How do mental health promotion and mental disorder prevention relate to HPH strategies? Jürgen M. Pelikan (juergen.pelikan@univie.ac.at) Christina Dietscher (christina.dietscher@univie.ac.at) Ludwig Boltzmann Institute for the Sociology of Health and Medicine, WHO-CC for Health Promotion in Hospitals and Health Care University of Vienna, 13th International Conference on Health Promoting Hospitals WS „How can we integrate mental health promotion action into HPH“?
Overview Specifics of mental health compared to physical and social health Resources, stressors and related HPH core strategies to address mental health Of patients in hospitals Of hospital staff Of population in hospital community DNGfK-Konferenz 23.09.2004, Prien am Chiemsee/Fraueninsel
How to distinguish between physical, mental, and social health? Symptoms for disease Symptoms for positive health Physical Physical pain Physical mal-functioning Physical well-feeling Physical well-functioning Mental (Cognitive, emotional, evaluative) Mental complaints & symptoms (anxieties Mental disease (depression etc.) Mental well-being Mental well-functioning (coping capabilities) Social Unemployment Poverty Social isolation High socio-economic status Well developed social network DNGfK-Konferenz 23.09.2004, Prien am Chiemsee/Fraueninsel
Resources and stressors for mental health of hospital PATIENTS HOSPITAL as setting for living HOSPITAL as provider of services STRESSORS & RESOURCES STRESSORS & RESOURCES Being away from everyday obligations Professional support for everyday functioning (hotel services) ... Unfamiliar, noisy Lack of privacy „Cold“ atmosphere Problematic day schedules ... Patients Three basic options for intervention: Reduce unnecessary stress Support / empower for coping for unavoidable stress increase resources STRESSORS & RESOURCES COMMUNITY as setting for living & provider of services DNGfK-Konferenz 23.09.2004, Prien am Chiemsee/Fraueninsel
Patient oriented strategies 1: HOSPITAL as setting for living The Hospital as ... HOSPITAL as setting for living HOSPITAL as provider of services STRESSORS & RESOURCES PAT-1: HP living in the hospital Hospital and presence oriented strategies ~~~~ Support for self-management Provide orientation and information Supportive, respectful and empowering communication and interaction ... Patients (also) outside and future oriented strategies COMMUNITY as setting for living & provider of services DNGfK-Konferenz 23.09.2004, Prien am Chiemsee/Fraueninsel
Resources and stressors for mental health of hospital PATIENTS HOSPITAL as setting for living HOSPITAL as provider of services STRESSORS & RESOURCES STRESSORS & RESOURCES Hospital admission as generally stressful life event Unknown, complex, medical / technical, expert-driven processes and procedures Uncertainty and low level of control … Handling and support by professional experts … Patients Three basic options for intervention: Reduce unnecessary stress Support / empower for coping for unavoidable stress increase resources STRESSORS & RESOURCES COMMUNITY as a setting for living & provider of services DNGfK-Konferenz 23.09.2004, Prien am Chiemsee/Fraueninsel
Patient oriented strategies 2: The Hospital as ... Setting for living Provider of services STRESSORS & RESOURCES STRESSORS & RESOURCES PAT-1: HP living in the hospital Hospital and presence oriented strategies ~~~~ ~~~~ PAT-2: HP coproduction Empowerment of patients for co-production by orientation, information, education / training, involvement in decision-making on all aspects of diagnosis, treatment, care, rehabilitation ... Patients (also) outside and future oriented strategies COMMUNITY as setting for living & provider of services DNGfK-Konferenz 23.09.2004, Prien am Chiemsee/Fraueninsel
Patient oriented strategies 3: The Hospital as ... Setting for living Provider of services STRESSORS & RESOURCES PAT-3: HP hospital setting STRESSORS & RESOURCES PAT-1: HP living in the hospital Hospital and presence oriented strategies ~~~~ ~~~~ PAT-2: HP coproduction Patient-enabling structures: Patient-friendly ... Designs Day schedules Culture of mental health awareness ... Patients (also) outside and future oriented strategies COMMUNITY as setting for living & provider of services DNGfK-Konferenz 23.09.2004, Prien am Chiemsee/Fraueninsel
