Interventions to promote mental health

• Mental health

  A state of wellbeing in which the individual realises his or her own abilities can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community (WHO, 2001)
• WHO argues that mental health promotion and mental illness prevention describes distinct areas, but they definitely have some overlapping aims
• Often mental health promotion interventions are also relevant to mental illness prevention for example just because they can be done with individuals who didn't have a mental illness, it doesn't necessarily mean they wouldn't be useful for people who do have a mental illness
• Scope of mental health promotion

  • Wider in a few different ways, including both the target of the intervention (things like quality of life, employment, relationships, or community well-being), the target audience (those at "risk", certain age groups, general populations)
• Mental health promotion can


  1. Strengthen individuals

  2. Strengthen communities

  3. Reduce "structural barriers" to mental health
• Strengthening individuals


  Increasing emotional resilience through interventions designed to promote self-esteem, life, and coping skills, such as communicating, negotiating and relationship skills
• Strengthening communities


  Increasing social inclusion and participation, improving neighbourhood environments, developing a range of interventions which support mental health for people of all ages, including anti-bullying strategies at school, programmes to improve health in the workplace, community safety measures and self-help networks
• Reducing "structural barriers" to mental health


  Tackling societal structures through initiatives to reduce discrimination and inequalities and to promote access to education, meaningful employment, housing, services, and support for those who are vulnerable
• 'Health professionals and health planners are often too preoccupied with the immediate problems of those who have a disease to be able to pay attention to needs of those who are "well" (WHO, 2005)
• Mental health has intrinsic value to society

  • Essential for wellbeing and quality of life- cant have a good quality of life if you don't have good mental health
  • Important for functioning, productivity
  • Contributes to all aspects of human life (relationships, physical health, social cohesion, productivity, employability, earning potential, education attainment, home life, crime reduction)
• Reducing or preventing mental illness


  • Preventing suffering
  • Potentially very cost effective as mental illness costs £££ - estimated at £105.2 billion per year in 2010 (Centre for Mental Health, 2010)
• Flourishing


  When an individual is free from psychopathology with high levels of emotion, psychological and social well-being
• Moderate mental health


  Doing okay but subjective wellbeing or functioning lower
• Languishing


  Low levels of wellbeing and functioning but who didn't have a mental illness
• Mental Disorder


  People who have a mental illness
• Compared to flourishing adults, moderately mentally healthy and languishing have: psycho-social impairment (e.g. poorer relationships), physical health (e.g. more cardiovascular disease), productivity (e.g. missed days at work)
• Evidence shows that having flourishing mental health precedes important outcome like fulfilling and productive work, good relationship with others etc. suggesting tat good mental health may have long term impact on future factors
• Potential target groups


  • Children and adolescents
  • Parents of young children
  • Older individuals
  • Individuals who have experienced trauma
  • Those more at risk due to socio-economic factors or environmental factors
  • Individuals who already have a mental illness
  • The general population
• Children and Adolescents


  • Mental illness usually starts in childhood and adolescents (Kessler et al., 2007)
  • Difference in development between the cognitive and emotional aspects of the brain (Steinberg, 2005)
  • Time of remarkable turbulence and instability (Harrop and Trower, 2001)
  • Young people experience change at a rate which adults rarely do in terms of: friendship groups, school environment, level of independence, dynamic with parents/guardians
  • Long lasting negative impact of a mental illness AND long-lasting positive impact of mental health: independence away from parents/guardians, educational attainment, development of peer support networks
  • Consequences would be more long term and severe in young people than in an adult
• Keyes (2006) found that in 12–14-year-olds, flourishing was the most common group, but by 15-18, the most common was moderate mental health. Fewer were flourishing
• Keyes (2006) found that adolescents that didn't have a mental illness weren't necessarily mentally healthy, didn't score high of wellbeing scores even though they dint have a mental illness
• Keyes (2006) found that flourishing youth were functioning better than moderately healthy or languishing youth
• Keyes (2006) found associations between increased measures of mental health and things like fewer conduct problems, arrests, tobacco, truancy, alcohol use etc, and increased psychosocial functioning like closeness to others and school integration
• Older individuals


  • Tend to report relatively good life satisfaction and mental health compared to other groups
  • Experience a variety of things which may negatively impact on their mental health like age discrimination, barriers to participation in meaningful activities, social isolation, poorer physical health, and poverty
  • Mental health and wellbeing of older people has been neglected across the spectrum of promotion, prevention, and treatment services
• Socio-economic status (SES)


  The social standing or class of an individual or group. It is often measured as a combination of education, income, and occupation. Encompasses income, educational attainment, and financial security, as well as subjective perceptions of social status and social class
• Lower SES status is associated with poorer health outcomes including mental health
• Effective interventions to reduce the effects of poverty and inequality on mental health at the individual/family level exist, but less evidence regarding community-based interventions and policy level interventions
• Individuals who already have a mental illness


  • Interventions can focus on confidence, self-esteem, hopefulness, and social integration and can influence clinical and quality of life outcomes
  • Adults with mental health problems are one of the most excluded groups in society, often caused by stigma and discrimination
  • 2/3 of men under the age of 35 with mental health problems who die by suicide are unemployed
• Only 18% of adults in the US are in flourishing so over 80% could benefit from interventions aimed at promoting mental health
• In Scotland, found that 14% of adults have good mental wellbeing, 73% had average and 14% had poor
• If we could shift the distribution, we would see more people in the flourishing category and less in the mental category
• Common intervention strategies


  • Macro level interventions: Supportive environments and public policy
  • Meso and micro interventions: Early stages of life interventions, Pre-school educational and psychosocial interventions, School-based interventions, Unemployment interventions, Stress prevention workplace programmes, Interventions of older people
• Early Life and School approaches


  • Meilstrup et al. (2020) found that lower SES adolescents had higher rates of emotional symptoms and lower levels of self-efficacy and social competence, but high self-efficacy and high social competence buffer the association between SES and emotional symptoms
• The Perry Preschool Project


  1. Goal: To improve disadvantaged children's capacity for future success in school and in life by promoting young children's intellectual, social, and physical development

  2. Programme Components: For one year a daily 2½-hour classroom session and a weekly 1½-hour home visit for each child. Children's cognitive and social skills are built and supported through individualized teaching and learning. A key feature of the curriculum is active learning, in which children are supported to initiate their own play and activities

  3. By age 27, the children who had experienced the programme: Completed more schooling, Committed fewer crimes, Had higher rates of employment, Earned a higher income

  4. By age 40, the children who had experienced the programme: Had fewer teenage pregnancies, Were more likely to have graduated from high school, Were more likely to hold a job and have higher earnings, Committed fewer crimes, Were more likely to have their own home and car
• 'there is still a need for a stronger and broader evidence base in the field of mental health promotion, which should focus on both universal work and targeted approaches to fully address mental health in our young populations' (O'Reilly et al. 2018)
• Quality of evidence has been appraised as generally low-to-moderate with many studies having considerable methodological issues
• Most studies tend to be short-term with little long-term follow-up
• Gaps in teacher training and support can create problems with programme delivery
• Whole-school approaches which involve different levels of school personnel, wider communities, and other agencies and last for at least a year tend to me most successful
• School based interventions are unlikely to be enough in areas of multiple deprivation: whole community approaches needed to strengthen psychological resources, support and opportunities (Holton, 2007)