Promotion

94 MENTAL HEALTH PROMOTION
Conclusions
In this chapter we hoped to emphasize universal interventions focused on positive
mental health and undertaken, where possible, in the context of health promoting
settings. At the same time, in recognition of the variety of practice and the evidence
available from evaluations we have included activities focusing on aspects of mental
health that have not been undertaken within the context of settings or whole-school
approaches. Some have been universal, but others were directed towards children who
have been designated ‘at risk’. Interventions have ranged from those which clearly
applied key health promotion principles to those with a narrower health education
focus.
Societies are increasingly multi-ethnic and multi-cultural and it has to be recognized
that conceptions of mental health in childhood will differ and these differences
will need to be understood and acknowledged in developing mental health promotion
activities. At the same time difficult questions can arise in pluralist societies about
values and practices in some groups which might be considered to place the mental
health of children ‘at risk’.
This chapter has considered the evidence for effective programmes in childhood.
There is evidence from activities implemented on a universal basis as well as evidence
for programmes with vulnerable groups. Although active efforts are being made to
bring evidence together from countries across the world it is still the case that most
disseminated evidence is drawn from programmes in a small number of higher income
countries. We raised a few special issues for the chapter at the outset and can provide
closing comments on these. In the case of inequalities in mental health the extent and
nature of the problems is widely acknowledged and many proposals made for redressing
problems at the global level. Although there have been improvements in some
countries the inequities across the world remain large. Within specific countries there
have been initiatives that have illustrated a commitment to improve mental health of
disadvantaged children. At the outset we commented on the competing ideas about
children and childhood some of which were very much in tune with empowerment
models of health promotion. There are a growing number of policies and activities
that now make tangible efforts to give children a participatory role in decisions about
situations which affect them. At the same time there are many situations where the
approach to children is top-down and authoritarian and their active involvement
is not encouraged. In all parts of the world very large numbers of children are experiencing
adverse circumstances which are barriers to achieving mental health. Many
demonstrate high levels of resilience in the face of these circumstances but others
are vulnerable to mental ill health or are experiencing problems. There is an urgent
need for national and international action to improve the health of all the world’s
children.