Keyconcepts:mentalhealthandmentalillhealth

Mentalhealth
Mentalhealthisapositiveconceptrelatedtothesocialandemotionalwellbeingof
individualsandcommunities.Theconceptisculturallydefined,butgenerallyrelatestothe
enjoymentoflife,abilitytocopewithstressesandsadness,thefulfilmentofgoalsand
potential,andasenseofconnectiontoothers.
Thetermmentalhealthisoftenmisunderstoodandinterpretedasreferringtomentalill
health.Thiscanbeconfusing,especiallysinceourmentalhealthserviceshavebeenmostly
concernedwiththetreatmentofmentalillness,ratherthanmentalhealthperse
i
.
Mentalhealthisadesirablequalityinitsownrightandismorethantheabsenceofmental
illhealth.Itisrelevanttoallpeople,regardlessofwhethertheyarecurrentlyexperiencing,
orrecoveringfrom,amentalillness.
ThetermsocialandemotionalwellbeingisgenerallypreferredbyAboriginalandTorres
StraitIslanderpeople,asitreflectsamoreholisticviewofhealth.Itisalsomoreappropriate
forpeoplefromculturallyandlinguisticallydiversebackgrounds,whomayhavediffering
viewsofconceptssuchasmentalhealthandmentalillness.
InNSW,thetermmentalhealthandwellbeingisusedtobeinclusiveofbothconcepts.

Mentalillhealth
Thetermmentalillhealthisusedwhenreferringtoaspectrumofproblemsthatinterfere
withanindividualscognitive,socialandemotionalabilities.Thistermencompassesboth
mentalhealthproblemsandmentalillnessesasfurtherdescribedbelow.
Mentalillnessormentaldisorderisaclinicallydiagnosableillnessthatsignificantly
interfereswithanindividual'scognitive,emotionalorsocialabilities.Thediagnosisofmental
illnessisgenerallymadeaccordingtotheclassificationsystemoftheDiagnosticand
StatisticalManualofMentalDisorders(DSM)ortheInternationalClassificationofDiseases
(ICD).Therearedifferenttypesofmentalillnessesandeachofthesecanoccurwitha
varyingdegreeofseverity.Mentalillnessesincludemooddisorders(suchasdepression,
anxietyandbipolardisorder),psychoticdisorders(suchasschizophrenia),eatingdisorders
andpersonalitydisorders.
Amentalhealthproblemalsointerfereswithaperson'scognitive,emotionalorsocial
abilities,butmaynotmeetthecriteriaforadiagnosedmentalillness.Mentalhealth
problemsoftenoccurasaresultoflifestressors,andareusuallylesssevereandofshorter
durationthanmentalillnesses.Thesewilloftenresolvewithtimeorwhenthelifestressor
changes.However,ifmentalhealthproblemspersistorincreaseinseveritytheymay
developintoamentalillness.Examplesofmentalhealthproblemswouldbethesadness
anddespairassociatedwithgriefandloss,symptomsassociatedwithstressandreactive
distress.
3.3Relationshipbetweenmentalhealthandmentalillhealth
Mentalhealthandmentalillhealthareinfluencedbyoneanotherbutarenotpolar
opposites.Thatmeans,theabsenceofmentalhealthdoesnotnecessarilymeanthe
presenceofmentalillhealth,anymorethanthepresenceofmentalillhealthimpliesa
completeabsenceofmentalhealth.
Whileitdoesnotreflecttheinterplaybetweenmentalhealthandmentalillhealth,theDual
ContinuaModelofMentalHealth
ii
(outlinedinFigure1below)showshowmentalhealthand
mentalillhealthbelongtotwointerconnectedbutseparatecontinua.Accordingtothis
view,apersonmaystillhavegoodmentalhealthandwellbeingwhilelivingwithadiagnosed
mentalillness.Inthesameway,apersonmayhavesignificantproblemswiththeirmental
healthbutnotmeetthecriteriaforadiagnosedmentalillness.Thisapproachisbeing
adoptedinpromotionandpreventionpolicyinanumberofcountries,includingScotland,
Wales,EnglandandCanada
iii
.

