Approaching Public Mental Health in Norway Brussels May 19/ 2015, irene.prestoy.lie@helsedir.no

Public Mental Health: The Norwegian Context 2012: Public Health Act The Working Environment Act The White paper on Public health was launched just before easter, includes a chapter on public mental health promotion For more information about the public health act in english, go to: https://www.regjeringen.no/en/aktuelt/new-norwegian-public-health-act--institu/id660492/

Changing focus in Public Health - The social model of health Mental health has been integrated in the public health strategy – adapting the social model of health as a starting point. This means, historically illustrated: The history of Public Health in Norway is similar to many other countries 1. We started out with water, sanitation, safety at work and universal health care services 2. Then moved on to individual life style factors, and for many years this was the main focus: exercise, tobacco, alcohol and nutrition 3. At the turn of the century, in Norway, as is true for the rest of Europe, evidence on social inequalities in health made us look outward again, towards the societal structures that shape the conditions in peoples everyday lives. For the public health promotion strategy, this means we are turning our attention towards environmental causes and psycho social factors that shapes the environment and determines mental health an well being.

Public Mental Health: Starting point inequity Inequity in mental health outcomes Social determinants of mental health Psychosocial mechanisms play a significant role HEALTH INEQUITY 1. Our national data shows us that the guy at the left has 6 times the risk of developing an anxiety disorder as the nurse to the middle right and that life satisfaction and perceived control (which we know is related to mental health outcomes) increase as we move to the right 2. This points at the social determinants, especially income and educational levels Because we also know that this pattern applies to children and youth Children’s risk of being diagnosed with conduct disorder increases as their parents income decreases While early detection, diagnosis and treatment plays an important role We have to address the issues that lie inherent in our inequity data: An important question is: How come parents’ educational levels and income has such an impact on children’s mental health and wellbeing? - We know that psychosocial mechanisms play a significant role in explaining the health disparities So to sum up: in 2012 – it was decided to approach mental health promotion from the inequity perspective This work is quite new in Norway and we are still working on developing the strategy

Social determinants of mental health Environmental: social support social integration perceived control social capital being active/ overall participation (work, school, democratic etc) + environmental factors in kindergartens schools , workplaces and communities Individual: experience of mastery and control temperament The evidence on inequalities in mental health points at the social conditions that shape our everyday lives. We are working on a whole of society approach,- addressing the factors which shape the conditions for well being and mental health The mental health field has traditionally (before it adapted the social model) focused mainly on illness, problems and individual causes and interventions. This is a necessary, but not sufficient solution to our challenges.

Chapter on mental health Public Health white paper Ministry of Health of Climate and Environ-ment Ministry of Labour and Social Affairs Ministry of Education and Research of Culture Ministry of Children, Equalities and Social Inclusion Directorate of Education Directorate for Labour and Welfare Directorate for Children, Youth and Families Through expanding the way we understand what determines mental health and wellbeing, we face entry points for action on all relevant levels in order to reduce mental illness, increase wellbeing and reduce inequalities in a whole of society approach. So we need to address the barriers or determinants on a number of different levels (INCLUDING macro and meso levels) We need a whole government approach that adresses the psychosocial aspect, i.e. is not illness oriented - On a national level we work with other directorates, and our ministry does the same We don’t control the measures in these sectors - So we need to collaborate with and contribute to their work and initiatives for mental health and wellbeing IMPORTANT: When we start adressing the determinants and start adressing mental health in other sectors; the language of wellbeing makes sense. If we approach the education sector og work sector talking about mental health; they will respond adressing mental illness But when we talk about wellbeing, feeling good and functioning well, they relate this to their social mandate ______________________________________ IN the process towards this white paper on public health - different ministries worked together on a chapter about mental health: Ministry of Children, Equalities and Social Inclusion Ministry of Culture Ministry of Education and Research Ministry of Labour and Social Affairs Responsebility across sectors will be adressed, through issues such as The quality of care in nurseries and kindergardens In schools; How the ‘learning environment’ i.e. administration, leadership, cooperation with parents and factors that influence pupils wellbeing can be adressed in a whole school approach Services for families, but also looking at how national politics influence families Efforts to support youths through upper secondary education Psychosocial factors influencing health and wellbeing at work, but also interventions to prevent exclusion for people with metal health problems and inclusion for those who have been out of jobs Social security and benefits Housing and the built environment Civil society SDoMH: on a national level; cooperating with other sectors Approaching the directorate for labour and welfare adressing psychosocial issues at work

Work life on the well being agenda Adress Psychosocial factors influencing health and wellbeing at work, but also interventions prevent exclusion for people with metal health problems and inclusion for those who have been out of jobs Window of opportunity: The Cooperation Agreement on a More Inclusive Working Life (The IA-agreement) To improve the working environment Enhance presence at work Prevent and reduce sick leave and prevent exclusion and withdrawal from working life. Agreement between the labour organisations / employer organisations and the government. 11/11/2018

Indicator system Monitoring factors that affect health and well being Collaboration with other sectors Includes indicators on factors that affect mental health and well being at the work place Se attachement for an English version of the Norwegian Public Health report in 2009. A new report will be launched in 2015. 11/11/2018

Work place intervention preventing risky use of alcohol and sick leave Ongoing RCT-study of early intervention tools to reduce risky drinking among employers Evaluation of the implementation process Cost/benefit analysis 11/11/2018

Thank you for the attention! 11/11/2018