Resources and stressors for mental health of hospital PATIENTS HOSPITAL as setting for living HOSPITAL as provider of services STRESSORS & RESOURCES STRESSORS & RESOURCES Patients Relaxed lifestyles and adequate illness management Sufficient psychosocial skills and coping capabilities ... Stressful lifestyles and inadequate illness management Lack of psychosocial skills and coping capabilities ... Three basic options for intervention: Reduce unnecessary stress Support / empower for coping for unavoidable stress increase resources STRESSORS & RESOURCES COMMUNITY as setting for living & provider of services DNGfK-Konferenz 23.09.2004, Prien am Chiemsee/Fraueninsel
Patient oriented strategies 4: The Hospital as ... Setting for living Provider of services STRESSORS & RESOURCES PAT-3: HP hospital setting STRESSORS & RESOURCES PAT-1: HP living in the hospital Hospital and presence oriented strategies ~~~~ ~~~~ PAT-2: HP coproduction Patients ~~~~ (also) outside and future oriented strategies PAT-4: HP illness management Develop psychosocial coping capabilities by information, education, training, counseling (secondary and tertiary prevention) Specific offers for developing adequate illness management, especially for at-risk groups of patients (e.g. terminally or severely chronically ill) ... Community DNGfK-Konferenz 23.09.2004, Prien am Chiemsee/Fraueninsel
Patient oriented strategies 5: The Hospital as ... Setting for living Provider of services STRESSORS & RESOURCES PAT-3: HP hospital setting STRESSORS & RESOURCES PAT-1: HP living in the hospital Hospital and presence oriented strategies ~~~~ ~~~~ PAT-2: HP coproduction Patients ~~~~ (also) outside and future oriented strategies PAT-4: HP illness management PAT-5: HP lifestyle development Develop relaxed lifestyles (e.g. stress prevention) and respective coping capabilities, by information, education, training, counseling (primary prevention) ... Community DNGfK-Konferenz 23.09.2004, Prien am Chiemsee/Fraueninsel
Resources and stressors for mental health of hospital PATIENTS HOSPITAL as setting for living HOSPITAL as provider of services STRESSORS & RESOURCES STRESSORS & RESOURCES Patients Lack of adequate support structures (for specific groups of patients) Availability of support structures ... Three basic options for intervention: Reduce unnecessary stress Support / empower for coping for unavoidable stress increase resources STRESSORS & RESOURCES COMMUNITY as setting for living & provider of services DNGfK-Konferenz 23.09.2004, Prien am Chiemsee/Fraueninsel
Patient oriented strategies 6: The Hospital as ... Setting for living Provider of services STRESSORS & RESOURCES PAT-3: HP hospital setting STRESSORS & RESOURCES PAT-1: HP living in the hospital Hospital and presence oriented strategies ~~~~ ~~~~ PAT-2: HP coproduction Support or develop self help groups for at-risk groups of patients Develop community support structures ... Patients ~~~~ (also) outside and future oriented strategies PAT-4: HP illness management PAT-5: HP lifestyle development ~~~~ PAT-6: HP community setting STRESSORS & RESOURCES COMMUNITY as setting for living & provider of services DNGfK-Konferenz 23.09.2004, Prien am Chiemsee/Fraueninsel
Resources and stressors for mental health of hospital STAFF HOSPITAL as setting for living HOSPITAL as workplace STRESSORS & RESOURCES STRESSORS & RESOURCES Adequate recreation areas Rules and regulations (e.g. for safety, working time) ... Noise Inadequate recreation areas Problematic working schedules ... STAFF Three basic options for intervention: Reduce unnecessary stress Support / empower for coping for unavoidable stress increase resources STRESSORS & RESOURCES COMMUNITY as setting for living & provider of services DNGfK-Konferenz 23.09.2004, Prien am Chiemsee/Fraueninsel
Staff oriented strategies 1: HOSPITAL as setting for living The Hospital as ... HOSPITAL as setting for living HOSPITAL as workplace STRESSORS & RESOURCES STA-1: HP living in the hospital Hospital and presence oriented strategies ~~~~ Provide adequate possibilities for recreation ... Staff (also) outside and future oriented strategies COMMUNITY as setting for living & provider of services DNGfK-Konferenz 23.09.2004, Prien am Chiemsee/Fraueninsel
