1. Physical Activity and Mental Health

2. Agenda Introduction ―Welcome ―Housekeeping ―Workshop Overview Mental Health and Mental Illness: Defining Key Concepts Mental Health Promotion Key Concepts Connecting Mental Health and Physical Activity Exploring Community Resources Reflecting on our Current Practice Wrap Up ―Questions Page 2

3. Physical Activity Resource Centre PARC is the Centre of Excellence for Physical Activity Promotion in Ontario PARC is managed by Ophea PARC services support capacity-building, knowledge-sharing and learning opportunities PARC services include providing: ―Consultations & referrals ―Trainings & workshops ―Physical activity resources ― Annual Symposium ―Resource database ―Weekly Listserv parc.ophea.net parc@ophea.net @parcontario

4. Ophea A provincial not-for-profit organization - established in 1921 and incorporated in 1990 Dedicated to supporting Ontario schools and communities through quality program supports, partnerships, and advocacy Supportive of Health and Physical Education (H&PE) as a foundational component of healthy schools and communities

5. CAMH Resource Centre The CAMH Resource Centre is a program of the Health Promotion and Prevention (HP & P) Unit within the Provincial System Support Program at the Centre for Addiction and Mental Health Funded by the Health Promotion Division of MOHLTC We provide system support, capacity building, content expertise and access to information, research and guidance as it relates to mental health promotion, substance use and tobacco for health promotion and public health audiences in Ontario

6. Physical Activity and Mental Health Mental Health and Mental Illness: Defining Key Concepts

7. Did you know? 1 in 5 Canadians will experience a mental illness in their lifetime. The remaining 4 Canadians will have a friend, family member or colleague who will. (Health Canada, 2002) 70% of mental health problems and illnesses have their onset during childhood or adolescence. (Government of Canada, 2006) The first symptoms and onset of major mental health disorders develop during adolescence and early adulthood; however, individuals in this age group are the least likely to access mental health services, with only one-third of those who need mental health services in Canada actually receiving them. (Statistics Canada, 2003) Some individuals claim that the stigma from their mental illness is worse than the actual illness itself. (Commonwealth of Australia, 2005)

8. What is mental health? What is mental illness?

9. Defining the terms: Mental Health vs. Mental Illness MH and MI are frequently confused Related, but distinct concepts

10. Mental Illness Mental illnesses are disorders which cause a serious disturbance in thinking, emotions or behavior What does mental illness look like? Depression Bipolar disorder Schizophrenia Anxiety disorders Personality disorders Eating disorders one in five

11. Stigma Stigma refers to negative attitudes (prejudice) and negative behaviour (discrimination). Stigma includes: Having fixed ideas and judgments Fearing and avoiding what we don’t understand From: Stigma: Understanding the impact of prejudice and discrimination on people with mental health and substance use problems. CAMH, 2007.

12. “The Ontario Burden of Mental Illness and Addictions”

13. Mental Health “Mental health is a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make contribution to his or her community.” -World Health Organization

14. Mental health > Absence of mental illness

15. Two Continuum Model of Mental Health Flourishing Languishing No symptoms Serious Mental Illness 1 2 3 4 Source: Mental Health for Canadians: Striking a Balance. Health and Welfare Canada, 1988.

16. Three Most Significant Determinants of Mental Health 1.Social inclusion 2.Freedom from discrimination & violence 3.Access to economic resources Keleher & Armstrong, 2006; Mental Health Promotion in Ontario: A Call to Action, 2008

17. Physical Activity and Mental Health Mental Health Promotion Key Concepts

18. Definition: Mental Health Promotion “…the process of enhancing the capacity of individuals and communities to take control over their lives and improve their mental health.” Mental health promotion uses strategies that foster supportive environments and individual resilience, while showing respect for culture, equity, social justice, interconnections and personal dignity.” Joubert, N., Taylor, L. & Williams, I. (1996). Mental Health Promotion: The Time Is Now. Ottawa: Mental Health Promotion Unit, Health Canada.

