Population mental health promotion: building capacity for mental health promotion across sectors

Kia ora koutou 

At the International Initiative for Mental Health Leadership (IIMHL) this year, the Public Health Agency of Canada and the Centre for Addiction and Mental Health hosted a two-day match in Toronto, Canada.

The theme was "Population Mental Health Promotion: Building Capacity for Mental Health Promotion Across Sectors". The network meeting was held in Washington DC.

Aotearoa/New Zealand 

Overall I think Aotearoa/New Zealand is leading in many areas and most people from around the world look to the Wellbeing Budget and new Mental Health and Wellbeing approach as "the" example and beacon of hope. People are looking to see how it works out. 

It was clear to me that we are doing better than most in the following areas.

• Acknowledgement of indigenous knowledge/mātauranga Māori and progress to kaupapa Māori services models.
• Indigenous people from around the world (particularly North America) expressed great frustration and pain at how difficult it is to have a non-European worldview acknowledged and their “wisdom for healing ourselves” empowered and supported. Carol Koha from Aotearoa described this as ‘Wise Best Practice” she talked about the work of Dr Carol Hopkins as a thought leader in this area. The graciousness of the indigenous leaders and their desire to share this wisdom for the benefit of all was humbling. (See First Nations perspectives under Suicide prevention below).
• Making progress on non-clinical approaches and the addition of peer workers and wellbeing coaching models.
• Acknowledging and including people with lived experience in processes and design. 
• Reduction of stigma and discrimination – I spoke a couple of times advocating for the voice of lived experience to be much stronger in the match and for less clinical and stigmatising language – I got a lot of support from the floor for this.

There was one great example of a good approach to lived experience where one Texas tertiary teaching facility has created a system of acknowledging lived experience as equivalent to qualifications up to masters level.

The University of Texas at San Antonio - The Hogg Foundation for Mental Health awards up to five $5,000 scholarships annually to graduate social work students in Texas who plan to provide mental health services after graduation. The scholarship programme was created in 1956 by Houston philanthropist Ima Hogg to attract students to mental health careers.

While New Zealand has a long way to go on all of these fronts, it was good to be reminded that we have good opportunities here in Aotearoa.

Mental health promotion

The match on mental health promotion was run by The Public Health Agency of Canada and the Centre for Addiction and Mental Health and was held in Toronto, Canada.

Site visits focused on early childhood programmes

There were some good train the trainer models of influencing Early Childhood Education (ECE) workers around mental health and wellbeing within their practice using the “tpitos” model – maybe something to consider down the track as we expand our schools focus.

See The Pyramid Infant-Toddler Observation Scale (TPITOS).

National mental health literacy social marketing in England

A major national programme is about to be launched by Public Health England, “Every Mind Matters”. There will be some good sharing with us as they progress this – the fact that it has gained Government support in England adds to our case for a national well-being programme in Australia and New Zealand.

Mental health public health training for health promotors

Canadian Public Health Authority developed a Foundations of Public Mental Health curriculum and an e-learning module that could be accessed.

Evidence exchange

Canadian/ Ontario Public Health have produced an on-line Evidence Exchange Network for those working in MH public health, which we will be linked into.

Workplace well-being

Poppy Jaman was an excellent speaker at the main conference. Poppy came from the City Mental Health Alliance (CMHA) in England. She was a champion of the 5 Ways to Wellbeing in the workplace and is also a person with her own lived experience of mental distress.

City Mental Health Alliance has developed partnerships with some major multi-national businesses such as BP and these companies are rolling out workplace wellbeing programmes worldwide. They will be bringing the CMHA programme to their Australia branches this year and may bring it to any offices of their companies in New Zealand.

The New Zealand Ministry of Health is keen to facilitate a working relationship between the Mental Health Foundation and City Mental Health Alliance.

Public Health England

The team from Public Health England shared that the London School of Economics has analysis that shows positive returns on investing in Bullying Reductions within four years and Workplace Wellbeing within one year.

See The Economic Case for Prevention in Young People’s Mental Health: Bullying.

Sweden

Sweden has a tool known as the “Prevention Index” to assess policy and programme impacts on public health. 

