The historic passage of health care reform in March 2010 has created an opportunity to move public health into the mainstream of US health care. This legislation includes a national health prevention and promotion strategy, including appropriation of substantial federal funding, to develop and expand prevention and wellness programs. The goal, in the words of the White House, is to “transition from a system focused primarily on treating the sick to one that helps keep people well throughout their lives” (available at http://www.whitehouse.gov/health-care-meeting/proposal/titleiv).
Where should mental health promotion fit within a reformed health care system? The 2009 Institute of Medicine report Preventing Mental, Emotional, and Behavioral Disorders among Young People: Progress and Possibilities (Washington DC: National Academies Press) described the robust research base supporting the benefits of interventions to prevent mental illnesses. These interventions seek to identify at-risk groups, with the goal of preventing or delaying the onset of mental illnesses. The report also provided strong support for mental health promotion, which views mental health as part of a spectrum that includes both disease and well-being. Mental health promotion is defined in broad terms that include not only psychological well-being but also effective functioning and social connectedness. This multidimensional definition leads to a “dual continuum” model that views mental health and mental illness as related but distinct constructs. Individuals can be free of a clinical diagnosis but still not thrive or, alternatively, can flourish even in the face of a chronic mental or physical condition.
This special issue of the American Journal of Public Health focuses on the emerging science of mental health promotion. These studies provide evidence that less optimal mental health is as strong a predictor of adverse health outcomes as is mental illness itself, suggesting the need to attend to individuals who are functioning poorly even in the absence of clinical disorders. The studies in this issue also demonstrate that although some degree of positive mental health is determined by genes and social circumstances, appropriate interventions can significantly improve psychological flexibility and well-being.
The challenges in promoting mental health parallel those seen for wellness and health promotion efforts. Universal interventions can be difficult to develop, and their impact difficult to measure, especially when they are implemented across broad, heterogeneous populations. It can be tricky identifying the appropriate role of the health care system in addressing nonmedical determinants of well-being, such as poverty, built environments, and social inequality. As a consequence, promotion efforts will need to be multidisciplinary, involving partners such as professionals in the housing, criminal justice, and educational systems.
At the same time, many of the best opportunities for mental health promotion may come through integration with broader wellness and health promotion efforts. Interventions designed to promote healthy lifestyles and reduce adverse health behaviors such as smoking and physical inactivity will be more successful if they also support self-efficacy and emotional well-being. Physical wellness, in turn, is likely to be a core element for helping individuals flourish mentally and emotionally. This linkage between physical and mental health and social factors echoes the World Health Organization's definition of health as “a state of complete physical, mental, and social well-being and not merely the absence of disease, or infirmity” (available at http://www.who.int/about/definition/en/print.html).
A central theme of the 1999 Surgeon General's report Mental Health: A Report of the Surgeon General (available at http://www.surgeongeneral.gov/library/mentalhealth/home.html) was that “mental health is fundamental to health.” Similarly, mental health promotion should be fundamental in these new efforts to promote health and well-being in the United States. The articles in this issue are intended to direct the public health community's attention toward this emerging science.