Mental health promotion in Health Promoting Hospitals

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Mental health promotion in Health Promoting
Hospitals

• Jürgen Pelikan
• Christina Dietscher
• WHO Collaborating Centre for Health Promotion in
  Hospitals and Health Care, Vienna, Austria

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Contents

• The context Why is mental health promotion high
  on the European agenda?
• Options for influencing mental health / mental
  disorder
• Mental health promotion as an important dimension
  in Health Promoting Hospitals
• Conceptual issues
• Overview What has been done so far?
• Possible next steps

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Mental health promotion high on the European
agenda
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There is no health without mental health

• (World Federation on Mental Health)

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Epidemiological data

• Mental disorders represent a huge burden to
  society
• and public economics
• Up to 25 of adult EU citizens concerned
• Fears and depressions (30 Mio.)
• Alcohol problems (21 Mio.)
• Alzheimer co. (7 Mio.)
• Schizophrenia, manic-depressive disorders, panic
  disorders (4 Mio., resp.)
• Stigmatisation an additional problem for people
  concerned
• More deaths from suicides than by road accidents
  in the EU (58 000 people)
• 3-4 of GNPs lost (absenteeism, treatment related
  costs)

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Agenda setting for mental health promotion in
Europe

• 1985 Mental Health Europe is founded as part of
  the World Federation for Mental Health (since
  1948)
• Slogan There is no health without mental
  health
• 1993 Treaty of Amsterdam article 152 EU
  mandate for Public Health
• 1997 Finland starts discussions of EU health
  ministers since then, many EU-Projects on mental
  health
• 2003-2008 Mental Health explicit topic of Public
  Health-Programme of EC
• 2003 Launch of EC Working Party on Mental Health
• 2005 (January) WHO Conference of Health
  Ministers Launch of
• Mental Health Declaration for Europe
• WHO Mental Health Action Plan
• 2005 (October) Launch of EU-Green Paper on
  Mental Health Start of consultation process
  last meeting Information, data and knowledge in
  mental health was held 18-19 May 2006.

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EU-Green Paper on Mental Health

• Goals
• Develop frameworks for exchange and cooperation
  between member states
• Coherent measures across sectors
• Involve as many stakeholders as possible in the
  development and implementation of solutions
• http//europa.eu.int/comm/health/ph_determinants/l
  ife_style/mental_health_en.htm

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WHO Mental Health Action Plan (2005)

• Improve awareness on importance of mental
  well-being
• Reduce stigma, discrimination, inequality
  enhance empowerment and support
• Actively involve people with mental health
  problems and their families in the process
• Development and implementation of comprehensive
  and efficient systems for mental health
  (including health promotion, prevention,
  treatment and care, rehabilitation)
• Training of competent experts
• Respect experiences and knowledge of those
  concerned as an important basis for planning and
  development of specific offers and measures
• http//www.who.dk/document/mnh/edoc07.pdf

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IMHPA action areas (2005)

• Support of parents and families in the early life
  years
• Mental health promotion in schools
• Mental health promotion at the workplace and
  prevention of work related stress
• Mentally healthy ageing
• Specific attention to groups at risk (vulnerable
  groups)
• Prevention of depression and suicide
• Prevention of violence and negative consequences
  of substance abuse
• Cooperation with primary and secondary health
  care sector
• Reduction of (social) inequality and
  stigmatisation
• Cooperation with other sectors in order to create
  supportive frameworks
• IMHPA Implementing Mental Health Promotion
  Action, one of the
• EC projects on mental health

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IMHPA action areas (2005)

• Support of parents and families in the early life
  years
• Mental health promotion in schools
• Mental health promotion at the workplace and
  prevention of work related stress
• Mentally healthy ageing
• Specific attention to groups at risk (vulnerable
  groups)
• Prevention of depression and suicide
• Prevention of violence and negative consequences
  of substance abuse
• Cooperation with primary and secondary health
  care sector
• Reduction of (soziale) inequality and
  stigmatisation
• Cooperation with other sectors in order to create
  supportive frameworks
• IMHPA Implementing Mental Health Promotion
  Action, one of the
• EC projects on mental health

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How can mental health / mental disorder be
distinguished from physical / social health and
disorder? What are determinants of mental
health / mental disorder?How can mental health
promotion be implemented?
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How can mental health be distinguished from
physical and social health?
Prevention
Promotion
C U L T U R E
MentalHealth
M A T E R I A L E N V I R O N M E N T
S O C I A LE N V I R O N M E N T
Behaviour / Action
Physical health
Social health
Prevention
Prevention
Promotion
Promotion
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What influences mental health / mental disorder?
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What possible interventions to support mental
health can be derived?

• General goal Reduction of risks improvement of
  (coping-)resources
• Person oriented
• Reduction of personal risks e.g. lifestyles,
  personal values,
• Improvement of resources e.g. stress
  management, communication skills, crisis
  intervention, mediation, conflict management
• Situation oriented
• Reduction of environmental stressors
• Improvement of supportive environmental
  conditions (e.g. support)
• Intervention areas
• Settings, e.g. hospitals
• Life phases (from babies to the elderly)
• Specific topics (e.g. addiction, violence)
• Capacity building via research, professional
  education and training
• Interventions can address
• psyche (via communication)
• Body (e.g. anti-depressants)
• Social status

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How can mental health promotion be related to
HPH?
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What does mental health promotion in the hospital
aim at?