Resources and stressors for mental health of hospital STAFF HOSPITAL as setting for living HOSPITAL as workplace STRESSORS & RESOURCES STRESSORS & RESOURCES Generally stressful working environment Emotional constraints ... Supportive leadership styles TQM, focusing also on staff orientation Teambuilding, Coaching ... STAFF Three basic options for intervention: Reduce unnecessary stress Support / empower for coping for unavoidable stress increase resources STRESSORS & RESOURCES COMMUNITY as setting for living & provider of services DNGfK-Konferenz 23.09.2004, Prien am Chiemsee/Fraueninsel
Staff oriented strategies 2: HOSPITAL as setting for living The Hospital as ... HOSPITAL as setting for living HOSPITAL as workplace STRESSORS & RESOURCES STRESSORS & RESOURCES STA-1: HP living in the hospital Hospital and presence oriented strategies ~~~~ ~~~~ STA-2: HP co-production Further develop participatory leadership styles Encourage self-responsibility and autonomy of staff Offer opportunities for personnel development ... Staff (also) outside and future oriented strategies COMMUNITY as setting for living & provider of services DNGfK-Konferenz 23.09.2004, Prien am Chiemsee/Fraueninsel
Staff oriented strategies 3: HOSPITAL as setting for living The Hospital as ... HOSPITAL as setting for living HOSPITAL as workplace STRESSORS & RESOURCES STA-3: HP hospital setting STRESSORS & RESOURCES STA-1: HP living in the hospital Hospital and presence oriented strategies ~~~~ ~~~~ STA-2: HP coproduction Friendly design Flexible working time regulations Culture of mental health awareness ... Staff (also) outside and future oriented strategies COMMUNITY as setting for living & provider of services DNGfK-Konferenz 23.09.2004, Prien am Chiemsee/Fraueninsel
Resources and stressors for mental health of hospital STAFF HOSPITAL as setting for living HOSPITAL as workplace STRESSORS & RESOURCES STRESSORS & RESOURCES STAFF Relaxed lifestyles and adequate illness management Sufficient psychosocial skills and coping capabilities ... Stressful lifestyles and inadequate illness management Lack of psychosocial skills and coping capabilities ... Three basic options for intervention: Reduce unnecessary stress Support / empower for coping for unavoidable stress increase resources STRESSORS & RESOURCES COMMUNITY as setting for living & provider of services DNGfK-Konferenz 23.09.2004, Prien am Chiemsee/Fraueninsel
Staff oriented strategies 4: The Hospital as ... Setting for living Workplace STRESSORS & RESOURCES STA-3: HP hospital setting STRESSORS & RESOURCES STA-1: HP living in the hospital Hospital and presence oriented strategies ~~~~ ~~~~ STA-2: HP coproduction Staff ~~~~ (also) outside and future oriented strategies STA-4: HP illness management Develop psychosocial coping capabilities by information, education, training, counseling (secondary and tertiary prevention) Specific offers for developing adequate illness management, especially for at-risk groups of staff (e.g. older, migrant staff) ... COMMUNITY as setting for living & provider of services DNGfK-Konferenz 23.09.2004, Prien am Chiemsee/Fraueninsel
Staff oriented strategies 5: The Hospital as ... Setting for living Workplace STRESSORS & RESOURCES STA-3: HP hospital setting STRESSORS & RESOURCES STA-1: HP living in the hospital Hospital and presence oriented strategies ~~~~ ~~~~ STA-2: HP coproduction Staff ~~~~ (also) outside and future oriented strategies Support relaxed lifestyles, especially stress prevention and respective coping capabilities, by information, education, training, counseling (primary prevention) ... STA-4: HP illness management STA-5: HP lifestyle development COMMUNITY as setting for living & provider of services DNGfK-Konferenz 23.09.2004, Prien am Chiemsee/Fraueninsel
Resources and stressors for mental health of hospital STAFF HOSPITAL as setting for living HOSPITAL as workplace STRESSORS & RESOURCES STRESSORS & RESOURCES STAFF Specific infra structures, taking into account the needs of shift workers (e.g. kindergardens) ... Lack of relevant support structures ... Three basic options for intervention: Reduce unnecessary stress Support / empower for coping for unavoidable stress increase resources STRESSORS & RESOURCES COMMUNITY as setting for living & provider of services DNGfK-Konferenz 23.09.2004, Prien am Chiemsee/Fraueninsel
