Health, Mental Health & Mental Illness
The World Health Organization (WHO) has defined health as ‘‘a state of complete physical, mental, and social well- being and not merely the absence of disease, or infirmity’’. Mental health is clearly an integral part of health and there is no health without mental health. Mental health is generally defined as the absence of psychological complaints and mental illnesses. WHO defines mental health as ‘‘not just the absence of mental disorder’’ but ‘‘as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community’’.
Mental health contributes to all aspects of life and has both material and immaterial, or intrinsic, values: for the individual, society, and economy. Mental health has a reciprocal relationship with the well-being and productivity of an individual. Conversely, Mental illness, is the ‘‘term that refers collectively to all diagnosable mental disorders’’ that are ‘‘health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning’’. Recent arguments suggest that mental illness and mental health are related and can co-occur in an individual. The costs of poor mental health have been estimated to account for between 3% and 4% of Gross Domestic Product (GDP) in developed countries and studies indicate that untreated mental health problems, can have profound longstanding social and economic consequences, including increased contact with the criminal justice system, reduced levels of employment and often lower salaries when employed, and personal relationship difficulties.
The compromised quality of life and economic prosperity, is not only through direct costs of health and social services but also due to loss of employment and productivity, and the implementation of mental health promotion (MHP) programs is imperative. The high social and economic costs of poor mental health has contributed to a growing recognition of the need to promote positive mental health and wellbeing, as well as to prevent the onset of mental illness as promotion and prevention reduce the impacts of poor mental health. In spite of the huge negative impact, mental health issues have been largely neglected in public health agendas and the values of mental health promotion and illness prevention have been underappreciated more than those of physical health to date. Separate strategies from treatment are needed for mental health promotion and prevention of mental illnesses, psychiatrists are not usually accustomed to these concepts and approaches of mental health promotion. However, just as the 1986 Ottawa Charter for Health Promotion shifted greater attention in public health from disease prevention to health promotion, positive psychology shifts attention from pathology and dysfunction to positive emotions and optimal functioning.
The Ottawa Charter, as a declaration statement, developed by the WHO, highlighted the goals of Mental Health Promotion; mainly focused on building healthy public policies, creating supportive environments, strengthening community action, developing relevant to mental health personal skills and in general reorienting health services to early detection of disorders and promotion of health and well-being. Similarly, the European Union, formulated Green Paper in 2005, constituting a declaration document of proposals for the establishment of an inclusive strategy on MHP across the European countries. Again, common principles and recommendations for modern mental health promotion were laid by the Melbourne Charter in 2008 providing a framework which recognizes the influence of social and economic determinants on mental health and mental illness, and identifies the contribution that diverse sectors make in influencing the conditions that create or ameliorate positive mental health. The charter stresses that mental health promotion is everybody’s concern and responsibility and effective mental health promotion builds on cross-sectoral collaboration with non-health sectors, including education, housing, employment and industry, transport, arts, sports, urban planning and justice.
Mental Health Promotion
As mental health is an integral part of health, mental health promotion is also an integral part of overall health promotion. WHO defines health promotion as ‘‘the process of enabling people to increase control over their health and its determinants, and thereby improve their health’’. It is also defined by O’Donnell as ‘‘the science and art of helping people change their lifestyle to move toward a state of optimal health,’’ which includes physical, emotional, social spiritual, and intellectual health. Again, WHO defined Mental health promotion as “the creation of living conditions and environments that support mental health and allow people to adopt and maintain healthy lifestyles”. It is widely recognized that promoting mental health and addressing mental ill health can be endeavored at different levels, taking into consideration individual, family, community and social determinants of mental health, and strengthening protective factors while reducing risk factors.
In many ways, promotion of mental health also overlaps with prevention, yet they are also distinct, in that the emphasis in mental health promotion is on positive mental health and prevention emphasize on the causes of disease. Prevention of illnesses focuses on the causes of risk factors to avoid illness, whereas promotion focuses on health. Health promotion is linked to health and its promotion, associated with interventions and offers a public health practitioner the means by which health can be improved by behavioral changes that require effort from the patient and/or engaging in community based intervention. The ideals of health promotion are based on ‘what causes good health?’ and ‘what factors or determinants are linked to health and which of these are modifiable?’, and ‘how are they modifiable?’. This salutogenic approach focuses on factors that support human health and well-being, rather than on factors that cause disease as well as the perspective is broader as compared to the traditional preventive and curative approach.
Public Mental Health
The field of public mental health approaches mental health targets at the population level focuses on enabling and achieving positive mental health. Consequently, public mental health is not just about the occurrence and prevention of mental disorders in the population, but also includes the promotion of mental health and wellbeing encompassing the experience, occurrence, distribution of positive mental health and mental health problems and their determinants. This multidisciplinary area of practice aims to enhance well-being and quality of life for individuals, communities and society in general. Promoting mental health is an integral part of public health and public health must focus not only on preventing and treating mental illness but also on promoting mental health by addressing the emotional, social, and psychological well-being of the population.
Mental Health Promotion Interventions
Interventions might be categorized into universal interventions focusing the whole population; selected interventions focusing the subgroups with significant risks; and indicated intervention focusing high-risk individuals; according to the range of target population, available resources and intervening limitations.
Challenges of mental health promotion:
Low sensitivity of in policy making, Low literacy of people on mental health, Low intro-sectoral coordination and inter-sectoral cooperation, Inadequate Mental health programs, Poor quality and in consistency in taking care of chronic diseases, Poor structure, system process, and resources of mental health system
Challenges for Psychiatrists
The greatest importance for mental health care is not only alleviate and reduce mental illness, but also to work actively to promote the mental health of patients. The three kinds of interventions of promotion, prevention, and treatment are interrelated and complementary; however, they are somewhat different from one another and psychiatrists also need to be competent in prevention of mental illnesses and mental health promotion in various settings. In addition to the treatment of mental illnesses, mental health promotion and prevention of illnesses have become principal challenges for psychiatrists with increased interest of mental health and mental illness.
The field of mental health promotion has acquired world-wide recognition and new initiatives are being undertaken and new research is emerging globally. It’s the time to concentrate appropriately on the issue to improve the mental health as well as to reduce the personal, social and global burden of mental illness.