Table of Contents
Many interconnecting factors influence mental, physical, and social well-being of people. Mental health is a key factor of overall health, which helps in dealing with challenges and stresses of everyday life. Sound mental health offers high quality of life to individuals and communities in general. Facing various unpleasant internal and external factors, such as family circumstances, conflicts, and disasters affects people’s mental health. Decisions on them are made on the basis of one’s sense of control when handling such circumstances. An individual possessing good mental health can recognize his or her capabilities, which enables him or her to tackle the everyday life stresses. A sound state of mental health protects and helps people to avoid risk-taking behavior, which may lead to poor mental health. While people have the ability to maintain good mental health, they need encouragement to sustain and achieve it. The process of increasing the number and improving the quality of factors that encourage sound mental health is termed “mental health promotion”. The purpose of this study is to discover how mental health promotion during childhood, school years, adulthood, at workplace, and in older age can lead to economic and social benefits, lower health costs, and social welfare. The current study also examines mental health promotion literature that includes current concepts, evidence of valuable interventions, as well as improvements in mental health sector.
1. Concept of Mental Health
Promotion of mental health builds the capacity of individuals by increasing their innate ability to sustain and achieve good mental health, as well as by establishing supportive environment, which decreases limitations to good mental health. It is an approach to wellness because it focuses on positive features of health rather, than focusing on needs and deficits. It also underlines the value of innateness to good mental health. Further, it also aims to realize wellness for entire society by addressing factors of mental health and by implementing health promotional strategies. It depends on cooperation between all sectors of the community, combined with purposeful involvement of those most affected by the issue, such as families and individuals, and by taking action to build capacity at political or structural level. Mental illness and mental health promotion are different concepts, but they overlap and complement one another to a great extent. Health promotion emphasizes strengthening and enhancing the capacity of one’s current state of health, while prevention is used to prevent illnesses, which may occur due to poor health. Some studies concerning mental health promotion offer contrasting views on the extent to which prevention and promotion should overlap and the extent to which these concepts should converge. Good mental health does not guarantee absence of any symptoms of mental illness, and prevailing illness may not ensure perfect mental health. Many people seem to be healthier than others, irrespective of whether or not have been diagnosed with a mental illness.
Illness and health cannot coexist, for they exclude one another. People having certain illnesses have skills and resources to shield themselves from poor mental health; however, they are impacted by the same conditions as those without mental illnesses. While some people are more susceptible to poor mental health than others, approach to mental health promotion focuses on minimizing mental health problems by enhancing mental health of entire communities. The following factors affect health of the population: social status, income, employment, education, social support, social and physical environment, working conditions, personal health practices, healthy child development, culture, genetic endowment, and health services. These factors can be divided into three groups for promoting mental health, namely:
- Access to economic resources (education, money, work, and housing)
- Social inclusion (civic engagement, group activity, involvement in community, and supportive relationships)
- Freedom from violence and discrimination (self-determination, physical security, and valuing diversity).
2. Evidence of Effective Interventions
A meaningful approach to population health also helps in evidence-based decision-making. Lewis (2013) argues that while promoting mental health, firstly, evidence is essential for regulatory bodies to legitimize their spending, secondly, for health agencies to implement programs, and thirdly, for affected people to know whether treatment will benefit them or not. Mental health interventions decrease risk factors that are responsible for poor mental health, as well as increase protective factors, which help in maintaining good mental health. Besides, these interventions also offer many benefits, such as economic, health-related, and social ones. There are effective interventions to encourage good mental health, such as reducing and preventing bullying in schools, enhancing parenting skills in early childhood, creating a balance between life and work, reducing workplace stress, and creating opportunities for community involvement through volunteering.
