Building on Strengths online version

Building on Strengths
A new approach to promoting mental health in New Zealand/Aotearoa

(online version)

Date of publication December 2002

HP3591

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Contents

1.0 Introduction

Professor Mason Durie has used the image of a house to describe overall health and wellbeing. The house is held up by the four cornerstones of health: mental health, physical health, spiritual health and environmental health. each cornerstone relies on the others to support the house. If one fails, the house will fall.

Mental health is an inseparable component of total wellbeing. The protection and promotion of mental health is as important as the promotion and protection of physical, environmental and spiritual health.

Increasing international attention is now being paid to keeping people mentally well. Mental illness must be treated when it occurs and an effort must be made to create social and physical environments that contribute to and promote positive mental health. equally, it is necessary to enhance the ability of individuals and communities to cope better with external stress and pressure.

Building on Strengths aims to make the case for increased mental health promotion in New Zealand. It also aims to provide a framework for mental health promotion activity that can be used by the health sector as well as other government sectors, community groups and local government.

The health sector is not alone in having a role to play in promoting mental health. Mental health is affected by a wide range of social and environmental factors that lie outside the influence of the health sector. It is therefore crucial that other sectors see a role for themselves in promoting positive mental health for New Zealanders.

The mental health promotion strategy outlined here applies equally to those who are well, to those who suffer from various degrees of mental or social distress and to those who have identified mental health problems.

Significant research and professional literature support the Building on Strengths approach adopted here. In particular two major documents exemplify this approach and can be used as important guides for the development of mental health promotion over the next five years. The first of these is the ottawa Charter for Health Promotion, adopted internationally in 1986 as the core document for health promotion, both physical and mental. The second is the Treaty of Waitangi, which with its principles of self-determination, partnership and participation (among others), has much to offer in promoting the mental health of all New Zealanders.

Building on Strengths challenges the health sector and other sectors to understand the roles they can play in promoting mental health.

1.1 Role of This Document

The role of this document is threefold. It aims to:

Build the case for increased mental health promotion activity; that is, activity that keeps people mentally well.
outline planned priority actions that will begin to lay a foundation for mental health promotion now and into the future.
Provide guidance for the health sector and other sectors on what they can do to contribute to mental health and wellbeing.

This new approach outlines the way in which mental health promotion can contribute to a wide range of health-promoting agendas and policy priorities. Building on Strengths addresses the debate of whether mental health promotion can effectively contribute to the prevention of certain mental health problems and, in doing so, challenges the myth that people can be neatly divided into those who do, or do not, have good mental health (adapted from Department of Health uK, 2001:35). The case put forward proposes that mental health promotion and prevention activities can be seen as ‘two sides of the same coin and entirely compatible, even mutually reinforcing’
(Stephens et al 1999), thus offering benefits that extend beyond promoting mental health.

1.2 Strategic Context

Building on Strengths has been developed within a wider strategic context for health set by Government. In particular, the Government is committed to reducing inequalities in health experienced by some groups. Building on Strengths aims to provide the necessary leadership to remove the potentially negative consequences of inequalities for the community’s mental wellbeing. The New Zealand Health Strategy, the New Zealand Disability Strategy and other strategies listed below provide the context and guidance for Building on Strengths to start reducing inequalities
and to contribute to the mental wellbeing of New Zealanders.

The New Zealand Health Strategy sets the strategic direction for all the health services in New Zealand. It establishes a vision for health services, principles for planning and provision of services and it outlines objectives for the health of the population. In particular, it focuses on tackling inequalities in health. The five priority service delivery areas included in the New Zealand Health Strategy are:

Public health.
Primary health care.
Reducing waiting times for public hospital elective services.
Improving the responsiveness of mental health services.
accessible and appropriate services for people living in rural areas.

Building on Strengths sits under this umbrella and aims to contribute to achieving the population health goals outlined in the New Zealand Health Strategy and other related strategies outlined here.

Figure 2: Strategy: Wider strategic context
Figure 2: Strategy: Wider context

The New Zealand Disability Strategy aims to improve the ability of people experiencing disability to participate in community life. The strategy supports the underlying philosophy of valuing every individual and is intended to move New Zealand towards becoming an inclusive society.

The Health Strategy (He Korowai oranga) supports Maori aspirations to take control of their own health. It upholds the structures based around whanau, Hapu, and iwi. It recognises that there is a range of community groups in Maori society, which make valuable contributions to the advancement of whanau health. He Korowai oranga contributes to improving the socioeconomic and health status of Maori. It also calls for reforms that will serve to value Maori solutions and integrate the delivery of health services that underpin the broader population health goals of Maori.

The Pacific Health and Disability action Plan sets the strategic direction and actions for improving health outcomes for Pacific peoples and reducing inequalities between Pacific and non-Pacific communities. a public health focus, under priority 2 (Promoting Healthy Lifestyles ) supports mental health promotion activity that is intended to:

develop effective health promotion models that are responsive to a range of settings for Pacific peoples in key health areas (Ministry of Health 2002c:11)
require services provided to Pacific peoples to encompass a holistic, integrated and culturally competent approach (ibid).

