This manual has been developed to help organisations implement Mental Health Promotion (MHP) programmes in a planned and systematic way. It has been developed to service the needs of three different settings. The three settings are:
- Schools - The primary target group to be addressed are the ‘gatekeepers’, who do their everyday work in schools and therefore have a key role in promoting and protecting mental health in schools settings. The Schools setting includes children and adolescents in formal education (from 5/6 years) on to university students. This does not include pre-schoolers and kindergarten.
- Workplaces - There are many different types of organisation and so the "workplace setting" is a general title which incorporates the many specific organisational settings. The key feature of the workplace is that there is an employer who can set policy and who can enable MHP to proceed with their workforce.
- Residences for older persons - Residences for older people include older people in ‘permanent’ homes, whether this is a nursing home or other residential facilities. It also includes older people who live at home and avail of some form of supportive service. However, older persons in ‘transitory’ homes, for example hospitals and rehabilitation centres are not included.
A Planned Approach
This manual goes beyond a piecemeal response to health problems as they arise - it provides a method to address problems before they become serious through a systematic and comprehensive approach to improving the health of individuals in the three settings. It does this by outlining a set of activities which are grouped into meaningful phases and by providing a range of advice which enables the manual to be used by people who do not have specific expertise in MHP.
A Project Management Based Approach
The approach taken in this implementation manual is to treat the MHP initiative in the same way as any other project in an organisation, i.e. a project management approach based on the implementation cycle.
This approach involves being systematic in planning and implementation, being clear about responsibilities and reporting, communicating in a planned way and monitoring and evaluating the project as it proceeds.
Differences Between the Settings
One of the main aims of implementing MHP in each of the settings is to ensure that the initiative moves beyond being a project to become a regular part the operations of the organisation. However, the meaning of integration into normal practice varies somewhat form setting to setting. In older people’s residence for example, promoting mental wellbeing is a duty of staff who work there and the aim of the MHP project is to enhance the practice of staff.
In workplaces, however, there is no obligation on employers to promote mental wellbeing, though there is an obligation to prevent harm coming to staff from factors within the working environment. In this setting, MHP is generally a voluntary initiative and its integration into practice is likely to take the form of improved policies and working practices rather than explicit mental health promotion activities.
In schools, somewhat like the workplace, promoting mental wellbeing is not the main business of teachers. Here, integration into practice is also likely to take the form of improved schools policies and also of improved educational practices and programmes.
The peculiarities of each setting in relation to MHP are explored further in the settings specific manuals.
What is Mental Health
A Positive State
Mental health is not just the absence of mental illness, but involves a positive sense of wellbeing also. Mental Health is thus the emotional and spiritual resilience, which enables us to enjoy life and to survive pain and disappointment and sadness. It is a positive sense of well-being and an underlying belief on our own and other’s dignity and worth.
Mental illness is characterised by a range of negative emotions and states – it may involve depression, anxiety, delusions and a range of other symptoms. It is best to think of mental health and wellbeing as being separate from mental illness – it is something which is qualitatively different from and can help protect against mental health problems.
What is Mental Health Promotion
The promotion of Mental Health works at three levels and each level is relevant to the whole population, to individuals at risk, vulnerable groups and people with mental health problems.
- Strengthening individuals - or increasing emotional resilience through interventions to promote self-esteem, life and coping skills, negotiating relationships and parenting skills
- Strengthening communities - this involves increasing social inclusion and participation, improving environments, developing health and social services which support mental health, workplace health, community safety and self help networks. In the current context, communities refer to each of the three settings.
- Reducing structural barriers to mental health - through initiatives to reduce discrimination and inequalities and to promote access to education, meaningful employment, housing, and support for those who are vulnerable.
Ethics and MHP
The Importance of Ethics
Ethical issues are of major importance in MHP as the focus of concern is on health issues generally and mental health issues specifically. While the focus of concern here is to maintain and promote mental wellbeing, rather than dealing with mental illness, there are nonetheless ethical concerns which apply. These concerns vary somewhat between the settings and a larger range of them apply in the schools and older people’s residences settings.
