Mental Health Promotion

Mental Health Promotion (MHP)
MHP is defined most comprehensively and usefully by Joubert and Raeburn in “Building on strengths” as:
“Mental health promotion is the process of enhancing the capacity of individuals and communities to take control over their lives and improve their mental health. Mental health promotion uses strategies that foster supportive environments while showing respect for culture, equity, social justice and personal dignity.” (Joubert & Raeburn, 1998; Ministry of Health, 2002a) (p19)
How is it different from health promotion?
MHP is similar to the process of community-based health promotion projects that usually focus on improving physical health or reducing smoking or trying to change specific risk factors or behaviours. In contrast to health promotion, MHP explicitly focuses on mental health outcomes such as increased sense of personal control, empowerment, resilience, positive coping strategies and the widening of informal social support networks in the whole range of populations (Willinsky, 1999).

In other words, MHP focuses on enhancing competence and positive mental health rather than reducing deficiencies, disorders and risks. The concept is described as the “competence enhancement model” (Williams, McCreanor, & Barnes, 2003). Mental health promotion applies to the whole population in the context of everyday life, not only to those at risk or with mental illness.

Why we need mental health promotion
Global health issues are rapidly changing. At the beginning of the 21st century, the public health sector is facing new challenges such as globalisation and chronic degenerative diseases (McMichael & Beaglehole, 2000; University of Auckland, 2006). The public health sector is also aware of evidence-based practice and cost-effectiveness (Mathers & Loncar, 2005). Yet unexpectedly, on top of these known challenges, community mental health seems to have become a major health issue around the world with the release of the recent WHO report in which depression is identified as heading the list of the ten leading causes of DALYs (The Disability Adjusted Life Year Lost) (Mathers & Loncar, 2005). A recent study reports that anti-depressants do not seem to be working (Kirsch et al., 2008). These reports are essentially a powerful driving force behind the upsurge of interest in mental health promotion which is believed to be the best tool for tackling this global health problem.

However, public health seems to remain preoccupied with a limited number of physical diseases instead of setting priorities in pursuit of mental healthiness, happiness and well-being (Ministry of Health, 2002; Population Health Dinner Debates, 2006). Community stress is everywhere. Discrimination, social isolation, depression, anxiety and suicidal thoughts are interrelated with social problems, and eventually, these lead to mental health concerns in the community (Ministry of Health, 2002), especially in disadvantaged population groups such as ethnic minorities and migrants.

Melbourne Charter
From Margins to Mainstream: 5th World Conference on the Promotion of Mental Health and the Prevention of Mental and Behavioral Disorders in Melbourne 10 - 12th September has drafted a charter for MHP to guide future works. The Melbourne Charter is expected to make a real difference in MHP. All delegates to the conference can contribute to the charter. The final document will be available in early 2009. Details here.

Everybody is a mental health promoter
We all can promote positive mental health, which is everybody's business (World Health Organisation, 2003). There is no health without mental health.

Nobody is immune to mental disorders, but the risk is higher among the poor, homeless, the unemployed, the uneducated, victims of violence, migrants and refugees, indigenous populations, children and adolescents, abused women and the neglected elderly (World Health Organisation, 2003).

Mental health promotion at the community level can concentrate on three themes: social inclusion, freedom from discrimination and violence, and access to economic resources such as work, money, education and housing (VicHealth, 2005). Mental health promotion tool kit is available from the Canadian Mental Health Association, National Office.

Mental health promotion can take many forms, because positive mental health is the result of many interacting factors, there is no single way to promote it (Willinsky, 1999). However, having an established evidence-based framework is very helpful, for example, Mental Health Promotion Framework 2005 - 2007 of Victorian Health Promotion Foundation (VicHealth, 2005).

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Global Health

Global Health
Global health issues can be divided up in a number of ways. Communicable vs Non-Communicable Disease (NCDs) is perhaps the most commonly used division as it allows important differences in terms of aetiology, epidemiological spread and options and scale of interventions to be thought through. Non-communicable disease is sometimes referred to as chronic disease.

Another way to divide up the many aspects of global health is to think of it in terms of the variety of disciplines which concern themselves with health at a global level including epidemiology, political science, demography economics, social science and the clinical disciplines.

And finally, one may think about global health in terms of the actors and stakeholders involved with global health, directly or quite commonly, indirectly. Politicians, aid workers, the private sector and civil society are all involved with the issues that determine population level health.

Common to all facets of global health however is the idea that the social and physical environment ranging from political freedoms to access to clean water are reasons for the difference between life and death for millions of people every year.

Communicable and non-communicable disease.
Communicable disease is responsible for about half of the global burden of disease. TB, HIV and Malaria have been the targets of important global health initiatives of late. With about 33 million people living with HIV, 14 million with Tuberculosis and 410 million cases of Malaria, it is clear that these three diseases are the issue of our time.

