Promoting Mental Health And Preventing Mental Illness: The Economic .
Promoting mental healthand preventing mental illness:the economic case for investment in WalesLynne FriedliMichael ParsonageOctober 2009
About the authorsDr Lynne Friedli works across Europe tosupport the development of public mentalhealth, as well as delivering trainingand policy advice within the UK. She is aconsultant for public mental health to theMental Health Foundation and the ScottishDevelopment Centre for Mental Health(SDCMH) and an honorary member of theFaculty of Public Health. She wrote Makingit possible: improving mental health andwell-being in England on behalf of theNational Institute for Mental Health inEngland and contributed to the BamfordReview of mental health promotion inNorthern Ireland and the UK Government’sForesight programme Mental Capital andWellbeing. Her report for WHO Europe andthe Mental Health Foundation on Mentalhealth, resilience and inequality waspublished earlier this year.Michael Parsonage is an economist whosince 2003 has been working part-time as aSenior Policy Adviser at the Sainsbury Centrefor Mental Health, where he has produced anumber of reports based on the applicationof economic analysis to mental healthissues. He has also worked on a consultancybasis for other organisations in the mentalhealth field, including the Mental HealthFoundation, the Scottish Association forMental Health and the Northern IrelandAssociation for Mental Health. He waspreviously employed as a senior economistin the Department of Health and in @btopenworld.comISBN 0-9547446-9-1Promoting mental health and preventing mental illness: the economic case for investment in Wales
1ContentsForeword2Summary31.0 Introduction62.0 Economic evaluation72.1 Constraints and limitations83.0Policy context3.1 Welsh Policy3.2 European Policy3.4 Happiness and wellbeing debates91112144.0Concepts and definitions: what is mental health?4.1 Dual continuum model of mental health4.2 Measuring mental health1516175.0Benefits of mental health promotion5.1 Benefits of preventing mental illness5.2 Benefits of promoting positive mental health5.3 Outcomes associated with positive mental health191922256.0Lifetime benefits of improved mental health6.1 Conduct disorder6.2 Long term cost6.3 Benefits of promotion and prevention compared293031327.0 Effectiveness, cost-effectiveness and ‘best buys’348.0Parenting skills and pre-school education359.0Lifelong learning: Health promoting schools and continuing education4110.0 Improving working lives: employment/workplace4711.0 Lifestyle (diet, exercise, alcohol) and social support5112.0 Environmental improvements6313.0 Conclusions67Reference69Appendices83Promoting mental health and preventing mental illness: the economic case for investment in Wales
2ForewordThis report‘Promoting MentalHealth and PreventingMental Illness:The Economic Casefor Investment inWales’ has beencommissioned bythe All Wales MentalHealth PromotionNetwork.The All Wales Mental Health PromotionNetwork, funded by the Welsh AssemblyGovernment, is committed to improving themental health and wellbeing of the wholepopulation of Wales. The Network aims toprovide strong leadership and a focus formental health promotion in Wales, increasepublic and professional understanding ofpublic mental health, develop evidence andlearning exchanges, and act as a conduitfor the dissemination of good practices inpublic mental health promotion.The occurrence of mental illness iswidespread. Mental illnesses often occurearly in the life span and persist throughoutthe life span. The consequences of mentalillness are multi-dimensional. The treatmentof some clinically diagnosed mental illnessis often limited in effectiveness.Therefore the costs of mental illness andthus the potential benefits of prevention areextremely high. Mental health promotioninterventions often intend to raise selfesteem, strengthen individuals’ life andcoping skills and emotional resilience.This report, produced by Dr Lynne Friedliand Michael Parsonage, uses economicanalysis to develop the case for greaterinvestment in Wales in both the preventionof mental illness and the promotionof positive mental health. The reportdemonstrates that the potential degree ofeconomic benefits of preventing mentalillness and promoting positive mental healthis considerable. The All Wales Mental HealthPromotion Network commend the analysis,conclusions and recommendations of thisreport to those responsible for resourceallocation to consider the greatest benefitover time to the population of Wales.Professor Mansel Aylward CB MD FFPMFFOM FRCPChair of the All Wales Mental HealthPromotion Network Advisory Board andChair of Public Health WalesOctober 2009Promoting mental health and preventing mental illness: the economic case for investment in Wales