19. Goals of Mental Health Promotion Mental health promotion (MHP) aims to: Enhance protective factors for positive mental health (resiliency) Reduce or eliminate risk factors contributing to poor mental health Influence some of the broader social determinants of health that contribute to poor mental health

20. Resiliency and Mental Health Resilience “involves being able to recover from difficulties or change—to function as well as before and then move forward” (Barankin & Khanlou, 2007)

21. Resiliency and Mental Health People who are resilient can: Understand and can sympathize with how others are feeling Communicate well with others Solve problems Be driven to achieve goals Be involved in meaningful activities Be hopeful for the future Develop good relationships (Barankin & Khanlou, 2007) Page 21

22. Risk and Protective Factors Risk FactorsProtective Factors Individual level physical illness parental mental illness academic failure adaptability, sense of security and feelings of mastery coping and problem solving ability feelings of optimism; resilience Interpersonal & Community level family distress, peer alienation work stress, unemployment lack of social support family harmony, positive parent- child interactions achievement and recognition in school or work community tolerance Societal level poverty violence and trauma discrimination, social exclusion and social injustice social inclusion, civic engagement and participation access to economic resources, services and supports

23. Addressing and Modifying Risk and Protective Factors Enhancing protective factors can: ―Protect from negative effects of risk factors ―Lead to reduction in duration and burden of disease if done early Resilience = individual characteristics + family characteristics + the physical and social environment Every person is different Risk and protective factors are cumulative Page 23

24. Social Determinants of Health Page 24

25. Social Determinants of Health Public Health Agency of Canada lists some key determinants of health as follows: income and social status social support networks education and literacy employment/working conditions social environments physical environments personal health practices and coping skills healthy child development biology and genetic endowment health services gender culture Page 25

26. What do you do to promote your mental health? Please use the poll option to indicate ways you promote your own mental health…

27. Physical Activity and Mental Health Connecting Mental Health and Physical Activity

28. Benefits of Physical Activity 20 to 30 minutes a day of moderate-intensity activity can: give you more energy reduce stress and anxiety improve concentration help you to sleep better help you to relax reduce your risk of dementia help you to meet people and make new friends help you to move with fewer aches and pains increase your bone strength help you control body weight reduce your risk for falls and injuries. Page 28

29. “There is no health without mental health.” Physical and Mental Health Connection

30. Benefits of Physical Activity on Mental Health Moderate-intensity exercise lasting at least 20 to 30 minutes produces an increase in the level of endorphins in the blood that leads to an enhanced feeling of mental wellbeing. Endorphins are the body's natural pain reliever People who participate in continuous exercise enjoy one of the most effective stress therapies available. Page 30

31. Physical Activity as Mental Health Promotion: A look at the evidence

32. Decreasing Symptoms of Mental Illness In children and adolescents, one review shows that physical activity may improve symptoms of depression, anxiety and improve self esteem (Biddle & Assare, 2011) In adults 18 and over, exercise seems to improve depressive symptoms in people with a diagnosis of depression (Rimer et al, 2012) In older adults, one systematic review demonstrates improvements in mood through physical exercise programs for those with depression (Blake et al, 2009)

33. Promoting Mental Health Physical activity, sport and exercise is positively associated with mood, emotion and psychological wellbeing (Biddle, 2000; Fox, 2000; Macauley and Rudolph, 1995). Physical activity can also produce changes in well-being through improved physical self-perception (Fox 2000) In older adults, one systematic review found that exercise and physical activity programs enhanced the well-being of older adults (Windle et al 2008).

