Improving the Health
of Canadians:
Exploring Positive
Mental Health
Release Date:
March 4, 2009
Privacy, Confidentiality and Security
Communication, Consultation and Dissemination
About the Canadian Institute for
Health Information (CIHI)
Health
Information
Research
and Analysis
Health Indicators
Data Holdings
Standards
Taking health
information further
Building new health
knowledge
Capturing the portrait of
health care
Laying a foundation for
health information
Canadian Population Health Initiative
(CPHI)
CPHI’s Mission:
•
To foster a better understanding of factors that affect
the health of individuals and communities; and
•
To contribute to the development of policies that
reduce inequities and improve the health and wellbeing of Canadians.
CPHI’s Strategic Functions
Knowledge Generation
Policy Synthesis
Knowledge Transfer
Knowledge Exchange
CPHI’s Key Themes 2007-2012
Mental Health and
Reducing Gaps in Health
Resilience
Promoting Healthy Weights
Place and Health
CPHI Council Members
(as of June 2008)
Cordell Neudorf (Chair)
David Allison
André Corriveau
Nancy Edwards
Brent Friesen
Judy Guernsey
Richard Massé
Deborah Schwartz
Elinor Wilson
Ian Potter (ex-officio)
Gregory Taylor (ex-officio)
Michael Wolfson (ex-officio)
Expert Advisory Group Members
Gregory Taylor (Chair), Public Health Agency of Canada
Carl Lakaski, Public Health Agency of Canada
Kathy Langlois, First Nations and Inuit Health Branch
Alain Lesage, Louis-H. Lafontaine Hospital
Dora Nicinski, Atlantic Health Sciences Corporation (Region 2)
Rémi Quirion, Canadian Institutes of Health Research
Margaret Shim, Alberta Health and Wellness
Phil Upshall, The Mood Disorders Society of Canada
Cornelia Wieman, Indigenous Health Research Development Program
and University of Toronto
Improving the Health of Canadians
Report Series on Mental Health
Series of three reports on the theme of mental health and how
mental health is linked to the determinants of health
• Two reports focused on segments of the population often
identified as ‘vulnerable’
• Final report focused on the construct of positive mental health
Report
Release Date
Report #1: Mental Health and Homelessness
August 30, 2007
Report #2: Mental Health, Delinquency and
Criminal Activity
April 29, 2008
Report #3: Exploring Positive Mental Health
March 4, 2009
Improving the Health of Canadians:
Exploring Positive Mental Health
Purpose of Report: Explores the concept of positive mental health
Organization of Report:
• Section 1: Looks at the operationalization of positive mental health.
• Section 2: Looks at how positive mental health is currently measured.
• Section 3: Looks at what characteristics are associated with high
levels of positive mental health and the role positive mental health
plays in health.
• Section 4: Looks at opportunities and strategies to promote mental
health via a population health approach.
• We are not aware of any other Canadian report that has looked a
positive mental health in this manner.
Operationalizing the
Concept of Positive
Mental Health
Improving the Health of Canadians:
Exploring Positive Mental Health
Report Framework
The Public Health Agency of Canada (PHAC) has
adopted a broad definition of mental health:
“Mental health is the capacity of each and all of us to
feel, think, and act in ways that enhance our ability to
enjoy life and deal with the challenges we face. It is a
positive sense of emotional and spiritual well-being that
respects the importance of culture, equity, social
justice, interconnections and personal dignity.”
Ability to Enjoy Life
Life enjoyment is often measured as an outcome
using concepts like happiness, life satisfaction
and subjective well-being.
Our ability to enjoy life is influenced by a number
of factors, including:
• our genetics and personality;
• our life circumstances;
• our family and social environments; and
• our behaviours.
Dealing with Life Events
Dealing with life events refers to our ability to cope with
and grow from the challenges we face throughout our
lives, as well as our resilience in overcoming adversity.
Coping strategies linked to positive mental health often
involve those that are engaging or problem-focused in
nature or that incorporate searching for or finding positive
meaning in life events.
Emotional Well-being
Emotional well-being refers to:
• the experience of positive emotions such as joy,
interest, contentment and love; and
•
our ability to regulate emotions in such a way that we
maximize the benefits and limit any potentially
destructive aspects.
Spiritual Values and Well-being
Common elements of spirituality include:
• Having a set of values, beliefs and or practices
(including both religious and more broader spiritual
values);
• Searching for and finding truth, meaning and purpose in
life; and
• Developing and maintaining relationships and feelings
of connectedness to oneself, others and something
larger than oneself.
Social Connections and Respect for
Culture, Equity, Social Justice and
Personal Dignity
The final component of the PHAC definition used to
operationalize positive mental health for this report speaks
to respect for culture, equity, social justice, interconnections
and personal dignity in mental health.
•
Our social well-being, or interconnections, refers to the connections
we have in the environments in which we live, learn, work and play.
•
The literature base for the other areas is beginning to emerge –
environments that are safe and able to meet people’s basic needs