In both the school and older people’s settings, the staff who work there have a duty of care towards their clients. While this is not the case in the workplace setting, employers nevertheless have a duty to maintain the safety and health of their employees. In practical terms, this means that the issues of informed consent must be addressed, particularly in the first two settings.
MHP programmes often involve the collection of sensitive mental health related information from individuals. Where this is the case, there is a need to do so in a professional manner where confidentiality and anonymity are guaranteed.
For each of the three settings, there is an obligation on the person who is implementing MHP to ensure that no harm is done through implementing the MHP project. The methods used for the assessment of potential risk vary with each setting - they may involve some form of ethics committee in the Older people’s settings, they may involve health safety committees in the workplace and they may involve parents committees in the schools.
The full range of ethical issues that may apply are considered in more detail in the settings specific manuals. There is also a ProMenPol statement of how to deal with ethical issues.
Why Should you Undertake MHP?
- A health philosophy - Many organisations have a philosophy to care for the health and welfare of individuals for whom they are responsible, i.e. pupils, employees or older persons. This can include specific commitments to undertake health actions and can be expressed in terms of an explicit health policy for the particular setting.
- Dealing with problems - MHP can be viewed as having a role to play in solving organisational problems. Examples include health problems in the workforce or clientele, absenteeism problems and low morale.
- The benefits - Many organisations undertake MHP actions because of the benefits they expect to gain. Benefits include reductions in health related costs, an improvement in absenteeism and productivity, improved morale and improved health and wellbeing.
The MHP Approach
A number of important features are embodied in this manual which are central to developing effective MHP programmes. These include:
- Beneficiary participation in the programme
- Communications and feedback
- A commitment to a balanced approach
- A focus on causes of ill health
- The programme should be needs based
Participation - Participation should be an explicit goal in designing the MHP programme because it is essential for effectiveness.
Communications - Communications refers to the need to keep stakeholders informed of the progress of the MHP project.
Balanced Activities - MHP actions should address both the individual and the environmental setting. Adopting this balanced approach is far more likely to be effective in improving mental health and wellbeing, as it deals with all of the causes of wellbeing and ill-health, rather than just a few.
Needs-Based - MHP should be based on the needs of individuals, be it in school, the workplace or residential care settings. Here, needs refer to personal preferences for action and objective and subjective risks.
It is especially important to take into account participants’ preferences for action. Doing so provides a reliable way of ensuring high levels of involvement in the programme.
Who Should Use this Manual
This manual can be used by a wide range of people, either inside or outside of the three settings. It is intended for use as a resource that a team of people can use to plan and manage an MHP programme.
Internal Actors - A certain level of health related expertise is assumed on the part of the user of the manual, though there may be a need to call in health and other expertise during the programme, depending on the resources available to the MHP project.
Many of the types of expertise needed to generate interest in, plan, manage and monitor a MHP project are generally easily found in large organisations. The project can be implemented in much the same way that any other organisational project is managed - it involves getting support for the concept, setting up a project team, analysing the problems to be addressed, designing a programme, and implementing and monitoring the programme. The kinds of people who are typically involved in these kinds of processes can use this manual to develop and implement a MHP programme.
External Actors - There is also a range of actors external to the setting who could be involved. They could include:
- Health education/promotion agencies
- Health and safety agencies
- Insurance companies dealing with health
- Local health authorities
- Private health consultants
- Occupational health practices
These suggestions should not be viewed as being exclusive - any person who feels that they want to establish a MHP programme can use the manual, once they are in a position to put together a team of people with the relevant skills and authority to make it happen.
Contents of the Manual
The manual is organised into 4 Phases of Activity. These are outlined below in the following diagram which can be Clicked in order to take you to the 4 Phases.
Within each of these phases the following contents are to be found:
- Objectives of the phase
- What needs to be done and how to do it
- Activities to be undertaken
Access to the ProMenPol Database
Furthermore there is a chapter explaining you how to access the ProMenPol database.