Presented at 25th European Congress of Psychiaty, Florence, 1 April 2017. The presentation argues for public health interventions, targeting the early years, by involving non-health sectors in the common task to promote mental health for all.

1. Public mental health: Time to
translate evidence into practice
Kristian Wahlbeck

2. Faculty Disclosure
X No, nothing to disclose
Yes, please specify:

3. Mental health is shaped early in life
Where and how we are born, grow, live, work and age
determines our mental health

4. 01.04.2017 Public mental health
Children who have been
maltreated or bullied are much
more likely to have mental health
problems in adulthood
Great Smoky Mountains Study, Lereya et al
Lancet 2015
Risk of mental
health problems
in adulthood
0.0
1.0
2.0
3.0
4.0
5.0
Normal population Maltreated Bullied
4
Oddsratio

5. Mental health determinants & risk
factors: Growing evidence base
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Early interaction deficits
Neglect, abuse and harsh
upbringing
School bullying
Work place stress
Lack of social support &
networks
Community environment
Socio-economic determinants
(poverty, social exclusion)
Life style
Alcohol and illegal drug use
Common NCD Specific

6. Cumulative incidence of first DSM-IV disorder
by comorbidity and severity
“Generalized“ psychopathology already present at age 13
6
Ormel et al., 201401.04.2017 Public mental health

7. New thinking opens up for new
interventions
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8. Mental health systems
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Psychiatric
services
Primary care
Prevention of
mental disorders
Mental health
promotion

9. Mental health promotion
• MHP aims to strengthen mental health and wellbeing in the population
• Mental health is dependent on structural determinants: mental wellbeing
is best achieved in equitable, just and non-violent societies (Patel 2014)
• New evidence shows that mental health promotion is effective
• Parenting support
• Socio-emotional learning programmes in schools
• Work-life interventions to improve stress coping skills
• Social activities for elderly people
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10. Evidence based public mental health
Consentious use of critically appraised
methods to promote mental health, prevent
mental health problems and provide
services.
Public mental health interventions
are typically complex, and a larger variety
of evaluation methods are needed than
In a clinical context

11. ROAMER: Geographic distribution of
public mental health publications
(weighted by GDP)
Forsman et al. 2015, Eur J Publ Health
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12. Effective public mental health
interventions
Parenting support interventions have been shown to promote life-long
mental health and well-being of the offspring.
School programmes have consistently been shown to have positive moderate
to strong effects on social and emotional skills and competences
Workplace reorganisation and increased control over work life improve
mental wellbeing, increase productivity and reduce costs. Job search groups
and individual placement and support promote mental health of job seekers.
Urban planning, such as housing programmes, have mental health effects
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13. Parenting support
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14. Intergenerational
transmission of
mental health
problems can
be stopped
Risk of mental disorders in the offspring
of parents with mental disorders is reduced
by 40% by preventive interventions
Siegenthaler et al. JAACAP 2012

15. 40 % of mental disorders can be
prevented in high-risk families
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Effect of interventions on the risk in the child of the mental disorder
diagnosed in the parent. Siegenthaler et al. JAACAP 2012

16. NIH/NIDA: A child’s first eight years
are critical for substance abuse
prevention
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“There is strong
evidence that a stable
home environment,
adequate nutrition,
physical and cognitive
stimulation, and
supportive parenting
can lead to good
developmental
outcomes.”

17. Parenting support enables financial
contribution to society
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Ministry of social affairs and integration, Denmark 2012
17

18. School programmes

19. School-based mental health
promotion
• a.k.a. ”socio-emotional learning, “emotional literacy”, “emotional
intelligence”, “resilience”, “life skills” and “character education”, targeting
• skills
• curriculum
• teacher education,
• peer support
• whole school approach
• Strong evidence of effectiveness
• Strong effects on socio-emotional skills
• Small to medium effects on emotional well-being
• Evidence of reduction of depression, aggression, impulsiveness and
antisocial behavior
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20. Income-to-needs ratio = poverty line = 1
Internalizing
problems
Norwegian Mother and Child Cohort Study (MoBa), N=75296 (Zachrisson & Dearing, 2014)01.04.2017 Public mental health20

21. Evidence-based school interventions
• Anti-bullying programmes
• Whole-school approach
• Teacher training programmes
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22. Workplace interventions

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24. Company performance and workplace wellbeing: indices by country
Source: Eurofound Third European Company Survey 2015
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25. Evidence base for workplace
interventions
• 14 systematic reviews show moderate effectiveness
of workplace interventions
Wagner et al 2016, Int J Occup Envir Med
• A systematic review and meta-analysis of universal
workplace interventions for prevention of
depression (9 RCTs, mostly CBT-based interventions)
show a small positive effect
Tan et al 2014, BMC Med
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26. Gap between evidence and practice
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Social determinants
of mental health
Mental health
promotion
27

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Social determinants
of mental health
Mental health
promotion
Mental Health in All
Policies
28

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Going upstream: Structural determinants
of mental health
29
Poverty
Gender inequality
War and conflicts
Social exclusion
Income inequality

30. The NCD challenge
We need to take the step from ”four diseases, four risk factors” to ”five
diseases, five risk factors”
Diet
Exercise
Alcohol
Tobacco
Adverse childhood events
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Cardiovascular
Diabetes
Chronic respiratory
Cancer
Mental disorders

31. EU Joint Action for mental health and
well-being 2013-2016
Based on the European Pact for Mental Health and Well-being
Mental health promotion in schools
Workplace mental health promotion
Prevention of depression and suicides
Community care and deinstitutionalisation
Mental health in all policies
• Identifies best practices for cross-sectoral work and whole-of-
government practices across Europe
www.mentalhealthandwellbeing.eu
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32. A tool for Mental Health in All
Policies: Mental health impact
assessment
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How does the proposed
development/policy impact on…
• social determinants of
mental health
• equity
• people’s control
• people’s participation
• resilience and communtiy assets
• social inclusion?

33. Successful mental health actions build
on intersectoral collaboration

34. Thanks!