Mental Health Promotion: Behaviour Change Approach versus the Policy Change Approach - Essay Example

?Introduction Mental health promotion has become one of the key areas of public health efforts in the modern times. According to Douglas et al. 273), the focus of public health promotion efforts on mental health is the result of recognising the crucial role that mental health plays in influencing physical health. Mental health also determines the health outcomes for a range of diseases such as cancer, diabetes and coronary heart disease. These considerations justify the selection of mental health promotion as the topic of this critical discussion. The study will describe two approaches- behaviour change and policy change approaches to mental health promotion. A critical analysis of the two approaches will then be undertaken, leading to a discussion of the strengths and weakness of each method alongside their overall effectiveness. The two approaches will also be discussed in terms of how they fit into a general health promotion model. An in-depth reflection on the course and this study will then be undertaken, followed by a conclusion. Mental Health Promotion According to WHO (2002, p. 9), health promotion is a process that enables people to increase control and make improvements on health. Mental health promotion contrasts from the concept of prevention of mental illnesses which involves implementing interventions before the onset of mental illnesses. Mental health is a big issue in public health promotion as evidenced by its debilitating impacts on livelihood. According to the NIMHE (2005, pp. 12-13), over 900,000 adults claiming sickness and disability benefits report mental illnesses as the primary condition. Further statistics indicate that approximately 15% of people aged 65 and over experience depression. Depression, anxiety and phobias affect one in six individuals in a population at any one time, with the highest rates occurring among the deprived. Public health promotion efforts follow several approaches in dealing with the issue of mental health. Two of these approaches include the behaviour change strategy and policy change approaches. In the behaviour change approach, efforts at the individual and community levels seek to enable improvements in mental health aspects through influencing perceptions and actual behaviour. On the other hand, the legislative approach to mental health promotion involves making efforts to change mental health policies to promote improvements in mental health and its outcomes. The two strategies have advantages and disadvantages, as well as different levels of efficacy. Besides, behaviour change and policy change approaches can be utilised in an integrated multi-strategy approach to mental health promotion. The Behaviour Change Approach to Mental Health Promotion As Douglas et al. (2010, p. 274) argues, the behaviour change approach to mental health promotion involves changing the perspectives of all sections of the society. Individuals with mental health illnesses and those at risk of developing mental health problems are influenced to change behaviour to achieve improvements, while at the same time tackling stigma, discrimination and social exclusion by the rest of the society. The approach also influences the community to understand, support and rid itself of discriminatory practices against the mentally ill and those around them as shown in Figure 1. In true public health promotion fashion, this approach seeks to achieve positive outcomes for the affected at an individual and communal level as discussed below. Figure 1: The behaviour change approach to mental health promotion. (Source: NIMHE 2008, p. 26) The approach for implementing behaviour change to promote mental health involves all stakeholders. The approach gears towards instituting cognitive behaviour changes that lead to strengthening of individuals, strengthening of communities and removal of salient and discernible barriers that arise against the mentally ill in society (NIMHE 2008, p. 26). At the individual level, behaviour change to promote mental health involves self-help approaches to adopt new behaviour and quit undesirable ones. Self-help and self behaviour change efforts to promote mental health include cognitively influencing individuals and those close to them to handle both non-clinical and clinical conditions for better mental health outcomes (Harwood and L`abate 2010, p. 117). Cattan and Tilford (2006, pp. 33-34) integrate behaviour change in mental health promotion using a life-long approach through which the individual develops behavioural mechanisms to improve on mental health. At the community level, the behaviour change approach involves efforts in raising awareness about mental health, agitating for equality and social inclusion, dealing with violence against the mentally ill and tackling employment issues among other activities (NIMHE 2008, p. 26). The communal approach to behaviour change mental health promotion achieves civic engagement, neighbourliness, social support and building of social networks (NIMHE 2008, p. 30). The behaviour approach has an appraisal mechanism that indicates the gains made in mental health improvements from the aspects of economic, social, identity and human capital. The success indicators at the individual level involve achieving self value, proper diets and physical activity, maintaining social relationships, contributing to the society and asking for help. The communal yardsticks for success include economic well-being, freedom from discrimination, social inclusion and a more informed and aware society in regard to mental health. From this discussion, the behaviour