Suicide prevention

Overall I think the Mental Health Foundation perspectives on suicide prevention were strongly supported by the information shared.

People were very interested in our conceptual frameworks and linking of suicide prevention with wider wellbeing and mental health promotion – there were some good examples and insights to take away.

First Nations perspective

There was a brilliant young indigenous woman who is also from the LGBTI community who is part of the Thunderbird Partnership Foundation of Canada – she talked about the core of their work being to create Hope, Belonging, Meaning and Purpose. Culture is obviously key and “language is key to culture and identity – it tells us who we are” (her words).

“The Thunderbird Partnership Foundation works with First Nations communities. Our top priority is developing a continuum of care that would be available to all Indigenous people in Canada, using the Honouring Our Strengths document as a framework.”

It occurred to me that the creation of Hope, Belonging, Meaning and Purpose is a good summary of what mental wellbeing is about for everyone and what Mental Health Foundation's work aims to achieve

All nations are struggling

Suicide is a worldwide issue and no country or programme has THE answer.

There was a strong theme of needing to continue to collaborate and learn from one another

LifeSpan approach

The LifeSpan approach and the work of Dr Helen Christenson from the Black Dog Institute in Australia were referenced several times.

Examples of actions that have reduced suicide

The following examples were shared:

• China – a clear correlation between improved economic conditions at a population level and reduced suicide.
• London – a safety and means approach – by training Underground transport staff to identify and respond to vulnerable people the number of deaths per week in London has reduced from 14 to 11.
• England – has had 6 years of reduced rates with the last year seeing an increase – the overall trend is down – they have a national strategy with a Minister for Suicide Prevention.
• Ireland, Scotland and Denmark are all experiencing some success.
• USA – you have to be persistent and consistent - counties where community training in suicide prevention and personal support was implemented saw rates reduce – however when the funding was withdrawn the rates rose again.
• USA – the Centres for Disease Control and Prevention (CDC) will not fund any programmes that are simply suicide awareness raising as they see this as increasing risk – they will only fund active suicide prevention. 
• USA – promoting “safety planning” and “caring contact” follow up for people who have attempted suicide is a proven model.
• USA – the Action Alliance for Suicide Prevention - created a network of gun owners who approach those who are vulnerable and suggest that they look after their guns for a while – the idea is gun owners will only listen to gun owners – as guns are a key cause of suicide death in rural New Zealand this has some promise.
• Canada – Mindset – have created media guidelines on how to report safely.
• USA – the Action Alliance for Suicide Prevention – have had some success working with the entertainment industry on how to portray suicide in safer ways. 
• New Zealand – I talked about the approach of Mental Health Foundation and people agreed that it is too easy to concentrate on helping people who are suicidal right now while not giving resources to stopping people becoming suicidal and changing the environment so that they continue to recover from crisis – people agreed that both suicidality focused interventions and MH promotion are important.

Overall approaches to mental health

The World Health Organisation Mental Health Action Plan

This plan has been extended to 2030. It has four priorities for all countries. These have informed the positions taken by the Mental Health Foundation:

1. Strengthen effective leadership and governance for mental health
2. Provide comprehensive integrated and responsive mental health and social care services in community-based settings
3. Implement strategies for promotion and prevention
4. Strengthen information systems, evidence and research. 

The USA Well-being Foundation

In many ways, our equivalent organisation in America described three priorities:

1. get the service models right
2. improve access to services
3. create healthy communities.

They talked about the USA having:

• an epidemic of loneliness, isolation and lack of inclusion that is rooted in injustice and inequality
• a fragmented care system that is incapable of seeing and responding to the whole person
• inclusion and power-sharing at all levels are the only way to create real change – who is at the table where decisions are made?

There are some important things for us to think about in what the Well-being Foundation are saying.

Finally... 

A couple of inspiring and thought-provoking comments that I continue to ponder on:

“People will forget what you say, forget what you do, but they will remember the way you make them feel” (Maya Angelou).

The City Mental Health Alliance: “Where strong relationships exist anything is possible.”

Thunderbird Foundation: “Create Hope, Belonging, Meaning and Purpose.”

Hei kona

– Shaun Robinson, Chief Executive, Mental Health Foundation.