Mental Health Promotion

Mental Health Promotion

 

The World Health Organization definition of mental health is the foundation of a truly public health approach to mental health, defining it as "A state of well-being in which the individual realizes 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." Most people think about mental illness when they hear the words 'mental health'. Just like heart health is more than the absence of heart disease; positive mental health is more than the absence of mental illness. To facilitate public understanding many use the term "well-being" or "flourishing" instead.

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Is mental well-being and illness really distinct?

Growing evidence suggests that mental disorders and mental well-being actually operate on dual continuums, meaning that someone can have positive mental health and have a mental illness, which is commonly called "being in recovery", or poor mental health but no diagnosable mental disorder. Multiple factors broadly support this concept. People's experiences support this concept. Can you think of someone in each of these quadrants? The mental health treatment community has long identified mental health recovery as a goal (quadrant 4). There is a weak correlation between symptoms of mental illness and mental well-being/ (flourishing), suggesting that flourishing is more than the opposite of mental illness. There is also evidence of distinct patterns of health outcomes across the quadrants. For example, languishing individuals are more likely to have arthritis compared flourishing individuals (languishing + mental illness 2x more likely, languishing but no mental illness nearly 1.5x more likely).

While mental well-being and illness are increasingly understood as distinct, they also influence each other; improving well-being of would impact the rate of illness in a population.

Visual representation of the 4 quadrants

Quadrant descriptions:

  1. Flourishing” - Good mental health and no mental illness
  2. Severe stresses on mental health (e.g. weak support system, lack of purpose, unemployment, poor housing, poverty) but no mental illness
  3. Mental illnesses and severe stressors on mental health
  4. Recovery” Mental illnesses but maintains good mental health, with a secure income, strong support system, life satisfaction and purpose, a home and job to return to after episodes of illness. A person may cope well with the challenge of mental illness.

Measuring Mental Well-Being

Researchers in the relatively new field of positive psychology are beginning to define and measure mental health. While no fully agreed upon operational definition of ‘flourishing’ exists, Keyes definition currently has the most empirical evidence across cultures to support validity and utility. According to Keyes, “complete mental health” or ‘flourishing’ means to have emotional, psychological and social well-being. In other words, you feel mostly happy and satisfied with life (EMOTIONAL), you have sense of self-worth and positive relationships with others, some combination of optimism, resilience, hopefulness, purpose in life, and control over one’s environment (PSYCHOLOGICAL), and you function in society, you achieved a level of social acceptance, sense of community, and social contribution (SOCIAL). An estimated 17-32% of the U.S. adult population ages 25-75 are flourishing. Most have moderate mental health (57%) and many are languishing (12%). Individuals with mental illness can flourish, but it’s less common; 1% of the total population and 7% of those with mental illness are flourishing.

Figure A. Complete Mental Health Model: Flourishing to Languishing by Major Depression Diagnosis
Major Depression Flourishing Moderate Mental Health Languishing TOTAL
NO (17%) (57%) (12%) (86%)
YES (1%) (9%) (5%) (14%)
TOTAL (18%) (65%) (17%) (100%)

FLOURISHING CRITERIA: high level on 1 of the 2 emotional, and 6 of 11 remaining scales of functioning.

  1. Emotional Well-Being (3 dimensions)
    1. Positive affect (cheerful, good spirits, extremely happy, peaceful, satisfied, full of life)
    2. Absence of negative affect (not hopeless)
    3. Life satisfaction
  2. Psychological Well-Being (Functioning-6 dimensions)
    1. Self-acceptance
    2. Positive relationships
    3. Personal growth
    4. Purpose in life
    5. Environmental mastery
    6. Autonomy
  3. Social Well-Being (Social functioning) (5 dimensions)
    1. Social coherence (e.g. My daily activities create value for my community.)
    2. Social actualization (e.g. Society isn’t improving for people like me.)
    3. Social integration (e.g. I feel close to other people in my community.)
    4. Social acceptance (e.g. People do not care about other people’s problems.)
    5. Social contribution (e.g. I cannot make sense of what’s going on in the world.)

Davey, L. (2010). How to talk about children's mental health: A FrameWorks MessageMemo. Washington, DC: Frameworks Institute.

