Geir Stene-Larsen, Director-General of the NIPH handing over the report to Anne-Grete Strøm-Erichsen, Minister of Health and Care Services
This is shown in a new report from the Norwegian Institute of Public Health that presents 50 recommended preventive measures. The report is the first summary of knowledge on the prevention of mental disorders in Norway.
The report “Better safe than sorry… Mental health: Health promotion and preventive measures and recommendations” has been prepared by the Norwegian Institute of Public Health on behalf of the Ministry of Health and Care Services. Central and local health authorities, as well as local and national authorities outside the health care system, will benefit from the report in their work.
Psychological problems and disorders represent a significant public health problem and can lead to disabilities in home and school / work and lost quality of life.
Schools and senior centres as preventive arenas
The report states that in preventive mental health care, measures related to socioeconomics, employment, housing, schools, centre-based child care, senior centres, family and lifestyle are as effective as measures in the health service.
“The population’s health is greatly influenced by factors outside health service control,” says Ellinor F. Major, Deputy Division Director in the Division of Mental Health at the Norwegian Institute of Public Health.
“School is an example: It is an important preventive arena because schools provide education and skills, which in turn provide employment and participation in society. The school also provides friendship, community and a sense of belonging, and the experience of coping protects against mental disorders.”
“In the report we recommend health-promoting schools. We have seen that several programmes to combat bullying and behaviour problems have a positive effect, and we recommend that such programmes are carried out continuously in all primary schools in Norway,” said Major.
Also, senior centres are highlighted as a prevention arena.
“Senior centres should be developed in such a way that promotes mental health and prevents loneliness, physical inactivity and depression. We need, however, more knowledge about what works,” said Major.
Good opportunities to prevent anxiety and depression
Anxiety and depression are the most widespread, and for society, the most costly mental disorders. However, these disorders are the easiest and most profitable to prevent.
The report recommends that programmes and groups that prevent anxiety and depression should be readily available in all municipalities.
“Even a small reduction in the number of new cases in one of these groups will have major positive consequences for society: Fewer will be affected by the disorders and the pressure on health services will be reduced,” said Major.
Strengthen evaluation research
The report recommends strengthening the evaluation of preventive measures. It is emphasised that the evaluation must be research based and include implementation, impact (effect), profitability (cost-benefit) and whether people want them (user satisfaction).
“There is a need for a national unit for evaluation research that can assist municipalities and counties with the testing of promising initiatives, quality assurance and further development of existing measures and evaluation of major programmes,” said Major.
Ten most important preventive measures in the report
The recommendations in the report are based on research-based knowledge. Emphasis is placed on both individual studies from Norway and other Nordic countries, and literature summaries of international research. In many areas there is little research into measures. The report indicates measures that should be developed or further developed and evaluated scientifically where knowledge is lacking.
These are the ten measures that the Norwegian Institute of Public Health considers most important:
- High employment. Unemployment is a strong risk factor for psychological problems. Economic policy and labour market policy are the key factors, as well as measures to reduce sick leave and disability pension.
- Health-promoting schools. A health-promoting school is characterised by an environment where students are not bullied, where they are part of a community of peers and where they feel able to cope with their school work. Bullying is a strong risk factor for psychiatric problems in children and adolescents. Many programmes to prevent bullying and behaviour problems have a good effect and are advised to be conducted continuously in all primary schools in Norway.
- High-quality centre-based child care. The mental health of small children is shaped by their daily interactions with other people. Nurseries of high quality have a number of mental health effects for most children. All pre-school children should be offered an easily accessible, affordable high quality day-care.
- Preventive measures in senior centres. Centres for the elderly should be developed in a way that promotes mental health and prevents loneliness, physical inactivity and depression. Mental health promotion and prevention among the elderly is a research area of great social importance that has had little research. There is a need for a separate study of the universal, selective and indicated measures that should be developed and evaluated for the elderly.
- Home visits to pre-school children. Abuse of children is a strong risk factor for later psychological problems. Home visit programmes to identify children who are abused and to reduce this problem should be implemented in municipalities. Inadequate parenting skills and too challenging parental tasks are risk factors for later mental health problems in the child. Programmes that strengthen parenting skills should be offered to all families with pre-school children. It is particularly important to implement programmes to identify and help families who are exposed to many stresses and families where there are children with disabilities or the onset of symptom development.
- Supported Employment (SE). Unemployment is a strong risk factor for psychological problems. There is also a risk factor for unnecessary negative consequences of living with a mental disorder. On the individual level programmes like “Individual Placement and Support” (IPS) have shown good effect. Such programmes should be available in all municipalities.
- Groups, classes and programmes for coping with anxiety and depression. Support groups, self-help groups and educational (psycho-educative) programmes (e.g. courses in coping with depression and internet-based applications) can both prevent and reduce symptoms of depression. Such groups and programmes should be available in all municipalities. School programmes and company programmes for anxiety and depression should be further developed and tested based on the most successful Nordic programmes and be made available to schools and workplaces.
- Programmes for the prevention of sleep problems. Sleep problems may be the country’s most widespread and underestimated public health problem and is also the initial issue for most mental disorders. Sleep restriction, stimulus control, relaxation techniques and sleep hygiene have been shown to be highly effective techniques in the treatment of sleep problems. On the basis of this, programmes for the prevention of sleep problems should be developed and tested.
- Strong evaluation research. Evaluation of preventive measures must be research-based and include implementation, impact (effect), profitability (cost-benefit) and whether people want them (user satisfaction). In addition to strengthening the established research groups there is a need for a national unit for evaluation research. Important tasks for a national unit will be to assist municipalities and counties with the testing of promising initiatives, quality assurance and further development of existing measures and to evaluate major programmes. Such a unit needs to collaborate closely with other research groups nationally and internationally. To strengthen research on measures and instruments and to stimulate collaboration between research groups, a new research programme in the Norwegian Research Council should be established.
The report is only available in Norwegian.