Okay. So now we're going to talk about becoming communities that support mental health. And I'm reminded that, somewhere early in the course, there was a discussion, I'm not sure it was a discussion. But there was a post by somebody who seemed very irritated by the fact that I kept talking about what we could do, or what we did do, or what we we're not doing with regard to mental health. And, I think this person was irritated, because his comment was that I'm not a psychiatrist, so why does she keep saying we? And the thing is I want to bring us back to that, because the reason that I keep talking about we, is it's not just up to psychiatrists. And that's why I think it's fitting that our last formal segment of the course here is about community supporting mental health, because I believe, we, as community members have a lot to do with regard to supporting mental health. And there's a part of it that gets taken care of in the mental health system, but there's also a part of it that happens in our everyday interactions with the other, with the people that we meet at work, and the people that we see over the fence, and the people that we meet in the elevator and the way that we think about people with mental illnesses and the way that we think about taking care of our own mental health. And so, that's what I say we and that's why this section is going to be about what we can do as communities to promote mental health. So this part of the lecture is focused on what all of us can do to move toward communities that support mental health. I do want to put this in the context of international agendas. From, on the international stage, there's a great deal of concern with international human rights, as one of the things that we have to consider with regard to promoting mental health. Certainly the right to health, the right to education, we know that these are all things that are going to contribute to promoting mental health. But also freedom from discrimination, because one of the great risks to mental health is being oppressed and discriminated against and excluded. I already mentioned the grand challenges in global mental a few lectures ago, lecture four I believe, and that was all about strengthening the capacity of mental healthcare especially in under-resourced regions. Even in parts of the world that we think of as resourced, the distribution of mental healthcare resources can be very uneven. So we really need to think about strengthening that capacity. Another field in the international agenda, agenda is collaborative responses to crisis. And we've seen many examples of this, where people have come from all over the world to respond to a crisis in a certain region, for example, when the earthquake happened in Haiti. And another thing on the international agenda is attention to immigrant refugee and transnational circumstances. When I say transnational, I'm talking about people who move between countries, which is increasingly becoming a reality. But the other thing that's increasingly becoming a reality is that many of us are receiving immigrants and refugees in many countries. And we know that those transitions and the circumstances that people come from can often be quite unsettling and distressing and so that we have to pay attention to mental health issues in those populations as well. So you remember us talking about mental health before, right? So mental health is this basic idea of people having a state of wellness and well-being, having the capacity to reach their full potential, and the ability to deal with the normal stresses of life. Now, we always talk about the normal stressors of life and in these definitions and I always want to ask myself what to be considered a normal versus extraordinary stressors? I think we can all agree that maybe something like a tsunami is an extraordinary stressor. And then there are other things that we will probably agree are normal stressors in terms of things like raising our families and paying the bills. But what, where is the division there? Because, when I think about what we can do as communities in terms of thinking about mental health, I think one of the things we have to think about is have we let the threshold for normal get too high. And, in fact, are we dealing with extraordinary stressors, maybe even creating them for ourselves. And not realizing that this is having an impact on our mental health or ignoring that impact. Another thing that we have in mental health definitions is talk about the ability to be productive and fruitful and being able to contribute to work, family, and community. And these were all considered important components of mental health. We talked extensively about the determinants of mental health and the importance of reducing social inequal, inequality. And I like Sturgeon's definition here, about the creation of conditions that enable optimal psychological and psychophysiological development. That really speaks so broadly to the issues that we've covered in terms of what's happening physically with us, what's happening across the lifespan. And then, also what's happening, Happening in our day-to-day interactions with each other, that may create those conditions or may undermine those conditions. When we think about health, mental health promote, promotion, what the World Health Organization has suggested is that we think about different levels of prevention for different groups. Though there's a type of mental health promotion that's for people who are not at risk, which we call universal prevention, that benefits everybody. There's a group of mental health promotion strategies that are for people who are at increased risk we call that selective prevention. And then, there's a group of mental health promotion strategies that are for people that we know are suffering or recovering from mental disorder and they call that indicated prevention. But, bear in mind, moving in between these categories can be a very easy thing. Especially when we consider that an estimated one in four will develop a mental or behavioral disorder over the lifetime. It's hard to think, it's hard to imagine that there are many of us that will really be able to say that we're completely not at risk of mental health disorder. Okay. So, thinking about that sort of primary prevention that, that effects averyone and benefits everyone. We think about mental health promotion is just good health practice and one of the ways we think about that is in terms of things like urban and rural planning. The kind of noise and crowding that people have to live in. The kind of green space that's available to them. Things like contact with nature that we talked about when we're talking about indigenous models of mental health. These are things that are part of general mental health promotion. Economic development is considered mental health promotion for the reasons that I've already mentioned. And we've also talked about work life and stress balance. Something that we haven't talked about, that's just as important though, is the public access to things