This presentation on positive psychology's view of healing trauma though post traumatic growth was given to an audience of 150 trauma survivors in San Francisco, CA.
A look at the topic of Grief and Loss and how one can minister to those in the grieving process. While it is somewhat broad-based, most of the presentation is for a Christian ministry to those who have recently lossed a loved one.
Understanding suicide and Crisis Intervention Muskan Hossain
Defining Suicide
Suicidal Ideation
Suicidal Ideation in Young Children
SUICIDE INTENT SCALE
Psychology and Psychopathology of Suicide
NEUROBIOLOGICAL PATHWAYS LINKED TO SUICIDE RISK
MIND OF A SUICIDAL PERSON
The Media Presentation of Suicide
Case Studies
Prevention of Suicide
Prevention of Suicidal Ideation
Crisis Intervention Of Suicide
Treatment of Suicidal Ideation
World Suicide Prevention Day
BOOKS ON SUICIDE AND CRISIS INTERVNETION
This presentation on positive psychology's view of healing trauma though post traumatic growth was given to an audience of 150 trauma survivors in San Francisco, CA.
A look at the topic of Grief and Loss and how one can minister to those in the grieving process. While it is somewhat broad-based, most of the presentation is for a Christian ministry to those who have recently lossed a loved one.
Understanding suicide and Crisis Intervention Muskan Hossain
Defining Suicide
Suicidal Ideation
Suicidal Ideation in Young Children
SUICIDE INTENT SCALE
Psychology and Psychopathology of Suicide
NEUROBIOLOGICAL PATHWAYS LINKED TO SUICIDE RISK
MIND OF A SUICIDAL PERSON
The Media Presentation of Suicide
Case Studies
Prevention of Suicide
Prevention of Suicidal Ideation
Crisis Intervention Of Suicide
Treatment of Suicidal Ideation
World Suicide Prevention Day
BOOKS ON SUICIDE AND CRISIS INTERVNETION
Depression, OCD, Psychopathy, and Schizophrenia are the four most commonly misrepresented mental disorders represented in the media. Here, we talk about the difference between the Myths surrounding them, and the Realities that compose them.
(This slideshow was made for COM-201 at Spalding University. All pictures and music are being used for educational purposes only -- that purpose being to educate viewers on the realities of various mental illnesses.)
The Demedicalization of Self-Injury: From Psychopathology to Sociological Dev...Sara Vannini
I made these slides up from a video I made for a course in ethnography. They are related to the article Patricia A. Adler and Peter Adler's article The Demedicalization of Self-Injury: From Psychopathology to Sociological Deviance.
Reasonable responses to unreasonable behaviour?: medical and sociological perspectives on the aftermaths of sexual violence - Liz Kelly, CWASU, London Metropolitan University
This ppt presentation discusses about the various models of mental illness. I found it useful to download as it gives a fair idea about various models which are generally not found in books.
Each month, join us as we highlight and discuss hot topics ranging from the future of higher education to wearable technology, best productivity hacks and secrets to hiring top talent. Upload your SlideShares, and share your expertise with the world!
Not sure what to share on SlideShare?
SlideShares that inform, inspire and educate attract the most views. Beyond that, ideas for what you can upload are limitless. We’ve selected a few popular examples to get your creative juices flowing.
A snap-shot of some of the structural changes underway in consumer health - and why the health industry is having difficulty adjusting. Includes three 'rejuvenation' strategies ensuring that the audience get to the future first.
Depression, OCD, Psychopathy, and Schizophrenia are the four most commonly misrepresented mental disorders represented in the media. Here, we talk about the difference between the Myths surrounding them, and the Realities that compose them.
(This slideshow was made for COM-201 at Spalding University. All pictures and music are being used for educational purposes only -- that purpose being to educate viewers on the realities of various mental illnesses.)
The Demedicalization of Self-Injury: From Psychopathology to Sociological Dev...Sara Vannini
I made these slides up from a video I made for a course in ethnography. They are related to the article Patricia A. Adler and Peter Adler's article The Demedicalization of Self-Injury: From Psychopathology to Sociological Deviance.
Reasonable responses to unreasonable behaviour?: medical and sociological perspectives on the aftermaths of sexual violence - Liz Kelly, CWASU, London Metropolitan University
This ppt presentation discusses about the various models of mental illness. I found it useful to download as it gives a fair idea about various models which are generally not found in books.
Each month, join us as we highlight and discuss hot topics ranging from the future of higher education to wearable technology, best productivity hacks and secrets to hiring top talent. Upload your SlideShares, and share your expertise with the world!
Not sure what to share on SlideShare?
SlideShares that inform, inspire and educate attract the most views. Beyond that, ideas for what you can upload are limitless. We’ve selected a few popular examples to get your creative juices flowing.
