Transcript PREVENTION INITIATIVES in

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
“. . . 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
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Mental Health Promotion
 Mental
Health Promotion
requires multi-sector action
including government and nongovernment agencies/services
(e.g. faith communities,
schools) working in partnership
Global Mental Health
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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
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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)
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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
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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
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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
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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
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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 WellBeing
 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
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WHO: Prevention of Mental Disorders, 2004. Geneva.
Prevention Interventions
Schools: PreK-16
 Workplaces
 Medical Settings
 Neighborhoods
 Faith Communities
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Schools
Start early
 Involve parents and community
 Age appropriate
 Repeat often
 Comprehensive
 Systemic improvements
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Student Well-Being
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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 intrapersonal, and physical and emotional health
In school, home, community
J. L. Romano (1999)
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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
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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
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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
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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
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Prevent Human Suffering through
Proactive Interventions
Prevention for Individual and Systemic
Change
Reduce Risks & Promote Strengths
Engage in Political and Social Advocacy
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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
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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
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Tensions between Professional
Training and Marketplace
Student Expectations
Training Program Adjustments
Multidisciplinary Collaborations
Research and Funding
Future Hopes
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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