like arts, and recreation, and education. These are all things that promote mental health and aren't necessarily equally available to the people in our communities. So when we think about what could we be doing in our communities to promote mental health? Certainly thinking about the public space and opening up public access to things, like green space, arts, recreations. These are important things to think about in terms of promoting mental health of the community level. What about promotions, sorry, mental health promotion for populations at increased risk? Well, for a second, we should probably talk about who those populations are. Childrens of parent, children of parents with mental disorders. We've talked about how they are at increased risk of developing mental disorders themselves. Possibly because of the genetic element. Possibly because of the family environment they're in. Older populations are at increased risk for mental disorder. We've already discussed it, but those reasons as well. Immigrants and refugees, we haven't spent much time on that, but as I alluded to a couple slides ago, the kinds of transitions that they have to go through, the circumstances that they may be leaving, and then, and then entering. There's a huge literature on settlement stress that actually suggests that the stress of settling in a new environment is higher than the stress that they may have lef, when they were immigrating or, or fleeing as refugees. So immigrants and refugees are definitely recognized as a population at increased risk. People who are living with other disabilities. There's a lot of co-occurrence of mental illness or mental disorder with physical disabilities. So, we know that this is a population as well, that's at increased risk. People living with chronic physical illnesses. There's a lot of depression associated with chronic physical illnesses. There's some illnesses that, where we know quite specifically that there are heightened risks for mental disorder. For example, cardio vascular disease, or HIV. People living in poverty. We've spoken of this many times now. And people who are living without complete access to human rights as I already mentioned. So what does it mean to have outreach to these groups of people? Well, that's partly about services being in places where these groups of people can access them, and it's partly about cross-sector collaboration which we've already discussed. That means that wherever they are now, they have access to mental health care services in places that are trusted by them and already used by them. But I also think we have to think about outreach in terms of what we as citizens and members of our communities do. If we are living in communities with people that we know. People are at increased risk for mental disorder and if we know that they're living in circumstances that put them at increased mental, risk for mental disorder, what is it that we are doing to help and out and reach out to people like that? And that can be as grand as actual, you know, advocacy and, you know, advocating for policy change and all that. But also it can just be about reaching out to people in a social way. There's so many times in this course that we've talked about the importance of social support and how damaging social isolation can be for people. And I think that when I saw we can do things about mental health. One of the things that I think we can do is be better connected to the people who are around us and especially aware of being connected to people who we know might be at risk of becoming depressed or otherwise mentally unwell because they're isolated. So mental health promotion to people who are diagnosed with mental illness. Fostering recovery and well-being is very important and this shift that's happening in the mental healthcare system around talking thinking through what it means to be recovered from mental illness, is one that also has to go broader than the mental healthcare system. We have to as communites be able to think about the possibility and the acceptability of people with mental illnesses living full lives even if they, they aren't completely free of symptoms. And the're certainly ways that, that can happen. So, fostering recovery and well being is not just something that happens in a mental health care system. It's something that also happens in the community. The combinations of services, treatments, and supports we've talked about many times. Targeting discrimination is something that we can all be a part of. And then targeting barriers to full participation is against something that we as community members can participate in. We can be open to having people who have mental disorders in our work places, in our schools, as part of our community life. And as people who may be dealing with that ourselves, we can also assert our entitlement to be a part of work and education and community life. And these are all, these are both ways that we improve the community life of people who are diagnosed with mental illnesses. And then, finally, we also have to think about mental health promotion for caregivers and family members, and we talked about that in more detail in the last lecture. But support for the caregiving role really is something that as community members we can be part of. You may remember in the last lecture there was one of those segments from the family, Family guide to mental health recovery. Where, somebody was talking about what a difference it meant for his family to be able to talk to other families about the fact that somebody, one of their relatives had a mental illness. And I love the way that I love the title of that segment. Because he talks about. It says something about how I've been waiting for this conversation my whole life. I think there are a lot of people who are waiting for that conversation. And when we talk about support for the caregiving role, some of it is the kind of formal support we talked about in that family lecture. But I actually have a colleague at the University of Calgary who did some research on caregiving for people. [inaudible] for families effected by mental illness. And he found that one of the most helpful types of support that people reported, in terms of being in a care-giving role, was just having people around them who recognized that they were in a care-giving role. And who would just ask how they were doing. They didn't have to do anything, just recognize that they were dealing with this. And ask about their loved one. And ask about how they were doing. Doing and that's something that I think we could be doing a lot more. If we were willing to be more open about the fact that we're dealing with these issues and if we weren't afraid to as people who we know are dealing other, theses issues what they're doing. Aside from that, there're some formal things like respite care, so that caregivers get brakes and access to healthcare and of course support for caregivers in the health and social service policy. So on that note we're going to move into the conclusion for this segment.