A snap-shot of some of the structural changes underway in consumer health - and why the health industry is having difficulty adjusting. Includes three 'rejuvenation' strategies ensuring that the audience get to the future first.
Muhammad Saud KharalPhD in Social Science, Department of Sociology Faculty of Social and Political Sciences, Universitas Airlangga, Surabaya Indonesia.
Email: muhhammad.saud@gmail.com
Logotherapy discusses how to search for the meaning of life and overcome the pain and suffering. A therapy based on Victor Frankl's Existential Analysis.
Similar to Talk at Canadian Mental Health Summit (20)
Networked Energy: Energy independence for AlderneyCitizen Network
by Chris Cook and Marcus Saul, Island Power
As Research Fellows at the Institute for Strategy, Resilience and Security, at University College, London, Marcus Saul and Chris Cook researched and developed the Pacific Natural Grid resource resilience strategy.
Here they explain how Denmark has led the way in creating sustainable networks of community-based energy production and distribution.
This has been transformative for Denmark, enabling it to become independent from the oil and gas industry’s dominance. But it is also transformative for communities, who are now creating their own energy economies.
Dr Dave Beck gave this talk for Part 5 of the ‘Grassroots Policies for Farming, Food and Wildlife’ webinar series, hosted by Citizen Network.
In his presentation Dr Beck discusses the harms caused by the monopolisation of supermarkets in the food industry. He also explores the positive possibilities of local currencies.
Dr Beck is a Lecturer at the University of Salford, Manchester.
The webinar recording is available to watch on Citizen Network's website at: www.citizen-network.org
Simon Duffy gave this presentation at the final conference of the UNIC Project, in Brussels in September 2023, providing an overview of personal budgets and the challenges ahead.
Sabrina Espeleta of War on Want outlines the enormous and growing level of world hunger. She explains how a few global corporations control the vast majority of food production and supply and markets exploit the food market, leaving communities, especially in the Global South at great disadvantage. Local peasant farmers are now organising to achieve food sovereignty, seeking to farm in ways in harmony with nature and to meet local needs. The Global North needs to respect the rights and autonomy of these people rather than to continue the pattern of exploitation.
This presentation was given on 6 July in Part 4 of a webinar series on grassroots policies for farming, food and wildlife.
Watch the recording at: https://citizen-network.org
Simon Duffy was asked by the Mayor’s Greater Manchester Charity and UBI Lab Manchester to talk at a recent roundtable event on the relevance of Universal Basic Income (UBI) to the problem of homelessness.
These are the slides from that talk. In summary Duffy argued that UBI is relevant to reducing homelessness in two slightly different ways:
1. UBI would help prevent homelessness - UBI addresses the inequalities in income and housing that create the risk of homelessness.
2. UBI would help people escape homelessness - UBI gives people a vital tool which significantly helps people change their situation in times of crisis.
Find more free resources on basic income at: www.citizen-network.org
A presentation for the One Yorkshire Committee introducing Democratic Yorkshire - a voluntary alliance consisting of a group of organisations and individuals interested in planning a better future for our County through modern democratic means secured in a written constitution.
In this presentation exploring planning law, Laird Ryan talks us through the planning process, explores what we can and can't influence and helps us consider how best to create real, organic and local alliances that make the best use of our energy.
To find out more about the Neighbourhood Democracy Movement please visit: https://neighbourhooddemocracy.org
Citizenship is our Business - The Avivo StoryCitizen Network
Avivo is one of the founding organisations in Citizen Network. they are also pioneers in self-direction and personalised support in Australia. Over the past few years they have been reorganising themselves around the principle that everyone is a citizen - and supporting everyone, including paid staff, to be citizens is their central purpose. Avivo are also leading Citizen Network's Rethinking Organisations programme and networking with other organisations on this journey.
Dr Simon Duffy spoke to Doncaster's Mental Wellbeing Alliance about the importance of thinking about what good help really means. He explored the importance of shifting power, resources and thinking upstream.
Markus Vähälä, CEO of Citizen Network, outlined the development of the cooperative as a framework to support the further development of Citizen Network as part of the 2022 Building Citizen network Together events hosted by Eberswalde University.
At BuildingCitizen Network Together in early 2022 Simon Duffy and James Lock discussed the development of Citizen Network and its current approach to membership and explored with members from all around the world next steps for its development.
These slides are from a talk Dr Simon Duffy of Citizen Network gave to Café Economique in Leeds, making the case for basic income. The argument set out is that UBI is one necessary part of a range of reforms necessary to support citizenship and strengthen community life. This talk preceded a (rather fiery) debate with Anna Coote of NEF who argued against UBI.
Simon Duffy gave this talk for Radical Visions on home, citizenship, institutionalisation and neighbourhood democracy. He explains why institutions are wrong and what we might be do to end the drive towards institutionalisation.
