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17
Chapter 2
Occupational perspectives on
mental health and well-being
Sheena E. E. Blair , Clephane A. Hume , Jennifer Creek
CHAPTER CONTENTS INTRODUCTION
FINAL
Introduction 17 The beginning of the 21st century is characterised
Understanding the terminology 17 by an increased interest in the prevention of men-
Health 18 tal ill health and the promotion of well-being. All
NOT
Mental health 19 professions involved in health and social care have
-
Well-being 19 explored ways of broadening their remit, perhaps
ELSEVIER
Health promotion 19 encouraged by the shift of working contexts in
Disease prevention 20 the United Kingdom, which are now largely com-
Health education 20 OF munity based. The World Health Organization
Mental health promotion 20 (WHO) (2001) has more formally linked ideas of
Wellness 21 activity and participation within the International
Lifestyle 21 Classification of Functioning, Disability and Health .
In Scotland, a link between policy and services is
Quality of life 21 CONTENT
apparent, for example in the National Programme
Factors contributing to mental health and Action Plan 2003 – 2006 to improve mental health and
ill health 21 wellbeing in Scotland (2001). In turn, this is part of
Protective factors 23 a broader Scottish Executive policy initiative that
PROPERTY includes attention to health improvement, social
Risk factors 24
SAMPLE justice, education and lifelong learning.
Promoting positive mental health 24 Until recently, the responsibility for health pro-
Occupational therapy and health motion lay within the field of public health. Now,
promotion 26 more attention is being given to health promo-
Occupational therapy and well-being 26 tion within health-care policies; for example, The
The contribution of occupational science 27 Health of the Nation (DoH 1992), Saving Lives (DoH
Summary 27 1999) and the National Programme for Improving
Mental Health and Well-Being (Scottish Executive
2003). These policies give priorities for action,
such as dementia awareness; suicide reduction;
eliminating stigma and discrimination in minority
ethnic groups, and the mental health of children
and young people. Policies designed to integrate
spirituality into health care, together with other
18
PHILOSOPHY AND THEORY BASE
publications such as Caring for the Spirit (South past decade from a preponderance of medical
Yorkshire Workforce Development Confederation terminology to a more client-centred and occupa-
2003), have led to changes in education for staff tion-focused style. The concepts defined here are
that broaden the focus of health promotion and health, mental health, well-being, health promo-
health education. tion, disease prevention, health education, mental
These policy initiatives have implications for health promotion, wellness, lifestyle and quality
occupational therapists throughout the UK and of life.
Creek (2004) predicted that the profession will
continue to have a much higher profile within HEALTH
health promotion. Those occupational therapists
who have accepted the challenge of explor- Defining health is a complex matter and the con-
ing the relationship between occupation and cept defies neat description. The occupational
health, and of working towards occupation- scientist, Wilcock (1998), offered an occupational
centred practice, are finding this an exciting perspective on health in which she explored
time. The discipline of occupational science has the relationship between occupation and health
boosted knowledge generation in this ar ea and and the importance of this relationship for pub-
the ideas of people as occupational beings, whose lic health. Wilcock acknowledged the enduring
complex actions and interactions significantly nature of the WHO (1946) definition of health:
FINAL
impact on health, have stimulated the enthu- ‘Health is a state of complete physical, mental and
siasm of students, educators, practitioners and social well-being, and not merely the absence of
researchers (Wilcock 1998). Occupational sci- disease or infirmity’.
NOT
ence has also encouraged a broader vision of the However , there have been many criticisms of
-
contribution of occupation to social justice, with this definition; for example, Webb (1994) noted
ELSEVIER
the notion of occupational justice (Wilcock & that it implies a static rather than a dynamic
Townsend 2000). phenomenon. In contrast, the moral philosopher
This chapter begins with an exploration of the David Seedhouse (1986, p61) offered a definition
OF that acknowledges the dynamic nature of health
terminology used to refer to mental health, men-
tal disorder and the promotion of positive mental and recognises individual differences:
health. There is then a discussion of the personal
characteristics, events and experiences that have A person's optimum state of health is equivalent
CONTENT
been found to promote or inhibit positive mental to the state of the set of conditions which fulfi l
health: protective factors and risk factors. The or enable a person to work to fulfi l his or her
third section describes strategies and interven- realistic chosen and biological potentials. Some
tions used to promote positive mental health in of these conditions are of the highest importance
PROPERTY for all people. Others are variable dependent upon
individuals and communities. It concludes with
some thoughts on the role of occupational therapy individual abilities and circumstances.
