Promotion

56 MENTAL HEALTH PROMOTION
• Social marketing
• Programme planning
• Evaluation
Another way is to relate theory to levels of influence on mental health as presented in
ecological models such as that of Bronfenbrenner (1979), described in Chapter 4,
who distinguished intrapersonal; interpersonal; institutional; community factors; and
public policy. This model was adapted by Glanz and Rimer (1995) to group theories.
Some of the concepts and theories in Box 3.4 relate particularly to one of these
levels, others to two or more levels.
Application of theory in a lifespan approach to mental
health promotion
It is not possible to make categorical statements about mental health promotion theory
and any distinctiveness it may have from general health promotion. All disciplines
continue to develop their theoretical foundations and this is particularly the case with
relatively new ones such as mental health promotion. We can tentatively suggest that
psychological theory maintains a higher profile in mental health than in general
health promotion. In a discipline with philosophical differences around what should
take place in its name there will be differing preferences in the selection of theory.
For example, those who conceive of mental health promotion as combining policy
and educational work informed by an empowerment model will tend to draw on a
different combination of theories than those with a narrower focus on health education
informed by a preventive medical model. If working in accordance with a lifespan
approach theory relevant to the whole of the lifespan as well as to its differing phases
will need to be used. In general the particular theory or combination of theories used in
mental health promotion practice will depend on the specific issue to be addressed.
The importance of adopting a critical approach to selection and use of theory was
noted earlier. Space precludes any detailed consideration of the critique of the theories
used in mental health promotion. In a lifespan book reflections on the notion of lifespan
development and developmental theories are particularly relevant. One theory,
for example, which has been subject to criticism is Piaget’s theory of cognitive development.
The general progression of thinking which Piaget described leading from
ego-centric through to formal operational is generally supported but the rather rigid
presentation of the progression through stages has been questioned through later work
(Donaldson 1978). Children, it transpires, can think at more sophisticated levels in
relation to some areas of their lives than others and in relation to situations which
make sense to them and where they are particularly motivated to understand. Given
the emphasis that is placed in health promotion on fostering children’s active participation
in the decisions that affect them it is important to draw on cognitive developmental
theory but not to use it so rigidly that children’s competencies are strictly age
related.
The usefulness of social cognition models of health related decision-making and