Staff oriented strategies 6: The Hospital as ... Setting for living Workplace STRESSORS & RESOURCES STA-3: HP hospital setting STRESSORS & RESOURCES STA-1: HP living in the hospital Hospital and presence oriented strategies ~~~~ ~~~~ STA-2: HP coproduction Develop supportive conditions in the community, e.g. staff kindergardens ... Staff ~~~~ (also) outside and future oriented strategies STA-4: HP illness management STA-5: HP lifestyle development ~~~~ STA-6: HP community setting STRESSORS & RESOURCES COMMUNITY as setting for living & provider of services DNGfK-Konferenz 23.09.2004, Prien am Chiemsee/Fraueninsel
Resources and stressors for mental health of POPULATION HOSPITAL as setting for living HOSPITAL as provider of services STRESSORS & RESOURCES STRESSORS & RESOURCES Adequate information about and procedures for access ... Inadequate information about and procedures for hospital access ... Hospital and presence oriented strategies Extramural services Population (also) outside and future oriented strategies STRESSORS & RESOURCES COMMUNITY as setting for living & provider of services DNGfK-Konferenz 23.09.2004, Prien am Chiemsee/Fraueninsel
Community oriented strategies 1: The hospital as ... Setting for living Provider of services STRESSORS & RESOURCES COM-1: HP access to the hospital ~~~~ Provide Information about adequate access to the hospital and develop adequate procedures for access ... Hospital and presence oriented strategies Extramural services Population (also) outside and future oriented strategies Community as setting for living DNGfK-Konferenz 23.09.2004, Prien am Chiemsee/Fraueninsel
Resources and stressors for mental health of POPULATION HOSPITAL as setting for living HOSPITAL as provider of services STRESSORS & RESOURCES STRESSORS & RESOURCES Hospital and presence oriented strategies Transferal to other levels of care ... Extramural services Population (also) outside and future oriented strategies Well-managed discharge and transferral processes ... STRESSORS & RESOURCES COMMUNITY as setting for living & provider of services DNGfK-Konferenz 23.09.2004, Prien am Chiemsee/Fraueninsel
Community oriented strategies 2: The hospital as ... Setting for living Provider of services STRESSORS & RESOURCES COM-1: HP access to the hospital COM-2: HP coproduction with other HC service providers ~~~~ Hospital and presence oriented strategies Extramural services ~~~~ Population (also) outside and future oriented strategies Support patients to cope with discharge and transferral Support professionals in primary / tertiary care to cope with discharge and transferral Support informal / lay carers to cope with discharge and transferral ... STRESSORS Community as setting for living DNGfK-Konferenz 23.09.2004, Prien am Chiemsee/Fraueninsel
Resources and stressors for mental health of POPULATION HOSPITAL as setting for living HOSPITAL as provider of services STRESSORS & RESOURCES STRESSORS & RESOURCES The hospital as a community resource (e.g. rooms, shopping) ... Noise (e.g. from traffic) ... Hospital and presence oriented strategies Extramural services Population (also) outside and future oriented strategies STRESSORS & RESOURCES COMMUNITY as setting for living & provider of services DNGfK-Konferenz 23.09.2004, Prien am Chiemsee/Fraueninsel
Community oriented strategies 3: The hospital as ... Setting for living Provider of services STRESSORS & RESOURCES STRESSORS & RESOURCES COM-1: HP access to the hospital COM-2: HP coproduction with other HC service providers ~~~~ Hospital and presence oriented strategies ~~~~ COM-3: HP hospital setting Low-traffic concepts Offer specific hospital facilities to the community ... Extramural services ~~~~ Population (also) outside and future oriented strategies Community as setting for living DNGfK-Konferenz 23.09.2004, Prien am Chiemsee/Fraueninsel
Resources and stressors for mental health of POPULATION Setting for living Provider of services STRESSORS & RESOURCES STRESSORS & RESOURCES Hospital and presence oriented strategies Extramural services Population (also) outside and future oriented strategies Stressful lifestyles and inadequate illness management Lack of psychosocial skills and coping capabilities ... Relaxed lifestyles and adequate illness management Sufficient psychosocial skills and coping capabilities ... STRESSORS & RESOURCES Community as setting for living DNGfK-Konferenz 23.09.2004, Prien am Chiemsee/Fraueninsel