change approach involves the individual and the wider community as the main determinants of mental health promotion outcomes. The approach relies on behavioural theories, making the assumption that individual and communal behaviour can be changed to the benefit of sections within the society. The behaviour change approach also assumes that individuals and the community at large will be receptive to the efforts to change their behavioural perspectives. The Legislative/Policy Change Approach Advocating for changes in policy is also another approach used in mental health promotion. Policy change efforts concern existing or under plan policies to ensure that those affected by the issue of mental health get the best possible outcomes. The Department of health (DoH) developed a policy on mental health at meeting the needs of the “well” and the “at risk” populations in order to create satisfaction for the entire UK society (2003, p. 23). The DOH’s Action Plan 2003-2008 identifies the fundamental role played by the Departments and national Agencies in working together to promote mental health. This DoH policy centres its effort on the various sections of the UK society affected by mental health issues. Thus, the DoH directs its efforts at children, youths and adults in an approach that caters for the diverse needs of each group. For instance, the policy seeks the institution of high quality early childhood education and home-based programmes to strengthen the relationships between children and their parents. For the young people, the policy focuses in improvement of social skills and inducting coping mechanisms. Adult mental health promotion includes community based efforts, greater social support and provision of better working conditions (DoH 2003, p. 24). The policy change approach involves scrutiny of such a policy and making deliberations on improvements to result in mental health promotion. Keleher and Armstrong (2006, p. 1) discusses the importance of policy monitoring, arguing that policy development based on robust evidence achieves better outcomes. The policy change approach seeks to make mental health policies more responsive to the needs of those affected. The approach also addresses the need to input research into practice and the need to eradicate outdated practices. Thus, the approach assures improvements on the lives of the well and at risk populations. Success through this approach is exemplified by the integration of the evidence-based practice of client-centred approach in social work with the mentally ill, alongside integration of a multi-disciplinary approach to achieve improvements in mental health (Ray, Pugh, Roberts and Beech, 2008, p. 6). This discussion establishes that the policy change approach involves wide sections of the society, including patient and carer forums, activists and government departments/agencies. The forums and activists agitate for changes in the existing or planned mental health policies to ensure that the best interests are considered for improvements in mental health. On the other hand, it is good practice for the policy makers to incorporate the input, views and concerns of the society. As a result, the approach achieves mental health promotion with policy generation incorporating improvements in the welfare of the mentally ill and those around them. The approach makes the assumption that consensus is assured, without which policy change efforts would always hit a dead end. Since an evidence base underpins most of the efforts of policy change approach, this method also makes the assumption that the evidence applied is valid and reliable. Analysis of the Approaches to Mental Health Promotion The two approaches discussed can be subjected to analysis based on a number of considerations; nature of health, assumptions about people, ethical and cultural considerations and lastly, support from the government. Concept of Health Upon analysis, the behaviour change approach draws from both promotion and preventive aspects of health. Whereas behaviour change such as proper nutrition and exercise help deal with mental problems/illnesses, such cognitive changes also promote positive well being. Glasgow et al. (2004, pp. 3-12) state that health behaviour change achieves overall public health promotion. Bandura (2004, pp. 143-166) also supports the view that health behaviour change results in health promotion, explaining that socio-cognitive means influence self-efficacy, ultimately affecting the well being of an individual. Hence, evidence supports the use of behaviour change to achieve improvements on mental health. The policy change approach also achieves both preventive and promotional mental health needs. In respect to the promotional needs that form the basis of this study, policy change is of particular importance in complementing the traditional preventive approach to mental health system with a promotional approach. As Douglas et al. (2010, p. 273) argues, policy changes towards the end of the 20th century up to now have effectively incorporated the promotion aspect into the mental health area. Such changes include identifying the role of the individual and community in mental health outcomes and tackling stigma and exclusion of the mentally ill. These changes in policy obviously impact positively on the lives of those at risk. As a result, policy change indicates the health promotion aspect of public health. Assumptions about People The behaviour change approach to mental health promotion underpins the roles of both the individual and the community, thus identifying them at both the individual and the collective level. As NIMHE (2008, p. 26) states, the behaviour change approach