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Pathways to Promoting Mental Health within Public Health and Beyond

Contents

I Introduction
II Mental Health Promotion in Ontario
III Survey Findings from Pathways to Promoting Mental Health: A 2015 Survey of Ontario Public Health Units
IV Conclusion and Next Steps
V References
VI Key Resources

--Submitted by Monica Nunes

I Introduction

The Centre for Addiction and Mental Health(CAMH) Health Promotion Resource Centre (CAMH HPRC), housed within the Provincial System Support Program at CAMH, recently launched the report Pathways to Promoting Mental Health: A 2015 Survey of Ontario Public Health Units. The report highlights the results of a 2015 provincial survey conducted as a partnership between the Ministry of Health and Long-Term Care's Health Promotion Division (MOHTLC – HPD) and CAMH HPRC. With participation from all 36 Ontario public health units (PHUs), the report documents current mental health promotion (MHP) activities in public health being delivered for Ontarians of all ages and stages and identifies specific MHP activities occurring for adults 18 years and older.

The release of the report is timely as it marks the one year anniversary of the announcement of Phase 2 of Ontario’s Comprehensive Mental Health and Addictions Strategy (http://www.health.gov.on.ca/en/public/programs/mentalhealth/docs/open_mi....) Along with an expanded focus on the adult population from Phase 1’s focus on children and youth, Phase 2 also identifies an explicit commitment to promoting mental health and well-being as one of five key action areas (MOHLTC, 2014). The results of this survey will be used to inform Phase 2 of the Strategy.

II Mental Health Promotion in Ontario

Prior to the Phase 2 announcement and since that time, there has been growing momentum within Ontario’s health system to promote the mental health of Ontarians. There is also an increasing focus on the role of Ontario public health units (PHUs) in promoting mental health given that the core purpose of PHUs is to prevent illness and promote health.

In Ontario, the Ontario Public Health Standards (MOHLTC, 2008 or as current) outline the requirements for PHUs to deliver “public health programs and services that contribute to the physical, mental, and emotional health and well-being of all Ontarians.” Recent research focusing on child and youth mental health promotion (MHP) shows that:

  • Ontario PHUs are active in promoting mental health for children and youth (CAMH HPRC, Public Health Ontario, Toronto Public Health, 2013).
  • There is a desire for public health to have an enhanced role in MHP (CAMH HPRC, Public Health Ontario, Toronto Public Health, 2013; Murphy-Oikonen et al., 2015).

Within public health and beyond, support for bolstering MHP draws from various factors including:

  • A growing understanding of mental health as more than the absence of disease. Mental health is increasingly understood as a positive concept, a resource for living, and something that we can all strive for even in the presence of mental illness.
  • An increasing awareness that we should value mental health as much as physical health particularly given the intersections between the two experiences. In fact, there is research to show a lower prevalence of chronic disease among those with good mental health (Keyes, 2005).
  • An interest in the potential return on investment by promoting mental health and preventing mental illness. The Mental Health Commission of Canada outlines that the costs of mental illness are not only extensive but long-term given that many mental health problems have their onset in childhood and adolescence. However, this reality also presents a huge opportunity to promote mental health, particularly in young people, by reducing the incidence of new illness. The Mental Health Commission of Canada estimates that investments in upstream mental health promotion approaches can have a substantial impact on the overall health of a population which is a good return on investment (MHCC, n.d.).

III Survey Findings from Pathways to Promoting Mental Health: A 2015 Survey of Ontario Public Health Units

Despite the increasing interest in MHP, research also reveals that in order to improve upon current MHP efforts within Ontario’s health system, there is a need to better understand how the provincial public health system presently delivers MHP in terms of scope, resourcing and prioritization. Consequently, Ontario’s 36 public health units participated in an online survey conducted as a partnership between the Ministry of Health and Long-Term Care's Health Promotion Division (MOHTLC – HPD) and CAMH HPRC to provide insight into MHP activities. Key findings from the report show that there is a substantial amount of MHP work underway, with wide variation in specific activities. Several characteristics of these activities are worth highlighting:

