The scope of
Mental Health Promotion /
Mental Disorder Prevention
Conceptual boundaries under debate
WHO Collaborating Centre on Health, Psychosocial
and Psychobiological factors, Belgium
Institut Wallon pour la Santé Mentale (Walloon Institute
for Mental Health), Belgium
Ligue Bruxelloise Francophone pour la Santé Mentale
(French-Speaking League for Mental Health), Belgium
Question
To what extent does the broadening of
mental health field have an impact on:
• The practice of care givers and professionals
involved in the mental health field?
• The general population, MH Services users
and carers?
• Policy makers, MHP / MDP Policies ?
The mental health field
Diseases
The mental health field
• Policies:
• Care givers:
• Public health
• How to cure?
• How to keep in life?
• Prevention:
• Primary:
• Mortality
• Morbidity prevalence
Diseases
• How to decrease the
incidence?
• Secondary:
• How to avoid complications ?
• Tertiary:
• How to avoid relapses?
Broadening of the
Mental Health field
• WHO definition of the health:
The health is not only a lack of illness
But also a complete physical, mental
and social state of well being
The mental health field
Functionnal
Diseases
The mental health field
• WHO Concepts
• Invalidity
• Deficiency
• Handicap
• Prevention:
• Physical: ie
• How to maintain a right to
sexuality and pregnancy with a
mental handicap?
• Psychologic: ie
Functionnal
Diseases
• How to develop or refind skills
and abilities with a mental
disorder?
• Social: ie
• How to keep citizenship with
mental problems?
• Care givers
• Skills
• Abilities
• Policies:
• Rigths and protection
• Forensic psychiatry
• Privation of liberty
• Protection toward others
The mental health field
Functionnal
Diseases
Adverse effects
The mental health field
• Fields:
• Prevention:
• Iatrogenic
• Drugs
• Environmental
Functionnal
• Risk factors
• Mediators
• Protective behaviors
for health
Diseases
• Care givers:
• The best care and cure? Adverse effects
• Evidence Based
Medecine
• Practice Based Evidence
• Value Based Evidence
• Family therapy
• Policies:
• Food and drugs
quality
• Environmental
nuisances
The mental health field
Ill being
Functionnal
Diseases
Adverse effects
The mental health field
• Fields:
• Life events
• Stress
• Distress
• Prevention:
Ill being
Functionnal
Diseases
• Care givers:
• Copings
• Resilience
• Quality of Life
Adverse effects
•
•
•
•
Work
Pauperisation
War and refugies
Immigrants and
transcultural
psychology
• Policies:
• Well being at work
• Discriminations
• Poverty
The mental health field
Ill being
Functionnal
Diseases
Adverse effects
Safety
The mental health field
• Care givers
• Health
behaviors
attitudes
• Perceived
safety
• Coping
with
violence
• Prevention
• Violence
Ill being
• In the city
• At school
• How to live in a world
Functionnal
Diseases
Adverse effects
Safety
• Multi cutural
• Multi ethnic
• Multi religious?
• Policies
• Perceived safety in the
city:
• Fighting against
offenders
• Illegal drugs
• Maffia and traffic with
human people
• Lightening in the street
• ¨Presence of security
stewards or policy in
the street….
And why not?
HAPPINESS
Ill being
Functionnal
Diseases
Adverse effects
Safety
Indeed
•Happiness, for instance, is
in the US constitution a
fundemental right of a
citizen…
Debate
• What is the impact of the broadening
of the Mental Health field on
1. Psychosocial workers?
2. The general population and on services users
and carers?
3. The relations with policy makers?
• General concluding statement
• Action point or recommendation
The broadening of the MH field
in general
+
For some years, the broadening of
MH field has given more
importance to the field in general,
for the general population, health
care professionals and policy
makers alike.
The broadening of MH field makes it
difficult to define. The use of 'Mental
well-being' includes:
1° 'Social determinants of (mental) health'
environmental,
social,
economic,
cultural and other factors that can
engender or favour the development of
mental health problems or pathologies;
2° Subjectivity of individuals who must
be able to enjoy good mental health and
to feel that it is good
The broadening of the MH field
for psychosocial professionals
+
Conceptual extension of the MH
field allows for the inclusion of the
subjectivity of individuals  The
main focus of attention of MH
professionals must go beyond the
‘pathology’ and must include as a
higher priority the dimension of
their relationship with the patient
1° Lack of an unambiguous vocabulary
shared by all the approaches and
disciplines in MH, as well as by policy
makers and programmes managers.
2°
Lack
of
visibility
and
comprehensibility of the MH field.
First-line health care professionals have
difficulty with MHP and MDP projects,
because of little knowledge of the
existing resources. They generally have
also difficulty dealing with mental
health problems, which can delay the
diagnosis and amplify the problems.
The broadening of the MH field
for the general population,
service users and carers
+
As ‘Mental Well-Being’ allows for the
inclusion of the subjectivity of
individuals, the accountability of MH
Services users is facilitated. This
involvement is in itself a priority of the
Mental Health Action Plan, and it is
also an opportunity when it comes to
the effectiveness of MHP / MDP
programmes
1° The awareness and image of the MH field
that are common among the general public,
non-specialised health professionals or in the
media generate additional questions in terms
of MHP and MDP
2° Lack of visibility and comprehensibility of
the MH field among the general public, MH
Services users and non-specialised health
care professionals. While individuals are
generally aware of the resources in the field
of physical health (doctors, general hospitals,
etc.), they know little or nothing about the
services, projects and structures in the MH
field.
The broadening of the MH field
for policy makers
1° According to more wide-ranging definitions, MH could concern the majority of
ministerial departments
No overall vision of the work being done in the field. Very many specific
prevention projects, but they are not part of a general and concerted approach to
the field, and they do not sufficiently take into account the social determinants of
(mental) health within the framework of MHP / MDP
2° Observable political vacuum in relation to certain sub-issues which can only
partially be included within the MH field, such as handicaps, school dropout,
conflicts connected with multi-ethnic cohabitation... and of which the social
determinants extend beyond this field (social precarity, well-being in the
workplace, etc.