Building on Strengths online version

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

(online version)

Published in December 2002

HP3591

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5.0 Guide For action Improving mental health

5.1 Action For Improving Mental Health

This section outlines priority actions, and lists interventions for promoting mental health, preventing mental illness and reducing inequalities in mental health experienced by some New Zealanders. The priority actions reflect the Ministry of Health’s intervention framework for reducing inequalities (Ministry of Health 2002).

The priority actions:

Outline Ministry of Health priority actions for mental health promotion.
Provide guidance to health sector providers and other sectors on what they can do to contribute to positive mental health and wellbeing for New Zealanders.

The priority actions are relevant to clinical planning and policy areas at a local, regional or national level. Interventions are included for populations as well as for individuals.

Building on Strengths has used the Ministry of Health framework for reducing inequalities as a guide for developing a range of interventions. each priority action is detailed according to three of the levels described by the Ministry framework. These three levels are:

Level 1: The social, economic and cultural factors that fundamentally determine the health of populations.

Positive mental health would be best achieved through co-operation between government sectors – health, education, housing, employment as well as non-government and community-based organisations. This approach challenges sectors to work together to tackle the determinants of health and thereby offer disadvantaged groups greater opportunity to be involved in creating solutions that support their positive mental health.

Level 2: The intermediary pathways through which the social, economic, and cultural determinants affect health.

The determinants of health can both directly and indirectly influence the positive mental health of our population. For example, they influence both an individuals self-esteem as well as people’s behaviour and ability to secure employment and housing. actions to promote mental health must address these factors.

Level 3: Health services.

Health services have a key role to play in the development of positive mental health by improving access to services and interventions and promoting mental health protective factors.

Figure 4: Intervention framework to improve mental health and reduce inequalities.

Reproduced from: National Health Committee. 1988. The Social, Cultural and economic Determinants of Health in New Zealand: action to Improve Health.

5.2 Action Streams

The following guides for action list mental health promotion interventions under the five key priority action streams.

1. Reorient health services to reduce inequalities between socioeconomic groups.

Collaborate across sectors to develop, implement and sustain an integrated mental health promotion strategic focus.
Identify across sector mechanisms that facilitate service user and community involvement in making progress on improved mental health.
Monitor, assess and evaluate, across sectors, mental health inequalities, social determinants and the relationship between the two.
Develop policies that encourage equitable education, labour market and housing outcomes.
Develop capacity to deal with emerging issues such as problem gambling.

Level 1: The social, economic and cultural factors that fundamentally determine the health of populations.

Ministry of Health to encourage intersectoral partnerships that promote knowledge and information sharing and which contribute to positive mental health action.
Promote understanding of an integrated mental health promotion approach in primary health care service provision.
Improve academic achievement such as qualification and literacy skills by Maori and Pacific people which leads to improved health gains.
Ministry of Health consult with DHBs and PHos to prioritise services (e.g. provider and workforce development) needed to promote and improve mental health outcomes.
Co-ordinate at a national level and across sectors, arrangements to identify and address structural barriers to achieving positive mental health for all New Zealanders.
Ministry of Health, Ministry of Pacific Island affairs, Te Puni Kokiri, Ministry of Internal affairs to improve ethnicity data collection, analysis and health measurement to inform mental health promotion resource allocation and funding of mental health promotion initiatives.
Integrate Treaty of Waitangi into mental health promotion policy development, implementation and evaluation.

Level 2: The intermediary pathways through which the social, economic, and cultural determinants affect health.

Implement community development initiatives, approaches and ethnic models of mental health promotion that strengthen the capacity of individuals and communities and which present as a buffer against stress and life transitions.
Integrate multidisciplinary approaches to mental health promotion.
encourage joint planning, decision-making and implementation of initiatives between health, other contemporary (eg, government agencies) and traditional (churches, iwi) decision-making forums to promote positive mental health.
Continue to invest in programmes that: mental health protective factors (e.g. healthy schools); develop supportive communities (eg, healthy cities), counter discrimination and stigmatisation (e.g. Like Minds Like Mine), advocate joint policy development (eg, reducing inequalities) to promote positive mental health.
Promote links between programmes (eg, sport, recreation, leisure, cultural, nutrition) that demonstrate positive benefits for mental health, especially depression and low self-esteem.
utilise programmes and initiatives that increase the visibility of mental health and understanding of mental health issues; for example, health information and education services including personal growth (self-esteem, life skills, parenting skills, relationship building) and workplace (stress management) programmes.

Level 3: Health services.

Identify and build on workforce and provider training and development opportunities. Continue joint provider and community action focused on raising awareness relating to empowerment and strengths-based approaches and effective forms of self-help and peer support.
Support forums that enable organisations and communities, interested in mental health to share information and knowledge and to discuss developments (eg, ‘Kia tu kia puawai’ community development pilot programmes, ‘Like Minds Like Mine’ information clearing house).
Support the development of a service integration model that promotes a compatible mix of mental health promotion and prevention interventions.
encourage employers to promote positive mental health in their workplace policies Time frames

Time frames

	Years 1-2	Years 3-5
	Planning and development phase. establish partnerships to progress actions across all sectors, inclusive of Local authorities, DHBs, PHos,NGos participation existing programmes reviewed. Negotiate co-ordination arrangements. Sectoral partnership to share information and develop objectives.	Reporting.	Ministry of Health to coordinate. all sectors to report back to Government on performance related to reducing inequalities. all sectors Ministry of Health, Ministry of Pacific Island affairs, Te Puni Kokiri, Ministry of Youth affairs, Ministry of Internal affairs, aCC, Ministry of Social Development, Ministry of education, District Health Boards, non-government agencies and providers, Local authorities, Primary Health organisations.

