Mental health: strengthening mental health promotion
Mental health is not just the absence of mental disorder
- The positive dimension of mental health is stressed in WHO's definition of health as contained in its constitution: "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." WHO's 191 member states have endorsed this sweeping statement.
How does one define mental health?
- It is a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.
- Mental health promotion is an umbrella term that covers a variety of strategies, all aimed at having a positive effect on mental health. The encouragement of individual resources and skills and improvements in the socio-economic environment are among them.
- Most health care resources are spent on the specialised treatment and care of the mentally ill, and to a lesser extent on community treatment and rehabilitation services. Even less funding is available for promoting mental health.
- Mental health promotion requires multi-sectoral action, involving a number of government sectors such as health, employment/industry, education, environment, transport and social and community services as well as non-governmental or community-based organisations such as health support groups, churches, clubs and other bodies.
Enhancing the value and visibility of mental health
- National mental health policies should not be solely concerned with mental illness but recognise and address the broader issues affecting the mental health of all sectors of society. These would include the social integration of severely marginalized groups, such as refugees, disaster victims, the socially alienated, the mentally disabled, the very old and infirm, abused children and women, and the poor.
Mental health promotion for children and adolescents
- Psychosocial and cognitive development of babies and infants depends upon their interaction with their parents. Programmes that enhance the quality of these relations can improve substantially the emotional, social, cognitive and physical development of children. These activities are particularly meaningful for mothers living in conditions of stress and social adversity. WHO has developed an international programme to stimulate mother-infant interaction that has been widely adopted.
- It is clear that schools remain a crucial social institution for the education of children in preparation for life. But they need to be more involved in a broader educational role fostering healthy social and emotional development of pupils.
- WHO has developed a 'life skills' educational curriculum, which teaches a wide range of skills to school age children to improve their psychosocial competency. The skills include problem-solving, critical thinking, communication, interpersonal skills, empathy, and methods to cope with emotions. These skills enable children and adolescents to develop sound and positive mental health.
- "Child-friendly schools" are another WHO mental health initiative to promote a sound psychosocial environment in the school to complement the life skills curriculum. A child-friendly school encourages tolerance and equality between boys and girls and different ethnic, religious and social groups. It promotes active involvement and cooperation, avoids the use of physical punishment, and does not tolerate bullying. It is also a supportive and nurturing environment; providing education which responds to the reality of the children's lives. Finally, it helps to establish connections between school and family life, encourages creativity as well as academic abilities, and promotes the self-esteem and self-confidence of children.
Working life and employment
- Special emphasis should be given to those aspects of work places and the work process itself which promote mental health. Eight areas of action have been identified: increasing an employer's awareness of mental health issues; identifying common goals and positive aspects of the work process; creating a balance between job demands and occupational skills; training in social skills; developing the psycho-social climate of the workplace; provision of counselling; enhancement of working capacity, and early rehabilitation strategies.
- Another significant issue is unemployment, in particular, youth unemployment. In this area, mental health promotion strategies seek to improve employment opportunities, for example, through programmes to create jobs, provide vocational training, and social and job seeking skills.
Mental health promotion and the ageing population
- Ageing of the population is a highly desirable and natural aim of any society. By 2025 there will be 1.2 billion older people in the world, close to three-quarters of them in the developing world. But if ageing is to be a positive experience it must be accompanied by improvements in the quality of life of those who have reached - or are reaching - old age.
Measuring and promoting quality of life
- WHO has developed a tool to assess quality of life as an additional measurement, along with the traditional morbidity and mortality data. A primary goal of mental health promotion is to help member states improve the quality of life of their people and to place mental health firmly on the national agenda.
For more information contact:
Developing Nursing Resources for Mental Health
Why develop Nursing Resources for Mental Health?
Mental health is crucial to the well-being of individuals, societies and countries. Mental health is more than the absence of mental disorders. It involves a state of well-being whereby individuals recognize their abilities, are able to cope with the normal stresses of life, work productively and contribute to the community.
Mental health problems are common: 450 million people suffer from a mental or behavioural problem and nearly one million people commit suicide every year. Depression, alcohol use disorders, schizophrenia and bipolar disorder are among the ten leading causes of disability worldwide.
Treatment is not available to most people. Despite the existence of effective treatments, the overwhelming majority of people with a mental disorder do not have access to effective treatments.
Nurses are important providers of treatment and care. In most countries, nurses are the largest group of professionals providing mental health care in both primary and specialist health services. However, in many countries the psychiatric education of nurses is inadequate and their role in providing mental health care is underdeveloped. Appropriately trained nurses can contribute to the promotion of mental health and the prevention and treatment of mental disorders.
What are the priorities?
1. Primary Health Care
WHO recommends that mental health care should be part of or integrated into primary health care. However, many nurses lack the knowledge and skills to identify and treat mental disorders. Education is necessary to improve the recognition of mental disorders in primary health care, increase the referral to more specialized health providers and enhance the initiation of supportive therapies. In addition, ongoing supervision and support from specialist mental health services are needed to assist nurses to care for people with more complex mental health needs.
2. Nurse Education
Mental health should be incorporated into basic nursing and midwifery education. Mental health concepts should be introduced early and should be part of the ongoing curricula. Also, there should be opportunities for experiential learning. Ongoing education is also needed to assist nurses to further develop their knowledge and skills, foster changes in attitudes and beliefs and reorient them from custodial models of mental health care to community based treatment. Specialist or post-basic education programmes for nurses should be established to ensure that nurses are able to provide services for people with severe mental disorders and provide support to primary care providers.
The areas to include in the education of nurses will depend on the needs of the country, the anticipated role of nurses, current competencies and the resources that are available. The following list is intended to provide general guidance when developing education programmes:
Advocacy, assessment of mental disorders, communication skills, community mental health nursing, emotional self care (i.e. nurses caring for their own mental health), evaluation and research, legal and ethical issues (including understanding the rights of people with mental disorders), management of emergencies (e.g. suicidal behaviour, violence), management of psychotropic medication, mental health care in humanitarian emergencies, promotion of mental health, public health models of mental health, stigma and discrimination, substance abuse, treatment of mental disorders, working in teams, working with service users and their families, working with specific groups (e.g. children and adolescents, elderly). It is important to ensure that educational programmes include practical opportunities to develop skills.
3. Involve nurses in the development of mental health policies
Mental health policies define a vision for improving mental health and reducing the burden of mental disorders in a population. Policies also establish a model for action based on agreed values, principles and objectives.
Nurses are important stakeholders who should be consulted and actively involved in the development of policies and plans. The development of nursing resources for mental health should be coordinated through a mental health policy. The WHO Fact Sheet 'Mental health policies and service development' provides more information on developing and implementing policies and plans.
4. Information for decision-making
While there is a growing body of research documenting good practice, many countries have little or no information on the size, composition, or quality of their nursing workforce for mental health, and no knowledge of their impact on health outcomes. It is important that countries gather this information in order to better inform mental health policy development and the role of nursing in the provision of mental health care.
WHO and the International Council of Nursing are developing a survey to collect information on psychiatric nursing in countries around the world.
|
