Best practice guidelines for mental health promotion programs: Children & Youth
This section provides the practitioner with the theoretical context for mental health promotion through definitions and underlying
concepts, with a focus on the promotion of resilience. Topics include:
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Health promotion
Health promotion is defined as a “process of enabling people to increase control over and to improve their health” (WHO, 1986).
The Ottawa Charter for Health Promotion (WHO, 1986) defined five key health promotion strategies:
Population health is an approach that is often used in health promotion, and is based on interventions that target the entire
population rather than smaller, select target groups. Population health in a Canadian context builds on public health, community
health and health promotion traditions for which Canada has been recognized internationally since the groundbreaking work
of the Ottawa Charter. Other key documents that have shaped the population health framework include the Lalonde Report, entitled A New Perspective on the Health of Canadians (Lalonde, 1974), andAchieving Health for All: A Framework for Health Promotion(Epp, 1986).
Population health aims to address the health needs of a whole population. It is based on the tenet that health and illness
are the result of a complex interplay between biological, psychological, social, environmental, economic and political factors.
The goal of population health is to achieve the best possible health status for the entire population by fostering conditions
that enable and support people in making healthy choices, and providing the needed services that promote and maintain optimum
health.
Social Determinants of Health: Canadian Perspective(Raphael, 2004) identified a range of factors that influence health (the determinants of health), which include:
- income and social status
- housing
- social support networks and social connectedness
- education
- employment and working conditions
- unemployment and employment security
- physical environments
- biology and genetics
- personal health practices and coping skills
- healthy child development
- health services.
Population health incorporates health promotion principles and strategies at all levels of society (e.g., individual, family,
community) in order to address these determinants of health. (Raphael, 2004)
Mental health promotion
The discussion paper Mental Health for Canadians: Striking a Balance(Health Canada, 1988) provided the impetus for placing mental health within a health promotion framework, and viewing mental health specifically
on a continuum, ranging from optimal to minimal. The paper also provided a forum to define optimal mental health for the whole
population, including people with a diagnosed mental health disorder. Further, this document supported the notion of promoting
mental health as being consistent with the health promotion process of “enabling people to increase control over, and improve,
their own health.” (WHO, 1986)
The field of mental health promotion is continuing to evolve, as is the definition of the term. A 1996 international workshop
hosted by the University of Toronto’s Centre for Health Promotion, along with the Mental Health Promotion Unit of Health Canada,
defined mental health promotion as:
The process of enhancing the capacity of individuals and communities to take control over their lives and improve their mental health. Mental health promotion
uses strategies that foster supportive environments and individual resilience, while showing respect for culture, equity, social justice, interconnections, and personal dignity.
(Joubert et al., 1996)
This definition is very similar to the general concept of health promotion as defined by the Ottawa Charter (WHO, 1986). Similarly, strategies used in mental health promotion—many of which are also used in the substance use field—also parallel
health promotion strategies. Various interconnecting factors affect mental health, as they do substance use and general health:
mental health status is determined by a complex interplay of individual characteristics, along with cultural, social and economic
circumstances at both the macro (society) and micro (community and family) levels (Commonwealth Department of Health and Aged Care [CDHAC], Australia, 2000).
In summary, health promotion and mental health promotion have common elements, in that both:
- focus on the enhancement of well-being rather than on illness
- address the population as a whole, including people experiencing risk conditions, in the context of everyday life
- are oriented toward taking action on the determinants of health, such as income and housing
- broaden the focus to include protective factors, rather than simply focusing on risk factors and conditions
- include a wide range of strategies such as communication, education, policy development, organizational change, community development and local activities
- acknowledge and reinforce the competencies of the population
- encompass the health and social fields as well as medical services.
What is distinctive about mental health promotion?
Mental health promotion emphasizes two key concepts: power and resilience. Power is defined as a person’s, group’s or community’s
sense of control over life and the ability to be resilient (Joubert & Raeburn, 1998). Building on one’s existing capacities can increase power and control.
Resilience has been defined as “the ability to manage or cope with significant adversity or stress in ways that are not only
effective, but may result in an increased ability to respond to future adversity” (Health Canada, 2000, p. 8). Resilience is influenced by risk factors and protective factors.
