Promotion and prevention is one of the overarching aims of the National Mental Health Strategy. A number of measures are advocated, designed to "...promote the mental health of the Australian community and, where possible, prevent the development of mental health problems and mental disorders."1
The measures proposed are based on a combination of: community education to reduce ignorance and stigma; secondary and tertiary prevention strategies to minimise the impact of mental illness when it occurs; and research.
The Strategy's approach acknowledges that society's attitude to mental health affects the impact of mental illness on the individual. The intended outcome is that " those with mental disorders will be ... better understood, less feared, less discriminated against and have better access to community life." 1
The Strategy also accepted that little evidence is available to show that primary prevention is effective for 'most severe problems and mental disorders'. It therefore placed greater emphasis on early intervention and rehabilitation as preventive strategies.
A number of national initiatives have been taken to progress mental health promotion objectives. The Community Awareness Program was the most ambitious. Commencing in 1995, it comprised a series of media advertisements promoting the message of 'mental illness is like any other illness.' This was backed up by the distribution of pamphlets, posters and other educational materials, along with the positioning of billboards in prominent locations in the several capital cities.
In the primary prevention area, limited initiatives were taken, mainly centred on allocation of funds to the National Health and Medical Research Council to strengthen the mental health research profile. (See Table 7)
Early intervention has been given greater focus by the Strategy. Community- based crisis teams are becoming more widespread. 'Early psychosis' services have been established in several locations, with the aim of reducing the long term impact of these disorders.
In a related initiative, the Commonwealth has made available $31 million to be targeted at reducing suicide in youth.
The Area Case Studies suggest there is little health promotion at the service delivery level. Local activities tend to be 'one off', centred around Mental Health Week and Schizophrenia Awareness Week. Negligible activity of a primary prevention type is conducted.
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Feedback from the national and local area consultations suggest that only marginal gains have been made in promoting mental health issues in the community.
- Strong support was expressed for the Community Awareness Program and its impact on raising awareness of mental health issues. Its major achievements were the validating effect it had on consumers, as well as the written materials, which continue to be used extensively by many community groups.
- The overwhelming feedback was the campaign made no inroads to changing community attitudes or behaviour towards people with mental illness. Consumers report that stigma and discrimination remain at the high level that existed prior to the Strategy.
- Opportunities for local groups to coordinate promotional activity with the national campaign were missed. The campaign also was not appropriate for a range of groups, including people from non-English speaking backgrounds and Aboriginal and Torres Strait Islanders.
- For mental health service providers, promotion work is a low priority. Defining what is expected of service providers, and the relative roles of primary health care in promoting broader mental health issues, is needed.
- On a positive level, better outcomes were reported when services targeted action at sections of the local community which, as a result of their attitudes, created difficulties for mentally ill people. Special campaigns of this type would benefit from national support in the form of educational materials, advice or funds.
On prevention issues, the Strategy is reported by national stakeholders to have had no obvious impact on the incidence or prevalence of mental disorders. Lack of relevant data on the extent of mental disorders in the community prevents validation of this view, but given no significant primary prevention programs have been conducted under the Strategy, there is little reason to challenge it.
National direction in the area of primary prevention is needed for several reasons.
First, mental health services need to be guided in clarifying responsibilities. Confusion is apparent as to what constitutes primary prevention and what, if any, activities may be effective within their sphere of control. From the providers' perspective, conflicting messages are communicated by the Strategy when it simultaneously urges primary prevention and prioritisation of 'serious mental illness'
Second, the Strategy needs to define and stimulate development of special programs for 'at risk' groups. As indicated earlier, a range of special needs groups has been identified in the professional literature.
Third, support for primary care providers, particularly general practitioners, is needed to assist them in working with people 'at risk' of developing mental illnesses.
Fourth, the National Strategy provides the best vehicle to take a position of 'moral leadership' to emphasise that all segments of Australian society share a responsibility for fostering and promoting well being. Exploratory work is needed to identify how this role can be used most effectively in promoting a public health approach to mental health.
In the area of early intervention, there are three important observations arising from this evaluation.
First, the 'culture of early intervention' is welcomed by consumers and carers but seen to be too limited in its distribution across mental health services. The approaches promoted in the new 'early psychosis' programs have relevance to all people who experience a mental illness, regardless of the type of illness or whether they are suffering their first or a subsequent episode.
Second, the use of the term 'serious mental illness' has paradoxically inhibited early intervention where it could be effective. Many consumers reported being refused admission to care because they did not meet the (unspecified) serious mental illness criteria, only to experience a full relapse shortly afterward. There are critical training implications for providers in this finding.
Finally, the expansion of extended hours services in the community is valued by all stakeholders and seen to have increased the availability of early intervention services. The main issue is that such services are still only available to the minority of Australians who suffer a mental illness.
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Table 7: Prevention and promotion policy objectivesTable 7 is presented as a list in this HTML version for accessibility reasons. It is presented as a table in the PDF version.
- To develop programs which educate the public on mental disorders, including those initiated through mainstream health promotion activities.
- To develop and evaluate primary, secondary and tertiary preventive programs as an essential component of all care provided for people at risk of mental disorder.
Source: National Mental Health Policy, 1992Top of page