Mental Health from the Perspective of Health Promotion Policy

Abstract

Mielenterveys on olennainen osa jokapäiväisessä elämässä toimimista. Mielenterveyden edistämisen tutkimus on tärkeää, sillä se keskittyy yhteiskunnallisesti sensitiiviseen terveyden alueeseen. Siitä huolimatta mielenterveyden edistäminen tai sen politiikka ei ole ollut kovinkaan suosittu tutkimusaihe ennen 2000-luvulle tulemista. Väitöskirjatutkimuksen perusolettamuksena oli väite, että mielenterveydellä on syrjäytyvä asema terveyden edistämisen alueella ja että terveyden edistämisohjelmat ovat rakentuneet tavalla, jotka eivät välttämättä tue mielenterveystavoitteita. Tämä on johtanut siihen, että mielenterveyden täytyy puolustaa rooliaan terveyden edistämisen alueella.

Huolimatta mielenterveyden yhä kasvavasta julkisuusarvosta, inhimillisen kärsimyksen määrästä tai yhteiskunnallisista kustannuksista, myös sen rooli kansallisissa terveysohjelmissa on ollut verraten pieni. Mielenterveyspolitiikka keskittyy usein organisatorisiin hoidon järjestelyihin, kun taas liittyminen somaattisen terveyden edistämisen strategioihin edellyttäisi esimerkiksi tupakan, ravitsemuksen ja liikunnan kaltaisten determinanttien tunnistamista ja toiminnan kohdistamista niihin.

Väitöskirjatutkimuksessa analysoitiin mielenterveyden roolia ja asemaa kansallisissa terveyden edistämispolitiikoissa toimintapolitiikan näkökulmasta laadullisin menetelmin. Osatutkimuksissa mielenterveyttä tarkasteltiin terveyspolitiikan muodostumisen eri vaiheissa. Siten mielenterveyttä tutkittiin ongelman ja toimintapolitiikan muodostamisen, toimintapolitiikan omaksumisen ja lopuksi arvioinnin näkökulmista.

Terveyden edistämispolitiikan tulisi entistä tehokkaammin huomioida mielenterveyden erityisvaatimukset. Mielenterveys on tunnistettu vakavaksi terveysongelmaksi, mutta sen erityispiirteitä ei osata toimintapolitiikassa vielä täysin huomioida. Poliittinen päätöksenteko suosii tehokkaita lyhyen aikavälin ratkaisuja, jotka valitettavasti sovellu mielenterveyden edistämiseen. Positiivista kyllä, mielenterveyden edistämisestä on viime aikoina tuotettu paljon tietoa. Jotta tätä tietoa voitaisiin hyödyntää paremmin poliittisessa päätöksenteossa, on sen aukikirjoittamiseen ja levittämiseen kiinnitettävä parempaa huomiota ja tutkijoiden sekä päätöksentekijöiden vuorovaikutusta lisättävä.

Mental health is an essential part in coping in our everyday lives. However, the area of mental health policy has not been a very popular research area until the 20th century, even though mental health promotion research is important as it focuses on an issue which is societally sensitive. Mental health is an interesting area from many perspectives. There have been difficulties in finding a unifying concept of mental health. Mental health determinants are also ambiguous as they are societal by nature. Traditionally health promotion strategies need determinants such as tobacco smoking, nutrition or exercise. Actions can easily be directed at these determinants. On the other hand, mental health policy usually concentrates on organisational care related activities.

Mental health has had a smaller role in national health programmes, in spite of continually rising publicity, the amount of human suffering and societal costs. Therefore the research began with an assumption that health promotion programmes are constructed in such a form which does not support mental health targets. Thus the hypothesis is that mental health has a defensive role in the area of health promotion.

As the research analysed the role and position of mental health in national health promotion policies, the perspective comes from the policymaking. In each part of the research, mental health is scrutinised from a different phase of the health policy cycle. Thus mental health is studied from the perspectives of problem appearance, policy formulation, policy adoption and finally policy evaluation. The research concentrates on the following main points; what kinds of arguments are used in health policy documents when mental health is discussed? What does the analysis of mental health determinants reveal from a policy perspective? How and to whom are mental health policy documents directed? What kind of a health target is mental health? The research showed that in policy documents mental health is clearly acknowledged as a problematic issue when compared to somatic health problems that the determinants of mental health situate widely in the social, socio-economic and environmental factors of health. The findings of the third study also suggested that certain documents do attempt to reach a variety of actors in the field with the use of language and discourse. When scrutinising the final phase of the policymaking cycle; evaluation of mental health targets, it was found that mental health has several unique features which cannot be converted into simple or quantifiable targets and thus evaluated for efficiency like somatic health targets.

The data of the research consisted of national health policy documents from Finland, Sweden, England, The Netherlands, Denmark and Portugal. Several interviews with key informants from each country were also used as background material. The research methods were qualitative, consisting of content and policy analysis and analysis of interpretative repertoires. The ideology of grounded theory was also applied throughout the research.

The analysis of policy documents revealed the assumptions, attitudes and values assigned to mental health. This research aimed to draw a realistic picture of how European welfare states speak about mental health and its promotion. The research also sought to point out that even the most effective targets do not necessarily equal the actual needs or what is actually done. Furthermore, the many aspects why mental health, its promotion and mental health policy have been considered difficult will be discussed. Stigma, ambiguous definitions, variety of background factors and causality are only a few obstacles linked to mental health. It seems that health promotion policy has to adapt to the needs of mental health.