• Improve personal well-being of
• Staff
• Patients
• Visitors and caring realtives
• Improve organisational climate in the hospital

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Mental health problems in the hospital setting

• Patients Patient role as stressful role (because
  of disorientation, pain, ...), with risks for
• Anxieties
• Depression
• Hospitalism
• ...
• Staff Health worker role as stressful role, with
  risks for
• Burnout
• Mobbing
• Violence
• Problematic coping behaviours (e.g. smoking)
• Substance abuse / addictions
• High rate of staff turnover
• ...
• Community Stressful role of visitors and caring
  relatives

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Why MPH in the hospital setting?

• Hospitals are focused on PHYSICAL health of
  PATIENTS, but MENTAL health of STAFF AND patients
  is important for
• Productivity, work satisfaction and health of
  staff (there is evidence about the link between
  stress and the immune system)
• Recovery and health gain of patients
• Health of caring relatives, as affected by both
  health status of patients, and behaviour of staff

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(Mental) Health determinants of the hospital
setting
Provider of services
Setting for living
STRESSORS RESOURCES
STRESSORS RESOURCES
Patients Staff Community population (with
personal risks and reources)
STRESSORS RESOURCES
Community
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18 HPH core strategies
HP for... HP by ...
Community
Patients
Staff
MIT-1
REG-1
Worklife in the hospital STA-1
Self-preservation of health
Living in the hospital PAT-1
Access to hospital COM-1
Work processes / routinesSTA-2
Treatment care PAT-2
Continuity of careCOM-2
Co-production of health
Workingenvironment STA-3
Regional environment COM-3
Supportive Hospital setting
habitat PAT-3
Disease management PAT-4
Disease managementCOM-4
Disease managementSTA-4
HP disease management
Lifestyles for staffSTA-5
Lifestyles for patientsPAT-5
Lifestyles for community COM-5
HP lifestyle development
Supportive regionSTA-6
Supportive regionPAT-6
Supportive regionCOM-6
HP community development
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Suggestion for mental health promotion in 18 HPH
core strategies
MHP for... MHP by ...
Community
Patients
Staff
MIT-1
REG-1
Worklife in the hospital STA-1
Self-preservation of mental health
Living in the hospital PAT-1
Access to hospital COM-1
Work processes / routinesSTA-2
Treatment care PAT-2
Continuity of careCOM-2
Co-production of mental health
Workingenvironment STA-3
Regional environment COM-3
MH-Supportive Hospital setting
habitat PAT-3
MH oriented disease management
Disease management PAT-4
Disease managementCOM-4
Disease managementSTA-4
MH oriented lifestyle development
Lifestyles for staffSTA-5
Lifestyles for patientsPAT-5
Lifestyles for community COM-5
MH oriented community development
Supportive regionSTA-6
Supportive regionPAT-6
Supportive regionCOM-6
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Suggestion Inclusion of MHP into the 5 standards
for HP in the hospital

• A written policy
• Include mental health promotion
• Patient assessment
• Assess for mental health needs
• Patient information and intervention
• Pay attention to MH needs of patients
• A healthy workplace
• Mental health promotion at the workplace
• Continuity and cooperation
• Support continuous mental health promotion also
  after discharge

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Developing the (mental) HP quality of the
hospital (I)

• Inclusion of MHP into the hospitals mission
  statement and management structure
• (M)HP-Steering group (involving the hospital
  directorate),
• (M)HP manager and team (as sub-division of the
  directorate),
• Network of (M)HP contact persons in the
  hospitals sub-units
• Explicit (M)HP budget
• Annual (M)HP action plan with specific goals,
  measures, projects and implementation strategies
  (e.g. non-mobbing policy for staff)
• Inclusion of (M)HP into existing guidelines and
  standards of the hospital and where necessary
  development of new (M)HP guidelines

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Developing the (mental) HP quality of the
hospital (II)

• Specific MHP-training for staff and executive
  personnel
• Participative development structures
• Health circles,
• System for proposing organisational change
• Regular information about MHP activities of the
  hospital
• Newsletters,
• Annual presentations,
• Intranet
• Cooperation in (regional) alliances for mental
  health promotion
• Regular evaluation, monitoring and reporting
  about MHP relevant outcomes and impacts (e.g.
  patient and staff surveys, Balanced Score Card)

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7 HPQM Strategies for Implementing the
Comprehensive Concept of HPH, Following
Donabedians Approach
Outcomes/ impacts of services ( settings)
Processes of services ( settings)
Quality function/ activity for quality of
Structures of services ( settings)
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What has been done so far in the HPH
network?Projects presented at HPH conferences
between 1997 and 2005
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How many projects have been carried out on mental
health?

• Analysis of projects documented in HPH conference
  abstract books and Virtual Proceedings
• Between 1997 and 2005, a total of 2270 abstracts
  were documented.
• Of these, 150 had a clear link to mental health
  (including projects in relation to psychiatric
  health care) ? 6,5!

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Development over time Number of projects per year
Kick-Off of TF on HP Psychiatric Health Care
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Geographical coverage Countries with high number
of projects
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Target groups
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Patient-oriented projects analysed by HPH core
strategies
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Recommendations

• Start with promoting the mental health of
  hospital staff
• Combine bottom-up with top-down approaches

Bottom-up Observe your own mental well-being
every day what makes you happy, what
doesnt? Create organisational opportunities to
discuss mental well-being of staff in a
respectful and open climate (e.g. weekly team
reflections) Find ways to cooperate with others
in order to address MH problems
Top-Down Develop an organisational MHP
policy Include mental health into regular patient
and staff surveys Implement health circles to
develop solutions for MH problems Support
empowerment of staff and patients by specific
trainings
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Possible next steps in strengthening MHP in HPH

• WHO project Stress prevention for nursing staff
  in the hospital
• Literature review on epidemiology of stress in
  European nurses
• Literature review on successful models
  (interventions on personal and organisational
  level) of reducing stress
• Developing tools for dissemination

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Thank you for your attention!