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PARTNERSHIPS IN HEALTH PROMOTION

Professor Graham D. Burrows, AO, KCSJ
BSc, MB, ChB, DPM, MD, FRANZCP, FRCPsych,
MRACMA, DipMHlthSc(Clinical Hypnosis), FAChAM

Department of Psychiatry, University of Melbourne
Austin Health

I speak to you today as President of the Mental Health Foundation of Victoria.  The Mental Health Foundation was formed in Victoria in 1930, under the name of the Victorian Council for Mental Hygiene.  When I joined in 1970, we changed the name the next year to the Victorian Council for Mental Health and then later to the Victorian Association for Mental Health, and currently the Mental Health Foundation of Australia (Victoria).  It currently has a membership of 190 organisations, representing approximately 15,000 people in other organisations, and 230-250 individuals around the state and interstate.  The Mental Health Foundation of Victoria is a member of the Mental Health Foundation of Australia.

Over the years it has established a large number of support groups for mental illnesses, including the Schizophrenia Fellowship in the late 1930's, the Association for Relatives and Friends of the Emotionally and Mentally Ill, the Anorexia and Bulimia Nervosa Foundation, the Obsessive Compulsive Disorders Foundation Support Group, the Alzheimer's Association of Victoria, the Mood Disorders Support Group, Carers Association Australia through the Australian National Association for Mental Health (ANAMH), the National Mental Health Week. 

Current programmes include a major commitment to Mental Health Week, which involves a launch, media committee, creative writing competition to all schools, an art competition and a poster launch.  The Mental Foundation of Victoria also runs telephone information, referral, resource and support services, the Mood Disorders Support Group, which has a major commitment and attendance and conducts a series of lectures.  Current programmes include the Victoria links with National programmes, such as the National Institute for Stress Evaluation and Management, Stress, Anxiety and Depression Awareness Campaign, and has a major role in Partnerships in Health Promotion.   I Chaired the World Federation for Mental Health Congress this year.

Priorities of the Foundation include the removal of stigma attached to mental illness, promotion of mental health and prevention of mental illnesses.  One way of doing that is to produce a number of publications for general practice and community education.  These publications include Understanding and Managing Stress, Understanding Depression, Adolescent Health and Wellbeing, A Guide to Responsible Gambling, Post-partum Psychological Disorders and is involved in a number of tapes and videos, including Stress, Anxiety and Depression. 

Major publications include the Depression Awareness Journal, which is distributed to medical practitioners throughout Australia and a journal called Mental Health Australia, however, brochures play a major role also in education include Dealing with Negative Emotions, The Anxiety Disorders: Causes and Treatment, and Depression Causes and Treatment.  I recall when I joined in 1970, I tried to find publications on mental health or general education " I could not find one.  There was none in the Health Departments.  Today, there is a great amount of material produced, including information on the Internet.  Unfortunately, some of this is really quite incorrect, if not, potentially damaging.  We have an encryption system to prevent inappropriate material being distributed.  I show you a copy of the Depression Awareness Journal, Mental Health Australia, the brochures and many of the publications that we use, including Your Guide to Understanding and Managing Stress and Adolescent Health and Wellbeing: A Guide to Effective Coping.

Major projects

Major projects included Towards a Gentler Society (TAGS), The Anti-Violent Society  (TAVS), The National Depression Awareness Campaign, Vision Information Enhanced Wellbeing 21, Partnerships in Health Promotion, and the National Institute of Stress Evaluation and Management. 

Partnerships in Health Promotion

This was formed in November 2000, and its concept was to take consortium national health and social impact of non-government organisations (NGOs) (not for profit organisations) and to address issues of joint concern to our individual constituencies.  This is in recognition of the governments and NGOs supporting partnerships in preference to replication of services to overlapping constituencies.  Foundation members of Partnerships in Health Promotion (PIHP) included:

• Alzheimer's Association Australia;
• Australian Red Cross;
• Mental Health Foundation of Australia;
• National Stroke Foundation;
• Pharmaceutical Society of Australia;
• The Smith Family;
• St. Vincent De Paul Society Australia;
• Victims Referral and Assistance Service, and
• Victorian Relief Committee.

Other members include:

• Australian Cancer Society;
• Australian Council of Trades' Unions;
• International Diabetes Institute;
• The Royal Australian College of General Practitioners;
• The Royal Australian and New Zealand College of Psychiatrists (Victoria);
• The Asthma Foundation, and
• The Salvation Army.

