Socio-economic Crises and Mental Health: FromResearch toAction Round Table Policies and strategies to alleviate the mental health impact of socioeconomic crisis What could Research, Policies and Practices of Mental Health Promotion and Mental Disorder Prevention contribute? Clemens Hosman Emeritus Professor of Mental Health Promotion and Prevention Maastricht University & Radboud University Nijmegen
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Socioeconomic Crisis and Mental Health Hosman Prevention Options
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Socio-economic Crises and Mental Health:From Research to Action
Round TablePolicies and strategies to alleviate
the mental health impact of socioeconomic crisis
What could Research, Policies and Practices of
Mental Health Promotion and
Mental Disorder Prevention contribute?
Clemens HosmanEmeritus Professor of Mental Health Promotion and Prevention
Maastricht University & Radboud University Nijmegen
Questions
1. Analysis and theory: What are the mediating and moderating factors and processes between Socioeconomic crises and Mental Health, that could be targets and entrees for preventive actions?
2. From Theory to Action: What evidence-based interventions are available in the domain of prevention in Mental Health? How effective? Are they relevant for alleviating the MH burden of Socioeconomic crises?
3. From Interventions to Public Impact: What is needed to get preventiveinterventions implemented, scaled, reaching target populations and tocreate significant public impact?
?
Alleviating the impact of economic crisis on mental health:
Preventive Actions
Socio-
Economic
Crisis
Mental health
Mental disorders
children
adolescents
adults
Elderly
Vulnerablegroups
Health, socialand economic
outcomes
What could we do?
Policies Interventions Practices
Alleviating the impact of economic crisis on mental health:
Preventive Actions
Socio-
Economic
Crisis
Mental health
Mental disorders
children
adolescents
adults
Elderly
Vulnerablegroups
Health, socialand economic
outcomes
Access mental health care
Early detection and treatment
Rehabilitation Anti stigma
Alleviating the impact of economic crisis on mental health:
Preventive Actions
Socio-
Economic
Crisis
Mental health
Mental disorders
children
adolescents
adults
Elderly
Vulnerablegroups
Health, socialand economic
outcomes
Mediating factors
Moderating factors
Macro level
Community
Family
Person
Access mental health care
Early detection and treatment
Rehabilitation Anti stigma
Interventions programsPractices
Policy 2016 Hosman
Alleviating the impact of economic crisis on mental health:
Preventive Actions
Socio-
Economic
Crisis
Mental health
Mental disorders
children
adolescents
adults
Elderly
Vulnerablegroups
Health, socialand economic
outcomes
Mediating factors
Moderating factors
Macro level
Community
Family
Person
Conditions for Implementation and Public Impact2016
Hosman
Mediators of impact socio-economic crisis on mental health
Poor Mental Health
Mental disordersDepression - Anxiety
Externalising problemsAlcohol-related disorders
Suicide
Work Income Debts Housing
Neighbourhood quality
Family functioning and Parenting
Stress, Vulnerability and Coping
Health care quality and access
Social capital: support and connectedness
Social protection
Entree points and targets of preventive Action
Health, social andeconomic outcomes
Mediating determinants
Socio-
Economic
Crisis
Community
Family
Individual
Negative impact ����
2016 Hosman
Impact model socioeconomic crisis on mental health
Socio-
Economic
Crisis
Pre-existing strengths
Mediating determinants
negative changes in:
Work, Income, Housing, Debts
Neighborhood qualityHealth care & Social services
Social protection
Social capital, support and connectednessFamily functioning & Parenting
Stress & Vulnerabilty in children, adults, elderly
Early childhood education – arrest violent crime -33% ‒ 41%
COPMI children parental MI depr.symptoms (7) .22 -40% (onset)
Fagan & Catalano 2012
Durlak et al. 2011
Cuijpers et al. 2008
Piet & Hougaard 2011
Siegentaler et al. 2012
Kraag et al. 2006
Ahlen et al. 2015
Chen et al. 2016
2016 Hosman
� domestic violence ����
� youth violence & delinquency ���� ROI $2 to $5
� lossed productivity ����
� cost welfare ����
� income ����
� school achievement ����
� social participation ����
Mental Health
Promotion
Prevention
programmes
show also
Social
and
economic
Benefits
Crucial for involving
stakeholders and getting public support
Economic benefits exceed costs of youth programmes up to 10x
IOM Report 2009; MHEEN Report of Zechmeister et al. 2008;
Aos et al. 2004 on >50 early childhood studies
Conclusions from outcome research
g Preventive interventions can be effective and cost-effective
g Evidence for broad spectrum of preventive outcomes and social & economic benefits from variety of intervention
g Long term effects found (up to 40 years)
g Large variation in efficacy and effectiveness: From large to small / no / iatrogenic effects. Meta-analyses Mean ES: small-moderate. Need for improvement
g Low implementation rate and low reach in population, almost no evidence on public impact
g Most interventions person-family oriented and from HICs More focus needed on social interventions and their outcomes
�
From Interventions to Public Impact
What is needed to get preventive interventions
implemented, scaled, reach target populations
and to create public impact?
Major bottleneck worldwide:
low implementation ratelow / selective access and reach
low public impactfrom HICs
Preventive programs can only make a difference when implemented at large scale
Improve Implementation, Scaling, Reach and Public Impact
� Improve effects of intervention (effect management)
� Use intervention & dissemination methods with large reach & low costs
� More interventions more adaptable and cosumable: working elements, kernals
� Make the multiple health, social and economic benefits visible
� Advocate for more prominent position of prevention and mental health in ….
� Increase power: Involve citizens, social movements, stakeholders
� Embed prevention in sectors, policies and legislation
� Enlarge resources for prevention by budget shifts and return for investment
� Train professionals and officials in preventon and mental health expertise
� Interorganisational collaboration and monitoring
� Use principles of ‘Colective Action’ and ‘Collective Impact”
� Improve management and shared leadership
Programs
Advocacy
Capacity
Shared leadership
Hosman 2016
Make it
smaller
Kernals
Principles
Working elements
Make it
Bigger & Coherent
integral
multicomponent program
+ wide implementation
Relevant Effective
preventive interventions
databases
for dissemination
Widely integrated in
daily life & practice
Prevention Density
Multually supporting &
complementory activities
to achieve Collective Impact
Make
implementation
large public reach
public impact
possible
Expertise
Manpower
Public support
Policy & legislation
Organization
Collaboration
Knowledge & Research
Crisis &
derpression
Single programs
you could adopt
and be inspired by
Createthe conditions
Hosman 2016
Thank you
Contact:
Prof. dr. Clemens M.H. Hosman
Emeritus Professor of Mental Health Promotion and Mental Disorder Prevention Radboud University Nijmegen & Maastricht University
Hosman Prevention Consultancy & Innovation, Berg en Dal, the Netherlands