Why prevention and promotion are vital for mental health

We readily accept the need for prevention and health promotion in relation to issues that affect our physical health, such as cigarette advertising or food labelling, but we don’t always take the same approach to issues affecting our mental health.   

However, if we are to reduce the incidence of mental illness in our community and improve our overall mental well-being we need to ensure that prevention and health promotion are an integral part of all mental health policies and programs. 

This approach would significantly change the way in which we currently approach mental health by challenging a broad range of sectors, including education, children’s services and the justice system, to put mental health on their agenda. 

How this could look is outlined in the following piece by Jaelea Skehan, Director of the Hunter Institute of Mental Health. She discusses a new document that her organisation has produced which provides a conceptual framework for strategic action to prevent mental ill-health and promote mental health and wellbeing in Australia. 

This document clearly defines the full range of activity needed to ensure that – as Pat McGorry says – “the preventive mindset is at the heart of everything we do” and sets an agenda for coordinated action and commitment to make prevention and health promotion a central focus of our approach to mental health in the future.

Jaelea writes:

The Australian community is interested in and engaged with mental health more than ever before. The time is right to capitalise and set a vision for mental health in Australia that involves not only the health sector, but all sectors and communities.

Last week, just two hours before the start of a long weekend, the Minister for Health, Sussan Ley MP, announced almost $300 million of continued funding to support the operation of community mental health organisations and existing national programs.

This announcement was certainly a relief for many organisations and staff, not to mention the Australians that currently rely on those services.  But scratch the surface and what the announcement means is another 12 months of ‘business as usual’ rather than the much promised review and reform of mental health and suicide prevention. 

As Frank Quinlan, CEO of Mental Health Australia, said following the announcement: “Ultimately, we must move away from short term planning, short term contracts, and develop a 10 year plan for reform. We hope that the National Mental Health Commission’s review of mental health will be the first step in this reform process.”

But of course, we all need to see the National Mental Health Commission’s report and then work with government to implement a new vision for mental health in Australia.  There is no doubt that Australia must improve the service system to ensure people experiencing mental illness get the support they need – when they need it, where they need it, and in the format that suits them best.

We need to innovate and look to new service models that value community-based treatment and look to the opportunities that technology can offer. We need to think about the workforce and invest in training and supporting them to deliver the best possible evidence-based and person-centred service they can. And we need to change the face of the workforce with more commitment to peer workers.

But we also think about and commit ourselves to reducing mental ill-health and its impacts. Our vision for Australia must include more people living well, so they don’t need the service system at all. 

Last month, the Hunter Institute of Mental Health released a plain language document that provides a new conceptual framework for strategic action to prevent mental ill-health and promote mental health and wellbeing.

Prevention First: A prevention and promotion framework for mental health builds on existing models and policies developed here in Australia and overseas to: define key concepts; develop a new conceptual framework for prevention and promotion activity that clearly defines the full range of activity needed; and set an agenda for coordinated action and commitment.

Prevention First has been written for a broad audience including governments, policy makers, health and mental health workers as well as sectors that must be part of the national solution to mental health such as children’s services, education and workplaces.

The importance of mental health promotion, prevention and early intervention has been written into almost every state and national policy document since the late 1990s and in 2000 the Australian Government elevated the role of promotion and prevention with the release of the National Action Plan for Promotion, Prevention and Early Intervention for Mental Health.  

But in many ways, the terms promotion, prevention and early intervention have become confused when applied to mental health, and are often used interchangeably. This has led to gaps in investment and gaps in action. The terms also have little relevance to sectors outside of health that are integral partners in this work.

Many policy documents to date have also held the view that prevention activity can only occur before the onset of illness. This has led to a division between service sectors, arguing for either prevention or treatment.  But what we need in mental health is consider prevention as having a vital role across the spectrum of interventions.

Prevention First uses plain language to outline seven key ‘Action Areas’ for prevention and promotion. It takes a broader view of prevention, outlining activities to prevent the onset of mental ill-health, activities to prevent the duration and severity of mental ill-health and activities to prevent the ongoing impact of mental ill-health on people’s lives and the lives of those who care for them.

Professor Pat McGorry, Executive Director of Orygen Youth Health, said that we need to think about the role of prevention across the service system.

“If we are going to transform mental health in Australia, we need a common language and a way that diverse sectors and service systems can work together to ensure that the preventive mindset is at the heart of everything we do,” he said.

Making a real difference to the mental health of Australians must involve breaking down the silos and looking for economies of effort across all sectors. Prevention and promotion approaches, by their nature, involve the domains of everyday life and operate in a range of service settings. Hence, there is opportunity for meaningful partnerships and meaningful involvement from the whole of society.

““The first step in a plan for improved mental health in Australia is to agree on what we want to achieve and commit to working together,” said Frank Quinlan, CEO of Mental Health Australia.

“If we are going to work in partnership with education, business, social services and the general health system, then we need a common framework that can turn our desire to prioritise prevention into coordinated action towards the best outcomes for all Australians,” he added.

The burden of mental ill-health cannot be addressed by only treating one individual at a time. We need to look at whole of life, not just wait for an episode severe enough to warrant a response from the service system.

Investing in the prevention of mental ill-health and the promotion of mental health and wellbeing  makes good economic sense, with return on investment showing real promise – not just in reducing future costs, but also increasing productivity and participation. 

But more than that, investing in prevention and promotion approaches makes good human sense. Mental health and wellbeing is a basic human right. It is the foundation of a healthy society and values the contribution of its members.

Hopefully it will not be a full 12 months before we can start implementing a reform agenda in Australia that includes not only the service system but a broader vision that includes, involves and indeed sets responsibilities for all of government, all of health and all of community.

Jaelea Skehan is the Director of the Hunter Institute of Mental Health.  

Prevention First is available for download at www.himh.org.au/prevention

This short video describes why a focus on prevention and promotion is needed and describes the Framework  www.vimeo.com/hinstmh/preventionfirst