Creating Caring Communities: Putting Mental Health on the Agenda

1. 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

2. Mental Health • a state of balance between physical, mental, cultural, spiritual and other personal factors, and between the self, others and the environment Sartorius

3. Positive Mental Health • 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.

4. Why the interest in mental health promotion? Why the interest from ‘health’? Why the interest from other sectors?

5. Increasing interest in population’s mental health • 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

6. Mental Illness Impact • 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)

7. Mental Illness Impact • 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)

8. Socio-economic & Life Stress Impact on Physical Health

9. Social Risk Factors • 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

10. 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

11. 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.

12. Many of the interventions designed to improve mental health will also promote physical health and vice versa. (when mental health promotion is thought of in a broader sense than previously understood)

13. Promoting mental health has the potential to reduce a whole range of risk behaviours and their consequences such as loss of productivity, crime, drop-out from school, disrupted family relationships (Moodle and Jenkins)

14. 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

15. What we spend on policing and courts and jails is not available to be spent on affordable housing, school systems, or income security. Feather

16. Mental Well-Being: the foundation of a healthy individual, family & community

18. Prerequisites 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

19. Isolation / alienation 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

20. Societal or community-level characteristics: • Culture, • Language, • Cohesion, • Control

21. Aboriginal Youth Suicide by Cultural Continuity Factors Cultural Continuity Factors Source: Chandler & Lalonde, 1998

22. Post-Traumatic Stress Response • 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

23. Post-Traumatic Stress Response • 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.

24. 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.

25. Mental Health Promotion • 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.

26. How do we approach mental health promotion?

27. Poverty Sexual Activity Education Drugs Diet Unemployment Smoking Social Supports Early Childhood Development

28. Principles of Health Promotion • Health education • Policy analysis • Community development and organization • Health advocacy • Legislation World Health Organization (1984)

29. Ottawa Charter for Health Promotion • Building Healthy Public Policy • Creating supportive environments • Strengthening community action • Developing personal skills • Reorienting health services World Health Organization (1986)

30. Key Population Health Promotion Ideas

31. Meaningful participation

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

33. Multi-sector collaboration and partnerships

34. 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

35. Finding ways to shift emphasis from a sector-by-sector approach to a broader and more cohesive problem approach • Community as the focus!

36. Partnerships • Within communities • Between communities • Within health organizations • Mental health promotion & health promotion • Treatment and promotion services • Between health organizations • With other sectors

38. 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

39. Housing • 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)

40. Intersectoral partnerships • 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.

41. Take action on a variety of determinants

42. Multiple StrategiesMultiple Levels • Reduce individual, socio-economic, and environmental risk factors, and • Promote protective factors

43. Supportive environments to reduce inequities & remove barriers Making healthy choices, easier choices.

44. Creating supportive environments • Policy • Economic development • Social action • Community schools • Early childhood supports

45. Creating Supportive Environments • 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

46. Government Healthy Public Policy • The way services are provided • Environmental policy • Policy on housing, transportation, etc • Economic policy • Taxation policy • Social policy

47. Healthy Policy is also for you & I • School boards • Recreation centers • First Nations Band councils • Municipal governments • Committees and organizations • Families • Workplaces

48. Capacity building and empowering practices

49. Capacity building • Increased awareness & knowledge • Skill development • Knowing how to access resources • Developing social networks • Learning from others

50. Actions that focus on the health of the population