34. Impacting the Determinants of Mental Health Recall that one determinant of mental health is social inclusion

35. Exploring Community Resources Physical Activity and Mental Health

36. Purpose: Guidelines define best practices for MHP initiatives CAMH; Dalla Lana School of Public Heath (U of T); Toronto Public Health Segmented populations by life stage & context Infuse MHP into existing / new initiatives (including physical activity programs) Each guide includes: Best practice guidelines & supporting theory Resources to plan/implement MHP initiatives Exemplary programs References Best Practice Guidelines for Mental Health Promotion Programs

37. Best Practice Guidelines for Mental Health Promotion Programs: Children &Youth Address risk & protective factors, including determinants of health Intervene in multiple settings; use multiple interventions; involve multiple stakeholders Focus on skill building, empowerment, resilience Establish caring relationships Provide comprehensive support systems Address policy & advocacy opportunities Demonstrate sustainability Ensure initiative is culturally appropriate, equitable & holistic

38. Older people 55+ years; spans 3-4 decades Several changes that affect majority of older persons: retirement changes in income levels physical changes changes in social support networks Eleven (11) best practice guidelines First guideline: Identify & address a specific population for your program/initiative Best Practice Guidelines for Mental Health Promotion: Older Adults 55+

39. CSEP’s Physical Activity Guidelines – Early Years www.csep.org

40. CSEP’s Physical Activity Guidelines - Children

41. CSEP’s Physical Activity Guidelines -Youth

42. CSEP’s Physical Activity Guidelines – Adults

43. CSEP’s Physical Activity Guidelines – Older Adults

44. CSEP’s Sedentary Behaviour Guidelines – Early Years, Children & Youth

45. YouThrive youthrive.ca youthrive.ca Bilingual web-based resource for leaders in communities and schools across Ontario who work with youth ages 12 to 19. Uses a health promotion approach to support positive mental health and prevent risk-taking behaviour among young people. YouThrive provides practical information to: Strengthen protective factors and resiliency among youth. Build young people’s health literacy – with a focus on positive mental health and well-being, and avoiding tobacco use, and substance misuse. Address the health inequities that exist among groups of youth in Ontario. Foster youth engagement. Developed by: Centre for Addiction and Mental Health, Canadian Mental Health Association, Ontario, Ontario Lung Association and Ophea.

46. Connect[ED] www.reallifeonline.ca www.reallifeonline.ca A free web-based resource developed by Ophea Teaches students in Grade 4, 5 and 6 how to be safer in an ever-changing world of technology Focuses on the development of the fundamental problem solving and decision making skills enabling students to make informed decisions online Content focuses on netiquette, online privacy and security and online relationships, including cyberbullying Includes grade specific video episodes with directly linked lesson plans and includes supports for both educators and parents

47. Evidence-based health promotion: physical activity and mental health http://cbpp-pcpe.phac-aspc.gc.ca/

48. Youth Fit for Life 12-week after-school physical activity program for children aged 5- 12 yrs who are in some form of after-school care. Group meets three times per week for 45-minute sessions that include resistance training & cardio in the form of noncompetitive activities and cooperative games. Once a week, there is training around interactive, behavioral life skills (such as goal-setting, recruiting social support, and positive self-talk) presented in a conversational group format. http://66.240.150.14/intervention_pdf/en/389.pdf

49. Senior Health and Physical Exercise (SHAPE) Project Part of research trial to determine impact of physical activity on quality of life of adults 65 and older. Program involved leader-led walking, three time/week for 6months and involved 582 older adults. http://66.240.150.14/intervention /657/view-eng.html

50. Conclusion: Why Mental Health Promotion and Physical Activity is a good “fit” Research shows that there is a connection between the physical activity and positive mental health and some evidence supporting the role of PA in decreasing symptoms of MI Evidence also shows that physical activity has a role in promoting mental health The body of literature on the role of physical activity on promoting mental health is still emerging, however examples exist of evidence-based programs with this focus

51. Physical Activity and Mental Health Reflecting on our Current Practice

52. Head, Heart, and “Sole” Self Promise An Idea I had… A feeling I experienced … A step I will take…

53. Contact Us parc.ophea.net parc@ophea.net Monica Nunes CAMH Resource Centre monica.nunes@camh.ca