A presentation for the Estia International Confernce in 2021 from Dr Simon Duffy exploring personal budgets, citizenship and community and the challenges for services aiming to work in partnership with people with disabilities in Greece.
An example of good practice in inclusion in employment from Slovenia, shared at the Day Centres Without Walls conference, hosted by JDC in Lithuania. Day Centres Without Walls is an Erasmus+ project funded by the EU.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
NVBDCP.pptx Nation vector borne disease control program
Talk at Canadian Mental Health Summit
1. The (equal) chance of a life well lived:
acting on the social determinants of
mental health and wellbeing
Dr Lynne Friedli
Mental Health Summit 2012
Winnipeg, Manitoba
15th/16th February 2012
2. Summary
Why mental health matters
What influences mental
health
Effective (& cost effective)
action
Photo credit: Jacqueline
Young of a life well lived
The chance lynne.friedli@btopenworld.com
Reasons to be cheerful.......
3. Something to hold on to ….
I did not hear the bird sounds
They had left.
I did not see the speechless
clouds.
I saw only the little white dish of
my
faith, breaking in the crater.
I kept saying: I’ve got to have
something
to hold on to.
Picture source: Sleeping with spirit #2 Bradley Guiboche courtesy
www.artbeatstudio.ca
The chance of a life well lived
Anne Sexton lynne.friedli@btopenworld.com
4. ‘too often the price of receiving support is exclusion from the life of
citizenship’ Simon
Duffy
The chance of a life well lived lynne.friedli@btopenworld.com
5. (Mental)...Wellbeing......
A subjective evaluation of how
we feel about and
experience our lives
It’s a hearts and minds thing....
The chance of a life well lived lynne.friedli@btopenworld.com
6. Dimensions of mental wellbeing
If I am not for myself, who will be for me?
And if I am only for myself, what am I? If not now, when?
Primo Levi
How we feel... How we think ...
coping style, mood, learning, knowledge,
emotions, flexibility, innovation,
subjective wellbeing Mental creativity
wellbeing
Meaning and
purpose .... sense
Relationships with
of coherence,
others… listening,
values, goals,
communicating, co
spirituality, politics,
operating, empathy,
beliefs
tolerance
The chance of a life well lived lynne.friedli@btopenworld.com
7. What we all need....
To be:
• Heard
• Believed
• Understood
• Respected
Picture Source: Warm Shore by Tedd Tribe www.artbeatstudio.ca
The chance of a life well lived lynne.friedli@btopenworld.com
8. Why mental health matters
He worked hard for respect, but he could not
find it.
There was in the world a great shortage of
respect and Chanu was among the famished
Monica Ali Brick
Lane
The chance of a life well lived lynne.friedli@btopenworld.com
9. Because it’s worth it....
While there are multiple barriers to economic
growth,
the growth of human potential is unlimited
Coote and
•Contribution mental health and mental illness make to
Franklin 2010
wide range of outcomes
•The ‘unexplained excess’ – classical risk factors do
not account for level of variation in outcomes
•Improving mental wellbeing saves (a lot of) money
•Improving mwb delivers social (as well as economic)
returns
•Improving mental health reduces inequalities
The chance of a life well lived lynne.friedli@btopenworld.com
10. Mental wellbeing is a key pathway
A worthwhile goal in itself and leads to better outcomes:
• prevalence of mental illness
• health behaviour
• physical health/recovery/chronic disease
management
• capacity to learn/educational attainment
• employability, productivity, earnings
• crime / violence reduction
• pro-social behaviour/social integration/relationships
• quality of life
The chance of a life well lived lynne.friedli@btopenworld.com
11. How does mental health influence
so many outcomes?
Some living conditions deliver to people a life that is worthy
of the human dignity that they possess, and others do not.
Dignity can be like a cheque that has come back marked
‘insufficient funds’.
Martha Nussbaum
Picture source: The open road by Loral Hildebrand courtesy of www.artbeatstudio.ca
