Mental Health Promotion ‐ Re‐thinking the Evidence Base

The case for investing in mental health promotion is often debated in terms of whether it can or cannot contribute effectively to the prevention of mental illness. As it happens, it can; however, as Phil Barker points out, curing illness does not necessarily result in health (Barker, 2000). Indeed, the user/survivor movement shares with the disability rights movement ethical concerns about an agenda dominated by the struggle to eliminate all disorders of the mind. Organisations like the Manic Depression Fellowship, which has pioneered a self-management T approach to bi-polar disorder, and the Mental Health Foundation’s Strategies for Living initiative (Mental Health Foundation, 2000), demonstrate the extent of interest in alternative approaches, not only to the management of mental health problems, but to the way in which mental health (and mental illness) is conceptualised. The call for ‘mad pride’ is part of a growing self-confidence within the user/survivor movement, and a demand for acceptance which includes a recognition of the positive aspects of mental health problems (Curtis et al, 2000). This relationship between identity and diagnosis has been forged through the experience of discrimination and the conditions under which people with mental health problems have used mental health services. It is no coincidence that service users have been among the most vocal supporters of standard one, not only because of its explicit commitment to challenging discrimination, but because of the opportunity it offers to transform the terms of the debate about mental health. The requirement to ‘promote mental health for all’ (Department of Health, 1999) will mean talking openly about the mental health needs of the whole community and will help to dispel notions of ‘them and us’. Such a transition challenges the myth that people can be neatly divided into those who do and those who do not have mental health problems. It provides a framework for addressing how, as a society, our mental health needs are met, or not met: in our families, our schools, on the streets, at work – where we feel safe, involved, respected and valued, or in fear, marginalised and excluded. Addressing the public health potential of mental health promotion might help us to move beyond the current impasse, where we appear to be trapped in a discourse of cure, while all around us we are witnessing the erosion of, or disregard for, those features of society which promote