The Promotion of Mental Health and Prevention of Mental and Behavioural Disorders

London, September, 2002

Sylvia Caras, PhD

The conference started with an evening reception, wine, juice, potato chips and olives, and a few welcoming remarks.

About 250 people are registered, less are present, mostly from the UK, a number from the US including from CMHS Anne Mathews-Younes and Bill Beardslee from the National Advisory Council; from the Carter Center, Rosalynn Carter and Thom Bornemann. Judith Cook and Crystal Blyler are on the program but I haven't seen them yet.

Overheard: Joel Slack has been appointed to the SAMHSA Advisory Council

Saraceno: WHO's constituency is the less developed countries.

McQueen, CDC: evidence is too strict a term, include fugitive literature, the evidence hierarchy is not valid, don't use it. Finding: insufficent evidence to determine effectiveness of interventions for depression.

Hawkins: must both reduce risk and enhance protection; these must work together; it is difficult to develop strengths in the presence of high risks like poverty, substance prevelance, inconsistent parenting; finding about the risk: protection relationship are consistent across race, culture, gender -; materials and syllabi -

The morning break was tea or coffee and cream and sugar if one wished.

The symposia break out room names were announced from the podium with instructions to ask at the main floor where the rooms actually were. Some 150 people individually asked staff for directions and there were no staff id's and no bold signage but all eventually became clear that we needed to go outdoors to another building and I wondered what if it had been cold or rainy?

Grotberg: practice resilient *behavior* to counter psychiatric disabilities running in families, encourage social alliances outside the family, encourage community service, don't focus on the problem, focus on developing strengths and activities in the kids, in the whole person, don't use a diagnosis and treatment model because behavior is bigger, broader.

Resilience factors consist of external supports, inner strengths, and interpersonal and problem solving skills.

External supports are provided and include: trusting relationships; encouragement to become autonomous; structure and rules; role models; and access to health, education, social and security services.

Inner strengths are developed and include: being likable; empathic and altruistic; respectful of self and others; autonomous and responsible; self-esteem; filled with hope, faith and optimism; creativty; and humor.

Interpersonal and problem solving skills are acquired and include: communicating with others; solving problems; managing feelings and impulses; reaching out for help and trusting relationships.

Transformations include greater empathy, altruism, and compassion for others - the greatest benefit of resilience.

Showing respect, listening, being sensitive to body language, asking if what is happening is acceptable ... may be sufficient to begin an interaction leading to the promotion of resilience and mental health and skills to deal with life's inevitable adversities.

Chigier: (targeted at adolescent Ethopian Jewish immigrants to Israel, but seems to me to generalize) five units based on the theme of "Feelings - And What to do About Them": Feeling Angry, Feeling Inferior, Feeling Strange, Feeling Different (because of color, race, ...), Feeling Strong.

Lunch was a wide selection of finger foods, small sandwiches, french fries, fried shrimp, ... pastries, juice, water

There were 60 seconds of silence at 1:46 and I felt very far from home.

Carter: avoidance and numbing as coping devices to trauma are predictors of psychiatric diagnosis

Raphael: traumatophilia, stress debriefing after mass violence is not effective; avoid medicalizing trauma

Jenkins, replying to a question about the role of survivor's, said "we need to involve a broader constituency" which I have heard others also say. It seems to me the formula for saying the advocates aren't representative, are exceptions, ... <sigh>

Henderson, answering the same question, said that there are multiple narratives

Wright, "Recognition of psychosis and depression by young people and their beliefs about treatment." "Vitamins and herbal treatments (47%) were most frequently rated as helpful medicinal treatments followed by anti-depressants (45%) and anti-psychotics (30%). The latter two years were also described as harmful by 24% of respondents."

Corkum: The themes for mental health promotion actions: social connectedness, freedom from discrimination, economic participation

I woke up in the middle of the night to find a fuse had blown and while I had overhead lights I had no electric outlet and thus no radio and since it was still 9/11 in the US I felt very scared. But there were no sirens, no one else seemed up, there were lights on in the building, and I finally read myself back to sleep.