The chance of a life well lived lynne.friedli@btopenworld.com
12. Meta analysis: comparative odds
of decreased mortality
The relative value of
social support/ social
integration
The chance of a life well lived lynne.friedli@btopenworld.com
Source: Holt-Lundstad et al
2010
13. Written on the body...
• protection from heart disease Somatised
pain
• stroke incidence and survival
• Reduces/mitigates harmful health behaviours
• overall lifetime mortality rates and life expectancy
• management of chronic disease
Medically
Frequent unexplained
attendance symptoms
The chance of a life well lived lynne.friedli@btopenworld.com
14. Psycho-biological pathways
Status Control Relatedness
Chronic low level stress ‘gets under the skin’
through the neuro-endocrine, cardiovascular
and immune systems, influencing :
Freedom to
• hormone release e.g. cortisol
live a valued
• cholesterol levels life Amartya
Sen
• blood pressure
• inflammation e.g. C-reactive proteins
Sources: Steptoe 2005; Friedli 2009
The chance of a life well lived lynne.friedli@btopenworld.com
15. Recover from, and manage illness
sooner
Odds of reporting illness as "limiting“ compare with most well
Adults reporting chronic muscular-skeletal illness (first) in HSE 2006
(odds of reporting illness as "limiting" - adjusted for age and self
assessed pain)
3.5
3
Influencing costs for: employers,
2.5
health & social care, independent
living
2
1.5
1
0.5
0
best second third fourth worst
quintiles of wellness
Source: Tom Hennell The nature of wellbeing and its relationship to
inequalities 2010
17. Contribution of mental health to
inequalities
Key domains: education/employment/health behaviour /
health/ consequences of illness /services
(Whitehead & Dahlgren 2006)
Mental health is a significant intermediary determinant
in each case, influencing:
• readiness for school/learning
• employability
• capacity, motivation and rationale for healthy behaviours
• risk for physical health (e.g. coronary heart disease),
• chronic disease outcomes (e.g. diabetes)
• relationship to health services, including uptake/treatment
The chance of a life well lived lynne.friedli@btopenworld.com
18. What we’ve learnt....
Mental health, and the factors that influence
mental health, have never been more
important
Menta
lS
Social Determinants
Healt
h
The chance of a life well lived lynne.friedli@btopenworld.com
19. What influences mental health?
Tend to the social and the individual will
flourish
Jonathon Rutherford
All societies cater for the disabilities of the
average person
Martha Nussbaum
The chance of a life well lived lynne.friedli@btopenworld.com
20. Commission on the
Social Determinants of Health
Closing the health gap in a generation - three key
domains for action/empowerment:
• material requisites
• psycho-social (control over lives)
• political voice (participation in decision
making)
• Best start, education & skills, quality work,
The income, healthy places, prevention
chance of a life well lived lynne.friedli@btopenworld.com
21. Mental health and deprivation
Not ‘every family in the land’
Findings from 9 large scale population based studies:
• Material and relative deprivation
• Childhood socio-economic position
• Low educational attainment
• Unemployment
• Environment: poor housing, poor resources,
violence
• Adverse life events
• Poor support networks
(Melzer et al 2004; Rogers & Pilgrim 2003; Stansfeld et al 2008;
APMS 2007)
Cycle of invisible barriers:
The chance of a life well lived lynne.friedli@btopenworld.com
• Poverty of hope, self-worth, aspirations
22. Explaining the social gradient:
mental illness journeys...
Most of the experiences that cause mental distress are directly
linked
to a lack of money....... powerlessness linked to poverty
Peter Campbell Beyond the Water Tower
• Adverse childhood experiences/stressful life
2005
events
• Racism and other forms of discrimination
• Contact with criminal justice system
• Socio economic status – parental income,
tenure, education, occupation
The • Institutional care in childhood
chance of a life well lived lynne.friedli@btopenworld.com
23. Big fish/little fish:
questions of power are unavoidable
Source: http://streetartlondon.co.uk/
The chance of a life well lived lynne.friedli@btopenworld.com
24. I own, therefore I am....
Source: Banksie – grafitti, London, England
The chance of a life well lived lynne.friedli@btopenworld.com
25. Money Economy,
Core Economy
Well-being depends on certain freedoms being upheld, as well as on
economic assets Amartya Sen
Economic/ environmental
instability
Economic
fiscal policy recession
focussed on
GDP psycho-social Social
instability
recession
materialis consumerism individualism
m
The chance of a life well lived lynne.friedli@btopenworld.com
26. Rising income inequalities in
Canada the rich could hireall make adie for them,
‘If
we, the poor, would
others to
nice living’
0.42 Fiddler on the Roof
Trends in inequality of disposable income
0.40
Gini coefficient of income inequality
0.38
0.36
0.34
0.32
0.30
0.28
0.26
0.24
1975 1980 1985 1990 1995 2000 2005 2010
OECD Divided we stand 2012
27. Redistribution lower than OECD
0.55
average 0.50
Redistribution through taxes and transfers
Gini coefficient of income inequality
Inequality of market income Inequality of disposable income (↗)
0.45
0.40
0.35
0.30
0.25
0.20
0.15
0.10
0.05
0.00
The chance of a life well lived lynne.friedli@btopenworld.com
28. Effective and cost effective action
“it’s better to be roughly right than precisely wrong”
The chance of a life well lived lynne.friedli@btopenworld.com
29. Scope of Action
Material resources Relationships and
Increasing equitable access Respect
to assets that support Social support, collectivity,
mental wellbeing respect for people experiencing
Interventio misfortune
ns to
promote
Inner
mental
resources
Meaningful wellbeing
Opportunities to
activity develop
Opportunities senses, imagina
to contribute tion, reason, tho
The chance of a life well lived
ught
(Martha Nussbaum Capabilities)
30. Summary of themes in (cost)
effectiveness
• Economic modelling
• Promotion, prevention, early intervention, recovery
• Commissioning for social value – SROI – how can
each $ spent also produce wider community
wellbeing?
