technische universität darmstadt - tervise arengu … · technische universität darmstadt. the...

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Technische Universität

Darmstadt

The concept of salutogenesis

Strategies of health promotion

Mental health promotion in different settings:

- environment

- communities

- mental health settings

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Darmstadt

The frequency, the chronicity and the increasing mortality and morbidity

of mental illnesses (Ösby et al 2013) are showing that only pathogenetic

approaches (i.e. only searching for reasons, symptoms and their

treatment possibilities) are not sufficient enough. Thus it makes more

sense to use salutogenetic approaches which care for mental health

promotion, prevention and recovery

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Darmstadt

Salutogenesis is searching for factors which enable people to stay healthy

in spite of traumata or sickness. From this point of view health is not a

state but a process. Salutogenesis is researching for factors and

ressources which are able to favor health

(Antonovsky 1997)

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It‘s a theory which describes the sense of coherence as a central factor to

stay healthy or to get healthy again. It encloses three factors:

1. the belief that incidents are understandable

2. the belief that there are enough ressources to cope with the challenges

3. the belief that the efforts are successful and make sense to future life

(Antonovsky 1997)

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Salutogenetic focus Pathogenetic focus

1. Coherence Inconsistency

2. Attractive health aims Avoidance strategies

3. Ressources Deficiency

4. Subject Norm

5. Context – self regulation Isolation of single facts

6. Evolution Status quo

7. Different possibilities Only two possibilities: yes or no

Health promotion is a process which gives people a better opportunity

for self-determination about their health. Therefore it‘s necessary that

people are able to administer and to realize their wishes and hopes to

get a comprehensive physical, mental and social well-being

(Bengel 2003)

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empowerment

Promotion of shared decision making

Promotion of self efficacy

Promotion of sense of coherence

Promotion of resilience

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“Recreation of self-control”

(Segal 1995)

Aim of empowerment: „People are informed about the illness

and treatment possibilities, they are enabled to choose, to

express their one needs, are able to assert themselves and

willing to take responsibility“

(Naidoo 2003)

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Self-efficacy: „The belief in the own personal abilities is the most

effective strengthener of human action we know”

(Bandura 1997)

Resilience: The ability to emerge critical life events empowered and

with better ressources than before

(Walsh 1998)

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Recovery marks a process which encloses 3 elements:

return to normality,

recovery of health,

acquirement of meaningful knowledge from unnecessary

experiences (refering to the illness)

(Amering 2007)

Recovery is including:

Hope, meaningfulness, ability for changing, self-control, active

participation, holistic view, optimism, creativity

(Bradstreet a.a.O. 2005)

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Personal Recovery includes hope, identity, meaning, personal

responsibility

Clinical Recovery means reduction of symptoms, improvement

of social functioning, successful risk management, relapse

prevention

(Slade 2010)

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author intervention Results

Olds 2002 Home visits by

mothers of risk

Children: Reduction of

incidence of mental

illnesses in lifespan

Lawrence,

Schweinhart 2005

Perry Preschool

Project

Reduction of crime

rates, better

integration after 35

years

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author intervention results

Hawkins,

Catalano 2002

Community that cares -

program

Reduction of crime rates

CMHEI 1999 Consumer – selfhelp -

initiatives

Reduction of hospitalization,

Improvement of life quality

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Author Intervention Results

Hegerl 2007 Alliance against depression Reduction of suicide

attempts and suicides:

24 % in 2 years

Berger, Gunia,

Gassmann 2013

psychoeducative

familiyintervention

Reduction of relapse

rates ( 19 vs 60 %),

Improvement of sense of

coherence, life quality

and familial cohesion

Falloon 2004 Assertive community

treatment

Reduction of relapse

rates, improvement of life

quality

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Preliminary note:

Only healthy employees are able to realize health promoting

strategies. Therefore health promotion must be implemented at the level of

employees as well as at the level of patients at the same time

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Active participation through

transparency of information politics

inclusion in decision making at the individual workplace

management by delegation

appraisal interviews

quality management

teamsupervision

guidance in healthy lifestyles

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Counseling in eating habits

Physical training at workplace

Stressmanagement, prevention of burn-out

Training in prevention of aggressive behaviour

Counseling in smoking cessation

Counseling in problems with drug/ alcohol misuse and addiction

Guidelines for prevention of sexual harrassment

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Written guidelines for health promotion

