Review / Open Access

DOI: 10.31488 /heph.103

How to Improve Population Mental Health on the Community and Country Level

Andrzej Brodziak 1,2, Renata Złotkowska1, Alicja Różyk – Myrta2

  1. Institute of Occupational Medicine and Environmental Health, Sosnowiec, Koscielna St. 13, 41 – 200 Sosnowiec, Poland

  2. Institute of Medical Sciences, University of Applies Sciences, Nysa, Armii Krajowej St. 7, 48 -300 Nysa, Poland

*Corresponding author:Prof. Andrzej Brodziak, Institute of Occupational Medicine and Environmental Health, Koscielna St. 13, 41 – 200 Sosnowiec, Poland, Tel: +48 32 266 08 85; Fax.: + 48 32 266 11 24;

Abstract

Background: In many countries, sometimes public mental health is significantly deteriorated. Some authors proposed principles of counteracting this situation based on cognitive behavioral therapy or so-called “positive psychology”, affecting particular individuals. It is much more difficult, however, to formulate the ways of influencing a given community or the whole population. Main body: The authors of the text begin the discussion by recalling the definition of mental health and population or public mental health. Next, they try to explain the most frequent causes of the deterioration of public mental health based on the concepts of unfriendly political programs, derivative irrational, abnormal social phenomena and the resulting “social disease”. Then, they consider the existing links influencing public mental health and search for the most superior, key social influences. The authors also try to characterize the contemporary, exerted impact of social media platforms like Facebook and Twitter. By discussing the possibility of positive modification of the actual state, they recommend a strategy of activities focused on the most sensitive links to population mental health. They wonder if is it possible to counteract the spread of the unfavorable set of mental traits, causing abnormal social phenomena by a group of people or a public health institution without waiting for the appropriate action of authorities. They consider the possibilities of shaping social attitudes by means of social media. Short conclusion: Recently, populist movements and nationalist and xenophobic attitudes have spread in several countries. It impairs the state of public mental health. The authors wonder if it is possible to propose remedies that affect the whole community. In their view, it is necessary to discern the key determinants of deteriorated public mental health. The results of eventual actions depend on understanding the nature of social processes and the goodwill of the network of people having pro-community and pro-social attitudes.

Keywords: mental health, population mental health, public mental health, cognitive behavioral therapy, positive psychology, well-being, quality of life

Background

At some point in the development or transformation of a particular community, a selected group of people, or even a number of people, may notice deterioration of population mental health. This may include increased crime, suicides, adverse economic consequences and subjective feelings of an unfavorable transformation of interpersonal relationships. One can then observe many manifestations of aggression or generally an unfriendly attitude towards fellow citizens. Data about such unfavorable changes reach the consciousness of such a community usually, first and foremost, through mass media. It is also felt in personal contacts. This is also sometimes demonstrated by systematically conducted sociological studies [1,2].

It is important to consider whether in such circumstances there are any actions to be taken by people involved in the public health domain. It occurs that there are some authors who are inclined to propose ways of remedying such disadvantages [3-7]. Jonathan Purtle sees the possibility of such actions by local health departments [3]. Kobau et al. consider the possibilities of improving population mental health through implementing positive psychology on the community and country level [4]. Kristian Wahlbeck recommends preventing mental disorders, suicides, fighting with stigmatization and defending human rights [5]. Menear et al. postulate the way to ameliorate population mental health by integrating mental health care into primary care [6]. Mantoura et al. propose a systematic approach of influencing the mental health of the population [7].

It is relatively easy to determine the possible actions that would affect a single individual. In this case, one could recommend some form of psychotherapy [8] or various tools developed within the domain of positive psychology [9-16]. Apart of influences exerted by writers, publicists, teachers, therapist some software tools could be recommended [17-22]. In our view it is, however, necessary to consider what the possibilities are to influence an entire selected population. Only means that reach a large number of members of a given community are able to change the unfavorable situation of population mental health.

Main Text

Definition of mental health and population or public mental health

The purpose of this debate requires clarification of what we mean by mental health, population mental health and public mental health. Manwell et al. promotes the formulation made by the Public Health Agency of Canada which states that: “Mental health is the capacity of each and all of us to feel, think, and act in ways that enhance our ability to enjoy life and deal with the challenges we face. It is a positive sense of emotional and spiritual well-being that respects the importance of culture, equity, social justice, interconnections and personal dignity” [23].

Jonathan Purtle writes in his article that “as with physical health, patterns in population mental health are produced through a complex interplay of biological and social factors and can be improved by policy interventions that reduce exposure to stressors and cultivate resources that promote resilience”[3]. It seems that Jonathan Purtle’s concept of population mental health differs slightly from the notion of public mental health [24]. A population or several neighboring populations usually live in the realm of a country (like the USA) or a region (like the EU) characterized by the current state of the spirit of the people living there.

As Curle, a public health researcher who visited Yugoslavia in the years 1992-1995, wrote, “not all violence is physical; some is inner-directed and can lead to suicide. Some is inspired by genuine idealism but too often this degenerates into cruelty excused as a struggle with alleged evil” [25].

An attempt to define the deterioration of public mental health based on the concepts of an unfriendly political program and irrational social phenomena, leading to a “social disease”.The parameters of a well-organized society are defined, e.g. in documents of the World Justice Project [26]. Its methodology discerns: 1. Compliance with the standards of democracy, 2. The level of corruption, 3. Transparency in governance, 4. The degree of respect for human rights, 6. Order and security 7. The effectiveness of legislation, 8. Civil (social) justice, 9. Judiciary (criminal) justice [16].