2 . Strengthening community action in mental health promotion activity and create opportunity for improved access to mental health promotion services.

explore joint planning mechanisms with government and non government organisations.
Create opportunity for greater equity of access to mental health promotion services by distributing resources in relation to need.
Promote sector actions that encourage an integrated mental health promotion approach, which includes primary prevention interventions.
Work with communities to develop and implement mental health promotion programmes focused on the needs of people located in specific settings (eg, schools, recreation centres, marae, churches, workplaces, public health organisations, rural etc.).

Level 1: The social, economic and cultural factors that fundamentally determine the health of populations.

Develop actions in consultation with consumers, health service providers, communities, professional organisations and other stakeholders.
Positive discrimination to favour disadvantaged groups.
advocate for a continuum of health promotion that recognises the complementary contributions of primary prevention approaches to mental health.
Ministry of Health and District Health Boards fund Maori and Pacific people’s workforce and provider mental health promotion capacity and capability.

Level 2: The intermediary pathways through which the social, economic, and cultural determinants affect health.

Support, allowing for local variations, actions that utilise the strengths, skill and resources of communities.
Support communities to eliminate discriminating and stigmatising behaviour (eg, representation on school boards of trustees).
Support programmes that assist people to cope at critical turning points in their lives (eg, grief management programmes).
encourage community participation in developing a multidisciplinary mental health promotion approach in primary health care.

Level 3: Health services.

Build on existing networks for linking MHP activities across sectors (e.g. Mental Health advisory Committee, National advisory Groups, District advisory Groups, Intersectoral In equalities Working Party, Te Waipounamu Health Promotion Coalition etc.).
Promote positive ageing programmes for people approaching retirement, programmes that support ‘open sexual identity’ for the population in general.
utilise sectoral networks to focus initiatives on improved community understanding of mental health (eg, Ministry of Health, Te Puni Kokiri, Ministry of Social Development funding schemes).
Develop education programmes that mobilise communities to eliminate barriers to social inclusion.
Develop mental health promotion programmes for implementation in refugee and asylum seeker communities (eg, new arrival and refugee resettlement programmes).

Time frames

	Years 1-2	Years 3-5
	Planning and development phase.	action as appropriate in each sector. Reporting.	Ministry of Health to co-ordinate. all sectors to report back to Government on performance related to reducing inequalities.

3. Create safe and supportive environments through partnerships with wider sector involvement
(cities, communities, workplaces, schools, homes).

Support and resource communities to develop, implement and improve their own capacity to promote positive mental health.
Foster activity designed to enhance community innovation, leadership and mental health promotion enterprise.
Identify and remove barriers that inhibit the effective provision of services for certain ethnic and social groups and communities (eg, data collection, service approaches, service access, sector or intersectoral collaboration).
Develop and implement programmes which foster community social inclusion and minimise stigmatisation.
Contribute to the mental health of groups experiencing exclusion (unemployment, inadequate housing, poor education, discrimination, powerlessness and exploitation).
Provide training in mental health promotion for the health sector and other appropriate sectors.
Develop and deliver ‘train the trainer’ programmes.

Level 1: The social, economic and cultural factors that fundamentally determine the health of populations.

Improve sectoral and community involvement in creating supportive mental health promoting environments (e.g. clean healthy environment, physical and psychosocial working conditions such as reduced workplace stress).
Support existing networks for linking mental health promotion activities across sectors (eg, MHaC, NaGs, DaGs Intersectoral Working Party, professional forums, DHBs, PHos).
Promote safe environments which contribute to the mental health of children and adolescents, giving attention to services that address adult problems such as substance abuse programmes which in turn reduce violence to children, lead to positive parenting programmes and provide housing to keep children in stable environments.
Consult with DHBs to establish priorities in relation to promoting positive mental health and wellbeing in their areas.
Support programmes that foster a secure cultural identity.

Level 2: The intermediary pathways through which the social, economic, and cultural determinants affect health.

Invest in the development of positive mental health (promoting environments, ie, where people live, work, play and come together and where people feel safe and supported).
Develop mental health promotion (including cultural-based models) training packages for non public health doctors, primary care practitioners, health workers, tangata whaiora caregivers and others.
Support initiatives that protect communities from violence, intentional abuse and trauma, depression, anxiety, drug and alcohol and eating disorders.
encourage mental health promotion best practice in primary health care.
Promote cultural norms that support development of positive mental health and wellbeing including individual and community cultural identity and ethnic pride.
Support education and training to reduce the prevalence of mental health problems related to intentional injury and suicide.

