So now we're going to shift to mental health promotion. In some ways you already know about mental health promotion. We've talked about the bio-psycho-social balance, and what promotes mental health and undermines mental health. We've also talked about social determinants of mental health. We've talked about family environment and mental health. We've talked so much about what are threats to your mental health that you probably already have some sense that dealing with those things is mainly how you do mental health promotion. And you're right. But what we're going to in the next sections is talk in more detail about how those things work and what kind of things people are doing around the world to try to promote mental health and communities. Hopefully, you're going to find this helpful as you think about for your assignments what kinds of things are in place in your community or not in place in your community, that might be promoting men, promoting mental health or increasing the vulnerability of mental illness. We're going to start with a life course approach. You remember that we talked about the family life cycle and how families go through different stages as they move through time. And within that, within the family, of course individuals go through different stages as well. And we now talk about that in terms of an individual life course. Some people still say individual life cycle, but we talk about the individual life course. The reason that we're going to talk about the individual life course is because what we know is that there are different developmental stages that have different transitions involved in them, and different stressors that may make people more vulnerable to mental health problems. So that's one way of thinking through what can we do to promote mental health as people move through the life course. So that's where we're going next. Much of what I'll be talking about in this segment comes from this document about prevention of mental disorders. It's available online, and I've put the link in your resources document. So when we talk about preventing mental disorders we are often talking about paying attention to risk and protective factors that affect people at different points in the life course. One of the most important phases for this is early childhood, because that lays down the foundation for future physical and mental health in so many ways. But other stages of life are important as well. The stages that I'll, I'll be focusing on in this section are the prenatal, postnatal, and infancy period. The transition to school, basically childhood, adolescence, the transition to independence and adulthood, movement into years that will be devoted to family and work. And then retirement when those previous responsibilities usually diminish. As I said during the lecture on families, family life cycles and individual life courses can vary a great deal depending on culture and the demands and opportunities in any given environment. So that means that in describing the changing challenges and exhortations at different stages of life, I'm very aware of speaking within a specific cultural context and the need to adapt. This thinking to address other cultural context. So we start at the be, beginning of the pre and postnatal period by talking about having preparation for having children. There are some cultures where there is a lot of preparation for having children. There are ways in which the community mentors people into a parenting role. It may even be that because of the way the community's set up, you spend a lot of time around other families and you get to be mentored into that parenting role. But there are many where this is not the case. An unprepared parent can have a profound effect on the mental well being of their children. This is why you'll see in, in what's coming up, that parenting training is one of the most widely endorsed mental health promotion programs. There are a lot of, there's a lot of literature that shows that early pregnancy, that is, pregnancy that happens when a girl may be physically mature but not emotionally mature, is associated with physical and mental, mental risk for both the mother and the child. When we think of the mental health risks this often has to do with lack of preparation for taking on the responsibility of raising a child or children. But it's also linked to the reduced chances for security and stability in circumstances of early pregnancy. Drug and alcohol use during pregnancy is known to have a direct influence on the neurodevelopmental, sorry the neurodevelopment of the developing infant. A syndrome like fetal alcohol syndrome in which children are exposed to excessive alcohol during the in utero experience and that are born with significant mental and physical deficits will effect the mental health of that child for the rest of his or her life. Inadequate prenatal care can also lead to mental disabilities for the child and mental stress for the mother, as does inadequate postnatal care. Women are at increased risk for depression following pregnancy. Although it should be noted that we call this postpartum depression, but it can start during the pregnancy as well. Postpartum depression often gets overlooked because women and family members think it will just go away or that it's normal or that it's shameful and it shouldn't be discussed. Unfortunately, that means that depression go untreated and can develop into longer major depressive episodes. In addition we know that there are consequences for children who were raised by depressed parents. In addition to the immediate concerns about their physical and emotional well being. They are more likely to develop depression later in life. As I've already mentioned, parent training is a widely used mental health promotion tool all over the world. There are several evidence based parenting programs that have really been shown to make a difference. Parent training is directed at people who are preparing for a child, but also to help people who are already have children. So that they can develop the skills they need to raise their children in health