are environments in which mental health can flourish.
Measuring Positive
Mental Health and Its
Link to Health
Links Between Positive Mental Health,
Mental Illness, Physical Illness and
Positive Physical Health
Source: Reproduced from B. Raphael et al. “Links Between Mental and Physical Health and Illness, “ in
Promoting Mental Health: Concepts, Emerging Evidence, Practice, eds. H. Herrman, S. Saxena and R.
Moodie (Geneva, Switzerland: World Health Organization, 2005), p. 132-147.
Ability to Enjoy Life
Life enjoyment has been linked to social well-being in the
family, school, work and community settings. For example:
•
Among youth, greater family cohesion, higher levels of family
stability, increased parental attachment and authoritative parenting
style have been associated with increased subjective well-being, life
satisfaction, psychological well-being and more active coping skills.
•
Feeling connected to school and having positive peer connections
are associated with positive health outcomes such as high selfworth.
•
People with a very strong sense of community belonging are more
than twice as likely to report very good/excellent self-rated mental
health.
Dealing with Life Events
Research shows an association between coping strategies and
better positive mental health outcomes, including improved
emotional and psychological well-being, increased feelings of
control and purpose, and higher life satisfaction.
Coping strategies linked to positive mental health outcomes
often incorporate finding positive meaning in life events, such as:
• Reframing a stressful event in more positive terms;
• Focusing efforts on managing the problems causing distress;
and
• Being able to take a non-judgmental, kind and
compassionate attitude toward one’s problems.
Emotional Well-being
Research shows a link between experiencing positive
emotions and the following:
•
•
•
•
improved outcomes in mental health and coping;
finding meaning in the face of adversity;
social relationships; and
physical health.
Individuals with improved ability to regulate, express and
use emotions experience a number of positive outcomes
such as better cognitive functioning, lower pain intensity,
and better family, intimate and social relationships,
competence, and psychological well-being.
Spiritual Values and Well-being
Studies show various links between positive mental
health and religious/spiritual beliefs and practices. For
instance:
•
Having increased levels of meaning and purpose in life is linked
to better quality of life.
•
Engaging in religious practice is linked to better health-related
outcomes and behaviours.
•
Religious beliefs, practices and coping skills are linked to better
life satisfaction and happiness, more pro-social behaviour, and
improved support and connections to others.
Social Connections
Quality connections and interactions with the people and
communities around us or our ‘social well-being’ is another
key element of positive mental health. For example:
•
Higher life satisfaction is linked to having more frequent
interactions with social supports;
•
Greater levels of family cohesion and social cohesion are linked to
more active coping skills and improved psychological well-being,
respectively;
•
Higher levels of community belonging are linked to better selfperceived physical and mental health; and
•
Providing support to others enhances the positive and general
mental health of those who provide support.
CPHI Analyses of Links
Between Positive Mental
Health and Health
Positive Mental Health Among Canadians
15 Years and Older, 2002
Life Enjoyment: 30% reported they ‘almost always’ enjoyed life,
had good morale, found life exciting and smiled easily.
Coping Ability: 24% reported having excellent or very good ability
to handle day-to-day demands and unexpected problems.
Emotional Well-being: 24% reported they ‘almost always’ felt
emotionally balanced, at peace with self, self-confident, and had pride
in themselves.
Spiritual Values: 33% reported that spiritual values played an
important role in life and helped them find meaning.
Social Connectedness: 45% reported they ‘almost always’ got
along well with others and listened to friends.
Source: Canadian Community Health Survey (Cycle 1.2, 2002), Statistics Canada.
Role of Positive Mental Health in Health
% reporting
mental illness
% reporting excellent selfrated physical health
Life
Enjoyment:
High
Moderate
Low
7%*
12%*
28%*
26%*
18%*
10%*
Coping
Ability:
High
Moderate
Low
9%*
15%*
36%*
31%*
15%*
8%*
Emotional WellBeing:
High
Moderate
Low
6%*
10%*
28%*
28%*
19%*
10%*
Spiritual
Values:
High
Moderate
Low
14%**
16%
17%
18%
17%
18%
Social
Connectedness:
High
Moderate
Low
11%*
16%*
29%*
21%*
16%*
11%*
Characteristics Associated with High
Positive Mental Health
• Analyses showed associations between high
levels of positive mental health and the
following factors:
–
–
–
–
–
–
–
Geographic location
Sex
Age
Education
Income
Race/Culture
Community Belonging, Available Social Support
Association Between Geographic
Location and High Positive Mental Health
Association Between Age and High
Positive Mental Health
Association Between Community
Belonging and High Positive Mental Health
Promoting Positive
Mental Health
Promoting Positive Mental Health
• Mental health is a concept receiving increased attention
in policy, research and practice/service arenas.
• Mental health policy in Canada has largely focused on
people living with mental illness.
• In the 1980s, with the growth of the health promotion
