Evidence-based mental health promotion resource - health.vic.gov.au

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Evidence-based mental health promotion resource13Electronic databases, reference lists and the advice of an expert panel were alsoused to identify relevant reviews. This process highlighted that understandings of thedeterminants of mental health, policies and programs for mental health promotion,and methods of evaluation are broad and diverse but yet to be suitably indexed. Inother words, databases are not sensitive to health promotion terms, the determinantsof health or mental health promotion. Nonetheless, our search strategy revealed a wideranging evidence base. Given the breadth of the evidence on a determinants of healthapproach to mental health and wellbeing, this resource is not a systematic review of allrelevant studies.1.3 Health promotion contextHealth promotion is often said to be everybody’s business. In other words, thepromotion of people’s health is a universal concern, understood and supported asrequiring multi-level, multi-sector spheres of action. This resource is consistent withhealth promotion’s universal principles, policies and practices, and its principleframework, the Ottawa Charter for Health Promotion (Appendix B), which takes adeterminants approach to health promotion.1.4 Understanding mental health promotionMental health promotion is underpinned by understandings of what constitutes mentalhealth, but it is often defined at the level of individuals rather than community orpopulation levels. Mental health promotion is frequently located in broad health andsocial development work, and distinguishes population-wide mental health promotionfrom the early intervention and prevention strategies of the mental illness movement.If a determinants approach is taken to defining mental health promotion, then it isnecessary to recognise the importance to mental health of ensuring people can developthe capacity to adapt to, respond to and/or control life’s challenges and changes, andhave the necessary resources to act on the circumstances that determine their mentalhealth and wellbeing.Consistent with health promotion generally, mental health promotion actions need tobe multi-level and intersectoral, and concerned with systems change, policy and thedevelopment of evidence about what population-based programs work. A key messagefor practitioners is that the inclusion in general health promotion programs, of mentalhealth promotion outcomes, will enhance their ability to achieve equity and tackleinequities (Mittelmark 2003; Tilford, Delaney & Vogels 1997). Equity-related outcomesare central to the Ottawa Charter for Health Promotion.Definitions of mental healthMental health is a state of wellbeing inwhich the individual realises his or her ownabilities, can cope with the normal stressesof life, can work productively and fruitfully,and is able to make a contribution to his orher community (WHO 2001,p 1).Mental health is the embodiment of social,emotional and spiritual wellbeing. Mentalhealth provides individuals with the vitalitynecessary for active living, to achieve goalsand to interact with one another in waysthat are respectful and just (VicHealth2005b, p 7).Definition of mental illness and mentaldisordersIn this resource, the term ‘mental disorders’is used rather than ‘mental illness’. Butas this VicHealth (2005a, p. 1) definitionmakes clear, the two terms refer to differentspectrums:Mental illness is a diagnosable disorderthat significantly interferes with anindividual’s cognitive, emotional and/orsocial abilities. Mental disorders are ofdifferent types and different degreesof severity.Definition of mental health promotionMental health promotion contributes togeneral health promotion by taking actionto ensure social conditions and factorscreate positive environments for the goodmental health and wellbeing of populations,communities and individuals. Mental healthpromotion requires action to influencedeterminants of mental health and addressinequities through the implementation ofeffective multi-level interventions across awide number of sectors, policies, programs,settings and environments.
14 Evidence-based mental health promotion resource1.5 Health promotion evidenceThere is considerable debate about what constitutes health promotion evidence.This debate follows the wide acceptance in the evidence-based medicine andepidemiological fields of a hierarchy of ‘rules of evidence’, which are derived frompositivist notions and developed from proof of causation and effect (McQueen 2001).Australia’s National Health and Medical Research Council (1998), for example,identified levels of evidence that particularly apply to medical treatment andinterventions, for which randomised controlled trials and quasi-experimental trialsare the highest standards. Rules of evidence designed for the medical sciences,however, have little fit with the action oriented fields of health promotion, which cutacross sectors and disciplines (McQueen 2001; Petticrew & Roberts 2002).There is no consensus on what constitutes ‘evidence’ in the broad field of healthpromotion, or on the methods of evaluation that provide the strongest evidence base.Typologies of evidence are thus proposed, rather than hierarchies, to indicate therelative contributions that different types of evidence can make to evaluation researchquestions (Petticrew & Roberts 2002). The use of a range of methods, therefore, isadvocated to evaluate critical success factors and outcomes.Evidence is not a stark term; rather, it should be used in terms of ‘weighing up’ thestrength of evidence before deciding on a course of action. Evidence of success couldthus be sufficient to show that action should be taken even when 100 per cent proof isnot available (Tones 1997). In decision making about what works, local knowledge andevidence on applied community-based programs, for example, may be more importantthan evidence that fits with prescribed levels of evidence in the medical–scientificor public health literature. Certainly, there are wide debates about different types ofknowledge, what constitutes evidence, the strengths and weaknesses of differentresearch methods, and thus what comprises robust evidence (Nutley, Walter &Davies 2002). These are debates that cannot be explored here.The task for this resource is to assess the quality of evidence for mental healthpromotion. Given the determinants approach we have taken, that task requires thedevelopment of criteria suitable for multidisciplinary and multi-sectoral health promotionfields of action. Because there is not yet a clear consensus on what evidence to include/exclude for reviews of health promotion interventions, and on what basis, each reviewneeds to establish its own criteria, drawing on accepted wisdom.
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Evidence-based mental health promotion resource - health.vic.gov.au

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