• De-clustering of disadvantage
• chance of aPlace/Whole System
The
Total life well lived lynne.friedli@btopenworld.com
31. Doing things differently…
Re-orienting services and programmes
Assessing policy impact
Addressing individual well-being holistically
Addressing social and community factors
Tackling wider well-being determinants
Focusing on strengths and assets
Measuring well-being outcomes
The chance of a life well lived lynne.friedli@btopenworld.com
32. ‘best buys’
There is not a single case in which children in either
Canada or the US have better outcomes than children in
Norway Phipps 2002
• Supporting family life: household production activities -
parenting/ HLE/ play/reading 8:1 return
• Supporting lifelong learning: early years; health
promoting schools and continuing education 25-
45:1 return
• Improving work: employment/ workplace up to 30%
saving
• social support/integration: befriending, volunteering,
timebanks cost effective
33. Focus of interventions
Policy responses that enhance connections, collectivity and
financial security
material social
collectiv
e
individual
‘Public disregard ruins the spine’
The chance of a life well lived
Brecht
lynne.friedli@btopenworld.com
34. Return to the social....
And what I shall endure, you shall endure
For every atom belonging to me as good belongs
to you......
Walt Whitman
Solidarity
Equity and Freedom
and the
Social to live a
core
Justice valued life
economy
I am, because we are...
The chance of a life well lived lynne.friedli@btopenworld.com
35. Yes, but what can I do....
That’s it
• Share your income folks!
• Share your time
• Develop an inequalities imagination*
• Acknowledge what people are up
against
• Hear, believe, understand, respect...
* Angie Hart
The chance of a life well lived lynne.friedli@btopenworld.com
36. So many roads, so much at
stake
So many dead ends, I’m at
the edge of the lake
Sometimes I wonder what it’s
gonna take
To find dignity
Bob Dylan
The chance of a life well lived lynne.friedli@btopenworld.com
37. Seeing things
‘What are illusions?’ Milo asked
‘Illusions,’ explained Alec, ‘ are like
mirages.
And mirages are things that aren’t really
there
that you can see very clearly.’
‘How can you see something that isn’t
there’?
yawned Humbug
‘Sometimes it’s much simpler than seeing
things Escape by Kathleen V Crosby
that are’, said Alec.
The chance of a life well lived lynne.friedli@btopenworld.com
38. Select bibliography
Beckfield J and Krieger N (2009) Epi + demos + cracy: A Critical Review of
Empirical Research Epidemiologic Reviews 31(1):152-177
CSDH (2008) Closing the gap in a generation: health equity through action
on the social determinants of health Final Report of Commission on Social
Determinants of Health Geneva: World Health Organization.
http://whqlibdoc.who.int/publications/2008/9789241563703_eng.pdf
Friedli L (2009) Mental health, resilience and inequalities WHO Europe
London;Copenhagen http://www.euro.who.int/document/e92227.pdf
Nussbaum M (2011) Creating capabilities: the human development
approach Belknap Harvard
Stiglitz JE, Sen A and Fitoussi JP (2009) Report by the Commission on the
Measurement of Economic Performance & Social Progress
http://www.stiglitz-sen-fitoussi.fr/documents/rapport_anglais.pdf
Wilkinson RG and Pickett KE (2006) Income inequality and population
health: a review and explanation of the evidence Social Science and
Medicine 62:1768-1784.
Zaveleta RD (2007) The ability to go about without shame: a proposal for
internationally comparable indicators of shame and humiliation OPHI
What can 'capabilities' contribute?