The Young Australians' Mental Health and Wellbeing "Embrace the Future", has developed out of the Partnerships Programme.  Future projects include: looking at stress in the workplace, racism and bullying, children and parenting, self-esteem and self-images, early childhood strategies for health awareness.  "Embrace the Future" the Young Australian Mental Health and Wellbeing project has been developed because it has been recognised that young Australians do have problems.  Do children and Adolescents have a problem with mental illness?  The answer is, "Yes" " 14% have a mental illness at any one time.  This includes 1% of the population who experience schizophrenia, which has its onset in adolescence; 1% of the population experience a bipolar disorder, which has its onset in adolescence; 3-5% suffer from bulimia nervosa, and 5% suffer from anorexia nervosa.  Did you know that anorexia is 10 times as common as diabetes in adolescence?  Eight percent suffer from anxiety disorder and 11% from depressive disorders. 

Young Australians have a number of mental health risk factors.  These include:

• Family violence;
• Physical or sexual abuse;
• School failure;
• Parenting difficulties;
• Homelessness;
• Unemployment;
• Parental mental illness;
• Isolated, living in a rural or remote areas;
• Socially disadvantages;
• Early school leavers;
• Lack of control, and
• A sense of hopelessness about the future.

There are multiple changes and stresses for adolescents, including:

• Enormous physical and emotional changes;
• Completing higher education/leaving school;
• First serious romantic relationships;
• Employment / unemployment;
• Peer pressure " drugs, alcohol, fast cars;
• Loss of loved ones / parental separation loss and grief issues related to divorce or family breakdown;
• Forced relocation;
• Loneliness and isolation;
• Parental expectation for performance, and
• Physical, emotional and sexual abuse.

In launching this programme, supported by Carole Crean, as Patron and a launch attended by Cherie Blair, married to Tony Blair, Prime Minister of the U.K., the following quote was given by me:

"Business, sporting, cultural, education and community leaders have an important role to play in helping shape the dreams and aspirations of Australia's youth.  Their advocacy and involvement in this programme will be vital for assisting young people along the pathways to fulfilling their goals, with positive self-esteem as the first step".

The Young Australians' Mental Health and Wellbeing Programme is part of the broader programme of the Partnerships in Health Promotion Programme, setting young people on the road to positive mental health.  This will involve an education and training programme to develop strategies for:

• Protection of positive mental health,
• Prevention of illness,
• Early intervention in prospective illness, and
• The removal of stigma associated with mental illness.

The Partnerships in Health Promotion as you would appreciate is a consortium with this network of independent health and social impact non-government organisations, with a strategic vision to work together for better health and wellbeing for Australians.  This collaborative network co-ordinates activities to address gaps in the prevention of illness and promotion of health and wellbeing.  Of course, the Young Australians' Mental Health and Wellbeing project will focus on the health and wellbeing of young Australians.  The aims of the youth programme are to strengthen individuals' and community awareness of mental illness, which will involve experiential training for young people, their leaders, teachers and mentors in mental health and wellbeing strategies.  The programme involves community education to assist young people in achieving their goals, building confidence, self-esteem and social skills, addressing depression, and stress and anxiety in young people.  The programme is a national programme and will be promoted to remote and rural areas, the indigenous population and to culturally diverse groups.  Of course, the programme needs to be accessible, affordable and will involve interactive multimedia resource materials, and involves education and training programmes. 

Young Australians' Mental Health and Wellbeing " Who are we?  We have a Board of Directors, we have multiple employed personnel, we have a role to Governments and with Governments, there is a Charitable Mental Health Trust Fund, we are involved with Mental Health Advocacy, and the Education Programmes are all to do with Mental Health Promotion, and prevention of mental illness and removal of stigma related to mental illness " one of the biggest problems we have is stigma and myth.  To be successful, this must involve young Australians, must involve partnerships and community linkages, it will be independently evaluated, we have of course some funding and seeking more, set timelines and there is a Reference Steering Group.  School programme participants include the students, parents, teachers, administrators, the community and Governments.  The Education and Training Programme will involve professionals with extensive experience in working with young people and with appropriately trained peer leaders and champions or mentors.  The programme is being developed in collaboration with young participants from the Partnerships and Health Promotion members.  The programme eventually will be delivered and broadened to include school, cultural, sporting and community youth groups and local councils.  The programme involves effective coping, particularly for the stresses of adolescence.  This is a most important dimension of effective coping for adolescents to feel the support of family, friends, professionals and the community. 

