What Public Health Could (Belatedly) Contribute to Mental Health Promotion
| Date | 01 February 1999 |
| Published date | 01 February 1999 |
| DOI | https://doi.org/10.1108/17465729199900014 |
| Pages | 22-29 |
| Author | Bret Hart |
| Subject Matter | Health & social care |
22 International Journal of Mental Health Promotion VOLUME 1 ISSUE 2 • APRIL 1999 © Pavilion Publishing (Brighton) Limited.
The contribution that public health makes
to the prevention of mental illness
Although public health practitioners may shy away from
considering mental health as part of their brief, and public health funders may be
reluctant to invest in mental health,
they are, probably unknowingly,preventing mental illness. For example, the neuro-
psychiatric complications of measles and rubella are prevented with immunisation
(Gruenberg, 1960). More recently,the brain damage and subsequent psychological
and behavioural problems associated with Haemophilus influenzae type b ( Hib)
meningitis have been averted by vaccination (National Health and Medical
Research Council, 1993).The promotion of folic acid supplementation prior to
conception has reduced the incidence of neural tube defects (Bower & Stanley,
1989). The mental illness associated with syphilis is now a rarity,thanks, in part, to
public health measures. The reduction of alcohol and drug consumption thathas
resulted from health promotion programs will have reduced the psychiatric
morbidity and mortality associated with substance misuse.
These are significant contributions from public health to reducing mental
illness associated with physical disease and injury.There is, however, no public
health strategy either to prevent mental illness per se or to promote mental health.
There may be a deep-seated bias to account for public health’s parochialism.
Reasons for public health’s neglect of
mental illness and health
Stigma
One of the reasons that public health has not embraced mental health is that the
word ‘mental’ has negative connotations that stem back to the Anglo-Saxon era.At
that time the prevailing view was that the mad were possessed by the devil and,
therefore, the treatment of choice was exorcism. In the thirteenth century a more
humane approach developed with
the establishment of almshouses for the sick, including the mentally ill. It was not
until the fifteenth century that there was segregation of those who had a physical
illness from those whose disease was neuropsychiatric in origin. These asylums
expanded from occupancy of 1,046 in 1827 to peak at 155,000 in 1959.
But their growth was not motivated by compassion.
Public opinion supported the removal of the unsightly mad from the public eye,
thereby further stigmatising people deemed to have a disease of the mind. It is
likely that epidemiologists and public health practitioners shared this prejudice and
were no doubt content to have their selective blindness to a major public health
issue facilitated by this institutionalisation policy. It was not until the late sixties that
the anti-psychiatrymovement turned public opinion against institutional care (Tyrer
et al., 1997) and the ensuing fracas further deterred public health practitioners
from exploring such a controversial area.
Cartesian dualism
Another impediment to acceptance by health practitioners of
arole in mental health is the belief that the mind is a separate entity from the body.
This is a legacyof a belief created by the early Greeks, but René Descartes in the
seventeenth century is given most credit for postulating that human beings are
composites of two kinds of substance. This paradigm persists today,doctors
specialising in the physic having minimal interaction with those concerned with
psyche. It is only in recent times that there has been some acknowledgment that
the head is attached to the body and that there is a physiological relationship
between the two, as explained by the proponents of psychoneuroimmunology (Ader
et al., 1995; Jessop, 1998).
As it has been difficult to establish that there is an internal relationship
between the soma and the psyche, it is not surprising that the scientific establish-
ment would find it difficult to accept that health – mental health in particular – is
influenced by external factors such as the socio-economic environment. For
example, it is scientific fact that premature mortality is higher among people who
have a low socio-economic status. The focus on pathological processes in the
aetiologyof disease may in part account for the fact thatthose who should be
advocating on behalf of their patients to address the underlying cause of their
premature death and burden of illness, including mental illness, have been
What Public Health Could
(Belatedly) Contribute to Mental
Health Promotion
Bret Hart
Coastal & Wheatbelt Public
Health Unit, Western Australia
FEATURE
Although public health practitioners have made some con-
tribution to the prevention of mental illness, this has not
been a result of deliberate intent. Considering the extent of
the problem, the response to mental illness as a public
health issue has been grossly inadequate. An exploration of
the historical reasons and an analysis of public health’s
reluctance to include mental health as part of its responsi-
bility may assist in the premarital counselling required to
broker what could be a mutually beneficial marriage with
mental health. The prospective fruits of this union are
explored, with recommendations for future action.
ABSTRACT
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