However, the practice of promoting mental health is still emerging, and there seems to be no agreement on which approaches are the best. At the same time, there remain protective and risk factors that can be enhanced or reduced by interventions. Both evidence and theoretical bases should be broadened by research in this area. Reviews and research mostly focus on results, but not on implementation or quality of programs that are essential to have positive outcomes. Although evidence base is undeveloped, policy makers and practitioners are making progress in promoting mental health practices because of expenses, related to mental health problems and the burden of suffering. Current evidence suggests that interventions cause economic and social problems. Stakeholders also believe that severity and rate of mental illness can be decreased by reinforcing protective components for good mental health.
Lack of protective components and presence of risk components can cause behavioral changes, associated with mental health, such as poor education, tendency towards crime, depression, suicidal tendencies, and drug abuse, all of which render economic and social consequences. Both protective and risk factors can be present at community and individual levels, as well as in different situations. For instance, protective aspects at individual level may include social support, self-esteem, personal coping skills, a sense of coherence, a sense of control or mastery, ability to sustain relationships, optimism, and a sense of belonging. These factors indicate good mental health and impact everyone, but different issues that happen to individuals can create susceptibility to poor mental health. In this reference, interventions usually focus on periods when people can find effective ways to maintain good health; they are early childhood, school, work, and senior age.
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2.1 Early Childhood
Parents’ mental health impacts the development and mental health of their children. To ensure proper mental health development during the first six years of children’s life, promotion of mental health in early childhood is essential, for it builds protective factors by improving life skills that are well-suited to infants, preschoolers, and teenagers, as well as by enhancing parent-child interaction. Interventions which target parents develop parenting skills and create supportive environments for children and parents to practice good mental health. Interventions, such as childcare programs, counseling of parents, and home visiting programs, have proved effective and made positive impact, which continues up to adult age.
Some protective measures, used by parents to build good mental health in early years of a child, include encouraging confidence and ability to adopt new techniques, recommended by child psychologists, and handling change. For example, the ability to control and express emotions, controlling behavior and acting according to situations, giving freedom and motivation to children to explore the world, solving their problems, and helping them to analyze different situations, arising as children learn and grow.
Programs that target mothers of young children are most effective in improving mental health of children of all ages. Interventions, such as home-based support, counseling, and parent training programs during early parenthood, have proved effective in improving mental health of young children and their mothers, especially in economically disadvantaged families. They have also expanded the knowledge about child’s behavior and healthier development. Home-based programs are also effective; they include visits by NGOs, trained volunteers, and healthcare nurses because such programs are helpful in situations when parents are confused and cannot act according to circumstances around them.
There are compelling benefits of mental health promotion during early childhood, for they solve short-term psychosocial problems of mothers, such as anxiety, stress, postnatal depression, and poor relationships between partners and spouses. In addition, they impact such aspects of child health as abuse, behavior, infant mortality, literacy, and language. As children become older, interventions which offer group training programs to parents can positively influence their behavior between the ages of three and ten and produce positive outcomes in the long-term perspective. What is more, they prove more successful than individual parent intervention programs. Hence, childcare is an intervention, which provides many benefits to individuals and groups within a community.
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2.2 School Years
School plays a significant role in promoting mental health to children. School-based interventions have positive health outcomes for a long-period and target many risk factors. This approach to promotion of mental health gives benefits that last till adulthood. By building social skills and establishing positive environment that develop the sense of identity and inclusion among students, interventions improve adjustment to school environment, enhance competencies, expand skills in problem solving, builds self-esteem, decrease bullying, loneliness, and aggression, reduce anxiety and depression, and helps in personality development. Engaging parents, students, and teachers through both school policy and curriculum delivers positive outcomes in mental health promotion for long-term rather than short-term interventions are achieved; they mostly focus on specific areas, such as coping skills, self-concept, and self-esteem. For instance, school-based interventions which reduce or prevent bullying behavior are most effective if used in the form of programs that attempt to change bullying behavior by addressing needs of individual and involve community and parents, so that positive behavior is fostered outside school environment. However, such programs help to reduce bullying behavior with younger children, rather than older children. Programs that implement age-related curriculum for raising awareness of mental health issues involve children in group discussions, stories, theatre, educational games, and art activities to teach about possible impact of behavior on other people, surrounding them. Such programs enhance emotional awareness, self-control, and competencies, thus leading to positive social interactions with parents at school and community level. These programs also help students to improve their educational processes in classrooms and IQ in general. Schools can support mental health programs that include parents of children that have problems such as substance use, delinquency, and aggression through group discussion at school and implementing a combination of practices at home.