encourages the strengthening of the individual and the community. In terms of decision making, the behaviour change approach subordinates the professionals to an advisory role and places the success of the approach on the public. The decision to adopt behaviour change by the different sections of the public determines whether improvements in mental health are achieved. Data utilised to inform the behaviour change approach is more subjective than objective. Behaviour change theories and concepts generated through interpretive research. Social cognition, health belief, self efficacy, planned action and other psychosocial theories identify the subjective aspects of health besides the biomedical explanations (Sutton 2002, pp. 1-2). Thus, the behaviour change approach is grounded on subjective data interpretation about the stakeholders. The policy change approach bases its success on leverage between government agencies and activism. Thus, policy makers and mental health change activists are the two most influential groups in the approach. This means that the approach operates at a more collective than individual level. The two parties make deliberations and considerations that define the decision making aspects of the policy change approach to mental health promotion. Increasingly, both parties agree that mental health policy should incorporate promotional aspects (Douglas et al. 2010, p. 273). Hence, decision making is eased among the two. In terms of objectivity/subjectivity of data, policy changes usually require use of the best available evidence to ensure that policy makers arrive at informed policies. In most cases, the policy change approach uses objective health data that assures validity and reliability. For instance, wrong statistics or unreliable evidence would result in questionable policies and extension irresponsible use of public funds. Ethical and Moral Considerations The behaviour change approach to mental health promotion satisfies contemporary ethical inclinations as it balances power between the professional side and the rest of the community. Rather than dictate, the professionals advise and educate the community and trust the community to make the right decisions in behaviour changes that improve mental health. The inclusionary nature of the behaviour change approach assures that cultural considerations are taken care of as directions are not dictated to the community. This approach narrows the disparity in the mental health issue as it promotes education and awareness across all society. The transfer of knowledge that characterises the behaviour change approach results in empowerment of the society regardless of cultural, racial or economic background. However, ethical issues arise when certain activities occur during the behaviour change approach. These include use of incentives to promote change which raises questions on informed consent and social marketing that segments audiences among other morally questionable impacts (Gryer and Bryant 2005, pp. 319-343). The policy change approach also creates opportunity for multi-perspective inputs as it allows the rest of the society to take part in policy formulation. Thus, the approach achieves more inclusion which bodes wealth with fulfilling ethical requirements. The moral obligations of the policy makers to listen to the rest of the society is upheld and met. Similarly, inclusion of various perspectives from the society helps accommodate diversity in views and, thus, narrow down the inequality gap. However, policy changes arising from certain sections of the society may be accompanied by vested interests. This results in morally questionable policies and increased disparity as such sections of the society are usually more socio-economically and politically powerful. Government Support for the Approaches The application of behaviour change in all aspects of public health promotion may or may not deemed appropriate by the Government administration of the time. A government guided by dictatorial disposition seeks to curtail input from other sections of the society and thus would not allow the inclusionary nature of the behaviour change approach. However, the behaviour change approach unfolds in a favourable environment in the UK in political terms. That the NIMHE (2008) champions the behavioural approach in mental health promotion indicates that the recent administrations value inclusion and appreciate both preventive and promotion in public health. On a similar note, the administration supports the policy change approach to mental health promotion. As Douglas et al. (2010, p. 273) discusses, the four governments that constitute the UK have in recent times adopted changes in policy to accommodate wider societal views in mental health. The DOH (2003, p. 3) incorporates modern themes in mental health that lead to promotion arguably through external input and sharing of ideas. Strengths and Weaknesses of the Approaches The behaviour change approach is a formidable strategy through its identification of both the individual and communal roles in promoting health. The inclusiveness of the approach is also an attractive feature as it balances power and decision making between the professionals and the public. However, the assumption that the public makes rational decisions can be counteractive, as well as the reliance on subjective information to inform mental health promotion. Overall, the approach still remains an effective and acceptable method of promoting mental health. The policy change method also allows for inclusion and balances power and decision making between the policy makers and the relevant stakeholders. The weaknesses of this method lie in