Pubic mental health: time to translate evidence into policy and practice
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Transcript of Pubic mental health: time to translate evidence into policy and practice
Public mental health: Time to translate evidence into practice
Kristian Wahlbeck
Faculty Disclosure
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Mental health is shaped early in life
Where and how we are born, grow, live, work and age determines our mental health
Public mental health401.04.2017
Children who have been maltreated or bullied are much more likely to have mental health problems in adulthood
Great Smoky Mountains Study, Lereya et al Lancet 2015
Risk of mental health problems in adulthood
Normal popu-lation
Maltreated Bullied0.0
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Mental health determinants & risk factors: Growing evidence base
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Early interaction deficitsNeglect, abuse and harsh
upbringingSchool bullying
Work place stressLack of social support &
networksCommunity environment
Socio-economic determinants(poverty, social exclusion)
Life style
Alcohol and illegal drug use
Common NCD Specific
Cumulative incidence of first DSM-IV disorder
by comorbidity and severity“Generalized“ psychopathology already present at age 13
6Ormel et al., 201401.04.2017 Public mental health
Public mental health7
New thinking opens up for new interventions
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Public mental health8
Mental health systems
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Psychiatric services
Primary care
Prevention of mental disorders
Mental health promotion
Public mental health9
Mental health promotion
• MHP aims to strengthen mental health and wellbeing in the population
• Mental health is dependent on structural determinants: mental wellbeing is best achieved in equitable, just and non-violent societies (Patel 2014)
• New evidence shows that mental health promotion is effective • Parenting support• Socio-emotional learning programmes in schools• Work-life interventions to improve stress coping skills• Social activities for elderly people
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Evidence based public mental healthConsentious use of critically appraisedmethods to promote mental health, prevent mental health problems and provide services.
Public mental health interventionsare typically complex, and a larger variety of evaluation methods are needed thanIn a clinical context
Public mental health11
ROAMER: Geographic distribution of public mental health publications (weighted by GDP)
Forsman et al. 2015, Eur J Publ Health01.04.2017
Public mental health12
Effective public mental health interventionsParenting support interventions have been shown to promote life-long mental health and well-being of the offspring.
School programmes have consistently been shown to have positive moderate to strong effects on social and emotional skills and competences
Workplace reorganisation and increased control over work life improve mental wellbeing, increase productivity and reduce costs. Job search groups and individual placement and support promote mental health of job seekers.
Urban planning, such as housing programmes, have mental health effects
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Parenting support
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Intergenerational transmission ofmental healthproblems canbe stopped
Risk of mental disorders in the offspring of parents with mental disorders is reduced by 40% by preventive interventions
Siegenthaler et al. JAACAP 2012
Public mental health15
40 % of mental disorders can be prevented in high-risk families
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Effect of interventions on the risk in the child of the mental disorder diagnosed in the parent. Siegenthaler et al. JAACAP 2012
Public mental health16
NIH/NIDA: A child’s first eight years are critical for substance abuse prevention
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“There is strong evidence that a stable home environment, adequate nutrition, physical and cognitive stimulation, and supportive parenting can lead to good developmental outcomes.”
Public mental health17
Parenting support enables financial contribution to society
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Ministry of social affairs and integration, Denmark 2012
School programmes
Public mental health19
School-based mental health promotion• a.k.a. ”socio-emotional learning, “emotional literacy”, “emotional
intelligence”, “resilience”, “life skills” and “character education”, targeting• skills• curriculum• teacher education,• peer support• whole school approach
• Strong evidence of effectiveness• Strong effects on socio-emotional skills • Small to medium effects on emotional well-being• Evidence of reduction of depression, aggression, impulsiveness and
antisocial behavior
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Public mental health20
Income-to-needs ratio = poverty line = 1Internalizingproblems
Norwegian Mother and Child Cohort Study (MoBa), N=75296 (Zachrisson & Dearing, 2014)01.04.2017
Public mental health21
Evidence-based school interventions
• Anti-bullying programmes• Whole-school approach• Teacher training programmes
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Workplace interventions
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Public mental health24
Company performance and workplace wellbeing: indices by country
Source: Eurofound Third European Company Survey 201501.04.2017
Public mental health25
Evidence base for workplace interventions
• 14 systematic reviews show moderate effectivenessof workplace interventions
Wagner et al 2016, Int J Occup Envir Med
• A systematic review and meta-analysis of universal workplace interventions for prevention of depression (9 RCTs, mostly CBT-based interventions) show a small positive effect
Tan et al 2014, BMC Med
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Gap between evidence and practice
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Social determinants of mental health
Mental health promotion
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Social determinants of mental health
Mental health promotion
Mental Health in All Policies
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Going upstream: Structural determinants of mental health
PovertyGender inequalityWar and conflictsSocial exclusionIncome inequality
The NCD challenge
We need to take the step from ”four diseases, four risk factors” to ”five diseases, five risk factors”
Diet ExerciseAlcoholTobaccoAdverse childhood events
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CardiovascularDiabetes
Chronic respiratoryCancer
Mental disorders
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EU Joint Action for mental health and well-being 2013-2016Based on the European Pact for Mental Health and Well-being
Mental health promotion in schoolsWorkplace mental health promotionPrevention of depression and suicidesCommunity care and deinstitutionalisationMental health in all policies
• Identifies best practices for cross-sectoral work and whole-of-government practices across Europe
www.mentalhealthandwellbeing.eu
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Public mental health32
A tool for Mental Health in All Policies: Mental health impact assessment
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How does the proposed development/policy impact on…
• social determinants of mental health
• equity• people’s control• people’s participation• resilience and communtiy
assets• social inclusion?
Successful mental health actions build on intersectoral collaboration
Thanks!