Non communicable diseases are on the rise. Presently cancer, heart disease, diabetes and obesity together form about half of the global burden of disease. Low income countries that have traditionally fallen victim to communicable disease are now also seeing diabetes and obesity epidemics giving rise to the ‘double epidemiological burden’, that is to say, poor countries are having to plan for both communicable and non-communicable disease epidemics.

Global health disciplines
Epidemiology, economics, demography, ethicists and political economists study global health issues.

A primary perspective emphasizes the cost-effectiveness and cost benefit approaches for both individual and population health allocation. Aggregate analysis from the perspective of governments, NGOs and Foundations for global health allocation focuses on the use of cost-effectiveness and cost-benefit analysis for the health sector. Cost-effectiveness analysis compares the costs and health effects of an intervention to assess whether health investments are worthwhile from economic perspective. It is necessary to distinguish between independent interventions and mutually exclusive interventions. For independent interventions, average cost-effectiveness ratios suffice, but for mutually exclusive interventions it is essential to use incremental cost-effectiveness ratios if the objective – to maximise healthcare effects given the resources available – is to be achieved. Individual health analysis from this perspective focuses on the demand and supply of health. The demand for health care is a derived demand from the demand for health, more generally. Health care is demanded as a means for consumers to achieve a larger stock of "health capital." The demand for health is unique, because individuals allocate resources in order to both consume and produce health.The optimal level of investment in health occurs where the marginal cost of health capital is equal to the marginal benefit resulting from it (MC=MB). With the passing of time, health depreciates at some rate δ. The general interest rate in the economy is denoted by r. Supply of health focuses on provider incentives, market creation, market organization, issues related to information assymetries, the role of NGOs and governments in health provision.

Another approach, embraced by ethicists and bioethicists, emphasizes distributional considerations. For example, the Rule of Rescue is a rule coined by A.R. Jonsen in 1986 that is currently used in a variety of bioethics contexts. The rule of rescue rule specifies that it is 'a perceived duty to save endangered life where possible' (Bochner et al, 1994, pp901) Recent bioethics research examines what kinds of international obligations of justice exist broadly clustered in three areas: (1) When Are International Inequalities in Health Unjust?; (2) Where Do International Health Inequalities Come From?; (3) How do we meet health needs justly if we can't meet them all?

A third approach emphasizes political economy considerations applied to global health. Political economy originally was the term for studying production, buying and selling, and their relations with law, custom, and government. Originating in moral philosophy (e.g. Adam Smith was Professor of Moral Philosophy at the University of Glasgow), political economy of health is the study of how economies of states — polities, hence political economy - influence aggregate population health outcomes.

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Electronic Health Records: EHR

The term "Electronic Health Record" is often used interchangeably with the terms:

Electronic Medical Record (EMR)
Computerized Patient Record System (CPRS)

The problem with these terms is that often industry pundits strongly differentiate between them, proposing that there is some major difference between an EHR, an EMR and a CPRS. For the most part, those who draw strong distinctions here are selling something: "A you definitely do not need an EHR, you want an EMR, which is clearly better and we happen to sell." or vice-versa. In reality one could argue that EHR, EMR and CPRS are just different names for the same thing.

They are all legitimately different, however, from what is typically called a Practice/Hospital Management Systems (PM or PMS or HMS). These systems track clinical information, but typically only that information which is required to run the business of a hospital or a practice. Even this line is blurry, however, since many Practice Management Systems are capable of doing things that would typically be thought of as purely clinical. (For instance a PMS might track lab results)

It is important to note that in many parts of the world, including the United States, the business of medical practices and the business of hospitals are very different. Practices are a place where a single clinician can set up shop and begin providing care in what is known as an Out-Patient setting. Hospitals are typically groupings of much greater resources, and are typically In-Patient. The distinction between In-Patient and Out-Patient (Ambulatory) is quite simple: whether patients typically spend the night. An In-Patient facility, (a hospital) primarily coordinates between patient "beds" and other clinical resources (Physicians, MRI/CAT/XRAY machines, the hot tub.. etc..) An Out-Patient facility typically thinks in terms of time, the primary coordination is to make sure that the patient and the clinician are in the same room at the same time.

As a result, Electronic Health Records (and also Practice Management Systems) vary greatly between In-Patient and Out-Patient settings. For instance, in the United States (which has a private payer model for healthcare finance - for the time being), this distinction has given rise to two different methods of communicating charges to payers (x12 837i vs 837p).

