PREVENTION of PREVENTION of PSYCHOLOGICAL PSYCHOLOGICAL DISTRESS and DISTRESS and PROMOTION of PROMOTION of WELL-BEING: A WELL-BEING: A GLOBAL PERSPECTIVEGLOBAL PERSPECTIVE

World Federation for Mental Health ConferenceWorld Federation for Mental Health Conference

October 29, 2007October 29, 2007

John L. Romano, Ph.D.John L. Romano, Ph.D.

University of MinnesotaUniversity of Minnesota

QUESTIONQUESTION

What are the major social What are the major social issues that impact the issues that impact the mental health and well-mental health and well-being of people in your being of people in your country or region of the country or region of the world?world?

QUESTIONQUESTION

What is done to prevent or What is done to prevent or reduce the incidence of reduce the incidence of psychological, physical, psychological, physical, and social distress in your and social distress in your country or region of the country or region of the world?world?

QUESTIONQUESTION

How might psychology and How might psychology and mental health professions mental health professions work to promote the work to promote the emotional, physical, and emotional, physical, and social well-being of social well-being of people?people?

World Health OrganizationWorld Health OrganizationDefines Health asDefines Health as

“. . . a state of complete “. . . a state of complete physical, mental and social physical, mental and social well-being and not merely well-being and not merely the absence of disease and the absence of disease and infirmity”infirmity”

endorsed by WHO’s 191 member endorsed by WHO’s 191 member statesstates

WHO Defines Mental WHO Defines Mental Health Health State of Well-Being: Cope with State of Well-Being: Cope with

normal stressors, work normal stressors, work productively, and contribute to productively, and contribute to communitycommunity

Mental Health Promotion: Mental Health Promotion: Strategies that have a positive Strategies that have a positive effect on mental health, effect on mental health, including improvements in including improvements in socio-economic environmentssocio-economic environments

Mental Health Mental Health PromotionPromotion

Mental Health Promotion Mental Health Promotion requires multi-sector action requires multi-sector action including government and including government and non-government non-government agencies/services (e.g. faith agencies/services (e.g. faith communities, schools) communities, schools) working in partnershipworking in partnership

Global Mental HealthGlobal Mental Health Mental health problems increasing and Mental health problems increasing and

dramatically adding to the global burden dramatically adding to the global burden of disease and disability world wideof disease and disability world wide

Mental disorders account for about 14% Mental disorders account for about 14% (2007) of global burden of disease: (2007) of global burden of disease: depression, alcohol/drug abuse, psychosesdepression, alcohol/drug abuse, psychoses

Many mental health disorders go Many mental health disorders go untreated due to stigma and lack of untreated due to stigma and lack of understandingunderstanding

Middle and low-income countries devote Middle and low-income countries devote less than 1% of health expenditures to less than 1% of health expenditures to mental healthmental health

Groups at risk include children Groups at risk include children and adolescents, elderly, and adolescents, elderly, displaced persons, abused displaced persons, abused women, indigenous personswomen, indigenous persons

World has realized dramatic World has realized dramatic improvements in physical improvements in physical health, but only limited health, but only limited improvement in mental health improvement in mental health

Noncommunicable Noncommunicable Diseases (NCD)Diseases (NCD) Rapid rise of NCD, e. g. heart Rapid rise of NCD, e. g. heart

disease, cancer, diabetes, disease, cancer, diabetes, stroke stroke

In 1998 NCD contributed to In 1998 NCD contributed to about 60% of deaths and 43% about 60% of deaths and 43% of global burden of disease. By of global burden of disease. By 2020 estimates are 73% and 2020 estimates are 73% and 60% (respectively)60% (respectively)

Cancer, cardiovascular disease, Cancer, cardiovascular disease, diabetes, and pulmonary disease diabetes, and pulmonary disease related to life style behaviors: related to life style behaviors: tobacco use, poor nutrition, tobacco use, poor nutrition, physical inactivityphysical inactivity

Much is known about the Much is known about the prevention of NCDprevention of NCD

Depression + NCD Reduces Depression + NCD Reduces Overall HealthOverall Health

Health Japan 21Health Japan 21

To Promote Healthier Citizens, e.g. To Promote Healthier Citizens, e.g. reduce smoking, improve nutritionreduce smoking, improve nutrition

Smoking rates: Males-53% (1997) to Smoking rates: Males-53% (1997) to 43% (2002), Females-steady 10-12%43% (2002), Females-steady 10-12%

Raise Awareness of Health/Tobacco Raise Awareness of Health/Tobacco LinkLink

Support Smoking Cessation ProgramsSupport Smoking Cessation Programs

Other ExamplesOther Examples

Scotland: Raise awareness of mental Scotland: Raise awareness of mental illness and promote mental health. illness and promote mental health. Reduce stigma.Reduce stigma.