McGorry: early (adolescent) psychosis, avoid inpatient care, can we find them? do they want help? can't involuntary treat yet but wish to treat at early pre-psychotic phase, subtle symptoms, how do we tell who is at high risk? try not screening but attracting, set up a magnetic access clinic located say in a shopping center

Kellum: in public health we are used to telling people what to do, being invasive, hence we need to build good partnerships (so that we can continue to impose without public objection)

Beardslee: Protecting the children and strengthening the family when a parent is depressed. Depression in a family prevents families from making meaning together, inhibits planning for the future. "Seeing the continuity and one's place in it." "Telling the story again and again." (I started to cry as he spoke, his kindness towards the family and his understanding, and remembering me as a kid, my mother and my father and whatever their problems were, me as a parent so isolated in my emotional life, my children and what damage has been done to them, and being sad for all of us.)

Cunningham: can mainstream systems ever be responsive to indigenous people? Western concepts are fragmented, Maori are asked to react to policies created on their behalf but aren't often included in creating those policies.

Price: interventions around involuntary job loss

There were concerts next door to where I was staying, The Proms, at the Royal Albert Music Hall, and I bought a moderate priced seat behind the orchestra to hear a wonderful classical concert played to a sold-out house.

Mittelmark: action will overcome rhetoric by approaching complex problems in small pieces, one step at a time, win by win; equal evidence weight given to health, social, economic and political promotion; strategy: review the needs, small wins, step by step, map the gap, set goals and standards, advocate. Social, economic, environmental well-being.

Edwards (Zululand) I am because we are. A human being becomes a person through others. An injury to one is an injury to all. Prevention of mental illness as part of general illness prevention and promotion of mental health as part of general health, as both continuous with and independent of mental health. Appreciative inquiry - group intervention and appreciations.

My net impression of this meeting is that it was an ivory tower conference, academics talking to researchers, and Janet made a brave, bold, and blistering comment during the final plenary, the only users on the program. She insisted on a place for consumers/users/survivors as stakeholders, a practical, empirical, non academic approach, and for looking at healthy examples of recovery as part of the agenda.

From the floor: prevention includes anthropology, education, economics, ... We've lost the "psych" (soul), where is spirituality.

From the abstracts:

Tomlinson: Research evidence is not the only criterion by which implementation decisions are made; Implementation decisions are often political rather than health-oriented in the narrow sense; Moving from research to the 'real world' requires engagement with existing organisational systems. "We have no doubt that research can help improve lives ... We suggest ... an agenda for action which locates evidence in appropriate political context and opens the way for broader debates and action on mental health."

Warriner: "mantralike request from service users: 'we want support in accessing real jobs for real pay.'"

Cook: "pursuing the goal of community employment shifts the focus from addressing disabilities and functional impairment to promoting strengths and productive abilities."

Willemse: minimal psychological interventions for depression may be as effective as individual and group therapy - a book with instructions for cognitive behavioural self-training skills to reduce mood problems and six short telephone contacts with a prevention worker"

Riper: techno-maniacs

Soetemans: one third of the children of mentally ill parents also develop major psychiatric problems; one third psychological problems; one third no major problems.

Solantaus: "The Beardslee Preventive Family Intervention represents a departure from many of the traditional ways for working in health services and especially in psychiatry.

from theories and models of psychopathology to those of development and resilience
from curative orientation to promotion and prevention
from clinician-based to parent-based family work
from perceptions and language of parental incompetence to parental competence
from questions-and-answers to narratives and family interactions
from adult-focused to child-focused work

Fadden: Family interventions are particularly important because of the key role they play in the reduction of relapse in service users, and distress in their relatives.

Francescato: self-help effective most effective in promoting change and mental wellbeing. Responsibility for one's own behaviours and attitudes and seeing people similar to me improve are the two major factors; exchange of information and finding friends were less important.