Figure1.DualContinuaModelofMentalHealth(Adapted)(Tudor,1996)
iv

Influencesonmentalhealth
Socialdeterminantsofmentalhealth
Mentalhealthisinfluencedbymultiplebiological,psychological,socialandenvironmental
factorswhichinteractincomplexways.Thefactorsthatdetermine,orinfluence,mental
healthhavebeenclusteredintothreekeyareas
v
:
Structurallevelfactorsincludesocial,economicandculturalfactorsthatare
supportiveofpositivementalhealth,suchassafelivingenvironments,employment,
andeducation;
Communitylevelfactorsincludeapositivesenseofbelonging,activitiestohighlight
andembracediversity,socialsupportandparticipationinsociety;
Minimalmentalhealth
andwellbeing
Maximal
mentalill
health
Minimal
mentalill
health
Optimalmentalhealth
andwellbeing
e.g.highlevelof
wellbeingbuthasmental
illhealth
e.g.highlevelof
wellbeingandnomental
illhealth
e.g.experiencingmental
illhealthwithlowlevels
ofwellbeing
e.g.Nomentalillhealth
butlowlevelsof
wellbeing
Individuallevelfactorssuchastheabilitytomanagethoughtsandcopewith
stressors.
Riskandprotectivefactors
Thedeterminantsofmentalhealthcanbeexpressedasriskandprotectivefactorsthatare
associatedwiththementalhealthofindividualsandpopulationgroups
vi
:
Riskfactorsincreasethelikelihoodthatmentalhealthproblemsandillnesseswill
develop,orincreaseindurationorseveritywhenamentalillnessoccurs.Somerisk
factorsplayacausalroleinmentalillness(e.g.exposuretoatraumaticeventisliked
tothedevelopmentofposttraumaticstressdisorder)whileotherriskfactorsmay
beindicatorsthatanindividualisathigherrisk(e.g.thehigherriskofdepression
generallyinthepostnatalperiod).
Protectivefactorsenhanceandprotectmentalhealthandreducethelikelihoodan
illnesswilldevelop.Protectivefactorsenhanceanindividualsabilitytocopewith
stressorsandenjoylife.Someprotectivefactorsareinternal,suchasapersons
temperament,whileothersareexternal,relatedtosocial,economicand
environmentalsupports.

Interventionsaimedatriskandprotectivefactorsshouldconsiderdifferencesacrosscultures.
Forexample,connectiontocultureandlandwouldbeclassifiedasaprotectivefactorfor
Aboriginalcommunities,whilepeoplefromculturallyandlinguisticallydiversebackgrounds
maycomefromsocietieswhereafocusoncollectivewellbeingisseenasprotectiveforthe
individual.
Keyconcepts:Promotionandprevention

Interventionstopromotementalhealthandwellbeingandtopreventmentalillhealthare
deliveredindifferentwaysacrossavarietyofservicesandsettings,includingthehealth
sector.Thiscomplexitycanmakeitdifficulttoplan,prioritise,implementandmeasure
outcomes.
Therearemanydifferentapproachestodescribingthefocusofinterventionsandtheway
interventionsaredelivered.Mostcommonly,peopleclassifythemaspromotion,prevention
andearlyintervention,whileotherstalkaboutprimary,secondaryandtertiaryprevention
withoutclarifyingthedistinctcomponentsofeachandhowtheyrelatetoordifferfrom
eachother.
Thefollowingsectionsdefineandthenfurtherexplainsomeoftheconceptsanddescribe
howtheyfitwithcurrentandfuturepractisewithinthehealthservice.Theyarebasedon
extensiveconsultationthroughoutNSW.