Finland: Promoting children’s mental Finland: Promoting children’s mental health. Promoting parent/child health. Promoting parent/child interaction. Early identification of risk interaction. Early identification of risk factors.factors.

United States: Healthy People 2010. United States: Healthy People 2010. Increase quality and years of healthy life Increase quality and years of healthy life and reduce health disparitiesand reduce health disparities

Mental Health Mental Health Resources in the WorldResources in the World WHO reports (2001) 32% countries WHO reports (2001) 32% countries

reported no government budget for reported no government budget for mental healthmental health

Of countries with a budget, 36% Of countries with a budget, 36% spent less than 1% of total health spent less than 1% of total health budget on mental healthbudget on mental health

Percentage of total health budget Percentage of total health budget on mental health from less than 2% on mental health from less than 2% (low income countries) to 7% (high (low income countries) to 7% (high income)income)

National mental health policies National mental health policies and budgets need to address and budgets need to address broad issues affecting the mental broad issues affecting the mental health of all sectors of society health of all sectors of society

(e. g. refugees, socially alienated, (e. g. refugees, socially alienated, poor, elderly, children)poor, elderly, children)

Mental Health and the Mental Health and the ElderlyElderly Increase number of elderly in Increase number of elderly in

the world (by 2025, 1.2 billion the world (by 2025, 1.2 billion elderly, and nearly 75% in elderly, and nearly 75% in developing world)developing world)

WHO's global movement on WHO's global movement on active agingactive aging

Active, healthy older person as Active, healthy older person as a community and economic a community and economic resourceresource

PreventionPrevention

Caplan’s (1964) Three-Part Caplan’s (1964) Three-Part DefinitionDefinition

PrimaryPrimary Secondary Secondary TertiaryTertiary

PreventionPrevention

Gordon (1987) and Gordon (1987) and

Institute of Medicine (1994)Institute of Medicine (1994) UniversalUniversal Selected Selected IndicatedIndicated

PreventionPrevention

Romano and Hage (2000)Romano and Hage (2000) Stops Problem from OccurringStops Problem from Occurring Delays Onset of ProblemDelays Onset of Problem Reduces Impact of Existing ProblemReduces Impact of Existing Problem Promotes Emotional and Physical Promotes Emotional and Physical

Well-BeingWell-Being Supports Institutional and Supports Institutional and

Community Policies that Promote Community Policies that Promote Well-BeingWell-Being

Social, Environmental, Social, Environmental, and Economic and Economic Determinants of Mental Determinants of Mental HealthHealth Risk Factors: Drugs/alcohol, lack of Risk Factors: Drugs/alcohol, lack of

education, poor nutrition, poverty, education, poor nutrition, poverty, racial injustice, violence/delinquency, racial injustice, violence/delinquency, war, work stress, unemploymentwar, work stress, unemployment

Protective Factors: Social participation, Protective Factors: Social participation, social services, ethnic minority social services, ethnic minority integration, social networksintegration, social networks

____________________WHO: Prevention of Mental Disorders, 2004. Geneva.WHO: Prevention of Mental Disorders, 2004. Geneva.

Prevention Prevention InterventionsInterventions Schools: PreK-16Schools: PreK-16 WorkplacesWorkplaces Medical SettingsMedical Settings NeighborhoodsNeighborhoods Faith CommunitiesFaith Communities

SchoolsSchools

Start earlyStart early Involve parents and Involve parents and

communitycommunity Age appropriate Age appropriate Repeat oftenRepeat often ComprehensiveComprehensive Systemic improvementsSystemic improvements