3SummaryThis report for the All Wales Mental HealthPromotion Network uses economic analysisto develop the case for greater investmentin mental health promotion, defined asthe prevention of mental illness and thepromotion of positive mental health,sometimes referred to as ‘wellbeing’.Improving mental health, that is promotingthe circumstances, skills and attributesassociated with positive mental health, isa worthwhile goal in itself: most peopleplace a high value on a sense of emotionaland social wellbeing. In addition, positivemental health also: contributes to preventing mental illness l eads to better outcomes, for examplein physical health, health behaviours,educational performance, employabilityand earnings, crime reduction.These beneficial outcomes are not just theresult of the absence of mental illness.They are due wholly, or in some degree, toaspects of positive mental health, whichinclude subjective wellbeing, resilience,social wellbeing and sense of meaning orpurpose. Although there are many gapsin the data, the economic benefits ofimproving positive mental health maybe extensive. For example, subjectivewell-being increases life expectancy by7.5 years, provides a similar degree ofprotection from coronary heart diseaseto giving up smoking, improves recoveryand health outcomes from a range ofchronic diseases (e.g. diabetes) and in1young people, significantly influencesalcohol, tobacco and cannabis use. Positiveaffect1 also predicts pro-social behavioure.g. participation, civic engagement andvolunteering. While the best outcomesare generally associated with the absenceof mental illness, the presence of positivemental health brings additional benefits,including for people with mental healthproblems.The scale of the economic benefits ofpreventing mental illness is considerable: M ental health problems have very highrates of prevalence; they are often oflong duration, and have adverse effectson many areas of people’s lives, includingeducational performance, employment,income, personal relationships and socialparticipation; N o other health condition matchesmental ill-health in the combined extentof prevalence, persistence and breadthof impact; M ental health problems often begin earlyin life and cause disability when thoseaffected would normally be at theirmost productive (unlike most physicalillnesses).The scope for securing benefits by means oftreatment, rather than prevention, appearsto be distinctly limited. A tendency to be cheerful, energetic and to experience positive moods; sometimes referred to as apositive disposition.Promoting mental health and preventing mental illness: the economic case for investment in Wales
4According to new figures prepared for thisreport, the overall cost of mental healthproblems in Wales (2007/08) is estimated at 7.2 billion a year. This includes: t he costs of health and social careprovided for people with mental healthproblems; t he costs of output losses in the Welsheconomy that result from the adverseeffects of mental health problems onpeople’s ability to work; a monetary estimate of the less tangiblebut crucially important human costs ofmental health problems, representingtheir impact on the quality of life.By way of comparison, the aggregate cost of 7.2 billion is larger than the total amountof public spending in Wales on healthand social care for all health conditionscombined, which amounted to 6.1 billionin 2007/08.The cost of mental health problems isalso very large relative to other healthconditions, accounting for a larger share ofthe overall “burden of disease” (as definedand measured by the WHO) than any otherproblem:Mental illness(including suicide)20.0%of total ve to its importance as a healthproblem, spending on mental health isdisproportionately low, accounting for 12.2%of public expenditure on all health andsocial care in Wales.One example of a common mental healthproblem for which there is robust evidenceof effective interventions is conductdisorder in childhood. According toestimates presented in this report: P reventing conduct disorders in thosechildren who are the most disturbedwould save around 150,000 per case inlifetime costs; Promoting positive mental healthin those children with some conductproblems (but not a clinicallydiagnosable disorder) would yieldbenefits over the lifetime of around 75,000 per case.For Wales, the total value of preventionin a one-year cohort (33,000 births) wouldbe 247.5 million, with the total value ofpromoting positive mental health amountingto 1,113.75 million.In comparison, the costs of intervention arevery low, ranging from 1,350 to 6,000 perchild for pre-school parenting programmes.Substantial investment in these programmesis therefore justified even if theireffectiveness is limited, given the size ofpotential benefits relative to cost. A rangeof evidence suggests that success rates atthe level required can be achieved in reallife settings.Promoting mental health and preventing mental illness: the economic case for investment in Wales
5For this reason, the report recommendsinvestment in pre-school interventions suchas support for parents as the top priorityin the provisional list of ‘best buys’ inpromoting mental health, as follows: S upporting parents and early years:parenting skills training/pre-schooleducation/home learning environment; S upporting lifelong learning: healthpromoting schools and continuingeducation; I mproving working lives: employment/workplace; P ositive steps for mental health: lifestyle(diet, exercise, sensible drinking) andsocial support; S upporting communities: environmentalimprovements.Although the evidence is incomplete insome cases, these areas of interventionappear to offer the most favourable balanceof effectiveness, scale of potential benefitand likely cost of implementation. Theydemonstrate that all sectors have a roleto play in improving mental health andthe need for interventions that involveindividuals and communities, but also thosethat address