Improving the Health of Canadians: Exploring Positive Mental Health

1. Improving the Health of Canadians: Exploring Positive Mental Health Release Date: March 4, 2009

2. Communication, Consultation and Dissemination Privacy, Confidentiality and Security About the Canadian Institute for Health Information (CIHI) Taking health information further Health Information Research and Analysis Building new health knowledge Health Indicators Data Holdings Capturing the portrait of health care Standards Laying a foundation for health information

3. Canadian Population Health Initiative (CPHI) CPHI’s Mission: • To foster a better understanding of factors that affect the health of individuals and communities; and • To contribute to the development of policies that reduce inequities and improve the health and well-being of Canadians.

4. Policy Synthesis CPHI’s Strategic Functions Knowledge Generation Knowledge Transfer Knowledge Exchange

5. CPHI’s Key Themes 2007-2012 Mental Health and Resilience Reducing Gaps in Health Place and Health Promoting Healthy Weights

6. Cordell Neudorf (Chair) David Allison André Corriveau Nancy Edwards Brent Friesen Judy Guernsey Richard Massé Deborah Schwartz Elinor Wilson Ian Potter (ex-officio) Gregory Taylor (ex-officio) Michael Wolfson (ex-officio) CPHI Council Members (as of June 2008)

7. Expert Advisory Group Members Gregory Taylor (Chair), Public Health Agency of Canada Carl Lakaski, Public Health Agency of Canada Kathy Langlois,First Nations and Inuit Health Branch Alain Lesage, Louis-H. Lafontaine Hospital Dora Nicinski, Atlantic Health Sciences Corporation (Region 2) Rémi Quirion, Canadian Institutes of Health Research Margaret Shim, Alberta Health and Wellness Phil Upshall, The Mood Disorders Society of Canada Cornelia Wieman, Indigenous Health Research Development Program and University of Toronto

8. Improving the Health of Canadians Report Series on Mental Health Series of three reports on the theme of mental health and how mental health is linked to the determinants of health • Two reports focused on segments of the population often identified as ‘vulnerable’ • Final report focused on the construct of positive mental health

9. Improving the Health of Canadians:Exploring Positive Mental Health Purpose of Report: Explores the concept of positive mental health Organization of Report: • Section 1: Looks at the operationalization of positive mental health. • Section 2: Looks at how positive mental health is currently measured. • Section 3: Looks at what characteristics are associated with high levels of positive mental health and the role positive mental health plays in health. • Section 4: Looks at opportunities and strategies to promote mental health via a population health approach. • We are not aware of any other Canadian report that has looked a positive mental health in this manner.

10. Operationalizing the Concept of Positive Mental Health

11. Improving the Health of Canadians:Exploring Positive Mental Health Report Framework The Public Health Agency of Canada (PHAC) has adopted a broad definition of mental health: “Mental health is the capacity of each and all of us to feel, think, and act in ways that enhance our ability to enjoy life and deal with the challenges we face. It is a positive sense of emotional and spiritual well-being that respects the importance of culture, equity, social justice, interconnections and personal dignity.”

12. Ability to Enjoy Life Life enjoyment is often measured as an outcome using concepts like happiness, life satisfaction and subjective well-being. Our ability to enjoy life is influenced by a number of factors, including: • our genetics and personality; • our life circumstances; • our family and social environments; and • our behaviours.

13. Dealing with Life Events Dealing with life events refers to our ability to cope with and grow from the challenges we face throughout our lives, as well as our resilience in overcoming adversity. Coping strategies linked to positive mental health often involve those that are engaging or problem-focused in nature or that incorporate searching for or finding positive meaning in life events.

14. Emotional Well-being Emotional well-being refers to: • the experience of positive emotions such as joy, interest, contentment and love; and • our ability to regulate emotions in such a way that we maximize the benefits and limit any potentially destructive aspects.

15. Spiritual Values and Well-being Common elements of spirituality include: • Having a set of values, beliefs and or practices (including both religious and more broader spiritual values); • Searching for and finding truth, meaning and purpose in life; and • Developing and maintaining relationships and feelings of connectedness to oneself, others and something larger than oneself.