Hospitals are typically more concerned with coordinating the care provided to a patient who is in a bed. They must either move resources between "beds" or move "beds" between resources. Most of the tasks surrounding patient care require some information to be recorded, either in a paper chart or in an EHR.

Hospitals might want to ensure that medical images are available in digital format. Many studies have shown that Computerized Physician Order Entry (CPOE) systems, which are part of a comprehensive EHR, dramatically reduce medical errors, especially those relating to medications. A hospital EHR should probably also have a clinical reminders system, to ensure that important clinical tasks do not fall through the cracks.

Again, the general focus of a hospital EHR is to ensure that clinical resources and patient meet. So it focuses around tracking


Where is the patient now?
What resource needs to come to the patient?
What resource should we move the patient to?
When will this patient vacate this space, so that another patient can be treated?
How many spaces (beds) do I have available?


An Out-Patient or Ambulatory EHR focuses on appointments.


When is the patient arriving?

What was done or discovered during this encounter?

When is the patient coming back?

An EHR is supposed to track the relevant clinical information in both of these systems. Often, clinicians expect separate systems to work together to accomplish this. They will buy one program to run the pharmacy, for instance, and another to track patient data. Usually this design results in projects to integrate the two products so that they act as one.

The point of an EHR is to be comprehensive, many argue that systems that rely on both paper systems and electronic systems have the worst of both worlds. Others believe that a hybrid approach (which is actually most typical) is the most effective.

Physicians often point out, correctly, that studies have shown mixed results regarding whether EHR's improve the care delivery in an single-provider setting. Many of the benifits of an EHR are more apparent in settings were multiple people are required to work together to corrdinate care. It should be no surprise that hospital EHR deployment is far more common than practice based deployment.

The most important thing to remember about EHRs is they are intended to serve the clinicians need to better manage information. The problem is that different clinicians have very very different clinical needs. Getting a large group of clinicians to agree about what they want is pretty much impossible (getting one to agree with what he or she said on different days is hard enough.

A friend of mine summarized it this way:

"Doctors have no idea what they want, and programmers give it to them"

However, the EHR industry is become better and better defined. There are hundreds of small vendors in the space and they are slowly consolidating. There is a new certification system (CCHIT) that is establishing firmer standards about exactly what an EHR should do.

Still, the true definition of an EHR will be somewhat nebulous as medical science discovers more and more relevant information that it should hold. Soon, the entire contents of a persons DNA will be stored in an EHR system. Obviously this makes an EHRs an important area for privacy research. While privacy concerns are important, there is a lot of FUD (Fear, Uncertainty and Doubt) about the real risks of having information stored in EHR systems.

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Smoking Results In Gum Disease And Oral Cancer

Currently there are 1.3 billion people on this planet who use tobacco in all its damaging forms. Let’s talk about its effect on the oral cavity.

University research has shown the smokeless tobacco as well as smoking tobacco in the majority of cases results in periodontitis (gum disease)and forms of oral cancer. Only half of all patients diagnosed with oral cancer survive more than five years.

For years, the American Dental Association (ADA) has sponsored advertising campaigns to encourage the public to stop using tobacco. For example, you no longer see professional baseball players chewing and spitting tobacco; they have switched to sunflower seeds.

The case numbers of oral cancer and gum disease in women has significantly increased, largely in part to an increase in the consumption of alcohol and smoking.

New data shows that patients with chronic gum disease have an increased risk of cancer of the tongue. In addition, recent studies show a relationship between gum disease and cancer of the spleen and/or heart mitral valve complications.

Northwestern University studies have shown a direct relationship between smoking and osteoporosis, particularly among post-menopausal women.

Dental research concentrates on evidence-based data. This has led dental experts to conclude that total cessation of tobacco use, even for moderate smokers, will reduce oral problems.

Unfortunately, in my (Fallbrook) office alone, the detrimental effects of tobacco has caused many of my patients to lose teeth and brought on oral cancer. To date I have lost five patients due to metastasis of cancer.

It is my recommendation that smokers consider quitting immediately. In some cases, difficulties can arise when someone decides to quit smoking. Your dentist, physician and local health facilities can assist.

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Stop Smoking In 10 Simple Steps

One's failure to quit smoking can be attributed to innately embedded thoughts that may be almost impossible to reorient. Indeed, abandoning this unhealthy habit requires changing one's way of thinking. Let's discuss 10 ways to quit smoking:

1. Learn about the numerous perils of smoking. Most smokers fail to quit because they are not aware of the fatal effects of smoking. The worse thing is, majority of these smokers already know the perils of smoking, but they cling to the false belief that they're not true - at least, until such time when they develop the particular ailment or disease.

2. Always tell yourself that you're not immune from ailments and diseases. You're just human. You're no alien from a dead world. Your body is fragile to damage and injury, and smoking enlarges that number tenfold. You're not exempt from the hazards of smoking. You're just like everybody: human.

