Mental Health Promotion For People With Mental Illness

Part One: Concepts

Definitions

Mental Health Promotion

Although many people believe that mental health promotion consists of public education efforts to raise awareness for managing life situations, and even though there are still some who feel it should focus only on the "well" population, research from a number of sources indicates otherwise. It is becoming increasingly clear that mental health promotion is a useful concept with significant potential for contributing to the mental health of all individuals and communities.

Its roots are in the health promotion tradition, best defined by the Ottawa Charter for Health Promotion as the process of enabling individuals and communities to increase control over the determinants of health and thereby improve their health. Mental health promotion, drawing on these concepts, has been defined in an international workshop sponsored by Health Canada (1996) 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 equity, social justice, interconnections and personal dignity (Centre for Health Promotion, 1997).

This definition contains several components common to what can be found in the literature as well as from key informants (Willinsky and Pape, 1997). Distilling the information from various sources, some key elements of mental health promotion emerge. A sense of control over one's health and resiliency (or the ability to bounce back from life's difficulties) are two fundamental goals. Steps toward these goals tend to involve environments that foster social justice, social support, and participation in decisions about one's life and health.

Starting with these elements, the routes to good mental health should therefore include enhancing individual capacities as well as improving the person's external environment. The endeavour also requires us to consider critical points when interventions may be needed, such as the need to deal with a mental disorder.

The concepts of prevention and population health, though separate from mental health promotion, have many elements in common with mental health promotion. Those activities which foster empowerment, resiliency, or self-efficacy, while promoting mental health, may also be helping to prevent or minimize possible mental health problems; primary prevention in particular, which targets the whole population, is very closely related to mental health promotion. But prevention and promotion are still different in their aims and scope. Prevention efforts in mental health tend to be directed towards populations at risk of developing mental disorders. They seek to eliminate those factors that cause or contribute to the incidence of mental illness. Mental health promotion, on the other hand, seeks to enhance mental health rather than prevent illness, and it serves the population at large as well as sub-groups. Its focus is not on incapacity but on strength, not on "fixing what is broken", but on "nurturing what is best within ourselves" (Seligman, 1998 on the mission of psychology, quoted in Compton 2001).

The distinction between population health and mental health promotion is even less clear, but some (admittedly soft) boundaries can be determined. Population health focuses on the range of conditions that determine health and their impact on the population in general, viewed through various life stages, and addressed through intersectoral strategies. It shares with mental health promotion a concern for participation and for the impacts of social/environmental factors on health, but does not stress individual and community control over health concerns as mental health promotion does. The extent to which the population health approach includes the scope for concentrating on particular groups such as those with mental disorders is still a matter of debate, but it seems clear that this is a component of mental health promotion. For the purposes of maintaining clarity in this paper, we will attempt to adhere to the definitions and elements of mental health promotion as described above, including those, such as the determinants of health, that overlap the population health perspective.

Mental Health and Illness and Related Terms

It is important to make the distinctions among the various terms used in reference to mental health. The publication Mental Health for Canadians: Striking a Balance, Health and Welfare Canada , 1988 offers the following definitions:

Mental health is the capacity of the individual, the group and the environment to interact with one another in ways that promote subjective well-being, the optimal development and use of mental abilities (cognitive, affective and relational), the achievement of individual and collective goals consistent with justice and the attainment and preservation of conditions of fundamental equality.

A mental disorder (or mental illness) is defined as a recognized, medically diagnosable illness that results in the significant impairment of an individual's cognitive, affective or relational abilities. Mental disorders result from biological, developmental and/or psychological factors, and can - in principle, at least - be managed using approaches comparable to those applied to physical disease (that is, prevention, diagnosis, treatment and rehabilitation).

A mental health problem is a disruption in the interactions between the individual, the group and the environment. Such a disruption may result from factors within the individual, including physical or mental illness, or inadequate coping skills. It may also spring from external causes, such as the existence of harsh environmental conditions, unjust social structures, or tensions within the family or community.

The additional definition of "consumer", based on discussions within CMHA, is provided:

Consumer is a term for people who have experienced mental health problems or mental illness, and have used the resources of the mental health system. It is the term most commonly used across Canada for this population, although it is recognized that other terms such as consumer/survivor, (psychiatric) survivor, or user are also used to reflect peoples' experience with mental health problems and the mental health system (Consumer Celebration Package, CMHA, National, 1994).

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