Management of resources in treatment (not only management of symptoms)

Low threshold to admission

Sustainable treatment strategies including close cooperation with other

community services

Questionnaires for needs of mental health promotion (SOC, QOL, nutrition,

drinking and smoking habits, life style, resources)

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Active participation through informed consent

Provision for special cultural needs

Training in health promoting activities

stressmanagement

selfregulation

training in mindfulness based strategies

counseling in eating habits

training in hysical activities

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psychoeducation, multi-family-intervention

psychosis workshops

selfhelp groups for patients and relatives

promotion of peer to peer groups (EX-IN, UFE, WaRP)

Written treatment agreements, patients mandates

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Implementation of treatments strategies which are adjusted to resources

Open wards

hometreatment

treatment pathways

independent visiting committees

independent ombudsman

awareness training in schools, public

care and attention of UN Human Rights Convention

www.euro.who.int

www.imhpa.net

www.hph-hc.cc

www.who-cc.dk

www.healthpromotinghospitals.org

www.hph.net

www.hpps.net

www.who.dk/mentalhealth

www.ex-in.info

www.power2u.org

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http://www.euro.who.int/

http://www.imhpa.net/

http://www.hph-hc.cc/



http://www.who-cc.dk/



http://www.healthpromotinghospitals.org/

http://www.hpps.net/

http://www.who.dk/mentalhealth

http://www.ex-in.info/



1. Schüffel W, U. Brucks, R. Johnen, V Köllner, F Lamprecht, U. Schnyder (Hrgs)

(1998) Handbuch der Salutogenese. Ullstein Medical Wiesbaden

2. Barry M, R. Jenkins (2007) Implementing Mental Health Promotion. Elsevier

Edinburgh London New York Oxford

3. Amering M, M Schmolke (2007) Recovery. Psychiatrie Verlag Bonn

4. Faust V (2007) Depression. In: Multiziplität der Depression. Psychiat Prax

5. Warner R (2009) Recovery from Schizophrenia . Current Opinion in Psychiatry 22

6. Naidoo J, J Wills (2003) Lehrbuch der Gesundheitsförderung. BZgA Köln

7. Anthony W (1993) Recovery from mental illness. Psychosocial Rehab Journal 16

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8. Slade M (2010) mental illness and well-beeing. BMC Health Services Research 10: 1-14

9. Segal SP, Silverman CJ Temkin TL (2010) Self-help and Community mental health agency

Outcomes. Psychiatric Services 61: 905-910

10. Barbic S, Krupa T, Armstrong I(2009) A randomized controlled trial of the effectivness of a modified recovery workbook programm Psychiatric Services 60: 491-497

11. Schrank B (2007) Recovery in Psychiatry. Psychiatr Bull 31: 321-325

12. Bäuml, J, G. Pitschel-Walz, H. Berger, H. Gunia, A. Heinz,G Juckel (2010) Arbeitsbuch Psychoeduaktion bei Schizophrenie. Schattauer Stuttgart New York

13. Berger, H. (2003) Gesundheitsförderung - Ein neuer Weg in der Psychiatrie. In: Klug, G. (Hrsg) Dem Menschen in seiner Welt begegnen. Psychiatrische Praxis. Supplement 1 Band 30 S14-2015.

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14. Berger, H., R. Paul (1999) The Health Promoting Psychiatric Hospital - What is the

difference? Experiences from the Philippshospital Pilot Hospital Project in Riedstadt. In:

Pelikan J.M, M. Garcia-Barbero, H. Lobnig, K. Krajic (Hrsg.): Pathways to a Health

Promoting Hospital. Conrad, Gamburg. 71 – 94

15. Berger, H., R. Paul (1999) From Establishing a HPH-Taskforce on Health Promoting Mental Health Services to HPMHS Network Activities. In: Berger, H., K. Krajic, R. Paul (Hrsg.): Health Promoting Hospitals in Practice: Developing Projects and Networks. Conrad, Gamburg

16. Berger, H., H. Gunia, J. Friedrich (2004) Handbuch Psychoedukative Familienintervention. Schattauer Stuttgart New York

17. Copeland (2005) Wellness Recovery Action Plan WRAP

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Prof. Dr. Hartmut BergerVitos Philippshospital D - 64560 Riedstadt

Tel. 0049-6158-183-216 Fax 0049-6158-183-243Email: [email protected]

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Many thanks for your attention

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