*** APOLOGIES FOR CROSSPOSTINGS ***

Dear All,

I hope you find this summary bulletin interesting. It is part of the HEA's
series of expert group reports with various population groups.

Thanks,
Katherine

Katherine Vik
Information and Multimedia Project Officer
Health Education Authority
Trevelyan House, 30 Great Peter Street, London, SW1P 2HW

SUMMARY BULLETIN

PROMOTING THE HEALTH OF PEOPLE WITH MENTAL HEALTH PROBLEMS - SETTING A
RESEARCH AGENDA

Introduction

In October 1996, the Health Education Authority set up ten expert groups to
look at the potential for health promotion with key populations groups.  The
expert groups were asked to address the following questions:

Which health promotion interventions, if any, work to promote the health and
well-being of individuals, families and communities, and to prevent ill
health?

What are the principal health promotion needs of these groups?

What are the implications for a new research, development and policy agenda?

In this bulletin we provide a summary of the work carried out by the expert
group on health promotion and mental health, which has been published as a
special issue of the journal Psychology, Health and Medicine ('Health
Promotion and Mental Health' vol.3,no.1 February 1998). The issue contains a
variety of papers written by members of the expert group with an overview by
Dr Lorraine Sherr

HEALTH PROMOTION

This issue is buttressed by recognition that present health promotion
techniques are not always effective within the mental health field.
Furthermore there is a lack of systematic application of health promotion
interventions for people with diagnosed mental illness. The question of
efficacy was thus particularly difficult to address given the paucity of
studies and the first recommendation related to the prioritising of
interventions for this group. The authors recommend a wider concept of
health promotion with emphasis placed upon the environmental factors that
influence mental health.  The value of appropriate targeting and the
potential contribution of psychological theories in increasing effectiveness
are primary considerations.  These are placed within a broader conception of
health promotion aimed at empowering individuals in tandem with
strengthening their communities. The group stressed the importance of
looking at health promotion among people with diagnosed mental illness as
well as exploring those who had mental health ramifications from physical
illness. Systematic data shows an added burden of deleterious health
behaviours in people diagnosed with mental health illness, including alcohol
use, tobacco use and suicidal behaviours.


THEORY INTO HEALTH PROMOTION PRACTICE

Psychological theories, for example, social cognition models, can help in
the design of effective interventions which, in turn, have the potential to
address gaps in current service provision.  A Bradford based study using one
such model - the Theory of Planned Behaviour - is used as an illustration of
how we can understand the behavioural process by which GPs can act as
'gatekeepers' to mental health services where Asian patients are concerned.
The author's recommendations include encouraging GP's to acknowledge that
certain psychological factors are influencing their referral intentions.
Social cognition models are also seen to be valuable in informing the
promotion of sexual health and strategies aimed at increasing smoking
cessation.  Emphasis is placed upon understanding the psychological
determinants of behaviour - such as the individual's perception of what
peers are doing, how strongly the health message is believed, mood, self
esteem and social support.
There is a parallel consideration of the psycho-social factors that
influence mental health amongst various vulnerable groups.  In cancer
patients, for instance, high levels of loneliness and low self efficacy
prompt the authors to recommend intervention aimed at increasing coping
skills and feelings of control.
The value of considering various psychological theories of addictive
behaviours (such as personality theories and behavioural theories) are
considered to be useful in informing health promotion, especially where
psychological dependency on tobacco is concerned.    It is stressed,
however, that health promotion and intervention informed by such theories,
although helpful, will need to be bolstered by economic policies designed to
reduce inequalities in health, in order to ameliorate the effects of the
psycho-social factors which increase the likelihood of poor mental health.


CHILDREN AND ADOLESCENTS

Many psychiatric problems are rooted in childhood experience, and
environmental factors are given prime consideration here.  The young
person's community context is seen as the most appropriate arena for health
promotion strategies aimed at reducing the risk factors associated with poor
mental health.  Schools and families, rather than clinician based
interventions aimed at the individual, are recommended as appropriate
centres for health promotion and risk limitation.
The authors take a developmental, ecological approach and present examples
of effective international practice that have reduced the incidence of
bullying and challenging behaviour.  Emphasis is placed upon raising
children's self esteem through improving peer relationships and involving
all those associated with the school community.  The American YNHPP project,
for instance, aimed at children from disadvantaged communities, has produced
sustained gains in academic achievement and social skills.
The importance of a resilient, understanding and knowledgeable environment
as a mentally healthy backdrop for the development of young people is seen
as paramount and special consideration is given to children excluded from
this.  Children excluded from school altogether tend to be at risk from
multiple socio-economic factors impacting upon mental health and the authors
argue for more comprehensive needs assessments and an increase in
collaboration between the agencies involved
Stress is also placed upon the vulnerability of young people to eating
disorders and the lack of appropriate targeting at this group.  Current
dietary advice, for example, does not acknowledge the likely links between
low cholesterol diets and depression, the written information available to
be 'fat phobic'.  A broader model of health promotion is recommended for
young people, with schools in particular seen as appropriate centres for
encouraging children's stress coping strategies and increasing their self
esteem.

A MENTALLY HEALTHY COMMUNITY

The factors determining mental health status often involve interacting
forces beyond the control of the individual.  Psychological well being can
be improved, however, if the target group is clearly defined and the
interventions used involve appropriate community settings and effective
techniques. Written information needs to be readable, noticeable and legible
to enhance impact, understanding and recall. This applies to information on
mental health implications of general medical conditions to prevent anxiety
and stress and promote coping as well as specific mental health publications
regarding development of conditions, medication and healthy living. The
increased use of self help manuals was noted, which could also benefit from
readability attention and evaluation.
Emphasis is placed upon the cost to society if environmental facts are
ignored and the complexities of multi-layered causation remain
unacknowledged.

RESEARCH TO INFORM HEALTH PROMOTION AND MENTAL ILLNESS PREVENTION

Research needs to be more 'client specific', and the wider psychological
impact of certain health promotion techniques should be acknowledged.  More
research is needed into the area of health promotion for specific mental
illness where illness and treatment factors may affect initiation and
maintenance of health behaviours. Few interventions are controlled for or
systematically evaluated. There is a need for a variety of applied studies,
particularly in relation to tobacco, exercise, alcohol, medication, stigma,
stress and healthy living. Needs analyses of individuals within the context
of their environments require greater emphasis if health promotion is to be
effectively involved in addressing the factors which militate against good
mental health.

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