Análisis de modelos curriculares

The term, ‘population health’ lacks a clear understanding of its meaning and scope.27 It does not have a specific definition although public policies and

academic articles commonly replicate the vastly altered definition of public health eugenist, C.E.A. Wilson, as ‘the science and art of preventing disease, prolonging life and promoting health through the organised efforts and informed choices of society, organisations, public and private, communities and individuals.’28 Public health systems have adopted a dichotomous policy approach of prevention and population health. Preventative policy efforts seek to eliminate factors that cause or contribute to illness while population health seeks to enhance existing health by focusing on individual and community strengths.29

21_{Juha Räikkä, ‘The social concept of disease’ (1996) 17}

Theoretical Medicine and Bioethics 353, 354.

22

Ibid357.

23

Ibid356.

24_{Guardianship and Administration Act 1995 (Tas).} 25

Mental Health Act 1996 (WA).

26_{Alcohol and Drug Dependency Act 1968 (Tas).} 27

David Kindig and Greg Stoddart, ‘What Is Population Health?’ (2003) 93 American Journal of Public Health

380.

28

C E A Wilson, ‘The untilled fields of public health’ (1920) 51 Science 23, 30.

29 _{Bonnie Pape and Jean-Pierre Galipeault, ‘Mental Health Promotion for People with Mental Illness’}

(Discussion Paper, Mental Health Promotion Unit of Health Canada, April 2002) <http://www.phac- aspc.gc.ca/publicat/mh-sm/mhp02-psm02/pdf/mh_paper_02_e.pdf>.

Population health is generally regarded as a ‘conceptual framework for thinking about why some populations are healthier than others as well as the policy development, research agenda, and resource allocation that flow from this framework.’30

Rose proposed that the most efficient way to prevent health problems in the individual is to reduce the whole population’s level of risk.31

Achieving this outcome of improved health and well-being requires a multiphase approach with the development of public health policies that first, build public consensus and an authorising environment, identify the problem, increase knowledge from research and experience, create public awareness, and set a national agenda.32

The distinction between population health and mental health promotion is even less clear. ‘Population health focuses on the range of conditions that determine health and their impact on the population in general, viewed through various life stages, and addressed through intersectoral strategies.’33 Mental health promotion is concerned with participation and the impacts of social/environmental factors on health but, unlike population health, it stresses individual and community control over mental health concerns.34

The recent trend of naming specific life conditions as a disease in the social sense of the word has caused some concern regarding the ‘medicalisation of life’35, a

phenomenon that had its policy genesis in WHO’s broad definition, a topic discussed in more detail in Chapter Two. This new social sense of disease has triggered a concomitant belief that particular public health practices or actions are justified, even obligatory.36

Categorising and labelling people as alcoholics, gamblers, drug users and tobacco users for example, marks them as different, suffering from a disease, and ill, all of which are conditions that impose on the state an obligation to intervene in the person’s life. It does this via its combined political, medical, and legal institutions

30 _{T Kue Young, Population Health: Concepts and Methods (Oxford University Press, 1998) 4.} 31

Geoffrey Rose, The Strategy of Preventive Medicine (Oxford University Press, 1993).

32 _{Alvin R Tarlov, ‘Public Policy Frameworks for Improving Population Health’ (1999) 896 Annals of the New}

York Academy of Sciences 281.

33

Pape and Galipeault, above n 29, 6.

34

Ibid.

35 _{Peter Conrad and Kristin K Barker, ‘The Social Construction of Illness: Key Insights and Policy Implications’}

(2010) 51 Journal of Health and Social Behavior 67.

36

to direct them back toward experiencing healthy well-being, and equally, to prevent others falling victim to ill health.

3.

THE CONCEPT OF MENTAL HEALTH

Whether we like it or not, the term mental health ... is firmly established in the thought and actions of several groups: First, under the guidance of voluntary and governmental agencies, the public has taken hold of the term in spite of (or, perhaps, because of) its ambiguity.37

Generally, ‘mental health’ refers to the enhancement of the state of mental well- being in an already well population.38 However, the level of clear scientific guidance that is present in general health tends to be absent in the mental health sector where terms are more fluid, lack clear delineation, and are generally used synonymously. There also seems to be a conceptual and textual avoidance existing in mental health, a likely product of the complexity of the subject matter but it may also be a reflection of the stigma that permeates the topic area.

The term ‘mental health’ is itself a theoretical construction of governments, mental health professionals, families, and other interested groups such as the powerful drug lobby to place a positive spin on the negative attributes of disease and illness.39 By euphemising terms, the public perception that mental illness is a cause for shame, and needs to be hidden, or disguised to make it more socially palatable is

reinforced. Confused, deficient and false assumptions contribute to the

inconsistencies and vagaries of language and concepts that are apparent in mental health discussion.

Unlike the polar opposites of illness and health in general health parlance, in mental health the terms ‘mental illness’ and ‘mental health’ are conceptually blurred. Using the standard health model as a reference guide, mental illness is an umbrella,

psychopathological term that covers a range of mind-related diseased states with a broad spectrum of behavioural disturbances: mental disorders. The social approach

37

Marie Jahoda, Current Concepts of Positive Mental Health (Ayer Company Publishers, 1999) 5.

38

Jayashri Kulkarni, ‘The Cost of Mental Illness’ (Report, Monash Alfred Psychiatry Research Centre, 2010) 1 <http://www.maprc.org.au/sites/www.maprc.org.au/files/THE%20COST%20OF%20MENTAL%20ILLNESS %20FINAL_0.pdf>.

39

Katherine Weare, Promoting mental, emotional, and social health: a whole school approach (Routledge, 2000).

to mental health, a topic discussed more fully in 4.0, views a ‘mental disorder’ as a product of society’s failure to ensure adequate and appropriate services that meet the needs of people who experience a mental illness. Although, arriving at a positive or precise definition of mental disorder using the social standard is difficult.40

In Australia, the combined civil, criminal and administrative processes relevant to the legal rights of, and impositions on, people experiencing mental illness is known as mental health law.41 Clinical, rehabilitation and support services are called mental health services.42 Hospitals, community treatment centres and other service delivery locations are called mental health facilities. Statutes authorising

involuntarily detention and treatment are called mental health acts.43 Psychiatrists, psychologists, psychiatric nurses and allied health staff working directly with the symptoms and behaviours caused by a mental disorder are called mental health professionals. The person experiencing a mental illness is a mental health patient, a person labelled as ill, suffering, in need of medical treatment, and potentially requiring intervention and control by the state. There are few, if any positive attributes associated with the role of the mental health patient who is at the epicentre of mental health law.