- Risk factors are variables or characteristics associated with an individual that make it more likely that he or she will develop
a problem (Mrazek & Haggerty, 1994, cited in CDHAC, 2000). Risk factors can be biological or psychosocial, and may reside within a person, his or her family or social network, or
the community or institutions that surround the person. They occur in innumerable contexts, including perinatal influences,
family relationships, schools and workplaces, interpersonal relationships, media influences, social and cultural activities,
the physical health of the individual, and the physical, social and economic ”health” of the community.
- Protective factors buffer a person “in the face of adversity and moderate . . . the impact of stress on social and emotional
well-being, thereby reducing the likelihood [that] disorders will develop” (CDHAC, 2000, p. 13). Protective factors may be internal (e.g., temperament, cognitive abilities) or external (e.g., social, economic or environmental
supports). They enable a person to protect his or her emotional and social well-being and cope with everyday life events (whether
positive or negative). Protective factors act as a buffer against stress and may be drawn upon in dealing with stressful situations.
Some research has suggested that a person’s resilience can be enhanced by improving his or her coping skills, reducing risks
and improving protective factors. However, other studies suggest that resilience is more than simply improving these factors:
resilience is reflected in the ability to respond over time as various things change in one’s life. It is dynamic rather than
static and it has a direct effect on a person’s coping process. Resilient children and young people believe they can cope
with adverse events because they have some control over what happens and are able to give deeper meaning to the adverse event
(Silliman, 1994).
People who have high resilience (i.e., have the capacity to “bounce back” after adversity) are still vulnerable to adverse
events and circumstances (CDHAC, 2000). However, a person’s level of protective factors—regardless of the number of risk factors—has been shown to lower his or
her level of risk (Resnick et al., 1997, cited in CDHAC, 2000). Protective factors also reduce the likelihood that a mental health disorder will develop, by either reducing the person’s
exposure to risk or reducing the effect of risk factors, or both.
Resilience consists of a balance between stress and adversity on one hand, and the ability to cope and availability of support
on the other. When stresses exceed a person’s protective factors, even someone who has previously been resilient may be overwhelmed.
The relationship between risk and protective factors is complex: “[I]t is not the presence of risk or protective factors but
rather the interaction and accumulation of these factors over time that affects the development of mental health problems
and mental disorders” (CDHAC, 2000, p. 53).
In conclusion, mental health promotion efforts should start by:
- respecting people as they are
- recognizing that people have the capacity to cope with life (regardless of whether they are currently coping well or not)
- acknowledging that they themselves are the best ones to know how to access their own intrinsic capacity.
A person’s increased sense of power and resilience is important not only as an outcome of an intervention, but also as an
integral part of the process—where the person truly feels that they are part of the process.
1. To increase resilience and protective factors
Mental health promotion aims to strengthen the ability of individuals, families and communities to cope with stressful events
that happen in their everyday lives, by:
- increasing an individual’s or community’s resilience
- increasing coping skills
- improving quality of life and feelings of satisfaction
- increasing self-esteem
- increasing sense of well-being
- strengthening social supports
- strengthening the balance of physical, social, emotional, spiritual and psychological health.
2. To decrease risk factors
Mental health promotion aims to reduce the factors that place individuals, families and communities at risk of diminishing
mental health, by reducing or eliminating:
- anxiety
- depression
- stress and distress
- sense of helplessness
- sexual abuse
- family conflict
- problem substance use
- suicide
- violence.
3. To reduce inequities
Mental health promotion aims to reduce inequities and their consequent effects on mental health. Inequities are often based on:
- gender
- poverty
- physical or mental disability
- employment status
- race
- ethnic background
- geographic location.
Reduce inequities by:
- implementing diversity policies.
- providing diversity training.
- creating transitional programs.
- promoting anti-stigma interventions/campaigns.
Willinsky & Anderson (2003) found that successful mental health promotion interventions include the following characteristics:
- clearly stated outcome targets
- comprehensive support systems with multiple approaches, including emotional, physical and social support, together with tangible
assistance.
- intervention in multiple settings, (e.g., home, school, daycare centre and community)
- provision of screening and early interventions for mental health problems at all stages of the lifespan
- involvement of relevant parts of the target group’s social network
- intervention over an extended period
- long-term investment in program planning, development and evaluation.
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