Mental Health Promotion: A Framework for Action

cmha.ca/documents/mental-health-promotion-a-framework-for-action

Mental health promotion is not a new concept, but it is still not well understood.
Nevertheless, research is showing that mental health promotion initiatives can have
concrete, positive outcomes for the entire population. It is a powerful resource with
significant potential for grounding the work of the Mental Health Commission of Canada.

Concepts: Mental Health and Mental Health Promotion

An understanding of mental health promotion requires a clear concept of mental health.
Key components of mental health generally include the capacity to: enjoy life, use abilities
and achieve goals, contribute to community, deal with life’s inevitable challenges and
bounce back from adversity, and form and sustain relationships with others. Because
mental health is more than the absence of mental illness, a person can have a mental illness
but still experience mental well-being (for example, attending college and enjoying
reciprocal relationships). Conversely, a person can be free of a diagnosed mental illness, but
still experiencing mental distress (for example, struggling to cope with a difficult life
situation). This notion of mental health and mental illness as two separate constructs, first
articulated by Health and Welfare Canada in 1988, is fundamental to our understanding of
how mental health promotion principles apply to people with mental illnesses. Mental
health promotion refers to the actions taken to strengthen mental health. It applies to all
people — specific groups as well as the general population. It:

Enhances capacity to take control of life and health Mental health promotion can help
people take charge of circumstances that affect their mental health, and participate in
decisions about their life and health.
Promotes resiliency Mental health promotion helps people bounce back from life’s
difficulties by enhancing protective factors, reducing inequities and ameliorating risk
factors for poor mental health.
Relies on intersectoral linkages Mental health promotion requires linked policies and
programs in government and business sectors including health, education, labour,
justice, environment, finance, and housing, as well as prevention and treatment of
illness.
Takes a positive perspective Mental health promotion is asset rather than deficit
based. It is constructed on a foundation of empowerment, helping people and
communities to recognize their strengths and determine their own destinies. And it
provides resources to enable this empowerment in a supportive environment.

Busting the myths of mental health promotion

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Like mental illness itself, mental health promotion is often misunderstood. In the
development of policy, it tends to be dismissed entirely, lumped in with prevention, or
sidelined to a peripheral role. This is a serious oversight, because its basic tenets can enrich
any mental health planning initiative. Some common myths are discussed below.

MYTH: Mental health promotion is a soft concept, and less significant than
clinical interventions.
It is true that the outcomes of clinical interventions are more immediate and more easily
measured than those of mental health promotion. But it is important to recognize that the
two approaches are not mutually exclusive. Clinical practice can take a mental health
promoting approach, focusing on people’s recovery, enabling them to take control over
their situation, and helping them connect to community.

MYTH: People with mental illness need a better system of services and
treatments; mental health promotion is a lower priority.
There is no question that an integrated system of services and supports is urgently needed,
but if it is working effectively, it will also be promoting the mental health of the people it
serves. Like all people, those with mental illness need a positive sense of self; a sense of
inclusion and belonging; purpose, meaning, and hope; and a practical understanding of
their own mental health strengths and challenges. These tools can enable them to gain
greater control over their lives, deal more effectively with life’s challenges, and work toward
recovery.

MYTH: Mental health promotion refers to public education and broad

determinants of health for the general population.
While these are aspects of mental health promotion, they represent only a small fraction of
its reach. Its universal principles apply to all sub-populations, and its strategies can take
many forms. The sample of applications in the following section demonstrates a range of
concrete mental health promotion strategies in a variety of settings.

Applications
A selection of applications along with program examples in boxes follows, organized
according to the five action areas for health promotion from the Ottawa Charter for Health
Promotion (1986).

1. Creating Supportive Environments

Creating better housing conditions
Reducing the strain of unemployment
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 Befriending program for older women to enhance social support
Reducing stigma through a variety of approaches

Changing Minds (CMHA Newfoundland Division, current) Instructional models based on real
people’s experiences, for community education about mental health and mental illness

Supporting students with mental illness in higher education

Handle with Care (CMHA and Hincks-Dellcrest Institute, 2004-present) A guidebook and train
the trainer program for promoting the mental health of young children in child care

2. Building Individual Skills

Mental health clubs for youth in schools to enhance resilience and promote social
competence
Adult literacy programs to promote confidence and inclusion

Consumer Development Project (CMHA, BC Division, current) Consumers developed tools to

train peers for participation in mental health system planning

3. Developing Healthy Public Policy

Workplace policies that support employee participation in organization and design of
their work
Policies for direct provision of funding to consumer controlled organizations

Ontario Peer Development Initiative (OPDI) (1991-present) Funded by Ontario Ministry of

Health, OPDI supports consumer/survivors to develop their own programs for maintaining their
mental health. All funded projects are consumer-run and all staff and board members are
consumers.