3. Know that you are more than how you currently are. If you want to, you won't have to give in to the smallest inclination to smoke. If someone asks you to jump in front of a speeding car, will you? You're not a fool, right? Hence, you're an idiot to remove seven minutes of your life per stick of cigarette.

4. Never view a stick of cigarette as a prize. It isn't.

5. Remember that smoking will never make you cool. Nowadays, when people would rather enjoy great health and live longer years, smokers are looked down on with pity.

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6. Remember that though smoking may help you relieve stress, it will come at a steep price. The perils of smoking are too big to ignore. Would you rather enjoy a few minutes of relaxation at the price of a lot of years subtracted from your life?

7. There's no rule that says you should smoke after eating. Smoking won't remove the taste of food inside your mouth. Want to eliminate this? Try brushing your teeth.

8. Realize that when you smoke in public, you're committing indirect homicide. Second hand smoke is just as hazardous as the smoke you inhale. When you smoke in a crowded place, you are comparable to a {walking personification|symbol|messenger of death and disease.

9. Know that smoking doesn't help you shred weight. Cigarettes burn your lung, not your fat.

10. Learn that smoking won't help you concentrate at work. It's all in the mind. It's all about you and not what you take in.

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Stop Smoking Tips for 2009

What's the most successful method to quit smoking?

The answer is a mere word...fear.

It may sound a little extreme, and it may even sound absurd, but successful ex smokers are in agreement in stating that the best technique to stop smoking is a powerful scare tactic. Sadly, such scare tactic may actually be true, and its hazards may be nearer than what we'd initially perceive.

A smoker can try several methods to abandon smoking. He may try the mental approach of classical conditioning by rewarding himself after every success or depriving or hurting himself after every manifested inability.

A smoker can also consider traditional techniques like nicotine patches, which are said to put a stop to the body's desire for nicotine too. Sadly, even years after their initial circulation to the market, nicotine patches have not yet garnered verification from the medical community.

What about a hypnotic approach, you might ask? Hypnosis is known as a method to help the patient to stop smoking by forcing his subconscious to forget about the body's perceived longing for a smoke. Though, a number of people think of this as merely as "sci fi"-ish as Star Wars .

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When everything's been said and done, one of the most effective method to make a smoker quit smoking is through fear.

It may be a actualized fear, for example, when the smoker suffers a heart attack or a stroke or is discovered that he has the beginnings of lung cancer. Statistics show that sixty-seven percent of smokers who experience their starting brush with a fatal ailment caused by their vile habit actually quit smoking. Almost 6 out of 7 of them quit for life.

It may also be an emotional fear, like the perceived horror of abandoning one's family, or failing to witness one's children grow up to be wonderful people. Such is truly a case of love conquering all - cigarettes included.


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How To Quit Smoking

If you are a smoker and are wondering how to quit smoking, you are not alone. Every day, thousands of smokers make the choice to quit smoking but unfortunately do not know where to start. Below is a strategy that you can put in place today.

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1. Set Goals That Inspire You
To achieve your smoke free goal, you need to be very clear about what you want. Do not just leave it as "I want to quit smoking". That is very vague. Without clear goals, you are not going to focus your time and effort on your goal.

To really inspire yourself to get the life you want, you need to have goals that are:

Specific
Measurable,
Inspiring and exciting.

Assuming you are a chain smoker who smokes 30 sticks a day, your powerful goal could be, "I must cut down my cigarette intake by 1 stick a day so that I am able to quit smoking by the end of this month."

2. Develop Your Action Plan
Now that you know what will want, you need to have a plan to achieve it. How do you plan to stop smoking? Do you want to experience the cold turkey method? Or do you require help in the form of nicotine therapy? Or would you rather go for natural ways to quit smoking?

Decide on your strategies and write them down. At this point, it is wise to check with your doctor if you are not sure which one suits you. Everyone is different and you may have medical condition that makes you unsuitable for some of the methods.

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3. Take Action
This is where you can your hands dirty. Every step you take, no matter how small, will bring you closer to your goals.

For example, if you have decided to make use of nicotine gums to reduce your reliance on cigarettes, do it. More importantly, ensure that the action you take is indeed moving you towards your smoke free goal.

4. Keep Changing Your Strategies Till You Succeed
At this point, you may like to know that statistics have shown that most smokers do not succeed in quitting smoking within their first 3 tries. This is because nicotine addiciton is not easy to get away from.

The trick here is not to give up but to keep learning from your actions and change strategies when needed to achieve your goals. How to quit smoking for all smokers is really a matter of mind over matter. Keep going and you willl definitely succeed in quitting smoking.


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