Working Paper 3 lynne.friedli@btopenworld.com
http://www.ophi.org.uk/pubs/Zavaleta_Shame_Humiliation_Final.pdf
Editor's Notes
Mental health – it’s the scaffolding in our lives, our children’s lives, in the lives of our communitiesSo, I’m going to talk about:the profound importance of mental health to life chances and life outcomes - across many different domainswhat we know about key influences – the social determinants of mental health and wellbeing – for individuals, families, communities and society some priorities for effective (and cost effective) action to improve population mental health and wellbeingAnd I’m going to suggest that we can do a great deal more than we think to protect and enhance mental healthDef of sd – something we can do something about
Which means that this agenda is also informed by – and relevant to – people with lived experience:Psychiatric survivor movement, the voices of consumers, the recovery movementThe wider struggles for the rights of people with disabilities – UN conventionPrinciples of Dignity in entitlement, equality of worth and value, everyone having something to contributePrinciples that respect people’s strengths, potential, capacity – particularly the strengths of those whose value is overlooked or denied ...Manitoba’s Rising to the challenge
So, mental wellbeing – how we feel about and experience our lives – individually and collectivelyA recognition that:how people feel matters...mental wellbeing is more than absence of mental illness, learning from survivor movement and recovery about what supports wellbeing, even when mental illness persistsat root, mental wellbeing is a hearts and minds response to our lives
Before moving on, take a moment to reflect on what we all need for our own wellbeingInsights from neuroscience and also work of Sen and others on capabilities – attempt to identify what people need from others in order to function wellWe all need – heard, believed, understood, respected – but profound inequalities in whose story is heard, whose truth believed, in who feels understoodThe greatest (and most painful) inequality may be inequality in the distribution of respect – how this is linked to material inequalities – and the impact of both – materialinequalities and inequalities in respect - on mental wellbeing
I want to look now at why mental health matters how understanding mhdeepens our understanding of the social determinants of healthAlso good reasons why mental health is sometimes referred to as mental capital...Mental health is a precious resource – something we passionately want for our children
So let’s explore a few key reasons why its worth paying attention to mental health in more depth:There’s a broad understanding of link between mental illness and poorer outcomes = but absence of wellbeing – ‘ill-being’ – also influences outcomes – whether or not we have a mental illnessMental Wellbeing helps to account for the unexplained excess – what does that mean? Whether we look at crime, education, health, issues like alcohol, drugs – classical risk factors – behaviour or material factors – poverty, housing - don’t account fully for the level of variation – Those four dimensions – think, feel, relate, meaning – give a richer picture of what influences outcomesAs I’ll show, improving mental health makes good economic sense, as well as social valueAnd understanding mental health fundamental to reducing health and other inequalities
Worthwhile in itself – most people value a sense of emotional and social wellbeingAlso a key pathway through which life events/life circumstances – social determinants - impact on outcomesAs we raise levels of wellbeing, we reduce prevalence of mental illnessRisk of physical health problems and improve recoveryEmotional wellbeing fundamental to our children’s capacity to learn, influencing educational outcomes right through school years and beyondStrong links between poor mental health and risk of crime, violence, anti social behaviourImproves Quality of lifeAll these outcomes have very considerable economic consequences
So how come mental health influences so many outcomes3 things:Because of the Social nature of human beings – Impact of mind on bodyContribution of mental health to inequalities
at 10 minutes old, the human baby is mimicking mum’s expression – making a valiant attempt to gain recognition and to secure care – on which her survival depends and will depend, throughout life. That baby knows what we often seem to forget- We depend on each other, which is why the social matters so muchWe see from this very powerful meta analysis based on around 145 studies the importance of social support/social integration on mortality riskThe size of this effect (someone to turn to, sense of belonging) is comparable with quitting smoking and it exceeds many well-known risk factors for mortality (e.g., obesity, physical inactivity, alcohol)Community-belonging is strongly related to higher self rated health, mental heath and health-behaviour change in Canada and may be an important component of population health preventionThese studies raise crucial questions about factors that support or undermine Community belonging
Grandma was right - It’s all in the mind, but it’s written on the bodyRobust evidence of impact of common mental health problems – depression/anxiety – on risk of and mortality from cvd, cancer, respiratory disease, metabolic disease – 2-3 fold increase – link between schizophrenia and reduced life expectancy (in order of 20 years)Beyond diagnosis– relationship between poor wellbeing and somatised pain, medically unexplained symptoms – influencing how people use services - frequent attendance/A&E, crisis care etc.Psychic pain is transformed into bodily complaints - body contains and expresses psychic painWe know this – but is it reflected in how we design and deliver public health and social care?Enormous economic and human value of addressing these issues
We know about the profound effects of stress – stress ‘gets under the skin’ – influencing hormones, health of our hearts, immunityBut what are the primary sources of stress?International comparative studies suggest that status – we’re back to that issue of respect – control - influence over the things that affect our lives/ - and relatedness - affiliation, sense of belonging - are universal determinants of wellbeingWe need to pay much greater attention to the factors that injure these needs and to the impact of injuries to these needs – lack of status, lack of control, lack of affiliation – primary causes of stress - undermining what Sen has called ‘freedom to live a valued life’.Lack of respect, lack of control, alienation/isolation – these are not generally seen as public health priorities – but there’s growing evidence of how these non material dimensions of deprivation influence disease
