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Introduction

The Open University — Thu, 12 May 2011 12:53:40 GMT

The term public health has two meanings: (a) dealing with threats to the public; (b) in the epidemiological context, measuring disease and planning strategies to prevent illness. If practitioners are serious about promoting mental health, they also need to consider and tackle the discrimination and exclusion encountered by people who experience mental distress. In this way they also start to address unseen mental health problems, and promote well-being.

Promoting well-being is a significant aspect of mental health promotion in which the focus is on wellness and enabling individuals to take control of their lives. This unit is an adapted extract from the course Developing mental health nursing practice (KYN293).

Learning outcomes

The Open University — Thu, 12 May 2011 12:53:40 GMT

By the end of this unit you will have:

knowledge and understanding of developments, strategies and the role of nurses in the delivery of public health policies
knowledge and understanding of a range of mental health models/ approaches to inform practice
knowledge and understanding of partnership working with service users, carers and their families across a range of care models and philosophies used within mental health.

1 Public health

The Open University — Thu, 12 May 2011 12:53:40 GMT

Mental health problems place a considerable burden on public health, the economy, and individual and social relationships (NICE, 2007). According to Mind (2005) the cost of mental health problems in England alone is more than £77 billion a year. The cost of private and NHS care is estimated to be over £12 billion, while a further £23 billion is lost as many people diagnosed with a mental health problem cannot work. Reduced quality of life and loss of life may account for £41 billion every year. In this section you will examine public health from a mental health perspective, beginning with an exploration of the relationship between public health and mental health.

JUPITERIMAGES/BananStock/Alamy

Figure 1

Activity 1 Public health

Allow 30 minutes

In the response area below, make a list of mental health conditions that are concerns of public health.

Interactive content appears here. Please visit the website to use it.

Discussion

Mental health has a huge impact on public health. Anxiety, depression and, of course, severe mental health problems such as schizophrenia affect not only the individuals concerned but also their carers, families and friends. Worries about self-harm and suicide, for example, affect the social functioning of everyone involved. Quality of life is inextricably related to psychological wellbeing.

In addition, there is evidence that many people with mental health problems have worse physical health than others. According to research by Soundy et al. (2007), individuals with schizophrenia die younger, much of the increased mortality being caused by obesity-related diseases such as cardiovascular disease, stroke and type 2 diabetes. The side effects of medication or lifestyle factors such as diet are implicated.

There are some particularly vulnerable groups: for example, abused people, people who misuse drugs and alcohol, prisoners, homeless people, refugees, and people with disabilities. Public health encompasses all of these groups who may have problems with their mental health, from children and young people, through people of working age and elderly people, to those with a dual diagnosis involving illicit drugs and alcohol misuse.

The effects of mental health on public health are pervasive. Public health is set within the home, the workplace, primary care and hospital-based services.

2 Perceptions

The Open University — Thu, 12 May 2011 12:53:40 GMT

In this section you will explore different perceptions, themes and definitions of mental health promotion that can apply to your practice. There are several definitions of mental health promotion but, as Boxer observes, they are ‘value loaded’ (2003, p. 477): they reflect individual philosophies and practices. Similarly, the choice of definition will reflect the focus of personal and professional style and will influence the choice of intervention.

The next activity invites you to explore definitions of mental health.

Activity 2 Getting to grips with definitions

Allow 1 hour

Read through the vignettes in Resource 1, linked below, and make notes on each of the six individuals in the space provided. Right-click on the link to open the document in a new window or tab.

View document

Is this person mentally healthy, and has this always been the case?
If your answer is yes, in what way are they mentally healthy?
If your answer is no, in what way are they not mentally healthy?
What might the nurse’s role in promoting mental health consist of for this person?

Interactive content appears here. Please visit the website to use it.

Discussion

The six vignettes are a brief description of the lives of very different people, each of whom can be perceived to possess elements of both positive and negative mental health. The vignettes seem to suggest that factors such as being reclusive or misusing alcohol are signs of negative mental health, but what if the individuals are happy and fulfilled? Likewise, working and exercising hard can be viewed as positive aspects of mental health, although there can be concerns about individuals who take these activities to extremes.

