Pubic mental health: time to translate evidence into policy and practice

Public mental health: Time to translate evidence into practice

Kristian Wahlbeck

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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

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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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Mental health systems

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Psychiatric services

Primary care

Prevention of mental disorders

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


ROAMER: Geographic distribution of public mental health publications (weighted by GDP)

Forsman et al. 2015, Eur J Publ Health01.04.2017


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


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


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


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.”


Parenting support enables financial contribution to society

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Ministry of social affairs and integration, Denmark 2012

School programmes


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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Income-to-needs ratio = poverty line = 1Internalizingproblems

Norwegian Mother and Child Cohort Study (MoBa), N=75296 (Zachrisson & Dearing, 2014)01.04.2017


Evidence-based school interventions

• Anti-bullying programmes• Whole-school approach• Teacher training programmes

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Workplace interventions



Company performance and workplace wellbeing: indices by country

Source: Eurofound Third European Company Survey 201501.04.2017


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



Social determinants of mental health


Mental Health in All Policies


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


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



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!

Health & Medicine

Pubic mental health: time to translate evidence into policy and practice