Student Well-BeingStudent Well-Being Development of knowledge, skills, Development of knowledge, skills,

behaviors, and attitudes that maximize behaviors, and attitudes that maximize students' functioning in settings where students' functioning in settings where they live and workthey live and work

Promote personal development through Promote personal development through (a) knowledge, (b) skills, (c)behaviors, (a) knowledge, (b) skills, (c)behaviors, (d) attitudes(d) attitudes

Domains of academic, inter-and intra-Domains of academic, inter-and intra-personal, and physical and emotional personal, and physical and emotional healthhealth

In school, home, communityIn school, home, community J. L. Romano (1999)J. L. Romano (1999)

WHO’s child friendly schools' WHO’s child friendly schools' initiative to promote positive initiative to promote positive psychosocial environment in psychosocial environment in school (e. g. cooperation, school (e. g. cooperation, tolerance, support, tolerance, support, family/school connections) family/school connections)

Work Life and Work Life and EmploymentEmployment Some countries 35-45% of employee Some countries 35-45% of employee

absenteeism due to mental health absenteeism due to mental health problemsproblems

Increase employer awareness of Increase employer awareness of mental health issuesmental health issues Psychosocial climate in work placePsychosocial climate in work place Social skills trainingSocial skills training CounselingCounseling Unemployment (especially of youth)Unemployment (especially of youth)

Prevention ProjectPrevention Project What is the NeedWhat is the Need Who and What is the FocusWho and What is the Focus Identify StakeholdersIdentify Stakeholders Stakeholders meet to planStakeholders meet to plan Conduct Needs AssessmentConduct Needs Assessment What is Being Prevented and What is Being Prevented and

PromotedPromoted

Prevention ProjectPrevention Project Project GoalsProject Goals Project ActivitiesProject Activities Who will Implement the ProjectWho will Implement the Project Who are the RecipientsWho are the Recipients Deliver the Project InterventionDeliver the Project Intervention Evaluate the interventionEvaluate the intervention Report back to StakeholdersReport back to Stakeholders Plan Future ProjectsPlan Future Projects

Prevention Best Prevention Best PracticesPractices Prevent Human Suffering throughPrevent Human Suffering through Proactive InterventionsProactive Interventions Prevention for Individual and Systemic Prevention for Individual and Systemic

ChangeChange Reduce Risks & Promote StrengthsReduce Risks & Promote Strengths Engage in Political and Social Engage in Political and Social

AdvocacyAdvocacy______________________Hage, Romano, Conyne, Kenny, Matthews, Schwartz, Waldo: Best Practice Hage, Romano, Conyne, Kenny, Matthews, Schwartz, Waldo: Best Practice Guidelines on Prevention Practice, Research, Training, and Social Advocacy for Guidelines on Prevention Practice, Research, Training, and Social Advocacy for Psychologists Psychologists (The Counseling Psychologist(The Counseling Psychologist, 2007), 2007)

Best PracticesBest Practices

Culturally Relevant Prevention Culturally Relevant Prevention PracticesPractices

Ethical Issues in PreventionEthical Issues in Prevention Prevention Addresses Individual Prevention Addresses Individual

as well as Systemic Factorsas well as Systemic Factors Prevention Based on Theory and Prevention Based on Theory and

ResearchResearch Develop Prevention CompetenciesDevelop Prevention Competencies

Future ChallengesFuture Challenges

Tensions between Professional Tensions between Professional Training and Marketplace Training and Marketplace

Student ExpectationsStudent Expectations Training Program AdjustmentsTraining Program Adjustments Multidisciplinary CollaborationsMultidisciplinary Collaborations Research and FundingResearch and Funding

Future HopesFuture Hopes Bring Prevention perspectives, concepts, Bring Prevention perspectives, concepts,

skills into the mainstream of psychology, skills into the mainstream of psychology, mental health and human development mental health and human development

Promote the importance of multidisciplinary Promote the importance of multidisciplinary partnerships to impact societal problemspartnerships to impact societal problems

Focus on strengths and protective factorsFocus on strengths and protective factors Greater attention to political, institutional Greater attention to political, institutional

and systemic barriers to the promotion of and systemic barriers to the promotion of mental health in all environments mental health in all environments