structural barriers to mentalhealth and wellbeing.Although there is now a much greater policyfocus on positive mental health and wellbeing, there is still a great deal to do inWales. There is a need for more consistentdefinition and measurement of mentalhealth, to untangle the many differentinfluences on mental well-being and toimprove data on both the effectiveness andcost-effectiveness of interventions.New measures validated for use in the UK,for example the Warwick and EdinburghMental Wellbeing Scale (WEMWBS), will beof considerable value in providing a morecomplete picture of the mental health ofthe population. Nevertheless, even onthe basis of existing data, the evidencesummarised in this report demonstrates avery strong case for greater investment,not only in the prevention of mental illnessbut also in the promotion of positive mentalhealth.Promoting mental health and preventing mental illness: the economic case for investment in Wales
61.0 IntroductionThis report analyses the case for mentalhealth promotion from an economicperspective. It was commissioned by theAll Wales Mental Health Promotion Networkin order to explore the cost effectivenessof investment in the promotion of mentalhealth and the prevention of mental illnessin Wales. Promoting mental health is aworthwhile goal in itself – most people valuea sense of social and emotional wellbeing.In addition, the evidence shows thatimproving mental health brings a wide rangeof other benefits for individuals, families,organisations and communities.This report covers the prevention of clinicallydiagnosable mental illness and, more broadly,the promotion of positive mental health andwell-being. The social and economic costsof mental illness in the UK are already wellestablished and are set out in a numberof earlier publications (SCMH 2003; NIAMH2004; SAMH 2006). Across the spectrum ofdisorders, mental illness is both a directcause of mortality and morbidity and asignificant risk factor for poorer economic,health and social outcomes. However, itis now becoming clear that the presenceor absence of positive mental health or‘wellbeing’ also influences outcomes acrossa wide range of domains. These includehealthier lifestyles, better physical health,improved recovery, fewer limitations in dailyliving, higher educational attainment, greaterproductivity, employment and earnings,better relationships, greater social cohesion2and engagement and improved quality of life.This report looks at the implications ofthese findings for Wales, based on ananalysis of the cost benefits of preventingmental illness, as well as the additionalbenefits of promoting mental health.Developing the economic case formental health promotion is a challengingundertaking. It raises a number of complexmethodological problems and the extent ofpublished evidence on the cost-effectivenessof different interventions is limited, evendrawing on international as well as UKstudies. On the other hand, the wider(non-economic) literature on mental healthpromotion is now very substantial. Althoughsome major gaps remain, there is increasingevidence of scope for effective action andits potential benefits. Using a variety ofmethods to add an economic component tothe wider evidence base, this report explorestwo main issues: the general case for mentalhealth promotion and possible priorities inthe choice between interventions.Because of limitations in the evidence base,the provisional nature of the conclusionswill be emphasised throughout. It isnevertheless possible to identify some clearmessages which we hope will be of valueto the intended audience of policy makersand practitioners, particularly in stimulatingdebate and raising awareness. The reportshould not be seen as a contribution toacademic research. The term mental health promotion is generally used to refer to any action to promote mental health,prevent mental illness and/or improve quality of life for people with mental health problems. In thisreport, we distinguish between promoting positive mental health and preventing mental illness and usethe general term mental health promotion to cover both promotion and prevention.Promoting mental health and preventing mental illness: the economic case for investment in Wales
72.0 Economic evaluationAny specific intervention to improve mentalhealth needs to be justified in the first instanceon the basis of evidence of its effectiveness:does it work? In other words, how muchdoes the intervention improve mentalhealth and well-being, along with otherrelevant outcomes such as physical health?Economic analysis adds the further test ofvalue for money: not only ‘does it work?’ but‘is it worth it?’ All interventions entail theuse of scarce resources and choices have tobe made between different ways in whichthese resources could be deployed. Pursuingone course of action necessarily precludesanother. Deciding on priorities is unavoidable.The role of economic evaluation is to clarifythe nature of these choices for decisionmakers and to ensure that all resources areused as productively as possible.Economic evaluation may take variousforms but can broadly be defined as asystematic attempt to identify, measure andcompare all the costs and all the benefitsof alternative interventions, includinga baseline option of not intervening. Anumber of points follow from this definition: The economic case for mental healthpromotion is not just or even mainly aboutachieving narrowly defined economicor financial benefits such as reducingfuture NHS costs or increasing GDP. Suchbenefits should certainly be included butare usually of relatively minor importance.It is emphatically not part of the economicapproach that the direct improvements inmental health and well-being which formthe fundamental rationale for promotion3should be ignored or excluded simplybecause they are not conventionally valued,marketed or counted in national income. Economic evaluation requires thecomprehensive coverage of costs andbenefits, including not only the benefitsof better mental health and well-beingaccruing directly to individuals, as justdescribed, but also any wider benefits forsociety as a whole, financial or otherwise(e.g. reduced crime). No particularpreference should be given to benefitsaccruing to the Exchequer in terms oflower public spending or higher taxation. Economic evaluation does not require allthe outcomes of an intervention to beexpressed in monetary terms; indeed, itshould be recognised from the outset thatthe benefits of mental health promotionextend beyond those that can realisticallyor sensibly be given a monetary value.Cost-effectiveness can readily be assessedusing non-monetary outcome measures. Economic evaluation does require thatall outcomes can at least be quantifiedin some way, including the subjectiveelements of well-being. The need tomake comparisons between alternativeinterventions highlights the importanceof developing standardised indicatorsor measures of well-being which canbe applied consistently across differentsettings and population sub-groups.3Economic analysis thus aims to provide aframework for the systematic assessment ofcosts and benefits, in quantitative but notnecessarily monetary terms. For a review of the strengths and weaknesses of different measures of well-being see NHS HealthScotland (2008) Selecting scales to assess mental wellbeing in .aspxPromoting mental health and preventing mental illness: the economic case for investment in Wales
82.1 Constraintsand limitationsAnalysing the effectiveness and costeffectiveness of mental health promotion isinherently difficult for a number of reasons.These include the following: M ental health remains a contested conceptwhich can be defined and measured invarious ways. The conceptualisation inpositive rather than negative terms whichis now central to policy frameworks formental health promotion puts the focuson positive indicators of well-being, butthese are still in the development stage. Better mental health is worthwhile notonly in its own right but also because itleads to improved outcomes in a rangeof other domains. Capturing theseindirect benefits in evaluation studiesraises various problems of coverage,measurement and attribution. T he benefits of improved mental healthare not only multi-dimensional butmay also accrue over many years, evena lifetime in the case of childhoodinterventions. This can give rise toserious difficulties of length as well asbreadth of analysis in research work. M ental health is subject to many influencesand the impact of a specific interventionmay be difficult to disentangle from theeffects of confounding factors. Statisticalassociations between mental healthand other variables are often open tointerpretation, concerning for examplethe direction of causation. P olicy interventions take a wide varietyof forms; for example, some may betargeted on high-risk individuals whereasthe focus of others is community-wide.Research methods need to reflect suchvariety, but the use of different evaluativeapproaches can lead to problems ofcomparability and consistency. Therandomised controlled trial, often seenas the gold standard for health research,is most suitable for single-componentinterventions in highly controlled settings,but many interventions to promotemental health do not take this form. The working of many interventions,particularly those targeted on individuals,will be mediated by broad structuralfactors such as poverty or unemployment.The role of socio-economic context needsto be taken into account in evaluationstudies but this is rarely straightforward.These and other difficulties in the analysisof mental health promotion have twomain consequences. First, there remainsignificant gaps in the evidence base.This is particularly so in the area of costeffectiveness. Few published studies containprimary economic data on costs and benefitsand, among those that do, the coverageis usually incomplete; for example, thecollection of financial information is oftenconfined to effects on the public sector.Second, the evidence base may be subjectto various forms of bias. For example,some types of intervention are easier toevaluate than others, resulting in the likelyavailability of more studies – with moreconclusive results – in the former area.Similarly, some components of cost andbenefit are easier to identify and collectthan others. In general, costs are easier tomeasure than benefits, particularly longterm benefits. The available evidence maytherefore systematically understate thenet returns on mental health promotion,particularly those interventions which havelong-lasting effects.Promoting mental health and preventing mental illness: the economic case for investment in Wales
