterminethereach,impactandeffectivenessofhealthpromotionaction

CapacityDevelopmentforPopulationMentalHealth

•  Developingmentalhealthpromotionpoliciesthatwilldeliveronimprovedmentalhealthatapopulationlevelo  creatinganenablingpolicystructureforcomprehensiveanduniversal

actionsonacross-sectoralbasiso  policyanddecision-makers–engageinmultisectoralpolicyanalysis,

developmentandimplementation

•  Advancingresearchtosupporteffectiveactiono  strengtheningandexpandingtheevidencebase–upstreaminterventionso  investinginimplementationresearcho  monitoringthestatusanddeterminantsofpositivementalhealthata

populationlevel

CapacityDevelopmentforPopulationMentalHealth

•  Strengtheningeffectiveimplementationo  systemsandsupportstructuresformultisectoralactiono  deliverymechanismsforembeddingmentalhealthpromotionpractices

intomainstreamsupportandservicedeliveryinasustainablemanner

•  Investinginmentalhealthpromotionpracticeo  aligningcapacitytodeliveronpopulationmentalhealtho  scaling-upandintegratingpopulationlevelactionsbasedoncross-sectoral

planninganddelivery

•  Developingworkforcecapacityo  baseofmultidisciplinaryknowledge,skillsandvalueso  workinginpartnershipwithothersectorstoeffectsystemschangeo  mobilisingpublicengagement

SustainableActionensuringthattheconditionsthatcreateandpromotepopulationmentalhealthand

wellbeingareaccessibletoall

structures

systems

science

skills