The Value of Model Programmes in Mental Health Promotion and Mental Disorder Prevention
| DOI | https://doi.org/10.1108/17465729199900012 |
| Pages | 18-19 |
| Date | 01 February 1999 |
| Published date | 01 February 1999 |
| Author | John Raeburn,Irving Rootman |
| Subject Matter | Health & social care |
18 International Journal of Mental Health Promotion VOLUME 1 ISSUE 2 • APRIL 1999 © Pavilion Publishing (Brighton) Limited.
ne’s response to this article depends very much on the stance one
brings to it. Its subject matter is primarily about
relatively large-scale, quantitative, experimental or quasi-
experimental prevention research projects. Although the term ‘mental health pro-
motion’ (MHP) is used, and indeed some of the individual projects mentioned,
such as the Community Mothers Programme (Johnson et al., 1993) could fall into
this category, the emphasis is clearly on prevention rather than health promotion.
This view is reinforced by statements
throughout the article.At the beginning, the history of model programmes in the
mental health area is traced from ‘prevention’ researchers and oth er preventionists
in the United States in the 1980s. On p10, we see that outcome criteria, referred
to as ‘a central feature of model programmes’, are related to ‘reductions in preva-
lence and incidence’ in a ‘targeted population’. In the final section, the need is
seen for national and international
collaboration for the ‘successful use [of] a model programme strategy for increas-
ing the effectiveness of prevention’, for
‘evidence-based prevention programmes’, and the development of ‘effective pre-
ventive practices and a supporting prevention science’.
Within the framework of such a prevention approach, the article is timely,clear
and very useful. There is clearly now a substantial literature to support the use of
mental health interventions in at-risk populations, and many of these derive from
research trials which meet the criteria of ‘model programmes’. It is good to have
these criteria examined and spelt out. Obviously,controlled studies with statistically
significant
quantitative outcomes and clearly defined procedures which can be adapted to ot her
contexts, and for wide-scale dissemination, are the benchmark.
At the same time, we are told that ‘there is still no evidence available that their
large-scale implementation on a district or national level has significantly improved
the health status of populations at risk as a whole’. There are several reasons given
for this rather pessimistic finding: the whole area is still too new for definitive
statements about it, dissemination attempts may be faulty,or the programmes not
readily translatable into other or larger settings, or to other cultures. In addition,the
dissemination process has to be carried out in a stepwise, systematic way,and the
authors’ emphasis on this is one of the key contributions of their article.
However,from a health promotion perspective – the one
with which both commentators identify – there is little here which seems to fulfil
the assertion thatmodel programmes have something to offer for mental health
promotion, as distinct from prevention. Our view is thatthe prevention vs promotion
debate will dominate the MHP arena in the coming decade, and, unfortunately,
Opositions on this topic seem rather fixed at present. There are those who would
maintain that the ‘only’ path to MHP is the one presented in this article – that of
model programmes of an ‘imposed’ nature, usually large-scale,and targeted a t
specific populations around risk factors, and where the outcomes are measurable
reductions in risks or disorder.
Others, coming from a health promotion perspective, will see MHP as primarily
to do with values, and the research associated with this stance involving a variety
of methodologies, both quantitative and qualitative. Where the health promotion
perspective differs fundamentally from the prevention one is in the arena
summarized by the term ‘empowerment’, and around the notions of community
control, self-determination, equity,justice and bottom-up processes. Where, one
might ask, is the Ottawa Charter for Health Promotion in all this – the document
that dominates most international discourse on health promotion?
Outcomes in a MHP context (vs a prevention one) are more likely to be in
terms of increasing capacity or resilience, than of the reduction of risks and
disorders, although the latter will also be part of the evaluative mix. It is to the
credit of the authors of the article that they do acknowledge that there are
criticisms thatthe types of model research programme outlined here are ‘top
down’, and are in ‘fundamental conflict with the empowerment of communities and
disadvantaged groups’. Later,a plea
is made for ‘a combination of a bottom-up and a top-down strategy’, which is to be
applauded, although the issue of ownership of projects and research data is not
addressed, and
so it appears that the professional researcher is to remain firmly in control of
agendas and processes.
In many respects, model programmes as outlined here seem to have a lot in
common with some of the earlier heart-health programmes, such as MRFIT and the
North Karelia Project, which not only had ambiguous results, but were very
expensive, and certainly not by any stretch of the imagination ‘empowering’. In an
age of increasing corporatization and centralization of social and economic
systems, one of the last hopes for an alternative view in the world could potentially
lie with MHP as
amovement, but these model programmes would seem to be
the veryantithesis of the ‘local’ and ‘democratic’ processes implied by this
alternative view.
Aprincipal issue raised in the article is over the way in which the methods and
findings of model programmes are disseminated, and in particular,whether
programmes should be disseminated in ‘pure form’ (programme fidelity) or be
The Value of Model Programmes in
Mental Health Promotion and
Mental Disorder Prevention
John M. Raeburn
and Irving Rootman
Centre for Health Promotion, University of
Toronto
COMMENTARY
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