  • All 36 PHUs (100%) were engaged in MHP for Ontarians of all ages and stages.
  • A total of 272 MHP activities for adults were reported by PHUs.
  • MHP activities for adults were concentrated among new parents/postnatal mothers,
  • parents/guardians of children and youth and pregnant women with fewer activities for young
  • adults, seniors, newcomers/immigrants/refugees, LGBTTTIQ individuals, and First Nations, Inuit and Métis groups.
  • Groups of PHUs (i.e. peer groups) with urban characteristics reported more activities than other groups of PHUS with 40% (or 109 of 272 activities) occurring in these areas.
  • 69% of all 272 MHP activities involved partnerships that contributed service delivery, content/subject matter expertise or community engagement efforts. Common partners include mental health and substance use agencies (46%), followed by multi-service community agencies (39%), primary care facilities (28%) and other diverse partners.

IV Conclusion and Next Steps
 
This report provides new and timely insight into MHP work currently being performed by PHUs for Ontarians of all ages and stages. The report also identifies five recommendations to help identify mechanisms and opportunities to better integrate MHP as part of PHU practice.

While the recommendations stem from a survey of PHUs, they have applicability beyond the public health system as the survey results reveal that PHUs are collaborating with partners from multiple sectors to deliver MHP activities. This is not surprising since we know that various service providers play a role in delivering mental health promotion programming in Ontario. Some examples include programs like Canadian Mental Health Association (CMHA) Ontario’s Mood Walks and Living Life to the Full as well as the comprehensive health promotion programs available through most community health centres as well as provincial health promotion resource centres (CMHA, 2015; CMHA 2015).

While PHUs are collaborating with partners from multiple sectors, research also shows there are opportunities to enhance consistency and coordinate provincial efforts to promote mental health across the public health system and among collaborating sectors (CAMH HPRC, 2015; CAMH HPRC, Public Health Ontario, Toronto Public Health, 2013; Murphy-Oikonen, J., et al., 2015)

Indeed, previous research on MHP in public health highlights the importance of facilitating partnerships and collaboration (CAMH HPRC, PHO, TPH, 2013; Barry, 2007). For instance, promoting mental health requires comprehensive approaches that address multiple health determinants at various settings, including those at the individual, interpersonal and environmental levels (CAMH, TPH & Dalla Lana School of Public Health, 2014), which partnerships can help facilitate. Where resources/capacity are limited, partnerships can be leveraged to enhance MHP through the sharing of resources (Freeman, 2010).

As a next step in facilitating a shared understanding and approach for MHP across Ontario, the CAMH HPRC is convening a multisector group to develop a set of guiding principles for MHP in Ontario. This group will work to develop guiding principles that promote a system-wide, population health approach to MHP for diverse sectors in Ontario including public health, community mental health and addictions, health care services, education and more.  

To learn more about the Pathways to Promoting Mental Health report, please visit the CAMH HPRC website at https://www.porticonetwork.ca/web/camh-hprc/pathways-to-mhp.

V References

CAMH Health Promotion Resource Centre. (2015) Pathways to Promoting Mental Health: A 2015 Survey of Ontario Public Health Units. Toronto, ON: Centre for Addiction and Mental Health. Retrieved from https://www.porticonetwork.ca/web/camh-hprc/pathways-to-mhp

CAMH Health Promotion Resource Centre, Public Health Ontario & Toronto Public Health. (2013). Connecting the Dots: How Ontario Public Health Units are Addressing Child and Youth Mental Health. Retrieved from:  https://www.porticonetwork.ca/documents/81358/128451/CTD_Report.pdf/1977...

CAMH, University of Toronto & Toronto Public Health. (2014). Best Practice Guidelines for Mental Health Promotion Programs: Children (7–12) and Youth (13–19). Retrieved from https://www.porticonetwork.ca/web/camh-hprc/
resources/best-practice-guidelines-for-mental-health-promotion-programs;jsessionid=9DBAA5953279B-
52447D332ADD38707AA

CMHA Ontario. (2015).  Mood Walks. Retrieved from: http://www.moodwalks.ca/

CMHA Ontario. (2015).  Living Life to the Full. Retrieved from: https://ontario.cmha.ca/public-policy/living-life-to-the-full/

Keyes, C.L.M. (2005). Chronic physical conditions and aging: Is mental health a potential factor? Ageing International, 30(1), 88-104.

