Settings and Populations: Mental health promotion and illness prevention
What do we know about... Mental health promotion and illness prevention...Definitions1
Mental health refers to how a person thinks, feels and acts in their day-to-day life. It is how people feel about themselves, their lives and the other people in their lives. It includes how a person handles stress, relates to other people, and makes decisions. It has been defined as a state of emotional and social wellbeing that enables people to undertake productive activities, experience meaningful interpersonal relationships, adapt to change and cope with adversity (WHO, 1999). Mental health is not the absence of illness, but rather, the ability to cope and feel positive about people and events in life.
A mental illness or disorder is a health problem that significantly interferes with a person's thoughts, feelings or social behaviour. It is diagnosed according to standardised criteria, usually the DSM-IV (American Psychiatric Association, 2000) or the ICD-10 (WHO, 1992). Some of the major types of mental illness are depressive disorders, anxiety disorders, psychoses and eating disorders.
A mental health problem also interferes with a person's thoughts, feelings and social behaviour, but to a lesser extent than a mental illness. Mental health problems are more common and include the mental ill health that may be temporarily experienced as a reaction to the stresses of life. While mental health problems are less severe than mental illnesses, they still can have a significant impact on a person's future opportunities and sense of wellbeing, and may develop into a mental illness if not effectively treated.
Mental health promotion is about improving wellbeing for all people, regardless of whether they are currently well or ill. It is about optimising people's mental health by developing environments that are good for us all. Mental health is affected by the events that happen in our normal day-to-day lives, as well as by the stressful events that inevitably occur from time to time.
Prevention refers to interventions that have the potential to prevent the onset of a mental health problem or mental illness. Prevention interventions require the identification of risk and protective factors for mental health. These are occurrences in everyday life that can affect mental health. Risk factors are occurrences that increase the likelihood that a mental health problem or mental illness will develop (such as long-term stressors), while protective factors are those that decrease the likelihood (such as good social support). Prevention interventions can be targeted to population groups identified according to the level of risk. There are three different levels of risk applied:
- General (universal) - These are interventions that are targeted at the general public or a whole population group. No specific risk factors have been identified and the intervention is aimed at preventing mental health problems for everyone. Interventions are designed to reduce risk factors and/or increase protective factors that are likely to be relevant to the whole population. Universal prevention and mental health promotion approaches are closely linked since they are both concerned with whole population groups and overall mental health and wellbeing.
- At risk (selective) - These are interventions aimed at individuals or population groups whose risk of developing a mental health problem or mental illness is higher than for the general population. Interventions are designed to reduce risk factors and/or increase protective factors for a population group identified as being at higher risk.
- High risk (indicative) - These interventions are for people who are at very high risk of developing a mental health problem or mental illness. They are designed to reduce risk factors and/or increase protective factors for people at imminent risk of mental ill health.
Early intervention refers to interventions appropriate for people beginning to show the early signs and symptoms of a mental health problem and people developing or experiencing a first episode of mental illness. For people at very high risk and showing early signs and symptoms, early intervention aims to prevent the progression to a diagnosable illness. For people experiencing a first episode of mental illness, early intervention aims to reduce the impact of the mental illness in terms of its duration and the damage it may cause to the person's life, and also to foster hope for future wellbeing.
1. Adapted from: Rickwood, D 2007 'Conceptual framework for PPEI and applications in general practice: Overview of the literature', in A O'Hanlon, A Patterson & J Parham (Series Eds.), Promotion, Prevention and Early Intervention for Mental Health in General Practice. Australian Network for Promotion, Prevention and Early Intervention for Mental Health (Auseinet), Adelaide.