The Partnerships in Health Promotions Network involves local Mental Health information databases, information resources, global Mental Health experts on-line, local doctors, local pharmacists, community and home health workers, workplace personnel, hopefully there will be multimedia kiosks in shopping centres, which will eventually be linked to homes, school and universities.  One subset of this programme is called the Depression, Stress and Anxiety (DSA).  This involves four of the partners:

• Mental Health Foundation of Australia;
• National Stroke Foundation;
• The Smith Family, and
• Australian Red Cross

We have been fortunate to receive funding from beyondblue, the National Depression Initiative, who are one of the partners. 

We begin with what is the depression, stress, anxiety education and training programme?  One definition of stress is "a condition in which there is a marked discrepancy between the demands made on a person and his or her capacity to respond".  Stress will lead to anxiety - if it is long enough and severe enough.  Anxiety disorders may lead to depression " 80% of anxiety disorders may end up being depressed eventually.  We know that stressful events often occur in our lives, but frequently we bounce back.  Nevertheless, repeated stresses can reduce our physical and psychological ability to cope.  Our programme involves a series of slides and material, which are going to the four organisations.  They are professionals, volunteers and consumers.  We will teach people how to relax, including:

• Exercise;
• Proper diet and sleep;
• Avoidance of excessive alcohol and elicit drugs;
• Relaxation training;
• Hypnosis;
• Meditation;
• Yoga, and
• Proper use of leisure activities.

You may ask what is anxiety?  Anxiety is a normal emotion experienced by everyone.  Anxiety, like stress can be useful and improve performance.  When anxiety is too severe, lasts too long, or connected to the wrong thing, the anxiety can become an anxiety disorder.  It has been estimated that up to 10% of the population may experience an anxiety disorder.  These anxiety disorders include:

• Phobia;
• Panic Disorder;
• Generalised Anxiety Disorder (GAD)
• Post-Traumatic Stress Disorder (PTSD)
• Obsessive-Compulsive Disorder (OCD), and
• Acute Stress Disorder. 

We believe anxiety can be managed with psychological therapies of which there are many types, Cognitive Behavioural Therapy (CBT), which is based on learning.  Medication may be necessary in some, particularly if it is severe and a combination of medications and psychological therapy is often the best approach.  Of course, it depends on the nature of the anxiety disorder to what type of therapy would be predominately used.  There are many famous people who have been depressed, including Winston Churchill and his "black dog".  We know that the course of depression is variable.  For some it will be an isolated event, for others it may appear at particular times of their lives.  It is now recognised by many that stress contributes to depression.  It is obvious in the first episode, but subsequent episodes may not involve stress.   Depression leads to depression. 

In Australia, depression is common " one in four women and one in six men will have depression at some stage in their life.  It often begins in the mid 20s.  Between 50-60% of people who become depressed experience a relapse.  Therefore, depression is a chronic condition.  It needs to be treated seriously and active treatment for the first episode is important, if it is to reduce further episodes.  In Australia, over 800,000 people each year suffer from depression. The cost to society is high.  It is the fourth highest cause of death and disability and it has been estimated that the cost to the community is in the vicinity of $20 billion per year, as a result of the illness, the impairment, loss, productivity, work loss and affect on the family.  Depression is now becoming the worlds leading cause of disability and burden following cardiovascular illness. 

Management of depression

Depression is treated with a number of talking therapies or psychotherapies, particularly Cognitive Behaviour Therapy where there is an effort to change the thoughts and beliefs.  Activity is important, physical activity leads to an increase of endorphins, encephalins, and natural opiates within the brain, leading to an improvement in mood.  People need to develop better problem solving behaviour techniques, be involved in anxiety and stress management and in the severe group, may require electro-convulsive therapy.  This is probably only 5% of the total depressed people.  In mild depression, talking therapies is the approach best taken.  In moderate depression, or clinical depression, antidepressant medication and psychotherapy is important, while in the very severe group suffering depression, antidepressant plus electro-convulsive therapy is important. 

The message the Mental Health Foundation is making, is to get across to people that healthy lifestyle, stress management, looking after themselves and prevention techniques is very important.

For further information contact:

Mental Health Foundation of Australia (Victoria)
270 Church Street, Richmond 3121
Tel: (03) 9427-0406
Email: mhfvic@pacific.net.au
Website: www.mentalhealthvic.org.au

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