Key directions in the action plan, under the priority of ‘Primary Care and Preventive Services’ are to:

work with local communities and enrolled populations
identify and remove health inequalities
co-ordinate care across services
integrate access to public health and primary care services.

The National Mental Health Strategy was launched by the Government in June 1994 with the publication of Looking Forward: Strategic Directions for the Mental Health Services and the subsequent National Mental Health Plan , Moving Forward: The National Mental Health Plan for More and Better Services.
The strategy has two key goals:

To decrease the prevalence of mental illness and mental health problems within the community
To increase the health status and reduce the impact of mental disorders on consumers, their families, caregivers and the general community.

one of the seven strategic directions of the strategy is to ‘strengthen promotion and prevention’. Te Puawaitanga sets out a Maori mental health strategic framework that aims to contribute to meeting the Government’s mental health policy objectives for Maori over the next five years. It provides District Health Boards with a nationally consistent framework for planning and delivering services to Maori who are experiencing mental problems and their whanau.

The Primary Health Care Strategy aims to see local populations enrolled in a primary health care service that improves health, keeps people well and which is accessible. There is a greater emphasis on population health, the need to reduce inequalities in health and the recognition of the role of communities in delivering an effective primary health care service.

The action Plan for Public Health, still under development, will set out a long-term vision for public health and how to achieve this. Fundamental principles include a population health approach by addressing the wider determinants of health. The plan will focus on the work of the public health sector and will also provide a framework for working across sectors to address the root causes of many health problems.

Building on Strengths is consistent with the five action streams based on the ottawa Charter (WHo) and which are designed to enable people and empower communities. These actions are to:

build healthy public policy
strengthen community action
reorient health services and programmes
create supportive environments
develop personal skills.

To achieve the aims of the New Zealand Health Strategy, Building on Strengths will work alongside other strategies to demonstrate how public and mental health approaches can be integrated to achieve mental heath gains and to reduce inequalities.

1.3 Treaty of Waitangi

The Treaty of Waitangi is New Zealand’s constitutional document. The Government recognises Maori as both a social group and as tangata whenua, the indigenous people of New Zealand/ aotearoa. The Government is committed to fulfilling its obligations as a Treaty partner. This special relationship is ongoing and is based on the underlying premise that Maori should continue to live in aotearoa as Maori, while being able to participate fully within the wider society. The nature of this relationship has been confirmed through interpretations of the Treaty of Waitangi, which
stem from decisions of the Waitangi Tribunal, the Courts of appeal and the Privy Council.

Central to the Treaty relationship and implementation of Treaty principles is a shared understanding that ‘health is a taonga’. Based on this understanding, Maori and the Crown (including Crown entities such as District Health Boards) will have a shared role in implementing health strategies for Maori, and will relate to each other in good faith with mutual respect, co-operation and trust.

While the Treaty of Waitangi is primarily about the relationship between Maori and the Crown, it also embodies much of the spirit of health promotion. Not only does it represent an important part of the constitutional context within which all health programmes unfold, but its principles have particular meaning for mental health promotion for Maori, if not all New Zealanders.

Building on Strengths has the principles of the Treaty of Waitangi – partnership, participation and protection at the heart of the New Zealand Health strategy.

Partnership:

refers to the Crown working together with iwi, Hapu, whanau and Maori communities to develop strategies for Maori health gain and appropriate health and disability services.

Participation:

emphasises Maori involvement at all levels of the sector in planning, development and delivery of health and disability services relevant to Maori.

Protection:

recognises that the Crown needs to be proactive in health promotion and the development of preventive strategies to ensure Maori enjoy at least the same level of health as non-Maori while safeguarding Maori cultural concepts, values and practices (Ministry of Health 2001a).

Like the Ottawa Charter, which is about the relationship between individuals, communities and governments, the Treaty of Waitangi is also about relationships especially the Crown’s relationship with Maori, the balance between state control and autonomy, and the opportunity for co-operative action so that mutual benefits might be realised. Building on Strengths reflects the key messages of both documents.

Linkages between Building on Strengths, the strategic references outlined in this document, the ottawa Charter and approaches embracing Maori holistic health models are fundamental to Maori aspirations underlying a Treaty of Waitangi commitment to Maori mental health and wellbeing.

The Building on Strengths approach acknowledges that a holistic approach to health is integral to Maori development and individual wellbeing (Dyall cited in ellis and Collings 1997). There is potential for greater attention to the wider determinants of health and to reverse the negative affects on the health status of Maori resulting from issues and trends that have not been taken into account in designing appropriate mental health services for Maori (Te Puni Kokiri 1994). For Maori this means whanau involvement in mental health promotion decision-making, maximising service choices, achieving community and individual potential and being consulted on mental health promotion activity relevant to Maori (Barrett 1996).

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