4. Reorienting Mental Health Services

Intervening early in psychosis with an expectation of recovery
Taking a consumer-centred, strengths-based approach
Service models that support independent living, enhance participation in community
life, and link to generic supports such as religious institutions and interest groups

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 Salmon Arm Mental Health System Progress Report (CMHA, BC Division, 1998) This
community-based approach to mental health system monitoring takes a consumer and community
focus and recognizes determinants of health. It gathers information from consumers, families,
providers, and external groups such as family doctors, RCMP, income support workers and other
community organizations. It asks: How well does the mental health system work as a discrete
system? How well do the services and supports within the system work together? How well does
the system relate with other parts of the community (e.g. family doctors, police, drug/alcohol
counselors)? How well does it support people with mental illness and their families to optimize
their recovery?

Promoting access to, and strengthening, the social determinants of health

A story about mental health promotion and determinants of health From 2002 to 2004, CMHA
National’s Citizens for Mental Health project, funded by Health Canada through the Voluntary
Sector Initiative, consulted with over 400 voluntary sector stakeholders to ask: “What are the
significant mental health issues for the communities you deal with, and what actions should the
federal government take on these?” The respondents represented a wide range of health and social
groups and organizations, different cultures, and all regions of Canada, but they all raised the same
themes. In particular, they identified social determinants of health such as housing, income,
employment, and justice as mental health policy issues. This previously hidden consensus has
significant implications for policy development and joint initiatives.

5. Strengthening Community Action

Promoting social support and community empowerment for older adults through
income generation, links with younger people to provide physical care, and visiting
neighbours for social support and practical help
Building collaborations between school and community to prevent drug abuse in at-
risk youth
Connecting people with mental illness to the natural community

Inclusion in Community: A Guide to Local Action (CMHA National, 1993) This project fostered
integration into regular community life by making generic services and groups more accessible to
people with mental illness. In different sites across Canada, a range of community partners jointly
identified and implemented inclusion strategies. Partners besides the mental health sector included
business people, colleges, government, religious leaders, and recreation staff. Approaches included:
community theatre troupe, consumer-run businesses, enhancing access to mainstream employment
and to recreation programs at the YMCA, expanding volunteer opportunities, and outreach to peers
in hospital to connect them to community.

Relevance for the Work of the Mental Health Commission

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The “Out of the Shadows” report provides a clear vision for recovery, choice, and
participation. Mental health promotion is consistent with this vision. Rather than a stand-
alone issue tacked onto the MHCC’s agenda, mental health promotion should be an overall
guiding principle. This principle can keep the Commission focused on helping people build
on their capacities and direct their own recovery journey. A mental health promotion
approach will help ensure that all the Commission’s work supports the assets, strengths and
resilience of individuals and communities. In particular, mental health promotion principles
can inform the approach the Commission takes to its initial identified priorities. For
example:

Fighting stigma A mental health promotion approach would ensure that the target
population participates in planning, implementing and evaluating anti-stigma public
education strategies. It would also broaden the anti-stigma agenda beyond just public
education to incorporate community linkages and inclusion initiatives.
Promoting knowledge exchange The mental health promotion principles of building
on community strengths and wisdom would lead a Knowledge Exchange Centre to
accept the legitimacy and value of various sources of knowledge beyond just the
clinical, and to ensure that its agenda includes promotion and recovery information.
Developing a national mental health strategy A national mental health strategy
informed by mental health promotion concepts would be grounded by principles of
participation, recovery, resilience, and maximizing control over life and health. It
would also establish clear interdepartmental linkages for promoting joint action on
the determinants of health.

Conclusion
The potential of mental health promotion goes far beyond public education. It is relevant for
all people, including those with mental illness, and its principles can provide a solid
foundation for the Mental Health Commission of Canada as it proceeds with its important
agenda. This would ensure an explicit and continuous acknowledgment that the MHCC
heard what people with mental illness have been saying about the importance of the social
determinants of health to their own quality of life, and the need for strategies in the service
system and beyond that foster resilience and the potential for recovery.

References
Health and Welfare Canada. (1988). Mental health for Canadians: Striking a balance. Ottawa:
Ministry of Supply and Services Canada. Jane-Llopis, E., Barry, M., Hosman, C., and Patel, V.,
guest editors (2005) The evidence of mental health promotion effectiveness: strategies for
action. International Journal of Health Promotion and Education Special Supplement 2.
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Pape, B. (2006). Mental Health Promotion: a review of the literature. Canadian Mental
Health Association, Ontario Division. Pape, B. and JP Galipeault (2002). Mental Health
Promotion for People with Mental Illness. For Mental Health Promotion Unit of Health
Canada. Trainor, J., Pomeroy, E., & Pape, B. (2004). A Framework for Support, third edition.
Toronto: Canadian Mental Health Association, National Office. Willinsky, C. and Anderson, A.
(2003). Analysis of Best Practices in Mental Health Promotion Across the Lifespan. Centre for
Addiction and Mental Health. World Health Organization. (1986). Ottawa charter on health
promotion. Copenhagen: World Health Organization Regional Office for Europe.

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