SAMPLE
in promoting mental health and well-being.
The WHO has been moving towards an under-
standing of the dynamic relationship between
UNDERSTANDING THE TERMINOLOGY what people do and their health. The Ottawa
Charter for Health Promotion (WHO 1986, p1) stated
There are many terms used in the field of health that health is ‘a resource for everyday life, not
promotion and disease prevention, each one the objective of living … it is a positive con-
given a variety of different meanings. These key cept emphasizing social and personal resources,
terms can be found in published papers and glos- as well as physical capacities’. The International
saries, and are frequently heard in occupational Classification of Functioning, Disability and Health
therapy seminars and conferences. It is particu- (WHO 2001) has a focus on activity and participa-
larly interesting to note that language usage by tion that locates occupation as a major domain
occupational therapists has changed over the within health.
OCCUPATIONAL PERSPECTIVES ON MENTAL HEALTH AND WELL-BEING 19
MENTAL HEALTH and welfare: ‘healthy, contented or prosperous
condition; moral or physical welfare’. An
The concept of mental health can be pr oblematic, Australian occupational therapist, Therese Schmid
not least because it may be understood very dif- (2005, p7), emphasised that the state of well-being
ferently in different cultural contexts (Fernando is a subjective experience consisting of: ‘feelings of
1993). Indeed, it has been said that ‘every defini- pleasure, or various feelings of happiness, health
tion of mental health has inherent cultural assump- and comfort, which can differ from person to per-
tions’ (Chwedorowicz 1992, cited by Tudor 1996, son’. Wilcock (2006, p36) agreed that ‘Health, hap-
p22), which means that no one definition will be piness and prosperity have more than an intuitive
appropriate for all purposes. fit with well-being’.
Mental health can be defined as the absence of The American occupational therapist Betty
objectively diagnosable disease – a deficit model – Hasselkus (2002, p60) wrote that ‘Research on
or as a state of physical, social and mental well- the human state of well-being is permeated by
being – a positive model (mentality 2004). Current the belief that a person's ability to engage in life's
definitions of mental health usually incorporate daily activities is a key ingredient’. She referred
both personal characteristics and the influence to the work of two psychologists, Ryff & Singer
of environmental and social conditions. In other (1998, cited by Hasselkuss 2002, p61), who sug-
words, mental health is an interaction between the gested that well-being can be defined by two
individual and her or his circumstances. FINAL
core features: ‘1) leading a life of purpose, and 2)
The Health Education Authority (1997) defined quality connections to others’. This description is
mental health as: ‘the emotional and spiritual resil- reminiscent of Winnicott's idea of reciprocity as a
ience which enables us to survive pain, disappoint- NOT
necessary precursor to well-being.
ment and sadness. It is a fundamental belief in our -
The psychotherapist Donald Winnicott is re-
ELSEVIER
own and others' dignity and worth’. The Scottish puted to have pronounced that ‘health was more
Public Mental Health Alliance (2002, p4) sug- difficult to deal with than disease’ (Phillips1989,
gested that positive mental health is a resource that p612). Certainly, changes have to be made in
OF
strengthens the ability to cope with life situations. It attitude, ideology and delivery of practice to
went on to say that the ‘core individual attributes of accommodate the values of client education and
positive mental health include the ability to: enablement, which are central to the promotion of
health. For over 40 years, Winnicott's work charted
CONTENT
• develop self-esteem/sense of personal worth influences on personal growth and development,
• learn to communicate and one of his key themes was the metaphor of
• express emotions and beliefs a containing space or holding environment as
• form and maintain healthy relationships a necessary precursor to health and well-being.
• and develop empathy for others’.