Community oriented strategies 4: The hospital as ... Setting for living Provider of services STRESSORS & RESOURCES STRESSORS & RESOURCES COM-1: HP access to the hospital COM-2: HP coproduction with other HC service providers ~~~~ Hospital and presence oriented strategies ~~~~ COM-3: HP hospital setting Extramural services ~~~~ Population ~~~~ (also) outside and future oriented strategies COM-4: HP illness management Develop psychosocial coping capabilities by information, education, training, counseling (secondary and tertiary prevention) Specific offers for developing adequate illness management, especially for at-risk groups of patients (e.g. terminally or severely chronically ill) ... Community as setting for living DNGfK-Konferenz 23.09.2004, Prien am Chiemsee/Fraueninsel
Community oriented strategies 5: The hospital as ... Setting for living Provider of services STRESSORS & RESOURCES STRESSORS & RESOURCES COM-1: HP access to the hospital COM-2: HP coproduction with other HC service providers ~~~~ Hospital and presence oriented strategies ~~~~ COM-3: HP hospital setting Extramural services ~~~~ ~~~~ Population (also) outside and future oriented strategies Support relaxed lifestyles, especially stress prevention and respective coping capabilities, by information, education, training, counseling (primary prevention) ... COM-5: HP lifestyle development COM-4: HP illness management Community as setting for living DNGfK-Konferenz 23.09.2004, Prien am Chiemsee/Fraueninsel
Resources and stressors for mental health of POPULATION Setting for living Provider of services STRESSORS & RESOURCES STRESSORS & RESOURCES Hospital and presence oriented strategies Extramural services Agreeable working and living conditions Adequate community support structures ... Population Generally stressful working and living conditions Inadequate support structures for specific risk groups ... (also) outside and future oriented strategies STRESSORS & RESOURCES Community as setting for living DNGfK-Konferenz 23.09.2004, Prien am Chiemsee/Fraueninsel
Community oriented strategies 6: The hospital as ... Setting for living Provider of services STRESSORS & RESOURCES STRESSORS & RESOURCES COM-1: HP access to the hospital COM-2: HP coproduction with other HC service providers Support general HP community development Support community mental health awareness Support the development of supportive infra structures and services (e.g. cooperation with schools, enterprises) ... ~~~~ Hospital and presence oriented strategies ~~~~ COM-3: HP hospital setting S T R E S S O R S Extramural services ~~~~ Population ~~~~ (also) outside and future oriented strategies COM-5: HP lifestyle development COM-4: HP illness management ~~~~ COM-6: HP community setting STRESSORS & RESOURCES Community as setting for living DNGfK-Konferenz 23.09.2004, Prien am Chiemsee/Fraueninsel
Conclusions All 18 HPH core strategies can be related to mental health prevention and promotion by reducing stressors and building up resources They do that by directly addressing cultural factors, or by indirectly addressing physical and social factors which are related to mental health Therefore mental health aspects have to be taken into account in assessing health conditions, planning, implementing and evaluating / monitoring HP measures. DNGfK-Konferenz 23.09.2004, Prien am Chiemsee/Fraueninsel
ENDE ENDE ENDE ENDE ENDE DNGfK-Konferenz 23.09.2004, Prien am Chiemsee/Fraueninsel
Resources and stressors for mental health of hospital PATIENTS ´HOSPITAL as setting for living HOSPITAL as provider of services STRESSORS & RESOURCES STRESSORS & RESOURCES Patients Three basic options for intervention: Reduce unnecessary stress Support / empower for coping for unavoidable stress increase resources STRESSORS & RESOURCES COMMUNITY as a setting for living & provider of services DNGfK-Konferenz 23.09.2004, Prien am Chiemsee/Fraueninsel
Resources and stressors for mental health of hospital STAFF HOSPITAL as setting for living HOSPITAL as workplace STRESSORS & RESOURCES STRESSORS & RESOURCES Staff STRESSORS & RESOURCES COMMUNITY as setting for living & provider of services DNGfK-Konferenz 23.09.2004, Prien am Chiemsee/Fraueninsel
Resources and stressors for mental health of POPULATION HOSPITAL as setting for living HOSPITAL as provider of services STRESSORS & RESOURCES STRESSORS & RESOURCES Hospital and presence oriented strategies Extramural services Population (also) outside and future oriented strategies STRESSORS & RESOURCES COMMUNITY as setting for living & provider of services DNGfK-Konferenz 23.09.2004, Prien am Chiemsee/Fraueninsel