Dr Lynne Friedli EMIP National Workshop Prague, Czech Republic Mental health promotion and public mental health: moving forward in Europe Dr Lynne Friedli EMIP National Workshop Prague, Czech Republic 22nd November 2005 EMIP Czech Republic lynne.friedli@btopenworld.com

Summary The EMIP project Mental health promotion in Europe Public mental health and mental health promotion Risk and protective factors Effective interventions Measuring success Public debate and engagement EMIP Czech Republic lynne.friedli@btopenworld.com

EMIP National Workshops Mapping: what is the present situation for mental health promotion and prevention? For example, in relation to policy, practice, services, resources, training Opportunities: what are the factors that support progress in mental health promotion? For example supporting policies (in all sectors), stakeholders, initiatives and networks National profile: strategic vision for the future development of mental health promotion and prevention EMIP Czech Republic lynne.friedli@btopenworld.com

EMIP National Reports National mental health data Policy context: existing mental health and other policies relevant to promoting mental health Strengths and weaknesses in the position of mental health promotion and prevention Opportunities and barriers Key priorities for action Progress on developing a National Mental Health Action Plan EMIP Czech Republic lynne.friedli@btopenworld.com

European policy environment WHO European declaration and action plan (Helsinki) EU Green paper MINDFUL (Stakes, Finland) IMHPA (University of Nijmegen) http://www.imhpa.net/index.php?id=8 Monitoring positive mental health (Bilbao) Quality of life/economics of well-being (ESS Wave 3) Holistic, ecological, sustainable, environmental, ethical WHO Health assets IMHPA to become European platform Mindful – european mental health information and monitoring system Monitoring positive mental health – indicators European social survey – personal and social well-being EMIP Czech Republic lynne.friedli@btopenworld.com

Public mental health or mental health for all promoting mental health for the whole population preventing mental health problems improved mental health; reduced incidence of mental health problems improving quality of life for people with mental health problems EMIP Czech Republic lynne.friedli@btopenworld.com

Addressing the wider determinants of mental health Public mental health “the science, art and politics of creating a mentally healthy society” Addressing the wider determinants of mental health Whole populations Individuals at risk Vulnerable groups Key settings How people feel is a significant public health indicator EMIP Czech Republic lynne.friedli@btopenworld.com

What is mental health? “much depends on dinner” Thinking Margaret Visser Thinking Physical health and well-being Feeling “The heart has its reasons….” Pascal EMIP Czech Republic lynne.friedli@btopenworld.com

mental health: how we think and feel Mental health: cycles of impact It’s all in the mind, but it’s written on the body…. mental health: how we think and feel genetic inheritance childhood adversity poverty social exclusion inequality behaviour relationships parenting education employment physical health quality of life crime A key rationale for evaluating mental health i.e. the impact of an intervention on mental health is because psycho-social factors are among the most important determinants of health in developed countries e.g. early childhood experience, anxiety and worry, quality of social relationships, amount of control we have, social status – these factors, broadly described as ‘well-being’ influence a very wide range of outcomes EMIP Czech Republic lynne.friedli@btopenworld.com

“We haven’t lost faith, we’ve simply transferred it from God to the medical profession” George Bernard Shaw Poverty Exclusion Discrimination Inequality Mental Health Physical Health EMIP Czech Republic lynne.friedli@btopenworld.com

Sources of support for people with mental health problems Diagnosis Education Treatment Family, friends & neighbours Self help & support groups Employment Sports Faith Communities Housing Leisure EMIP Czech Republic lynne.friedli@btopenworld.com

Intervention approaches he worked hard for respect but he could not find it. There was in the world a great shortage of respect and Chanu was among the famished (Monica Ali, Brick Lane) Strengthening protective factors Reducing risk factors Strengthening individuals Strengthening communities Reducing structural barriers EMIP Czech Republic lynne.friedli@btopenworld.com

Strengthening protective factors Psycho-social, life and coping skills e.g. self-expression, self-esteem, learning new skills, stress or anger management, relaxation, efficacy Social support as a buffer against adverse life events e.g. building social contacts, self-help groups, drop in, home visits, mentoring, time banks, volunteering Access to resources and services which protect mental health e,g, benefit uptake, supported employment, access to mainstream services EMIP Czech Republic lynne.friedli@btopenworld.com

GDP and Life Satisfaction (from nef) A Challenge to the Political Status Quo EMIP Czech Republic lynne.friedli@btopenworld.com

The vision What would policy look like if the goal was well-being? parenting engagement civic life relationships well-being economy friendship mutuality social networks local democracy education lifelong learning community assets environment sustainability work/life balance EMIP Czech Republic lynne.friedli@btopenworld.com

Health Assets & Health Needs (from Dominic Harrison 2005) Healthy Diseased Less Healthy Healthy Diseased Less Diseased Saluto-genesis Epidemiology Opportunity Management Health and disease are not at both ends of a single continuum . Disease can always be reduced and health always improved. Interventions to tackle disease may not increase health and vice versa. Risk management EMIP Czech Republic lynne.friedli@btopenworld.com

Community assets strengthening communities e.g. building capacity, control, engagement, inclusion know how creativity resilience resourcefulness tradition intergenerational solidarity cohesion equity control safety participation local democracy social networks mutuality cultural assets lifelong learning built and natural environment access to resources public spaces EMIP Czech Republic lynne.friedli@btopenworld.com

Mental health promotion Mental health impact Pathways of Impact: Mental health promotion Economic capital Human capital Social capital Identity capital human capital (knowledge and skills) social capital (trust and interdependency); identity capital (self image, assertiveness and confidence). health EMIP Czech Republic lynne.friedli@btopenworld.com

What works in different domains? feelings: confident, understood, respected, empowered, safe skills: life skills, relaxation, help seeking, keeping fit, accessing information meaningful activity: employment, volunteering, education, leisure, creativity, spiritual growth social support: self-help groups, opportunities for friendship, faith communities access to resources: paid work, adequate welfare benefits, appropriate services influence: opportunities to participate, being consulted, shared decision making, advocacy EMIP Czech Republic lynne.friedli@btopenworld.com

What demonstrates that living in a community promotes mental health? Access to resources: who doesn’t have access? Feeling safe: who doesn’t feel safe? Good place to live: who doesn’t agree? Influence local decisions: who doesn’t have a say? Feeling supported: who is isolated? Hopeful about the future: who isn’t hopeful? Feeling valued: what makes people feel valued? Feeling respected: what makes people feel respected? Being involved: who isn’t involved and why? Knowing where to get help: who doesn’t know? EMIP Czech Republic lynne.friedli@btopenworld.com

Moving forward for mental health promotion connecting and mainstreaming public debate and engagement policy and emerging ideas evidence and indicators EMIP Czech Republic lynne.friedli@btopenworld.com

The five fruit and vegetables of mental health Valuing yourself and others Talking about your feelings Keeping physically active Eating well Drinking in moderation Keeping in touch with friends/loved ones Caring for others Getting involved/making a contribution Taking a break Learning new skills Doing something creative Seeking Help Individuals Communities Policy EMIP Czech Republic lynne.friedli@btopenworld.com

Notes for policy makers …. How people feel is a significant public health indicator Include ‘mental health impact’ in decision making Quality of life may be a more important indicator of success than symptom reduction It’s all in the mind, but it’s written on the body Modify services, not people Curing illness doesn’t necessarily result in health EMIP Czech Republic lynne.friedli@btopenworld.com

notes for us all …. Keep on making waves – without which no tide can turn…… EMIP Czech Republic lynne.friedli@btopenworld.com