In the activity above you investigated your understanding of mental health and explored your values. What do your work colleagues think? In the next activity you ask them about their perceptions.

Activity 3 Other perceptions

Allow 30 minutes

When you are next in practice, ask two colleagues for their views of the mental health status of each of the people in Resource 1 and note their responses. You could also ask friends and family, which might help to uncover more of the assumed values that can underpin mental health promotion.

Discussion

If you did not already appreciate the challenging and value-laden nature of ‘mental health’, you probably do now! Were your views similar to your colleagues’? You probably became aware of different biases in your own and other people’s views of mental health. For example, some people may think it is fine to pursue very few activities and interests, whereas others may believe that mental health involves ‘well-roundedness’: engaging and interacting with a range of activities and people.

In Activity 2 you started to identify your own values about mental health. In the next activity you will look at a range of definitions of mental health.

Activity 4 A range of definitions

Allow 1 hour

Read through the definitions of mental health in Resource 2, linked below. Look back at your notes for Activity 2 and write comments on how these definitions relate to your own criteria for mental health. Which definition, if any, do your comments suggest you favour most?

View document

Interactive content appears here. Please visit the website to use it.

Discussion

The definitions in Resource 2 point in different directions. The first is actually two definitions: a positive one and a negative one. There is some doubt about whether Gerry is mentally healthy going by the negative definition, as he has been labelled ‘schizophrenic’. However, he does seem to have a sense of wellbeing, which accords with the positive definition. What did you think of Theresa’s mental health status? This vignette may bring to the fore certain values that relate to your (and your colleagues’) views of the role of women generally. Theresa’s lifestyle may be considered to be her own choice, and that she is therefore mentally healthy. On the other hand, positive mental health may be seen as requiring more than this. Perhaps this is what is implied in the second and third definitions, which are concerned with a sense of one’s own worth and the capacity to cope with change. So which view of mental health is preferable?

The contentious nature of mental health makes the endeavour of mental health promotion all the more interesting.

3 Conclusion

The Open University — Thu, 12 May 2011 12:53:40 GMT

You have begun to explore the relationship between public health, mental health and the promotion of mental health. In particular, you have gained knowledge and understanding of approaches to practice and their underlying values and philosophies.

Next steps

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References

The Open University — Thu, 12 May 2011 12:53:40 GMT

Boxer, J. (2003) ‘Mental health promotion’ in Barker, P. (ed.) (2003)Psychiatric and Mental Health Nursing: The Craft of Caring, 1st edn,London, Arnold. pp. 476–87.

Coombes, L. (1998) ‘Mental health’ in Chadwick, R. (ed.) Encyclopaediaof Applied Ethics, San Diego, CA, Academic Press, vol. 3, pp. 197–212.

Health Education Authority (1997) Mental Health Promotion: A QualityFramework, London, Health Education Authority.

Mentality (2003) Briefing 24: Mental Health Promotion – ImplementingStandard One of the National Service Framework for Mental Health,London, Sainsbury Centre for Mental Health.

Mind (2005) The Financial Aspects of Mental Health Problems [online],www.mind.org.uk/Information/Factsheets/Statistics/Statistics+5.htm[accessed 20 March 2008].

National Institute for Health and Clinical Excellence (2007) PublicHealth Interventions to Promote Positive Mental Health and Prevent MentalHealth Disorders Among Adults: Evidence Briefing, London, NICE.

Soundy, A., Faulkner, G. and Taylor, A. (2007) ‘Exploring variabilityand perceptions of lifestyle: physical activity among individuals withsevere and enduring mental health problems: a qualitative study’,Journal of Mental Health, vol. 16, no. 4, pp. 413–503.

Acknowledgements

The Open University — Thu, 12 May 2011 12:53:40 GMT

Acknowledgements

Grateful acknowledgement is made to the following sources:

Figures

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Unit image

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