What we also see is that once people are ill, levels of wellbeing influence how people experience and recover from illness – Improving mental health can make a significant difference for the increasing numbers of people living with – and trying best to manage – a long term condition. And of course, managing chronic disease and its consequences is set to place significant additional pressures on health, social care, welfareImproving mental health – resilience in the face of adversity
For all these reasons, as you might expect, mental health makes a significant contribution to inequalitiesPicture you’ll recognise – levels of inequalities, here by life expectancy – gap by healthy life expectancy likely to be very much widerBurntwood/Churchill – 71.3 (68 for men, 74 for women)Brandon, South eastern – both average over 80 (78 men, 82 women)LE for racialised groups is 8-10 years less than the averageThere’s an overall difference of around 10 years between LE and HLE (78.3m, 83w vs 68.3m and 70.9s)
That’s a map of health inequalities, but whichever domain of inequality we look at – education, employment, recovery - mental heath has a significant influenceEmotional wellbeing of children and readiness for schoolheath behaviour – we’re finally starting to see that diet, exercise, sensible drinking etc are outcomes not causesRelationship to services – whether we feel valued, respected etcPoor mental health often reinforces inequalities, because those who are most disadvantaged are most likely to experience both mental illness and poorer mental wellbeing. So, mental health is a consequence and a cause of inequalities and a crucial factor in understanding the limitations of focusing on ‘health behaviour’
What I’ve argued is that Mh needs to sit at the heart of our thinking about social determinantsThat mh reminds us of the Social nature of human beings – importance of designing population health around thatMental wellbeing is dynamicIt’s produced socially, mutually, reciprocally As we’ll see - It’s deeply affected by all those factors that impact on the social – relative income, wealth, housing, the environmentIt’s a particularly precious asset in times of change, adversity, insecurity‘you knew that’... But do we act or make policy like we know ... Or hold politicians to account like we know..And of course it’s only half the picture – if mh is so important ....
What protects and what is toxic to mhstatus, control, sense of belonging, respect, relatedness (to each other and other species), meaning and purpose, feeling valued – of course these things don’t drop from the sky, but are embedded in wider issues of power, privilege and political voice – What influences mental health?
Mental health is an intermediary determinants – it’s back to the cause of the causesThe social determinants: Distribution of power, privilege and resourcesOur children see it, systematic reviews demonstrate it:how social position influences our exposure to health risks and health assets – disadvantage and advantage – iDeeper understanding of mental health helps us to understand the nuances of all this – how it intersects with gender, ethnicity, disability, age - the relationship between the material and self respect, holding your head up, ‘what Sen has called ‘the ability to go about without shame’ And how all this Impacts on intimate relationships, care of children and care of the self...
This also involves understanding the wider structural factors that influence individual mental illness journeys – individual and collective experiences of pain, anger, demoralisation, despairAt this stage, I guess some people in the audience are getting restive – you knew all this – many of you may feel you can’t do anything about most of itI was recently at a public meeting in the North of England where a regional DPH was being challenged about health inequalities. And she said ‘ I can’t do anything about poverty, unemployment – the social determinants. And a community rep said ‘ we know that. We understand that. But what you could do is show you know what we’re up against.That story is about the importance of Respectful optimism – recognising the power of human spirit but also acknowledging what people are up againstIt’s about the Importance of connecting with collective traditions of making meaning out of adversity – anti poverty movements, civil rights, trades unions, feminism, gay liberation, mad pride, disability rightsHow we explain inequalities is a mental health issue.... Fix the individual? Or fix society?
If mental health is about relationships - our relationship to each other – questions of power are unavoidable We need to work towardsPower with – solidarityPower to – agencyPower within – confidenceAnd away from Power over Issues of accountability and vested interests
A further important element is how all this links to some very important current debates about the pressures of consumerism, materialism – what impact this has on mental health – especially of childrenRange of recent studies suggest that children are very aware of and influenced by these pressures
See here the scale of the increase since the late seventiesManitoba The gap in average householdincome has more than doubled in just 20 years for bothrural and urban communities. In 1986, the wealthiest rural households in Manitoba earned an average of $21,790 more than the poorest households. Twenty years later, the difference was $47,005. The gap was even bigger in Winnipeg and Brandon, with a difference of almost $80,000 in 2006. On average, the wealthiest urban households earned $114,300, while the poorest households made do on $34,400. This growing gap in income was accompanied in many cases by profound and growing health gaps.
And here the relatively limited levels of redistribution‘stickiness’ of position. For example, about half of the children who were in the bottom quintile of the group’s income distribution in 1994 were again observed in the bottom quintile in 2004; only 4 percent of these children had moved up to the top quintile.living in a lone-parent family, having a parent without paid work, living in one of the Atlantic provinces, or having a parent who is non-white. Atlantic provinces, Quebec, Manitoba/Saskatchewan or BC are more likely than children from Ontario to have ‘ever’ had family equivalent income in the bottom quintile, with the size of the association largest for children living in the Atlantic region.