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2.3 Promotion of Mental Health at Workplace
Work conditions and employment are important factors of health for adult population. For these people, promotion of mental health interventions focuses on work related stress and unemployment. Effective interventions, which decrease unemployment strain, include counseling to increase coping skills, enhancing employment opportunities for unprivileged groups, job creation, and literacy programs that improve job seeking skills for adults and youth. Since people spend more than 10 hours every day at work, workplace plays an important role in promoting mental health interventions. Depression and stress resulting from high job performance and job insecurity destabilize mental health of adults. Poor mental health also relates to workplace bullying and occupational violence.
An employer can promote mental health at workplace by identifying positive aspects of work, identifying common goals, creating a balance between workers’ skills and job demands, increasing job control, assessing workload, and providing social support to workers. Both employers and workers should work together in areas that need changes at individual or managerial level. Employers should encourage employees’ participation in social programs by allowing them to make decisions on issues, which affect mental health at workplace.
2.4 Mental Health of Senior Population
Although it is difficult to differentiate adults from seniors, the latter aspect of adulthood poses significant challenges to achieving and sustaining good mental health. One of the challenges, related to senior population, is a myth that dementia, or Alzheimer’s, generally affects people of old age and is an inevitable aspect of aging process. This misconception leads older people, susceptible to developing poor health, to other symptoms, related to poor mental health, such as abuse, illnesses, and economic and social disadvantages that may not be addressed or recognized.
Reality, however, is such that seniors can maintain perfect mental health in later years of their lives. With moral support, older people can enhance capacity for positive mental health and even tackle the challenges of aging. Aging brings a range of cognitive and physical changes that may impact one’s mental health. Protective aspects change with aging, similarly to change of economic, social, and health factors. Lack of resources may increase susceptibility to depression and loneliness, especially for older women who live alone and, thus, have less support.
The wealth of knowledge and wisdom, gained throughout the lifespan, are protective factors, but cognitive functioning continues to decline. Loss of employment and retirement can also negatively impact the sense of identity, level of income, and lack of social support. For older men and women, loneliness and isolation are prime factors for declining mental health. Older people are flexible, show a positive sense of self, and can use adaptive strategies and personal skills to maintain their mental health. However, coping skills alone do not meet the demand for social contact of senior people. Social contacts decrease as people retire and their friends and family members die; thus, older people become reserved and selective in choosing friends. Although older people are diverse in population, there are several approaches to promoting their mental health. Moreover, their skills, wisdom, and experience can make useful contributions to the society and volunteering. At the same time, such intervention can improve individuals’ mental health
The study of current literature on mental health promotion discloses the presence of complex interrelationships between the community, individuals, social formations, and various factors of mental health. Approaching these issues requires participation of various sectors and factors; people using them bear the responsibility to ensure that their involvement does not negatively impact mental health of people. Most interventions address building personal skills and supportive environment to increase protective determinants in the settings, where individuals spend most of their time. However, current literature does not provide enough focus on mental health problems of older people and offers little explanation of existing problems. While the factors of good mental health address the entire population, there is a limited approach to interventions that improve mental health of older people. The literature addresses effective interventions that focus specifically on adults and children. Furthermore, childcare is an important area for promoting mental health during early childhood. Parents, especially mothers, generally are the main caregivers, as children spend most of their time at home. With more women entering workforce, children spend more time doing outdoor activities. Such exposure can lead children to indulging in nefarious activities that may affect their mental health. The general message of literature review is that focus on mental health promotion is relatively low but rapidly growing due to structural changes in the society. The evidence-based interventions need expansion and implementation in broader context, which will help policy makers and stakeholders to develop programs that will meet the needs of the population.