promoting environments. It has actually been demonstrated that widespread dissemination of parent training programs will decrease the amount of child abuse and neglect. So attention to mental health promotion in the pre- and post-natal period is largely centered on the prevention of neurodevelopmental disorders that will increase the chances of future mental disorder. And the prevention of child abuse and neglect, that will increase the chances of future mental illness. Childhood is an important stage during which children develop important skills that will be the foundation for the future. An important aspect of mental health for promotion for children is having in place programs that will help promote the development of those skills that they will need so much as they grow, as they, as they grow up. Another important element is having in place programs that will identify any early problems with development. For many of these problems that develop in early childhood, early intervention can make a huge difference in terms of them catching up with their peers and being able to move into adulthood without major deficits or disabilities. Interventions in a family environments can be key at this stage as well. The reality is that parents have a huge, probably the most influence on the mental health of school aged children. Later on peers will become very important as well, but parents are key at this stage. Dealing with issues of family violence, conflict, neglect, or disengaged parents, is important for dealing with risk factors to child mental health. I've also added parental death here. Because we know that children who lose a parent are at increased risk for mental health problems, and will need additional support. Finally, we are now recognizing that there are children who develop major mental disorders in childhood. We are seeing more children with depression and anxiety. More rarely, even psychotic disorders. And there is a lot of controversy around giving these children pharmaceuticals that were originally developed for adults. The preferred intervention at this stage is to increase support to these children through counseling, working with families and working with schools. The same is true for children who are dealing with issues like conduct disorders. Conduct disorders are basically a group of disorders that describe children who are disruptive and acting out. Potentially violent as well. Because we know that children with conduct disorders can grow into adults with other mental disorders, but also because we know that these children do not finish school or may become involved in criminal activities, it's very important to intervene with them early. In this area, interventions are usually focused on working with parents to influence the family environment and schools are increasingly recognized as important allies in mental health promotion. Schools could both support mental health interventions for children who are having difficulties, but also promote mental health through programming that encourages the development of health promoting practices, self esteem, self confidence, et cetera, that will help promote mental health across the life span. Adolescence brings new challenges. This is the stage when we see the emergence of problems that could have a huge impact on future life opportunities and future mental health. For example, this is when there are risks for academic failure and disengagement from school. Remember that education is a social determinant of mental health. This can also be a time of increased family conflict, as adolescents start to assert their independence. The family may also be changing for other reasons, like divorce, which can create huge loss for the adolescent. And issues like family violence, family disorganization or neglect, continue to be a threat to the mental health of children in such situations. Other current, concerns arise from the increased exposure to things like bullying and violence that can be threats to mental health. Adolescence is the period during which many will start to experiment with alcohol and psychoactive substances as well. And substances problems can start to develop at this stage. For these and many reasons we can start to see people experiencing depression and anxiety that may be with them long into adulthood. Even without the kind of problems I've just listed, the increased demands of adolescence and early adulthood can be overwhelming for some people, and mental health problems may begin to emerge. There are additional risk factors that are associated with coming from a family in which there are several people with histories of mental illness, because we believe this confers genetic vulnerability to mental illness. Adolescence and early adulthood is often when we see first episodes of major mental illnesses. Some of the interventions that are being used to promote mental health for people at this stage of life include things that will help them to deal with these stressors. But some are directed at, at specifically increasing their personal skills and resources. Others will be directed at increasing the support and stability in their environments. Major players at this stage in mental health promotion are the schools, as they are seen as the place where adolescents can learn life skills, gain support, and find positive sup-, peer support. You see mutual support groups there as a potential intervention, and community safety is considered important to this work as well. Whether we're talking about school safety, neighborhood safety, or safety in the family home. Another area in which there are promising practices for mental health promotion with adolescents is through the work of adult supports and mentors. If adolescents are in situations where their own families are not able to provide the kind of safety, nurturing, and mentor-ship that we expect from the family system Then it becomes important for other adults to be involved. Sometimes all it takes is one person who is a trusted source of support and mentorship to make a tremendous difference in the life of a child or adolescent who needs it.
