Archives
Book Review
Mental health promotion and young people: concepts and practice
Louise Rowling, Graham Martin and Lyn Walker (eds)
ISBN: 0 074 710486 2002 272 pp pages Sydney, Australia: McGraw-Hill Book Company
Simone Fullagar
School of Community Health, Charles Sturt University, Albury, NSW
Mental health promotion and young people: concepts and practice is an edited collection with eighteen chapters that introduce the reader to current issues in mental health promotion policy and practice. It includes diverse examples of urban and rural programs targeting young people in Australia. A breadth of topics are addressed, such as: same-sex attracted youth and suicide risk; the role of health education and school settings; depression, risk and resilience factors; interventions with juvenile offenders; cultural considerations within Aboriginal communities; and the potential of the internet to reach rural young people. Louise Rowling, Graham Martin and Lyn Walker provide a useful overview of current thinking within the field of mental health promotion. Although the collection claims to be 'multidisciplinary' there is clearly a preference for the disciplines of psychology and social epidemiology within the field. The early chapters explore the somewhat muddy conceptual terrain of contemporary mental health policy and promotion frameworks. Lyn Walker and Louise Rowling pose a question that emphasizes the tensions inherent in the different directions with mental health: 'Do we focus on the promotion of positive mental health ad well-being or prevention of mental illness?' (p. 4)
While the social determinants of mental health are consistently referred to in this book there is a tendency to formulate the complex relation between the individual's well-being and the social world in terms of identifiable risk and protective factors and conditions. There is minimal exploration of sociological analyses of power relations, structural forces and the historical context of contemporary mental health discourses; although Louise Rowling (p. 13) does introduce a more critical perspective through which she questions the assumptions informing current understandings of mental health. As an example, Rowling cites the preference that many Aboriginal and Torres Strait Islanders have for the term 'emotional and social well-being' rather than 'mental health'. Yet we don't see this issue taken up by Ernest Hunter et al in their otherwise compelling chapter on the paradoxes of mental health promotion with Aboriginal communities. This chapter is located towards the end of the collection and I think it would have framed the text in a different way had it followed on from the earlier conceptual discussion. Indeed the distinctions between emotional well-being and mental health provide a useful point from which to examine how our contemporary experiences of inner subjectivity, embodied feeling, existential crisis and dilemmas of being are addressed in terms of mental health and illness. Richard Eckersley touches on these sociocultural issues in sweeping, and somewhat alarmist, critique of Western progress and the impact of individualism on suicide and mental illness in young people. He does, however, make an important link to the work of risk theorists, such as Beck, in relation to the way young people are positioned within shifting social, economic and cultural relations. Suicide is the example Eckersley (p. 78) draws upon to identify how those at the ends of the socio-economic spectrum encounter mental health risk in relation to intensified pressures to compete for employment, social status and fulfilling relationships.
The book has a strong focus on a range of innovative, school-focused mental health promotion practice models in six chapters (the Resourceful Adolescent Program, Mindmatters Project, Gatehouse Project, Clarkson School Community Profiling Project, the Mentally Healthy Schools initiative and discussions on the intervention or prevention role). This emphasis on promotion in school settings suggests the widening responsibilities that educational institutions now have in relation to producing 'healthy' citizens of the future. There remains unasked questions within mental health promotion about the relation between normal mental health and the rise of 'disorders' (depression, anorexia, anxiety, attention deficit disorder etc). A critical analysis of this relation may help to make visible the disciplinary gaze of clinical psychology with its individualizing explanations of 'mental health' problems. The emphasis placed on identifying various techniques for improving and measuring individual mental health (as 'resilience') by a number of authors in this collection, appears to override questions about the complicity of mental health promotion in normalizing particular kinds of mental health and illness. These issues have unfortunately fallen outside the scope of the book, but nevertheless could usefully be addressed with undergraduate or postgraduate students in sociology or the health professions. For example, the range of mental health promotion approaches in the book provides students with the opportunity to develop their own analysis of the different power-knowledge relations, or 'truths', that shape professional intervention in young people's lives. There is also one highly problematic claim made by Graham Martin in his chapter examining the correlation between happiness and youth suicide. He explains the sharp rise in the female suicide rate (p. 246) between the 1950s and 1970s as an effect of feminist ideology where women's rising expectations weren't matched by 'reality'. As a secondary point he refers to the increased availability of potentially lethal prescription drugs such as barbiturates. Martin's lack of any reference to current feminist research into the gendered nature of suicide suggests a dangerously simplistic analysis that blames 'feminism'.
There are several chapters that identify the importance of community development and 'capacity building' practices in developing social relations and infrastructure that foster emotional well-being. Yet the notion of community generally remains under-theorised, apart from references to social capital, trust relations and resiliency. The chapters by Cindy Tuner and Meg Morrison and Carolyn Sullivan provide two interesting examples of projects that focus on developing partnerships with young people and new communication practices. The Reach Out! Project involved young people in rural and urban Australia to develop a youth friendly, anonymous and interactive website to promote help-seeking. A similar partnership model of practice was developed by the Community Health Adolescent Murraylands Peer Support Project to address youth marginalisation in rural South Australia. Both chapters outline the transformative relations that can occur between professionals and young people through projects that seek to position young people as experts-in-their-own-lives. They outline the collaborative work required to build and maintain the relationships that are essential in partnership projects. The current emphasis on partnership projects within health promotion funding models needs to take into account the costs of developing such participatory relations, rather than view them as a cheap option. In this way the collection works to make visible the kinds of social relations that can be produced 'with' young people and outlines more traditional approaches to mental health promotion.
eContent Home