Promotionofmentalhealthandwellbeing
Promotionofmentalhealthandwellbeingisaboutenhancingsocial,emotionalandmental
wellbeingandqualityoflife.Initiativescanoccurwithwholepopulations,selectedgroups
orindividuals,andcanoccurinanysetting.Itisapplicabletoallpeople,inlcudingthose
peoplecurrentlyexperiencingorrecoveringfromadiagnosedmentalillness.
Muchofthementalhealthpromotionworkinternationallyhasbeenconductedwithinthe
frameworkoftheOttawaCharterforHealthPromotion
vii
,whichprovidesagoodsummary
oftherangeofrelevantactivity.WithineachofthefiveplatformsoftheOttawaCharter
therearestrategieswhicharerelevantforthewholecommunityandspecificallyforpeople
livingwithadiagnosedmentalillness.Someexamplesofstrategiesinclude:
1. Buildinghealthypublicpolicye.g.stigmareduction,socialinclusion,humanrights,
accesstotransport,crimeprevention.
2. Creatingsupportiveenvironmentse.g.antibullyingprogramsinschoolsand
workplaces,strengtheningfamilies,mentoringandpeersupportforyoungpeople,
supportedaccommodation,peersupportforpeoplewithmentalillness,supporting
peoplewithmentalillnesstoreturntoschoolortheworkforce.
3. Strengtheningcommunitiestotakeactione.g.communitybasedsuicide
prevention,droughtsupportinruralareas,consumerledinitiativesandconsumer
advocacy.
4. Developingpersonalskillse.g.lifeskillstraining,mentalhealthandillnessliteracy,
parentingskills,managementofemotions,workplacetraining.
5. Reorientingservicestoapromotionandpreventionapproache.g.servicesthat
canrespondinatimely,ageappropriateandculturallyappropriateway.
Recoveryfrommentalillnessisbestdescribedasaprocess,sometimeslifelong,defined
andledbythepersonwiththeillness,throughwhichtheyachieveindependence,self
esteemandameaningfullifeinthecommunity
1
.Wellbeing,qualityoflife,asenseof
controloveroneshealth,andtheabilitytobouncebackfromadversityarekey
componentsofrecoveryapproachesandareconsistentwiththepromotionofmental
healthandwellbeing
1
.
Preventionofmentalillhealth
Preventioninterventionsworkbyfocussingonreducingriskfactorsandenhancing
protectivefactorsassociatedwithmentalillhealth.Theseriskandprotectivefactorsoccur
withinthecontextofeverydaylife.Theyarefoundin:perinatalinfluences;family
relationshipsandthehome;schoolsandworkplaces;interpersonalrelationshipsofalltypes;
sports,artandrecreationactivities;mediainfluences;socialandculturalactivities;the
physicalhealthofindividuals;andthephysical,socialandeconomichealthof
communities
viii
.
Preventioninitiativesarerelevanttoallpeople,regardlessoftheirmentalhealthstatus,
similartothepromotionofmentalhealthandwellbeing.Thefocus,however,ofthe
interventionchangesdependingonwhetheritoccursbeforetheonsetofillness(primary
prevention),duringanepisodeofillness(secondaryprevention)orafteranepisodeofillness
(tertiaryprevention)
ix
.
Primary
prevention:
Initiativesandstrategiestopreventtheonsetordevelopmentofmentalill
health,whichmay:
Targetthewholecommunity(universal);
Targetgroupsknowntobeathigherrisk(selected);or
Targetindividualsatveryhighriskwhomaybeshowingearlysignsofmental
illhealth(indicated).
Secondary
prevention:
Initiativesandstrategiestolowertheseverityanddurationofanillnessthrough
earlyintervention*,includingearlydetectionandearlytreatment.These
interventionscanoccuratanystageoflife,fromchildhoodtoolderage.The
distinguishingfeatureisthatinterventionoccursearlyinthepathwaytomental
illhealth.
Tertiary
prevention:
Interventionsandstrategiestoreducetheimpactofmentalillhealthona
personslifethroughapproachessuchasrehabilitationandrelapseprevention.It
alsoincludesactionstoensurepeoplehaveaccesstosupportswithinthe
community,suchashousing,employmentandsocialinteractions.

*Earlyinterventioncomprisesinterventionsthatareappropriatefor,andspecificallytarget,
peopledisplayingtheearlysignsandsymptomsofmentalillhealth.Bydefinition,early
interventionisaformofpreventionactivityandoverlapsbothprimaryandsecondary
prevention.Interventionscanbe:
1. Preventionfocussedtargetingindividualsbeginningtoshowtheearlysignsand
symptomsofaproblem(indicatedprimaryprevention);and
2. Treatmentfocussedtargetingindividualsexperiencingafirstepisodeofmental
illness(secondaryprevention).
HealingisaconceptthatconsiderstheissuesthatmayimpactonIndigenous
peoplessocialandemotionalwellbeinginawaythatrecognisestheimpactof
history.Itisconsistentwiththepromotionofmentalhealthandwellbeingandthe
preventionofmentalillhealthandincludes:preventativestrategiestohaltthe
intergenerationaltransmissionoftraumaandgriefandwhichlooktofoster
resilience;activitiesthatseektohelppeoplerecoverfromdifferentmanifestations
oftraumaandgrief;crisisresponseservices;andactivitiesthatbuildstronger
communities.


i
Barry,M.M.andJenkins,R.(2007).ImplementingMentalHealthPromotion.Elsevier.
ii
Tudor,K.(1996).MentalHealthpromotion:ParadigmsandPractice.London:Routledge.
iii
TasmanianDepartmentofHealthandHumanServices.(2009).BuildingtheFoundationsfor
MentalHealthandWellbeing:AStrategicFrameworkandActionPlanforImplementing
Promotion,PreventionandEarlyIntervention(PPEI)ApproachesinTasmania.p.40.
iv
Tudor,K.(1996).MentalHealthpromotion:ParadigmsandPractice.London:Routledge.
v
HealthEducationAuthority(HEA)(1997).MentalHealthPromotion:Aqualityframework.
HEA:London.
vi
Barry,M.M.andJenkins,R.(2007).
vii
WorldHealthOrganisation(WHO)(1986).OttawaCharterforHealthPromotion.Geneva:
WHO.
viii
CommonwealthDepartmentofHealthandAgedCare(2000).NationalActionPlanfor
Promotion,PreventionandEarlyInterventionforMentalHealth2000.MentalHealthand
SpecialProgramsBranch.Canberra:CommonwealthDepartmentofHealthandAgedCare.
p.6
ix
Caplan,G.(1964).Principlesofpreventativepsychiatry.BasicBooks:NewYork.