16. Social Connections and Respect for Culture, Equity, Social Justice and Personal Dignity The final component of the PHAC definition used to operationalize positive mental health for this report speaks to respect for culture, equity, social justice, interconnections and personal dignity in mental health. • Our social well-being, or interconnections, refers to the connections we have in the environments in which we live, learn, work and play. • The literature base for the other areas is beginning to emerge – environments that are safe and able to meet people’s basic needs are environments in which mental health can flourish.

17. Measuring Positive Mental Health and Its Link to Health

18. Links Between Positive Mental Health, Mental Illness, Physical Illness and Positive Physical Health Source: Reproduced from B. Raphael et al. “Links Between Mental and Physical Health and Illness, “in Promoting Mental Health: Concepts, Emerging Evidence, Practice, eds. H. Herrman, S. Saxena and R. Moodie (Geneva, Switzerland: World Health Organization, 2005), p. 132-147.

19. Ability to Enjoy Life Life enjoyment has been linked to social well-being in the family, school, work and community settings. For example: • Among youth, greater family cohesion, higher levels of family stability, increased parental attachment and authoritative parenting style have been associated with increased subjective well-being, life satisfaction, psychological well-being and more active coping skills. • Feeling connected to school and having positive peer connections are associated with positive health outcomes such as high self-worth. • People with a very strong sense of community belonging are more than twice as likely to report very good/excellent self-rated mental health.

20. Dealing with Life Events Research shows an association between coping strategies and better positive mental health outcomes, including improved emotional and psychological well-being, increased feelings of control and purpose, and higher life satisfaction. Coping strategies linked to positive mental health outcomes often incorporate finding positive meaning in life events, such as: • Reframing a stressful event in more positive terms; • Focusing efforts on managing the problems causing distress; and • Being able to take a non-judgmental, kind and compassionate attitude toward one’s problems.

21. Emotional Well-being Research shows a link between experiencing positive emotions and the following: • improved outcomes in mental health and coping; • finding meaning in the face of adversity; • social relationships; and • physical health. Individuals with improved ability to regulate, express and use emotions experience a number of positive outcomes such as better cognitive functioning, lower pain intensity, and better family, intimate and social relationships, competence, and psychological well-being.

22. Spiritual Values and Well-being Studies show various links between positive mental health and religious/spiritual beliefs and practices. For instance: • Having increased levels of meaning and purpose in life is linked to better quality of life. • Engaging in religious practice is linked to better health-related outcomes and behaviours. • Religious beliefs, practices and coping skills are linked to better life satisfaction and happiness, more pro-social behaviour, and improved support and connections to others.

23. Social Connections Quality connections and interactions with the people and communities around us or our ‘social well-being’ is another key element of positive mental health. For example: • Higher life satisfaction is linked to having more frequent interactions with social supports; • Greater levels of family cohesion and social cohesion are linked to more active coping skills and improved psychological well-being, respectively; • Higher levels of community belonging are linked to better self-perceived physical and mental health; and • Providing support to others enhances the positive and general mental health of those who provide support.

24. CPHI Analyses of Links Between Positive Mental Health and Health

25. Positive Mental Health Among Canadians 15 Years and Older, 2002 Life Enjoyment:30% reported they ‘almost always’ enjoyed life, had good morale, found life exciting and smiled easily. Coping Ability:24% reported having excellent or very good ability to handle day-to-day demands and unexpected problems. Emotional Well-being:24% reported they ‘almost always’ felt emotionally balanced, at peace with self, self-confident, and had pride in themselves. Spiritual Values:33% reported that spiritual values played an important role in life and helped them find meaning. Social Connectedness:45% reported they ‘almost always’ got along well with others and listened to friends. Source: Canadian Community Health Survey (Cycle 1.2, 2002), Statistics Canada.

26. Role of Positive Mental Health in Health

27. Characteristics Associated with High Positive Mental Health • Analyses showed associations between high levels of positive mental health and the following factors: • Geographic location • Sex • Age • Education • Income • Race/Culture • Community Belonging, Available Social Support

28. Association Between Geographic Location and High Positive Mental Health

29. Association Between Age and High Positive Mental Health

30. Association Between Community Belonging and High Positive Mental Health

31. Promoting Positive Mental Health

32. Promoting Positive Mental Health • Mental health is a concept receiving increased attention in policy, research and practice/service arenas. • Mental health policy in Canada has largely focused on people living with mental illness. • In the 1980s, with the growth of the health promotion movement, the concept of mental health promotion emerged as an attempt to distinguish efforts to promote positive mental health from efforts to treat mental illness.

