1. PREVENTION of PSYCHOLOGICAL DISTRESS and PROMOTION of WELL-BEING: A GLOBAL PERSPECTIVE
World Federation for Mental Health Conference
October 29, 2007
John L. Romano, Ph.D.
University of Minnesota

2. QUESTION
What are the major social issues that impact the mental health and well-being of people in your country or region of the world?

3. QUESTION
What is done to prevent or reduce the incidence of psychological, physical, and social distress in your country or region of the world?

4. QUESTION
How might psychology and mental health professions work to promote the emotional, physical, and social well-being of people?

5. World Health Organization Defines Health as “
World Health Organization Defines Health as “. . . a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity” endorsed by WHO’s 191 member states

6. WHO Defines Mental Health
State of Well-Being: Cope with normal stressors, work productively, and contribute to community
Mental Health Promotion: Strategies that have a positive effect on mental health, including improvements in socio-economic environments

7. Mental Health Promotion
Mental Health Promotion requires multi-sector action including government and non-government agencies/services (e.g. faith communities, schools) working in partnership

9. Global Mental Health
Mental health problems increasing and dramatically adding to the global burden of disease and disability world wide
Mental disorders account for about 14% (2007) of global burden of disease: depression, alcohol/drug abuse, psychoses
Many mental health disorders go untreated due to stigma and lack of understanding
Middle and low-income countries devote less than 1% of health expenditures to mental health

11. Groups at risk include children and adolescents, elderly, displaced persons, abused women, indigenous persons
World has realized dramatic improvements in physical health, but only limited improvement in mental health

12. Noncommunicable Diseases (NCD)
Rapid rise of NCD, e. g. heart disease, cancer, diabetes, stroke
In 1998 NCD contributed to about 60% of deaths and 43% of global burden of disease. By 2020 estimates are 73% and 60% (respectively)

13. Cancer, cardiovascular disease, diabetes, and pulmonary disease related to life style behaviors: tobacco use, poor nutrition, physical inactivity
Much is known about the prevention of NCD
Depression + NCD Reduces Overall Health

14. Health Japan 21
To Promote Healthier Citizens, e.g. reduce smoking, improve nutrition
Smoking rates: Males-53% (1997) to 43% (2002), Females-steady 10-12%
Raise Awareness of Health/Tobacco Link
Support Smoking Cessation Programs

15. Other Examples
Scotland: Raise awareness of mental illness and promote mental health. Reduce stigma.
Finland: Promoting children’s mental health. Promoting parent/child interaction. Early identification of risk factors.
United States: Healthy People Increase quality and years of healthy life and reduce health disparities

16. Mental Health Resources in the World
WHO reports (2001) 32% countries reported no government budget for mental health
Of countries with a budget, 36% spent less than 1% of total health budget on mental health
Percentage of total health budget on mental health from less than 2% (low income countries) to 7% (high income)

17. National mental health policies and budgets need to address broad issues affecting the mental health of all sectors of society
(e. g. refugees, socially alienated, poor, elderly, children)

18. Mental Health and the Elderly
Increase number of elderly in the world (by 2025, 1.2 billion elderly, and nearly 75% in developing world)
WHO's global movement on active aging
Active, healthy older person as a community and economic resource

20. Prevention Caplan’s (1964) Three-Part Definition Primary Secondary
Tertiary

21. Prevention Gordon (1987) and Institute of Medicine (1994) Universal
Selected
Indicated

22. Prevention Romano and Hage (2000) Stops Problem from Occurring
Delays Onset of Problem
Reduces Impact of Existing Problem
Promotes Emotional and Physical Well-Being
Supports Institutional and Community Policies that Promote Well-Being

23. Social, Environmental, and Economic Determinants of Mental Health
Risk Factors: Drugs/alcohol, lack of education, poor nutrition, poverty, racial injustice, violence/delinquency, war, work stress, unemployment
Protective Factors: Social participation, social services, ethnic minority integration, social networks
__________
WHO: Prevention of Mental Disorders, Geneva.

26. Prevention Interventions
Schools: PreK-16
Workplaces
Medical Settings
Neighborhoods
Faith Communities

27. Schools Start early Involve parents and community Age appropriate
Repeat often
Comprehensive
Systemic improvements

28. Student Well-Being
Development of knowledge, skills, behaviors, and attitudes that maximize students' functioning in settings where they live and work
Promote personal development through (a) knowledge, (b) skills, (c)behaviors, (d) attitudes
Domains of academic, inter-and intra-personal, and physical and emotional health
In school, home, community
J. L. Romano (1999)

29. WHO’s child friendly schools' initiative to promote positive psychosocial environment in school (e. g. cooperation, tolerance, support, family/school connections)

30. Work Life and Employment
Some countries 35-45% of employee absenteeism due to mental health problems
Increase employer awareness of
mental health issues
Psychosocial climate in work place
Social skills training
Counseling
Unemployment (especially of youth)

31. Prevention Project What is the Need Who and What is the Focus
Identify Stakeholders
Stakeholders meet to plan
Conduct Needs Assessment
What is Being Prevented and Promoted

32. Prevention Project Project Goals Project Activities
Who will Implement the Project
Who are the Recipients
Deliver the Project Intervention
Evaluate the intervention
Report back to Stakeholders
Plan Future Projects

33. Prevention Best Practices
Prevent Human Suffering through
Proactive Interventions
Prevention for Individual and Systemic Change
Reduce Risks & Promote Strengths
Engage in Political and Social Advocacy
___________
Hage, Romano, Conyne, Kenny, Matthews, Schwartz, Waldo: Best Practice
Guidelines on Prevention Practice, Research, Training, and Social Advocacy for
Psychologists (The Counseling Psychologist, 2007)

34. Best Practices Culturally Relevant Prevention Practices
Ethical Issues in Prevention
Prevention Addresses Individual as well as Systemic Factors
Prevention Based on Theory and Research
Develop Prevention Competencies

35. Future Challenges
Tensions between Professional Training and Marketplace
Student Expectations
Training Program Adjustments
Multidisciplinary Collaborations
Research and Funding

36. Future Hopes
Bring Prevention perspectives, concepts, skills into the mainstream of psychology, mental health and human development
Promote the importance of multidisciplinary partnerships to impact societal problems
Focus on strengths and protective factors
Greater attention to political, institutional and systemic barriers to the promotion of mental health in all environments