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What do we mean by mental health?
What do we mean by mental health improvement?
Factors that can influence the development of mental illness
Mental health improvement at different levels
Scottish policy context
The National Programme for Improving Mental Health and Wellbeing
The Declaration and Action Plan for Mental Health in Europe

What do we mean by mental health?

There are many different definitions of the term mental health. More often than not it is used to denote mental illness and related issues of treatment. In this instance it is used as an umbrella term to cover both illness and wellbeing.

Mental wellbeing is an area which is often overlooked and misunderstood. However, there is growing international recognition of the benefits of addressing mental wellbeing in a comprehensive approach to mental health.

'Mental illness': Mental illness refers to a diagnosable illness that significantly interferes with an individual's cognitive, emotional or social abilities e.g. depression, anxiety, schizophrenia.

'Mental wellbeing': There are also many different definitions of mental wellbeing but they generally include areas such as: life satisfaction, optimism, self esteem, mastery and feeling in control, having a purpose in life, and a sense of belonging and support.

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What do we mean by mental health improvement?

Mental health improvement (sometimes called mental health promotion) involves any action to improve mental health.

Like mental health, it is an umbrella term that may include action to:

• Protect and promote the mental wellbeing of the whole population, including those experiencing mental illness (e.g. increasing; self esteem and confidence, feelings of belonging, coping skills, resilience, cognitive skills, etc.). Promoting wellbeing focuses on the building of competences, resources and strengths and has a major contribution to make to personal and social development.
• Prevent mental illness – i.e. reducing risk factors for mental illness (e.g. lack of support services including transport, shopping and recreational facilities, neighbourhood violence and crime, socio-economic disadvantage, parental mental disorder, bullying, etc) and increasing protective factors (e.g. social support, community connectedness, good physical health, positive school environment, job control, infant attachment, etc) and (see table below for further information on risk and protective factors)
• Improve the quality of life of those people experiencing mental health problems (e.g. recovery oriented services, reducing stigma and discrimination, job retention and rehabilitation, etc.)
• Mental health improvement therefore not only concerns the beliefs, attitudes and behaviours of individuals, but also broader socio-economic and environmental determinants.

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Factors that can influence the development of mental illness

Table adapted from WHO (2004) Prevention of mental disorders: effective interventions and policy options: summary report.

SOCIAL, ENVIRONMENTAL AND ECONOMIC DETERMINANTS OF MENTAL HEALTH

Risk factors:

• Isolation and alienation.
• Lack of education, transport, housing, recreational facilities.
• Neighbourhood disorganisation, violence and crime.
• Socio-economic disadvantage.
• Poverty, poor social circumstances.
• Work stress, unemployment.
• Poor nutrition.
• Social or cultural injustice and discrimination.
• Peer rejection.
• Violence and anti-social behaviour.

Protective factors:

• Empowerment.
• Positive interpersonal interactions.
• Social support and attachment to community networks.
• Social responsibility and tolerance.
• Access to social services and a variety of leisure activities.
• Social participation and inclusion.
• Economic security and access to meaningful employment.

INDIVIDUAL AND FAMILY DETERMINANTS OF MENTAL HEALTH

Risk factors:

• Parental mental illness.
• Loneliness, social isolation.
• Parental substance misuse.
• Low birth weight, birth complications.
• Personal loss – bereavement.
• Stressful life events.
• Physical, sexual and emotional abuse.
• Family conflict/discord/violence.
• Substance misuse.

Protective factors:

• Ability to cope with stress.
• Physical activity.
• Good parenting, stable and supportive family environments.
• Feelings of security, mastery and control.
• Self-esteem.
• Good physical health.
• Social skills.
• Positive attachment and early bonding.
• Pro-social behaviour.

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Mental health improvement at different levels

Mental health improvement works at a variety of levels:

Strengthening individuals
Mental health can be improved by increasing emotional resilience through interventions designed to promote self esteem, life and coping skills e.g. communication, negotiating, relationship and parenting skills, physical activity, stress management, etc.

Strengthening communities
It can also be improved by increasing social support, inclusion and participation, improving community safety, neighbourhood environments, promoting childcare and self help network, developing health and social services which support mental health, improving mental health within schools and workplaces e.g. through anti bullying strategies and mental health or stress strategies.

Reducing structural barriers to mental health
Mental health can be improved through initiatives to reduce discrimination and inequalities and to promote access to education, meaningful employment, housing, services and support.

Each level is relevant to the whole population including individuals at risk and people experiencing mental health problems.

All settings and related services therefore have a potential to influence mental health, including workplaces, housing, transport, health services, justice services, education and life long learning, community services, sport and leisure, etc. In addition mental health improvement is applicable across all stages of life: infants, children, young people, younger adults and older adults.

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Scottish policy context

In Scotland, Government policy on mental health integrates mental health improvement (i.e. promotion and prevention) and treatment (i.e. implementation of mental health legislation and mental health services) within the Scottish Government Health Department, under the auspices of the Mental Health Division (external link).

Strategic direction for mental health improvement or public mental health has evolved from a number of policy areas including: mental health, public health, social justice and social inclusion, education, enterprise and life long learning and arts, sports and culture.

Wider public health policy in Scotland has increasingly identified mental health as an integral part of the wider agenda for health improvement (Towards a Healthier Scotland, Scottish Executive, 1998 (external link)).

In 2000 a framework for further improvements in health and health services was established and included a commitment to a national anti stigma campaign, the promotion of positive mental health and a national framework to reduce suicides in Scotland (Our National Health: a plan for action, a plan for change, Scottish Executive, 2000 (external link)).

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The National Programme for Improving Mental Health and Wellbeing

Further emphasis on the importance of continuing efforts in these areas was given in 2003 (Partnerships for Care: Scotland's Health White Paper, Scottish Executive, 2003 (external link)) and a subsequent framework for action for health improvement in Scotland included a commitment to establishing a 3 year action plan for the National Programme between 2003-2006 (Improving Health in Scotland: The Challenge, Scottish Executive, 2003 (external link)).

This was extended into a second phase (2006-2008) with underpinning resources from the Scottish Executive Health Improvement Fund. Further information on the Scottish Executive's mental health improvement work can be found at www.wellscotland.info (external link).

The Scottish Government is currently developing a new plan for mental health improvement. NHS Health Scotland will play a significant role in supporting its development and delivery in 2008/09 as well as an ongoing role in supporting NHS partners to deliver the targets in Delivering for Mental Health (external link) – particularly those relating to suicide prevention, health improvement of people with mental illness and the dementia actions.

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The Declaration and Action Plan for Mental Health in Europe

Scotland, as part of the United Kingdom, has welcomed the World Health Organisation Declaration [PDF – 375Kb] and Action Plan for Mental Health in Europe [PDF – 233Kb]. The declaration establishes a solid framework for mental health policy in Scotland to follow. Scotland will play its part in contributing to Europe wide work to help support the implementation of the Declaration and Action Plan across Europe.

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