Barry, M.M. (2007). Building capacity for effective implementation of mental health promotion. Australian e-Journal for the Advancement of Mental Health, 6(2). Retrieved from https://aran.library.nuigalway.ie/bitstream/handle/10379/2614/01%202007_...

Mental Health Commission of Canada. (n.d.) Making the Case for Investing in Mental Health in Canada
http://www.mentalhealthcommission.ca/English/system/files/private/docume...

Ministry of Health and Long-Term Care. (2008). Ontario Public Health Standards. Toronto: Queen’s Printer for Ontario. Retrieved from http://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/

Ministry of Health and Long-Term Care. (2014). Expanded Mental Health and Addictions Strategy. Retrieved from http://www.health.gov.on.ca/en/public/programs/mentalhealth/docs/open_mi...

Murphy-Oikonen, J., Pavkovic, M. Sawula, E., Vandervoort, S. (2015). Identifying Areas of Focus for Mental Health Promotion in Children and Youth for Ontario Public Health. Retrieved from https://www.porticonetwork.ca/documents/81358/128451/Identifying+Areas+o...

VI Key Resources

Websites:

CAMH Health Promotion Resource Centre Website

CAMH Health Promotion Resource Centre (CAMH HPRC) is Ontario's source for health promotion evidence regarding mental health and substance use and we build related capacity in health promotion, public health and allied health professionals. The website hosts mental health promotion research reports, infographics on population mental health, archived webinars and more on the subject of mental health and substance use. Website: https://www.porticonetwork.ca/web/camh-hprc

National Collaborating Centre on Healthy Public Policy – Population Mental Health Section

The National Collaborating Centre for Healthy Public Policy (NCHPPP) is one of Canada’s six National Collaborating Centres for Public Health, or NCCs. The NCCs were created in 2005-2006 in order to help to bridge research with action. The NCCHPP conducts work in the area of population mental health and has developed several useful resources including a briefing note on defining a population mental health framework and a framework for healthy public policies favouring mental health. Website: http://www.ncchpp.ca/550/Population_Mental_Health.ccnpps

Related Reports:

Pathways to Promoting Mental Health: A 2015 Survey of Ontario Public Health Units (2015)

Pathways to Promoting Mental Health: A 2015 Survey of Ontario Public Health Units is a report that highlights the results of a 2015 provincial survey conducted as a partnership between the Ministry of Health and Long-Term Care's Health Promotion Division and CAMH HPRC. The report documents current mental health promotion (MHP) activities in public health being delivered for Ontarians of all ages and stages. The report also identifies specific MHP activities occurring for adults 18 years and older.  The full report, summaries in English and French, and infographic are available here: https://www.porticonetwork.ca/web/camh-hprc/pathways-to-mhp.

Identifying Areas of Focus for Mental Health Promotion in Children and Youth for Ontario Public Health (2015)
 
Identifying Areas of Focus for Mental Health Promotion in Children and Youth for Ontario Public Health is a report that highlights potential areas for public health action in the area of mental health promotion. This research was developed through Public Health Ontario's Locally Driven Collaborative Project on child and youth mental health promotion.  View the full report and summary at https://www.porticonetwork.ca/web/camh-hprc/resources/research-reports.

Connecting the Dots: How Ontario Public Health Units are Addressing Child and Youth Mental Health (2013)

Connecting the Dots: How Ontario Public Health Units are Addressing Child an Youth Mental Health is the final report of a research study conducted by CAMH HPRC in partnership with Public Health Ontario and Toronto Public Health. The study explores how Ontario's 36 public health units address and promote mental health in children and youth.  View the full report and summary at https://www.porticonetwork.ca/web/camh-hprc/resources/research-reports