Health Promotion in Mental Health Care - Essay Example

Health Promotion in Mental Health Care 2008 Health Promotion in Mental Health Care Introduction Mental health of the population has now been recognized as the problem with critical public health significance on a global scale. The huge health, social, and economic effects associated with the increasing number of people that in some or other way need mental health services is increasingly the subject of acute public and expert attention. Vast reformation of health care systems that has been recently launched by many developed countries is a distinct characteristic of modern globalized world. This tendency is especially evident in the developed states such as the UK, United States, Australia, New Zealand, and Canada where the neoliberal philosophy underlies government policies in the realm of political and social life (Donelan et al., 1999). Unfortunately, these policies result in the distinct trend towards privatization and weakening of health care systems. At the same time, the need for quality mental health care is steadily increasing. However, the economic trends, coupled with state budget cuts, and limited access to mental health providers in the community do not allow health care systems respond adequately. Emergency departments are swamped with people with mental health problems with nowhere to go; and the failure to treat those with serious mental health problems has resulted in incalculable cost, in terms of real dollars and human suffering, to the community and individuals (Gruskin & Dickens, 2006, p. 1904). The economic aspect is only one side of the coin: abundant criticism poured on the traditional intervention methods and models currently used in mental health care systems suggests that the time has come to search for alternative approaches. One of the available alternatives is the public health model that has already been tested in different environments, but has not yet received universal acclaim. The nature of this model as well as the outcomes of its prior use suggests that it can be effectively used in the field of mental health Main Body Over the last decades the developed states have effectively implemented a series of public health approaches to health issues such as obesity and anorexia, seat belt use, drink driving prevention, diabetes and other. However, one highly important aspect of our health has not received due consideration probably because of the fact that it does not belong to the realm of physical health. Although mental health has already been proven to be the key to overall physical health, many people still lack adequate understanding of its importance mental health and are not willing to seek help for mental health problems. The role of mental health is stressed in every modern definition of health which fall into three major groups: Cultural: health is a standard of physical and mental well being appropriate to a particular society. Normative: health as an fixed level, or an ideal physical and mental state Functional: health is a state of being necessary to perform certain physical and mental activities (Townsend, Davidson & Whitehead, 1990) There is a common agreement among representatives of any of these major groups that health represents a complex amalgam of numerous factors summarized by the World Health Organization: “Health is a state of complete physical, psychological, and social well-being and not simply the absence of disease or infirmity” (Wright et al. 1998, p.1312). The turn toward more comprehensive perception of health suggests that the traditional narrow paradigms that focused on the physical and/or social aspects of health might have lost their relevance which, in its turn, highlights the need for a new approach. Public health model has recently emerged as one of such alternative options well suited to cover the broad concepts of mental health and mental disorder. The use of public health model in mental health services is not an entirely new option though public health has usually focused on the physical aspects of health (WSBH, 2007). Substantial body of theoretical and practical research representing diverse perspectives and frameworks is available on the issue of the public health model and mental health services. The quintessence of a public health approach in mental health is the non-individual focus: it targets societies, communities or groups that consist of members with similar characteristics (either in terms of age, or specific needs, state of health, etc). Prevention is another founding stone of the public health model which implies that the key concern is to prevent illness or disorder first of all by providing information to people. This information provides people with knowledge about how to practice healthy behavior and is normally called health promotion. Health promotion is a reflecting approach serving to facilitate physical and emotional well-being of individuals and groups. Although the actions undertaken within this approach may take different forms and employ a variety of tools, the most common form of health promotion efforts is a program targeting a specific population in a unique setting. Thus, in schools and other educational institutions, health promotion approach may include a range of physical and mental health practices to target to educational goals such as improved cardiovascular fitness, non-utilization of potentially hazardous chemical substances, social skills proficiency, affective development, and enhanced motoric functioning (Zins & Ponti, 1985). Another essential aspect of the public health model is to organize information, people and other available resources properly. Only in this case the efforts undertaken within the public health framework will be effective. One more distinct the distinct feature of the public health model is the absence of focus on diagnostic and treatment aspects traditional for other models: the focus of this model is the health of the entire population. Therefore, the public health model can be defined as a model “…characterized by concern for the health of a population in its entirety and by awareness of the linkage between health and the physical and psycho-social environment” (NFCMH, 2003, p.3). In other words, the public health is not solely concerned with the problems of etiology, diagnosis, and treatment of illnesses though these aspects are also not left without consideration. However, the primary interest rests with the health promotion, prevention of diseases, epidemiologic surveillance of the health of entire population, and access to and evaluation of services. Also, interventions undertaken within the framework of this model are population based, not targeted at specific individuals (WSBH, 2007). The difference between traditional mental health system and the public health approach can be illustrated using a popular public health model proposed by Mrazek and Haggerty (1994). While the traditional mental health systems normally have only two levels, inpatient and outpatient (which means unless a person is not a patient she is does not fit in the system), this model identifies three additional levels of public mental health: Universal preventive interventions: this type of interventions is delivered to the entire population. An example of such intervention in mental health is anti-stigma campaigns that reduce discriminatory practices and institutional fear that negatively affect social well-being of people with mental problems. These interventions are also helpful in promoting various community services for mental health. Selective interventions: these interventions target those people who are at high risk of developing mental health illnesses due to specific characteristics of social groups they belong to. Indicated interventions: this type of interventions targets people with low though noticeable symptoms who have an individual risk of developing a mental illness. A good example of this intervention is respite which is a place where a person can spend several nights having access to mental health professionals. Unlike traditional hospital units such centers do not lock their patients up while the price of staying there is much lower (Mrazek and Haggerty, 1994, p.24-25). The narrow focus of traditional mental health system (the treatment of symptoms) has often resulted in inadequate and sometimes even dangerous outcomes. A typical example of such situation may be treatment of a certain mental disorder using specific medications that effectively cope with the disorder but simultaneously undermine physical health either in the short-term or stimulate development of a chronic illness. Application of the broader public health model enables psychiatrists to avoid this drawback because in contrast with the traditional approach “…the field of public health has long embraced a holistic, multidimensional, future-oriented view of health as vital not only to individuals but also to groups and communities.” (Hutchinson et al., 2006, p.244) The public health model may also be a more effective option in prevention of mental problems. The multidimensional view of health implied in this model helps identify the hidden relationships that have rarely been noticed in the traditional models. A good example of such situation is the treatment of schizophrenia with the help of specific medications. Many patients with diagnosed schizophrenia already have high rates of type 2 diabetes. However, despite this fact majority of them (50 to 75 percent) are prescribed second generation antipsychotic medications (SGAs). Although SGAs effectively alleviate the symptoms of schizophrenia they also increase the risk of obesity and acquiring or exacerbating diabetes (NFCMH, 2003). Given the amount of comprehensive in-depth studies on the etiology of diabetes, it does not seem to be an overwhelming task to weigh the risks of diabetes and use alternative options instead of SGAs in cases when the estimated risk is high. However, the narrowness of traditional approach often prevents health care practitioners from doing so. By contrast, a disease prevention strategy based on the principles of public health approach enables the practitioners share information from different fields more intensively. This will definitely contribute to the change in practices and behaviors that may be harmful for patients. Empowerment is another essential feature of a public health approach. People within the traditional health care system are defined by their label, and they are actually redefined by the medical discourse in such a way that the label itself “functions as a master status that overshadows all other aspects of the person’s life” (Hughes, 2002, p. 146). An example given by Hughes (2002) to illustrate this phenomenon is that a person with a mental illness such as schizophrenia is labeled schizophrenic, often regardless of whether or not treatment is being sought, thus rendering the label itself to have the effect of “lock[ing] the individual into outsider status” (p. 147). Labels render people ‘subject to the interpretation by others’ (Schaefer, 1991, p. 395). Labeling people as ‘patients’ reflects the discourse created by the medical approach of identifying people and uncritically accepted by many modern policy makers. By contrast, a public health approach pays much attention to the notion of empowerment. The core elements of empowerment are significant involvement of individuals in designing and implementation of treatment, planning and evaluating mental health care systems and services. The idea underlying this approach is that the best way for people to learn how to adequately manage their condition is to take an active role in management (WSBH, 2007). Conclusion The emerging health threats and risks associated with living in the modern globalized technological world require new forms of action to successfully address them. Unfortunately, the conservative nature of modern health care system requires substantial effort to shift the current paradigm and replace it with a public health approach. This consideration is particularly relevant to the realm of mental health service. Therefore, the best option to fulfill the goal of a public health approach and reach the population the most effective manner is establishing a lasting good faith partnership between local healthcare organizations, local governments and media, voluntary organizations, and public. In the local community level such a concerted effort in partnership, with highly specialized agencies, is the best option in order to deal with the menace of declining mental health services system. The challenge for the coming years will be to fully realize the potential of health promotion efforts undertaken within the framework of a public health approach at different levels of society. One of the most evident and essential needs is to break through traditional boundaries within government sectors, between nongovernmental and governmental organizations, and between the public and private sectors involved in a health promotion effort. Cooperation between these sectors and organizations is required to establish new forms of highly beneficial and equal partnerships for health at all levels of governance in societies to more effectively promote healthy behaviors. With partnership and cooperation in place more community members actively participate in the effort improving quality of life and healthcare. References Donelan, K., Blendon, R. J., Schoen, C., Davis, K., & Binns, K. 1999, “The cost of health system change: Public discontent in five nations”, Health Affairs Vol. 18, No. 3, pp. 206-216. Gruskin, S., & Dickens, B. 2006, “Human rights and ethics in public health”, American Journal of Public Health Vol. 96, pp. 1903-1905. Herman H, Saxena S, Moodie R, Walker L. 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