93.0 Policy contextThere is growing policy support for a greaterfocus on promotion and prevention andfor the assessment of population health toinclude measures of positive physical andmental health, as well as morbidity andmortality data.Health Challenge Wales, for example,provides a national focus for action toimprove health and wellbeing. Designed forLife, the template for world class health andsocial care for Wales, states:We will focus on health and wellbeing,not illness, by: u sing every avenue to promotehealthy communities; e mpowering individuals to takeresponsibility for their own health.(Welsh Assembly Government 2005a)In Wales, the rest of the UK4 and in Europe,the past few years have seen an increasingshift in health policy from a predominantfocus on mental illness, to recognition ofthe importance of mental health and wellbeing to overall health.4 Scottish Government (2009) Towards a mentally flourishing Scotland: Policy and Action Plan 71822/0081031.pdfNIMHE/CSIP (2005) Making it possible: improving mental health and well-being in 0possible%20Final%20pdf.pdf ;Welsh Assembly (2006) Mental Health Promotion action plan for Wales: consultation g enPromoting mental health and preventing mental illness: the economic case for investment in Wales
10This has stimulated wider debate on howa ‘wellbeing focus’ might influence thefuture direction of policy on the economy,health, education, employment, cultureand sustainable development (Marks et al2006; Layard 2005; Government Office forScience 2008).This emphasis on the benefits of positivemental health is matched by researchdemonstrating the value of a focus onassets, as opposed to a deficit model and acall for more studies on the determinantsof health, as distinct from studies on thedeterminants of illness.5 The currentfinancial crisis has also generated concernabout the psychological impact of recessionand interest in promoting mental health asa source of resilience (Friedli 2009).656These trends are clear in the increasingemphasis on positive mental health inWales, for example in the aspirations for2020 set out in Our Healthy Future:We will promote positive mental healthand well-being throughout life, andstrive to reduce the risk factors thatcontribute to poor mental health andprevent recovery.(Welsh Assembly Government 2009)Promoting mental health and wellbeingis also part of the recovery approach toimproving care, services and quality of lifefor people with mental health problems inWales (Mind Your Heart 2009). WHO defines a health asset as any factor (or resource) that enhances the ability of individuals,communities, populations etc to maintain health and well-being. Evidence shows that interventions tomaximize and take advantage of health assets can counter negative social and economic determinantsof health, especially among vulnerable groups. The result is improved health s/assets/20050623 1?language Frenchhttp://ec.europa.eu/health/ph determinants/life style/mental/ev 20090427 en.htmPromoting mental health and preventing mental illness: the economic case for investment in Wales
113.1 Welsh policyImproving the mental health of thepeople in Wawles lies at the heart ofthe Welsh Assembly Government’sPublic Health agenda and thecurrent radical reforms of the NHS inWales. This focus goes well beyondconventional approaches to improvingthe health of the population, willresult in improved outcomes forall communities, across the socioeconomic spectrum in Wales.(Professor Mansel Aylward CB MD FFPMFFOM FRCP – Chair of the All WalesMental Health Promotion NetworkAdvisory Board and Chair of PublicHealth Wales)The requirement to promote mental healthis set out in standard one of Raising theStandard (2005b), which also emphasisesthe need to consider the mental healthimpact of wider social and economicpolicies, for example in education,employment and housing7.Welsh policy for education, health, socialservices and youth justice services explicitlyhighlights the importance of: t aking opportunities to promote theemotional health and well-being of allchildren; t he link between positive emotional healthand well-being, positive educationalexperiences and other life outcomes.Improving emotional health and well-being isintegral to the seven core aims of the WelshAssembly Government’s vision for children andyoung people, based on the UN Conventionon the Rights of the Child (Welsh AssemblyGovernment undated). Emotional well-beingis one of 16 priorities for action outlined inthe Welsh Assembly Government response.8Services and action to improve the mentalhealth of children are also a feature of thegovernment’s strategy for tackling childpoverty, with a focus on supporting parents,guidance for emotional wellbeing in schoolsand the ten year all Wales strategy for childand adolescent mental health services,Everybody’s Business.9 Wales’ strategy forparenting support is set out in the ParentingAction Plan (Welsh Assembly Government2005c). Progress on this was recentlyreviewed by the National Assembly forWales Children and Young People Committee(2009) which made strong recommendationsfor greater support and a greater focus onparenting.7 For a UK wide toolkit for assessing mental health impact a-toolit1.pdf8 http://cliconline.co.uk/wag priorities eng.pdf9 Welsh Assembly Government (2005) A fair future for our Children: The Strategy of the Welsh AssemblyGovernment for Tackling Child Poverty; for an overview of implementation of the CAMHS strategysee Children’s Commissioner for Wales people/childpoverty/strategy/fairfuture/?lang enPromoting mental health and preventing mental illness: the economic case for investment in Wales