What can we do?Huge amount of effective practice across Canada – featured over next two daysFinal section:Direction of travel/key principlesStimulate some discussion on what we can stop doing…
Some key themes in the cost effectiveness literature that strongly support greater investment in population mental health:Use of economic modelling means that we can factor in the very wide range of outcomes influenced by mental health - physical health, employment, crime, suicide etc. – using a longer timescale – across the life course – to demonstrate the extent of savings accruedThe majority of serious mental health problems begin early in life and, unlike cancers and most heart disease, they cause disability when those affected would normally be at their most productive. early manifestation of poor mental health and its persistence over the lifetime are untypical of poor health generally and constitute a major reason why the overall cost of poor mental health is so large. Commissioning for social value – sometimes called SROI – means asking how each intervention $ also protects or enhances the social – supports family life, creates local jobs, empowers communities, strengthens control, uses local resources or skills, builds connectionsDeclustering disadvantage is based on growing recognition that positive and negative outcomes cluster – Take debt advice– cost effectiveness is due to ‘problem clustering’– that debt influences individual health, family health, school attendance in children, sickness absence, frequent attendance in primary care and damages the local economyaddressing outcome clusters involves whole community or total place approaches – and recognising that some disadvantage is particularly ‘Corrosive’ - poor education and racial discrimination for example.Mental health is an important factor in explaining the clustering of disadvantage and the urgent need for public health to move away from single issue, single outcome interventions. Not least because of substitution – if we fail to address the underlying issues, even if everyone stops smoking, stops drinking – tobacco, alcohol, will be replaced by something else and health inequalities will remain.
“targeting individuals case by case, in the absence of change at the community level has not worked, could not work. Targeting specific outcomes in isolation from the rest of a community’s life and circumstances has not worked, and could not work. The evidence points to targeted, integrated and holistic support and intervention at a community level” (Colin Mair)Strengths based approaches – should contribute to struggle for social justice, not distract from it... Psycho social assets are not an alternative to a fairer distribution of material assets
Range of work on best buys in improving mental health – your own Institute of Health Economics in AlbertaBut I want to start with the work of Shelley Phipps and her observation:It’s notable just how many of the poorer outcomes she found in canada related to mental health Low birthweight, asthma, accidents, anxiety, activity limitations, trouble concentrating, disobedience at school, bullying, lying, hyperactivityBest buys across a population would include: and there are no surprises hereSupporting family life – work-life balance, quality of childcare, pre-school education, but also, crucially, the home learning environment – building the capacity and confidence of parents and communities as educators of their children – need to be careful that contact with professionals doesn’t undermine parents – stronger focus on factors that inhibit positive parentingSupporting life long learning - Adult education and basic skills - increase education of women from no qualifications to basic qualifications significantly reduces depression Improving quality of work – more important than ever for mental health to be on the agenda in the workplace – cost effectiveness case for quite simple awareness raising, as well as access to support, rehab, and a focus on keeping people in workGrowing evidence on effectiveness of environmental improvements, green space/blue space, stop and chat, walkability, reducing low level, street level incivilities
the pull of ‘life style drift’ is so very strong – and is often supported by the wellbeing agendaBut the overwhelming theme to emerge in the research literature is the importance of the social, the collective, the material and that this is where the balance of our efforts should lieFire fighting: responding to immediate need/distressIndividual skills and resilienceParents, family, social relationships /networks Material circumstances (income, wealth, housing, debt, benefits, credit)Social justice (reducing inequalities in the distribution of valued resources – including employment)Environmental justice (green/blue/play space, noise, pollution, street level incivilities)–
These themes have led to calls for a return to the social – Which raises questions about what protects the social – the role of Equity and Social Justice – but also the nature of the relationship between professionals and disadvantaged communities
I’ve argued that mental health is an important pathwayThat a deeper understanding of mental health deepens our understanding of how social position influences the chance of a life well lived – the mental heath impact of our experiences of employment, housing, income, education, discrimination – is both immediate and far reachingI’ve argued for the universal importance of the need – of each individual, family and community – for respect, control, affiliation . These needs are of course consistent with equality of human dignity and the wider human rights agenda.Recognition of these mental health needs can and should shape policy, planning and the design and delivery of interventions and I hope very much can contribute to the nature of our conversations over the next two days.So, I began by suggesting we can do more to promote mental health than we imagine:Share your income: what does that mean? Wouldn’t most of us here do a better job if we drew on the expertise of people living on low incomes – so – work in partnership and share your pay accordingly Develop an inequalities imagination – use it, along with the evidence from epidemiology, epigenetics and neuroscience Listen – hear, believe, understand ,respect