Miles, J., Espiritu, R.C., Horen, N., Sebian, J., & Waetzig, E. (2010). A Public Health Approach to Children's Mental Health: A Conceptual Framework. Washington, DC:

Georgetown University Center for Child and Human Development, National Technical Assistance Center for Children's Mental Health.

Seligman, M., Steen, A., Nansook, P., Peterson, C. (2005). Positive Psychology Progress-Empirical validation of Interventions. American Psychologist. Vol. 60, No 5. 410-421. Hone, L.C., Jarden, A., Schofield, G.M., & Duncan, S. (2014). Measuring flourishing: The impact of operational definitions on the prevalence of high levels of wellbeing. International Journal of Wellbeing, 4(1), 62-90. doi:10.5502/ijw.v4i1.4

Hone, L.C., Jarden, A., Schofield, G.M., & Duncan, S. (2014). Measuring flourishing: The impact of operational definitions on the prevalence of high levels of wellbeing. International Journal of Wellbeing, 4(1), 62-90. doi:10.5502/ijw.v4i1.4

Keys, C (2002).

Keyes.,C. (2007). Promoting and Protecting Mental Health as Flourishing. A Complementary Strategy for Improving National Mental Health. American Psychologist. Vol 62, No. 2. 95-108.

Keyes,C. & Simoes, E.J. (2012). To Flourish or Note: Positive Mental Health and All-Cause Mortality. American Journal of Public Health | November 2012, Vol 102, No. 11

What is a public health approach to mental health?

PUBLIC UNDERSTANDING Expanding awareness and urgency about what creates mental well-being and resilience, and the various opportunities to impact them.
HEALTH IN ALL POLICIES Cross sector policies that promote mental well-being and resilience.  
COMMUNITY CAPACITY Building community capacity of the cultural or geographic community to share stories, identify common interests, identify most relevant needs and implement actions to create mental well-being and resilience.  Thriving communities are those where individuals are empowered and lead change, especially those most impacted by trauma and negative social conditions.   Building community capacity is a continuous process of expanding leadership, coming together in dialogue to identify shared concerns and solutions, learning together and evaluating the their results.

Enhancing Protective systems

COMMUNITY (Culture, Environment) Community protective system includes many systems, including culture and faith, which provide meaning, guiding values, and sense of belonging.  This also includes nurturing environments and systems (e.g. schools, child care, libraries, etc.) that operate in communities and provide important positive social bonds, relationships, skills, and meaningful support.  Communities support social connections, which facilitates practical links to opportunity (economic, housing, political, etc.).
RELATIONSHIPS Relationships with trusted, safe and competent people are a critical source of resilience.  Relationships and social connectedness, provide a sense of belonging, develop our interests, awareness, and skills through.   Attachment to parents and family members are often the first important relationships we form.  Teachers, friends, and other community connections, formal and informal are also common influences.  Relationships are valuable throughout life, and provide different benefits based on our stage of development.  There are numerous structures and policies that support opportunities to develop a sense of belonging and relationships. 
SKILLS Individual competencies that help such as having a sense of hope, self-efficacy, purpose, self-regulation, and problem solving skills.  Opportunities to develop talents, interests, and to have a meaningful role (e.g. in a classroom, household, or team) support these social and emotional skills.  Toxic stress can impact these skills.   There are many parenting skills programs available; parenting skills are critical because of the important role parents play in the development of the next generation.  They are also not the only important set of skills. 

What does mental health promotion look like in your community?

Here are a few examples:

  • Programs that help young people develop problem-solving and coping skills, either in school or in community-based organizations, such as peer leadership activities, suicide prevention curricula, and life skills curricula.

  • Mentoring programs and activities that help a young person connect with a caring adult.

  • Home visiting programs in which nurses or other professionals work directly with families to support parents, provide education about child development and promote parent-child interaction.

  • Any activities that promote exercise, sleep, and good nutrition.

  • Projects that encourage help-seeking and reduce the stigma associated with mental illness.

  • Initiatives that encourage gratitude and mindfulness.

  • Creating spaces for communities to gather, build relationships and identify common needs.

  • Community dialogues about historical trauma.

  • Working on changing policies to reduce incarceration, substance abuse, or other adverse childhood experiences.

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