12Well-being is also at the heart of the SchoolEffectiveness Framework (SEF) and is a coreelement of the work of education settings,including the Health Promoting Schoolsnetwork, which is expanding to all schoolsin Wales.The major potential benefits for schools inactively promoting emotional health andwell-being are set out in the consultationdocument Thinking Positively: EmotionalHealth and Well-being in Schools and EarlyYears Settings (Welsh Government Assembly2009). The national strategy for schoolbased counselling services in Wales will alsocontribute to the well-being of childrenat secondary school (Welsh AssemblyGovernment 2008).The skills and attributes associated withgood mental health - confidence, selfesteem, health and wellbeing, activecitizenship – are also seen as an importantelement of regeneration and tacklingall aspects of poverty in deprived areas,set out in the ongoing Communities Firstprogramme launched in 2001, as well ascontributing to wider goals for Wales, forexample learning for life and criminaljustice.10Overall, the strong focus on promotion andprevention in Wales, together with thewider commitment to wellbeing, providesa supportive policy environment for theprevention of mental illness and thepromotion of mental health.103.2 European policyThe WHO Declaration and Action Planmade a significant contribution to movingthe promotion of mental health and theprevention of mental disorders up theagenda in Europe (see Box 1) and stronglyinfluenced the European Commission GreenPaper Improving the Mental Health of thePopulation (European Commission 2005). Anumber of themes emerge in this literature: t he social and economic prosperity ofEurope will depend on improving mentalhealth and wellbeing; p romoting mental health, i.e. buildingcommunities and environments thatsupport mental wellbeing, will deliverimproved outcomes for people withmental health problems; m ental health and wellbeing arefundamental to quality of life.The importance of mental health withinthe European Union was confirmed in theestablishment of the European Pact forMental Health and Well-Being (June 2008)and the European Parliament ResolutionFebruary 2009.11 The case for promotionand prevention has also been str
3.2 european Policy 12 3.4 Happiness and wellbeing debates 14 4.0 Concepts and definitions: what is mental health? 15 4.1 Dual continuum model of mental health 16 4.2 Measuring mental health 17 5.0 Benefits of mental health promotion 19 5.1 Benefits of preventing mental illness 19 5.2 Benefits of promoting positive mental health 22
Mental Health, Mental Health Europe NGO and the UK Royal College of Psychiatrists7. "No health without mental health" has also been adopted by the Irish organisation Mental Health Ireland, Supporting Positive Mental Health. Burden of Mental Disorders Mental disorders have been found to be common, with over a third of people worldwide
3.1 Prevalence of mental ill health 9 3.2 Mental health service need 9 3.3 Mental health service provision gap 10 3.4 Housing system and homelessness 10 3.5 Entries into homelessness 11 3.6 Mental health and housing system capacity 12. 4 Links between housing and mental health 13 5 Housing for people with lived experience of mental ill health 16
A mental health policy (1996) and plan (2007-2011) existed. Emergency and disaster plans for mental health did not exist. Legislation A new Mental Health Act 846 2012 was passed in 2012 and was awaiting Government to establish the Mental Health Board. Financing of mental health services Mental health had a ring-fenced budget of 1.4% of
Module 1: Exploring the world of e-mental health 9 Objectives 9 Getting to know existing e-mental health options 10 Table 1: Types of e-mental technologies 11 . e-mental health options Digital resources and services have a significant role to play in promoting and supporting people's mental health. It is convenient, can provide .
mental health is about much more than mental illness, and that there are significant benefits to be gained by approaching mental health from a public health perspective. Positive mental health, mental wellness and mental health promotion have emerged as the missing pieces in a system that has traditionally been
Preface Promoting Mental Health: Concepts, Emerging Evidence, Practice aims to bring to life the mental health dimension of health promotion. The promotion of mental health is situated within the lar-
15099.1 Mental health & Work report:15099.1 Mental health & Work report 7/7/08 16:19 Page 3 BACKGROUND 1 1.1oduction Intr 1 1.2ental Malth he problems and their prevalence 1 1.3ctors Fat tha affect the prevalence of mental health problems 2 1.4ciation Asso between mental health and physical health 2 1.5reatment T and outcomes 2 1.6he T impact and cost of mental health problems 3
Certifications: American Board of Radiology Academic Rank: Professor of Radiology Interests: Virtual Colonoscopy (CT Colonography), CT Enterography, Crohn’s, GI Radiology, (CT/MRI), Reduced Radiation Dose CT, Radiology Informatics Abdominal Imaging Kumaresan Sandrasegaran, M.B., Ch.B. (Division Chair) Medical School: Godfrey Huggins School of Medicine, University of Zimbabwe Residency: Leeds .