PROPERTY For him, health was concerned with nurturing
Being mentally healthy implies having the ability relationships and reciprocity. Occupation tends to
SAMPLE engage people in mutual endeavour where such
to cope with changes and life transitions, adapt to
circumstances, set realistic aims, reach personal reciprocal relationships can develop and, there-
goals and achieve life satisfaction. In contrast, fore, offers real possibilities for the promotion of
mental health problems disrupt people's capacity healthy individuals and of healthy communities
to think and feel in a way that is normal for them, where people can live and learn together.
interfere with the ability to make decisions and
shatter people's sense of well-being. HEALTH PROMOTION
WELL-BEING Since the mid-1980s, a confusing array of terms
has been used in this area, including health
The state of well-being, like health, is a multifac- promotion, health education, disease prevention
eted phenomenon. The Oxford English Dictionary and health protection. For example, Downie and
(Brown 1993) definition links it with both health colleagues (1993, p59) defined health promotion
20
PHILOSOPHY AND THEORY BASE
as ‘effort to enhance positive health and prevent Secondary prevention refers to all treatment-related
ill-health, through the overlapping spheres of strategies designed to reduce the prevalence of
health education, prevention and health protec- mental disorder, and tertiary prevention refers to
tion’. They emphasised that the health promotion interventions that reduce disability, mitigate the
approach involves a sense of individual control. severity of disease, prevent relapse or contribute
Seedhouse (1997, p61) also defined health pr omo- to rehabilitation and recovery.
tion in terms of effort, and helpfully attempted to
unpick some of the terms used within his definition: HEALTH EDUCATION
Health promotion comprises efforts to enhance All health-care professionals have a responsibil-
ways of acting and believing based on conservative ity in terms of health education, which has been
political values and to prevent disease and illness, described by Downie and colleagues (1993, p28)
through a co-ordinated plan to infl uence individual as ‘communication activity aimed at enhancing
behaviour in specifi c ways (health education), positive health and preventing or diminishing
providing and strongly promoting the uptake of ill-health in individuals and groups, through
medical surveillance (disease prevention), and by influencing beliefs, attitudes and behaviour of
legislating to guarantee or fi rmly enforce some those with power and of the community at large’.
behaviours in order to reduce some morbidities Health education can also be targeted at different
(health protection). FINAL
levels (Draper et al 1980).
The WHO (1986, p1) definition is useful for occu- 1. Health education about the body and its main-
pational therapists because it views health promo- NOT
tenance, for example at school.
tion as a process of enablement: ‘Health promotion -
2. Health education involving information about
ELSEVIER
is the process of enabling people to increase control access to and appropriate use of health serv-
over, and to improve, their health’. ices, such as radio advertisements about sexual
OF health advice lines.
DISEASE PREVENTION 3. Health education within a wider context that
includes education about national, regional
The pr evention of mental disorders, or the preven- and local politics that have ramifi cations for
tion of relapse, is often seen as one of the aims of health.
CONTENT
mental health promotion strategies (WHO 2002).
The WHO (2002) pointed out that the idea of pri- MENTAL HEALTH PROMOTION
mary disease prevention as a way of preventing
disease from developing does not work well in the Inter est in the promotion of mental health has a
PROPERTY
field of mental health, where it can be difficult to history of more than 100 years, dating back to the
determine the exact time of onset or even to agree formation of the Finnish Association for Mental
SAMPLE
on a definite diagnosis. Rather, the primary preven- Health in 1897. The World Federation of Mental
tion of mental disorders involves interventions at Health was founded in 1948 to promote better
three levels. understanding of mental illness and to serve as
a means of drawing attention to mental health.
• Universal prevention tar geting a whole popula- More recently, an initiative between the European
tion group; for example, advertising on televi- Commission and the WHO (WHO 1999) acknowl-
sion the safe limits of alcohol consumption. edged that issues surrounding mental health
• Selective prevention tar geting subgroups at high problems contribute to five of the 10 leading
risk; for example, providing free nursery places causes of disability worldwide and that, while
for the children of single parents. ongoing improvements in physical health can be
• Indicated prevention tar geting individuals at detected, this is not the case for mental health.
high risk; for example, offering counselling to Mental health promotion is about ‘improving
the children of mothers with depression. quality of life and potential for health rather than
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