movement, the concept of mental health promotion
emerged as an attempt to distinguish efforts to promote
positive mental health from efforts to treat mental illness.
Promoting Positive Mental Health: A
Role For Everyone (1)
• Various inequities associated with gender, poverty,
disability, race/ethnicity, unemployment and geographic
location can themselves influence mental health.
• Strategies that focus on mental health promotion apply to
all people and communities.
• Mental health promotion typically emphasizes supporting
individual resilience, creating supportive environments and
addressing the influence of the broader determinants of
mental health
Promoting Positive Mental Health: A
Role For Everyone (2)
Mental health promotion strategies and activities can be grouped into
three broad levels of analyses:
• Societal
– Addressing social, ecological, economic, political and cultural
factors that have an effect on mental health (e.g. employment,
housing, education)
– Creating supportive environments
• Community
– Strengthening community action; situated to deal with government
and non-government organizations on one hand and
families/individuals on the other
• Individual
– Developing and building on personal skills, strengths and
resiliency; supporting personal and social development through
information, education and enhancing life skills
Promoting Positive Mental Health: A
Role For Everyone (3)
• Specific goals of mental health promotion include:
– enhancing protective factors that help individuals, families and
communities to deal with events; and
– increasing conditions, such as social cohesion, that reduce risk factors for
diminished mental health among individuals, families and communities.
• Programs highlighted in the report point to some common strategies
that appear to be effective at promoting positive mental health:
– They bring about change in a variety of settings, such as the family,
school, workplace and community.
– They target different groups across the lifespan.
– They combine mental health promotion activities and prevention activities.
– They are tailored and sensitive to the needs of the target group.
Promoting Positive Mental Health:
Conclusions
A scan of the emerging evidence in this field indicates:
•
•
•
•
•
Many mental health programs tend to have a symptom
management, illness treatment or preventative focus rather than
a primary focus on promoting positive mental health;
Some programs and initiatives are incorporating a positive mental
health focus or approach into their programming;
Programs and interventions are being offered or implemented at
the grassroots level but, in many cases, evaluations are not
available;
Some programs and interventions target specific sub-groups, but
they do not necessarily look at the causes behind gradients or the
interaction of various determinants of health; and
Population-based policies and interventions are scarce.
Conclusions
Conclusions
• To date, the term “positive mental health” has been used in many
different ways. Numerous, sometimes overlapping, terms are used
to reflect the same concepts; or the same terms are used to refer to
different concepts, thereby contributing to a lack of definitional
clarity.
• Despite this variation, there are commonalities in current views of
positive mental health. They include:
– Our individual feelings, and the development of our capabilities
and resilience;
– The ways we deal with adversity so that we can grow and
change positively;
– Our sense of meaning, purpose and engagement in life; and
– Our quality supportive environments, connections and social
relationships.
Conclusions (2)
Measuring Positive Mental Health
•
Positive mental health is not consistently measured or tracked over time in
Canada.
Positive Mental Health linked to Better Health/Less Illness
•
Compared to groups with moderate and low levels of positive mental health
(as measured by life enjoyment, coping ability, emotional well-being, spiritual
values and social connectedness), people with high levels reported higher
levels of excellent physical and mental self-rated health, as well as less
reported mental illness and reduced activity days.
Factors Associated with Positive Mental Health Outcomes
•
Community belonging and having available social support were consistently
linked to positive mental health outcomes; education and income were not
clearly or consistently associated with positive mental health outcomes.
Conclusions (3)
• Information presented in the report suggests that there is
value in looking at what is working for populations that are
doing very well and come to understand what is contributing
to adverse and negative outcomes.
• Mental health promotion is about fostering the development of
positive mental health by supporting individual resilience,
creating supportive environments and addressing the
influence of the broader determinants of mental health.
• Strategies that focus on mental health promotion apply to all
people and communities.
CPHI Mental Health
Current and Planned
Reports and Activities
Complementary Products
• Workshops that reflect content of given mental health report
• Collection of Papers: “What Makes a Community Mentally Healthy?”
• Exploring Positive Mental Health—Supporting Documents:

Literature search methodology

Data analysis methodology

Policy scanning methodology

Summary report

PowerPoint presentation

Bibliographies

External commentaries on report
It’s Your Turn
cphi@cihi.ca
www.cihi.ca/cphi