Promoting Mental Health:
A Public Health Approach
B Mukanga
Copperbelt University, School of Medicine
UN General Assembly Resolutions ( 2004)
• Calls upon states to guarantee that the rights of everyone to the
enjoyment of the highest attainable standard of physical and mental
health will be exercised without discrimination of any kind.
Mental Health
WHO 2001
• A state of wellbeing in which the person uses
1. His or her own abilities.
2. Can cope with the normal stresses of life
3. Can work productively
• Able to contribute to his or her community
• Inseparable from physical health
• More than the absence of disease
Why this is important
• Mental disorders are the leading causes of the global burden of
disease
• Mental ‘’health’’ is not only the absence of mental disorder, and
promoting mental health may not only reduce the burden of mental
disorders, but also improve population well being.
The Continuum of Mental health and Mental
disorder
• More than a dozen major categories/types of mental disorders.
• Many are clear cut deviations from ‘normalities’ (such as
Schizophrenia or Dementia)
• Some such as depression and substance abuse are dimensionally
distributed in the population ( like blood pressure)
• Actions that can shift the distribution can theoretically lead to a
healthier population and reduced burden of disease.
Whole Prevention Spectrum
Intervention Type Target Population
1.PRIMARY PREVENTION
• Universal Prevention Healthy population
• Selective Prevention Population at risk
• Indicated Prevention High risk persons +Beginning of
symptoms
2.SECONDARY PREVENTION
( Early detection and treatment) Persons with diagnosed disorders
3.TERTIARY PREVENTION
• Recurrence prevention Former mental patients
• Improving quality of life Chronic patients
Mental Health Promotion ( What is it?)
• Mental health promotion is the strategic and sustainable approach to
eliminating and minimising the factors that give rise to distress and
loss of wellbeing and introducing and maximising those that create
circumstances in which all can flourish ( Department of Health,
Victoria, Australia).
• Mental health promotion involves actions to create living conditions
and environments that support mental health and allow people to
maintain and adopt healthy lifestyle. These include a range of actions
to include the chances of more people experiencing better mental
health.
Determinants of Mental Health
The determinants of mental health are categorised in the
Biopsychosocial frame which include:
• Biological: Genetic predisposition, alcohol or drug abuse, poor
physical health or disability
• Psychological: Personal traits ,coping strategies
• Social: Poverty, gender disadvantage, discrimination , violence.
Pathways to Mental Ill health.
Most distal- societal or structural
• Poverty, socio-inequality
Next level -Neighbourhood or community factors
• Dangerous neighbourhood, marginalisation
Next level –Family factors
• Conflict, lack of warm relationship , bereavement.
Next level-Individual factors
• Genetic vulnerability, disability, physical health problems, unemployment.
Promoting Mental Health
Key principles include :
• Actions which strengthen protective factors ( eg, safe neighbourhoods) and
reduce risk factors ( for eg inequality).#
• Inter-sectoral actions including education, labour , justice , transport, housing
and welfare, as well as specific activities in the health field.
• Actions across the life-course
Evidence based prevention
Framework
Challenges to Mental health preventive
strategies
• The trajectories that determine mental health are still unclear
complicating the task of identifying specific targets for mental health
promotion.
• Actions aimed at promotion are difficult to evaluate in controlled
experiments, limiting the strength of evidence on effectiveness
• Very difficult to measure mental health outcomes, because many
interventions are not primarily intended to promote health.
Immediate Policy
Recommendations?
Addressing Social Disadvantages
• Reducing absolute poverty
• Promoting income equality
• Reducing discrimination and marginalisation.
Women and Children
• Promoting health pregnancy and safe childbirth.
• Promoting early childhood developing.
• Promoting quality education.
• Life skills training
• Empowerment of young people.
Community and Healthcare
• Reducing violence across life course
• Social support to vulnerable groups e.g., people with disabilities ,
refugees .
• Building peoples friendly community spaces , especially urban
communities.
• Healthy workplace/stress, reduction and management policies.
• Improving access and quality of care for chronic diseases including
mental health.
Conclusion
• There is no health without mental health.
• Interventions for promoting mental health and may not always meet
the criteria required for other areas o evidence based health policies;
In such instances , observation evidence should guide policy and
practice.
• Promoting mental health has the potential not only to reduce the
burden of mental disorders but also lead to improvement in overall
population wellbeing