Level 3: Health services.

Ministry of Health actively engage with ministries and providers of programmes that foster safe and supportive environments (eg, Strengthening Families, Family Start, Family wellbeing, safer community council programmes).
Provide direction using initiatives and processes that involve partnerships empowering and enabling (e.g. mayors against discrimination, parents as first teachers programme).
Support programmes that protect women, children, older adults and vulnerable people from the trauma of domestic violence and abuse (eg, antibullying and anger management programmes, Zero Tolerance for Violence, programmes that support positive and healthy role models).
Coordinate support around existing initiatives and processes which build on partnerships that empower communities to create safe supportive environments (eg, Mayors against discrimination, parents as first teachers programme).
Build alliances and work with partners to protect women, children, older adults and other vulnerable people from the trauma of domestic violence and abuse (eg, anti-bullying and anger management programmes, Zero Tolerance for Violence, programmes that support positive and healthy role models).
Support development for peer group networks (eg, Kia Piki o Te Taitamariki programme, rangatahi suicide prevention coordinators).
Promote refugee and new migrant mental health and wellbeing programmes focused on problem gambling, exercise programmes, primary care access, resettlement.
Support anti-bullying programmes.
Promote whanau development.

Time frames

	Years 1-2	Years 3-5
	Scope and planning activity. Negotiate co-ordination arrangements.	action as appropriate in each sector. Reporting.	Ministry of Health to co-ordinate. all sectors to report back to Government on performance related to reducing inequalities.

4. Develop personal skills by emphasising mental health protective factors such as resiliency,
social support and life skill development.

Develop and implement programmes that enhance protective factors, such as coping capacity, resilience, life skills development, and which facilitate social support.
Develop and implement programmes that increase people’s (individual and community) competence and control over their life circumstances.
Develop guidelines to assist individuals to identify and cope with mental health problems.

Level 1: The social, economic and cultural factors that fundamentally determine the health of populations.

Collaborate across sectors, including education, social services, justice, housing, accident compensation, child youth and families etc., to find ways to strengthen individual resiliency and life skills and strengthen social support mechanisms.
Encourage integrated mental health promotion focused education, training and standards in primary health care.

Level 2: The intermediary pathways through which the social, economic, and cultural determinants affect health.

Support programmes that promote factors associated with bonding and positive child development.
Support job search and problem solving skills for recently unemployed people.
Build understanding of mental health promotion, prevention strategies and primary care for mental health service users.

Level 3: Health services.

Disseminate information on mental health promotion programmes with an emphasis on non violent behaviour and good communication and social skills.
Support positive parenting skills development.
Support prenatal and postnatal home visiting programmes for women and their babies.
Promote leisure, cultural, recreation and physical activity programmes.
Promote the importance of having a healthy body and healthy body image so that young people are encouraged to like and accept who they are (e.g. beyond body beautiful programme).

Time frames

	Years 1-2	Years 2-5
	Scope and planning activity. Negotiate co-ordination arrangements.	action as appropriate in each sector. Reporting.	Ministry of Health to co-ordinate. all sectors to report back to Government on performance related to reducing inequalities.

5. Build healthy public policy through improved research and evaluation to identify and address mental health promotion needs.

Work with health research agencies, DHBs and communities to identify and support research and interventions that have the potential to contribute to the positive mental health of people across populations and communities.
Develop a co-ordinated approach to sharing and disseminating mental health promotion research information.
Develop a set of indicators that links community development to better mental health outcomes.
Develop comprehensive mental health promotion service assessment and evaluation models.

Level 1: The social, economic and cultural factors that fundamentally determine the health of populations.

Advocate investment in research and development, including assessment and evaluation using cultural references and models.
Identify research agenda linking policy to positive mental health outcomes.
Encourage collaboration between academia, other government agencies, public and mental health providers and community groups.
Participate in developing international policy and research agenda.

Level 2: The intermediary pathways through which the social, economic, and cultural determinants affect health.

Incorporate evidence based models into mental health promotion service delivery.
Build on new models to enhance responsiveness to the needs of Maori and Pacific peoples (Ministry of Health, Ministry of Pacific Island affairs, Te Puni Kokiri, office of ethnic affairs).
Develop a research base around measures and indicators of mental health and wellbeing.
Improve research collation, analysis and evaluation.
Support international developments in the area of mental health promotion.

Level 3: Health services.

Conduct research into positive ageing.
assess and evaluate all contracted mental health promotion programmes.
Identify mental health and wellbeing measures and indicators.
Identify barriers to positive mental health for priority population groups.
active participation in developing international approaches and leadership in mental health (e.g. New Zealand Membership in The International Women Leaders Group for Mental Health).
Pursue opportunities for collaborative research across sectors (e.g. funding sought from the Health Research Council, Foundation for Science Research and Technology etc.).

Time frames

	Years 1-2	Years 2-5
	Planning and development phase. Report and investigate. Negotiate co-ordination arrangements.	action as appropriate in each sector. Reporting.	Ministry of Health to co-ordinate. all sectors to report back toGovernment on performance relatedto reducing inequalities.

Contents