the possibility of incorporating the views of parties with vested interests. However, the policy change approach remains an effective one in promoting mental health. The Position of the approaches in Public Health Promotion WHO (2005, p. 111-112) provides an inter-sectoral approach to mental health promotion; the VicHealth’s Framework (Appendix 1). This approach takes into consideration the key determinants of mental health and the relevant themes of action, the population profile and action areas and the sectors and settings for action. The key aspects of this framework include its multisectoral approach, multiple reinforcing strategies, focus on socio-economic determinants and increased social inclusion. The behaviour change approach if clearly discernible within the framework in terms of promoting social inclusion, promoting self-determination and individual life control and individual skill development. The outcomes also indicate a behaviour change approach; self esteem and belonging, reduced violence and crime and supportive and inclusive environments. The policy change approach is also integrated within this model in terms of ensuring economic participation, promoting community strengthening and organisational involvement, legislative platform and resource allocation. This model also brings to light the role of multiple strategies in mental health promotion. Thus, the behaviour change and policy change approaches can be integrated to offset their individual weaknesses and synergistically take advantage of their strengths. Reflection on the Course and Mental Health Promotion Study The approach adopted for this reflection is the DEADACRE framework (MacDonald 2001). In terms of description, this course has brought me to the realisation of the importance of public health in the society. I am now aware of the promotion aspect of public health and I am restless and highly motivated to practice what I have learnt. Upon expansion, I realise that I usually feel like this whenever I learn something profound. Hence, this is not a one-off experience. To account for these feelings, I am certain that my training and life experiences set me off towards such feelings. Nursing practice and training has sensitised and conditioned me towards instituting change in society, besides the great satisfaction I get from achieving such changes. However, denial sets in through a feeling of powerlessness in light of the magnitude and historical dimensions of the challenges I seek to tackle. I have adapted to accepting that I cannot change everything around me. This is usually not difficult to accept when I give my best at a problem. The consequence of not changing my perceptions and feelings lie in a lack of satisfaction with my life. On the other hand, I gain motivation and satisfaction alongside greater learning when my feelings are affected this way. I resolve to act on my feelings- to use the high motivation as drive towards contributing towards mental health promotion. My way forward is to undertake personal constructive learning on the matter and pursue further education in public health. I expect to be better placed to contribute to public health promotion after this. The inner drive and motivation should overcome any reservations and temptations to switch careers. Conclusion The behaviour change approach to mental health promotion involves cognitively influencing the behaviour of individuals and the community to promote mental health. On the other hand, the policy change approach involves efforts to institute relevant changes to mental health policy in order to improve it. Upon analysis based on the considerations of the concept of health, assumptions on people, ethics and government support- the methods have different strengths and weaknesses that can be leveraged in a multi-strategy approach to achieve the best outcomes. A reflection on the study shows that it elicits emotions of restlessness and high motivation in me. Upon analysis and synthesis, I resort to further studies in public health promotion to better place myself to contribute positively in public health promotion. References Bandura, A., 2004, Health promotion by social cognitive means. Health Education & Behavior, 31(143), pp. 143-166. Cattan, M. and Tilford, S., 2006, Mental health promotion: A lifespan approach. England: McGraw Hill. DOH, Promoting mental health: Strategy & action plan 2003-2008. Belfast: DOH. Douglas, J., et al., 2010, A reader in promoting public health second edition. UK: Sage Publications. Glasgow, R.E., et al., 2004, The future of health behavior change research: What is needed to improve translation of research into health promotion practice? Annals of Behavioral Medicine, 27(1), pp. 3-12. Grier, S. and Bryant, C.A., 2005, Social marketing in public health. Annual review of public health journal, 26, pp. 319-339. Harwood, T.M. and L`Abate, L., 2010, Self help in mental health: A critical review. London: Springer. Johnson, N., 2005, Mental health promotion in primary care: A toolkit. UK: DOH Press. Keleher, H. and Armstrong, R., 2005, Evidence based mental health promotion research [pdf]. Available at [Accessed 6 January 2012]. MacDonald, G 2001, Learning materials for PG Health Development. UCE. Ray, M., Pugh, R., Roberts, D. and Beech, B., 2008, Mental health and social work. UK: SCIE Research Briefings. Sutton, S., 2002, Health behavior: Psychosocial theories. UK: Cambridge. WHO, 2002, Prevention and promotion in mental health [pdf]. Available at [Accessed 6 January 2012]. WHO, 2005, Promoting mental health: Concepts, emerging evidence and practice, WHO Press. Appendix 1: The VicHealth Health Promotion Framework Source: (WHO 2005) Read More