There is a famous story about the vital work of health promotion and disease/injury prevention.
It concerns a village by the side of a river where growing numbers of people are seen floating downstream, struggling and drowning. The villagers, being compassionate and humane, organize a complex and sophisticated rescue and treatment response. But they’re all so busy, no-one has the time to go upstream and see who is pushing them in, or to stop them from doing so!
As explained by Dr. Trevor Hancock, a public health and social policy scholar from University of Victoria, this story represents the widespread assessment needed in BC’s mental health care system. “Before we look at how to manage the downstream mental health care system we’ve created (or failed to create) to address our growing mental health and addictions crises, we must look upstream to understand what is contributing to the crisis in the first place, and how we can change that.”
Simply put, ‘upstream’ means to look at or toward the beginning of some process or course of activity. In mental health care, an upstream approach asks us to consider the social, economic, and environmental origins of health problems that manifest at the population level, not just the symptoms nor the end effects.
Too often, our response to high levels of need and demand is to call for more mental health services. Clearly there is a need for these ‘downstream’ services and support, and clearly the mental health and addictions sector has been under-funded in the health care system for decades.
But we seldom pay enough attention to the ‘upstream’ part of the equation:
- Why are so many people needing mental health and addiction services in the first place?
- What is happening in our communities and the wider society that may be contributing to the problem?
- What can we achieve by going upstream to reduce the burden of mental health and addiction problems, and thus reduce the demand on services?
- How do we create more mentally healthy communities?
Systemic Change Through Mental Health Promotion
A full two-thirds of the classic World Health Organization definition of health is about mental and social wellbeing, not physical wellbeing. But, as Dr. Hancock notes, “these are challenging times to maintain mental and social wellbeing, as mental health problems have become an increasingly heavy burden for the health care system, families, communities, and society as a whole.
While there are undoubtedly biological and behavioural factors at work, we must pay more attention to upstream factors such as inadequate support for parenting and early child development, social stressors at school and work, and poverty, inequality, racism, colonialism, and the rising concern with climate change.”
As well, it’s important to note that what makes us mentally healthy, lies well beyond the health care system to include approaches such as mental health promotion. This approach involves any practice or policy that builds capacity for robust community mental health through actions at the individual, family, community, and societal levels. Mental health promotion relies on cross-sector collaboration to strengthen emotional resilience and coping skills, while creating supportive environments that reduce barriers to achieving and maintaining mental health.
Joanne de Vries is a communications professional who provides public education and consultation services to businesses, non-profits, and different levels of government. She is one of the principals of Alliance Communications, and the Founder and CEO of the Fresh Outlook Foundation.