33. Promoting Positive Mental Health: A Role For Everyone (1) • Various inequities associated with gender, poverty, disability, race/ethnicity, unemployment and geographic location can themselves influence mental health. • Strategies that focus on mental health promotion apply to all people and communities. • Mental health promotion typically emphasizes supporting individual resilience, creating supportive environments and addressing the influence of the broader determinants of mental health

34. Promoting Positive Mental Health: A Role For Everyone (2) Mental health promotion strategies and activities can be grouped into three broad levels of analyses: • Societal • Addressing social, ecological, economic, political and cultural factors that have an effect on mental health (e.g. employment, housing, education) • Creating supportive environments • Community • Strengthening community action; situated to deal with government and non-government organizations on one hand and families/individuals on the other • Individual • Developing and building on personal skills, strengths and resiliency; supporting personal and social development through information, education and enhancing life skills

35. Promoting Positive Mental Health: A Role For Everyone (3) • Specific goals of mental health promotion include: • enhancing protective factors that help individuals, families and communities to deal with events; and • increasing conditions, such as social cohesion, that reduce risk factors for diminished mental health among individuals, families and communities. • Programs highlighted in the report point to some common strategies that appear to be effective at promoting positive mental health: • They bring about change in a variety of settings, such as the family, school, workplace and community. • They target different groups across the lifespan. • They combine mental health promotion activities and prevention activities. • They are tailored and sensitive to the needs of the target group.

36. Promoting Positive Mental Health: Conclusions A scan of the emerging evidence in this field indicates: • Many mental health programs tend to have a symptom management, illness treatment or preventative focus rather than a primary focus on promoting positive mental health; • Some programs and initiatives are incorporating a positive mental health focus or approach into their programming; • Programs and interventions are being offered or implemented at the grassroots level but, in many cases, evaluations are not available; • Some programs and interventions target specific sub-groups, but they do not necessarily look at the causes behind gradients or the interaction of various determinants of health; and • Population-based policies and interventions are scarce.

37. Conclusions

38. Conclusions • To date, the term “positive mental health” has been used in many different ways. Numerous, sometimes overlapping, terms are used to reflect the same concepts; or the same terms are used to refer to different concepts, thereby contributing to a lack of definitional clarity. • Despite this variation, there are commonalities in current views of positive mental health. They include: • Our individual feelings, and the development of our capabilities and resilience; • The ways we deal with adversity so that we can grow and change positively; • Our sense of meaning, purpose and engagement in life; and • Our quality supportive environments, connections and social relationships.

39. Conclusions (2) • Measuring Positive Mental Health • Positive mental health is not consistently measured or tracked over time in Canada. • Positive Mental Health linked to Better Health/Less Illness • Compared to groups with moderate and low levels of positive mental health (as measured by life enjoyment, coping ability, emotional well-being, spiritual values and social connectedness), people with high levels reported higher levels of excellent physical and mental self-rated health, as well as less reported mental illness and reduced activity days. • Factors Associated with Positive Mental Health Outcomes • Community belonging and having available social support were consistently linked to positive mental health outcomes; education and income were not clearly or consistently associated with positive mental health outcomes.

40. Conclusions (3) • Information presented in the report suggests that there is value in looking at what is working for populations that are doing very well and come to understand what is contributing to adverse and negative outcomes. • Mental health promotion is about fostering the development of positive mental health by supporting individual resilience, creating supportive environments and addressing the influence of the broader determinants of mental health. • Strategies that focus on mental health promotion apply to all people and communities.

41. CPHI Mental Health Current and Planned Reports and Activities

42. Complementary Products • Workshops that reflect content of given mental health report • Collection of Papers: “What Makes a Community Mentally Healthy?” • Exploring Positive Mental Health—Supporting Documents: • Literature search methodology • Data analysis methodology • Policy scanning methodology • Summary report • PowerPoint presentation • Bibliographies • External commentaries on report

43. It’s Your Turn cphi@cihi.ca www.cihi.ca/cphi