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

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?

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

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

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

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

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

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

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

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)

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

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

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 2010. Increase quality and years of healthy life and reduce health disparities

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)

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)

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

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

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

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

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, 2004. Geneva.

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

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

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)

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

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)

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

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

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)

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

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

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