We assume that the readers of this article will look at the multi-dimensional profiles of 113 countries and will compare the charts of countries like Germany, France, Turkey, Russia, Venezuela. The visible rosette profiles for Turkey, Russia, Venezuela are collapsed, shrunk, twisted. Two of these profiles are reprinted in Figure 1 and Figure 2. One can say they reveal the occurrence of a set of irrational, abnormal social phenomena or in other words, a kind of “social disease” that affects these countries. Unfortunately these profiles record only some facts but do not explain what the cause of these “diseases” is. What is more, the diagram does not indicate the causes of the beginning of processes which transformed the social situation. In our view, it is possible to grasp the origins of unfavorable changes if one is sensitive to the appearance of: (a) an attempt to implement a political program and way of social organization that is not empathetic (friendly) to all major social groups; (b) secondary, exaggerated, often irrational social phenomena.

It can be stated that the political and social program being implemented is not empathetic if it is contrary to the features enumerated in the definition of mental health quoted above.

As examples of secondary irrational social phenomena, one can indicate manifestations and consolidation of the populist movement, intensified nationalist, xenophobic and egocentric attitudes, and signs of significant manipulation (dissemination of false, biased information) realized by important mass media centers. The susceptibility to populist arguments indicates that an increased number of people is gullible or even naive. This susceptibility is possible when criticism and skepticism are not desired values.

Populist movement leaders who promote nationalist and xenophobic attitudes often try to unite citizens through social manipulation, which involves false appreciation of their superiority. The unfavorable state of the spirit of a certain population also causes an increase in controversy and even an ideological war between people of liberal and conservative points of views. The presence of these negative social transformations can be treated as “the appearance of the threat of a social disease” [27].

Possible elements influencing the state of the mental health of a selected community

It seems that the mental health of a certain community depends on the influence exerted by the following elements of society.

  1. Convictions and influence of people who raise children, 2. Messages during the religion classes, 3. Communication during religious ceremonies, 4. Influences in schools of all levels,

  2. The content of university education, 6. Influences in medical and health care institutions,

  3. Workplaces, 8. Mass media (newspapers, TV, websites), 9. Social media, 10. Books,

  4. Conversations with members of family, friends and co-workers, 11. Messages of contemporary authorities (especially judiciary).

This raises the question of whether it is possible to undertake actions that would influence the majority of these elements. It seems that no single person or even institution has the opportunity to make changes to the messages distributed in these various possible elements of society. At most one may wonder if any of the enumerated elements exerts an overriding influence on the others.

Seeking the most critical, key social interactions

When looking for the most superior influences, it is necessary to determine the time needed to effectively implement the given impact. It is necessary to consider the moment in time of the possible impact during the life span of the concerned persons and the average time needed to change the direction of the affected elements of the population.

For example, a new, altered option of cultural or ideological influences, promoted by the authorities, has been operating since the takeover of power and can be relatively quickly altered. In contrast, the influence of the church can last for decades and the change in its message is modified very slowly. Some thinkers are convinced that people’s state of mind in a given age is influenced most by contemporary philosophers. It cannot be denied that, for example, the theories formulated by Friedrich Nietzsche and George Hegel influenced historical events in the twentieth century. The followers of the left-wing Hegel philosophical school, including Engels, Marx, Lenin and Stalin, who established the communist regime, later fought in the Second World War with Nietzsche and right wing Hegelian proponents.

Many social phenomena of the 21st century are related to concepts spread by postmodernists. Since the days of the French Revolution and emergence of the first democratically-run countries, the eternal philosophical dispute between materialists (agnostics) and idealists (creationists) has become more important. Considering the above mentioned elements of possible impacts, it is not necessary to reflect on the possibilities of thorough changes in the activities of the governmental institutions. For our purposes, it is necessary only to determine how quickly the institution under consideration is able to initiate or possibly promote the message of “positive psychology”. For example, if you were able to influence the current Minister of Education, initiating change could be implemented quickly.

It seems that large-scale mass media such as leading newspapers (journals) and prominent intellectual property awards organizations (the Nobel Prize, Pulitzer Prize, Goncourt Prize) are still important for the state of spirit in large social organisms such as larger western powers or the European Union. In recent years, the policy of large philanthropic and aid foundations (like Bill & Melinda Gates Foundation) [28] and large social media platforms have also taken on importance.

The impact, so far of Facebook and Twitter

Mary Aiken in her book “The cyber effect” remarked that a growing number of people support unusual, often conspiratorial ideological theories, living in “separate” cultural worlds [29]. Cass R. Sunstein in his book also emphasizes the great threat to the continued existence of democracy, of “a situation where thousands, perhaps millions, of tens of millions of people listen only to the echoes of their own voices” [30].

Facebook programmers added some years ago a new feature called “News Feed”. The reason for this amendment was that Facebook users began to have too many so-called “friends” and they were not able to follow their comments. Therefore they are eager to use the feature “News Feed”, which scans their posts and provides the summary “what new”, which is, however, tailored according to the user’s preferences.

This new feature is largely contributed to the creation of the so-called “social reverberation cabin” and “information bubbles”. This phenomenon prompts us to listen only to ourselves and to the arguments of like-minded persons. We affirm in our “truth”, and other opinions we all recognize as heresy. It is believed that this algorithm, by creating these information bubbles, has contributed to the triumphant spread of populism and nationalism.

Laura Spinney, Scott Shane and Mike Isaac drew attention to this phenomena [31-34]. They call Facebook an engine of propaganda and scam. Twitter’s negative effect is similar [34]. Only in recent years has it been realized that social media, not just Facebook and Twitter, but many other digital platforms can be the tool of hostile, external centers deliberately destabilizing the state of mental public health [32-34].

The strategy of activities focused on the most sensitive element of population mental health

It seems that instead of planning to influence all of the mentioned population mental health determinants, focus should be put on realistic actions aimed at reaching the most important disabling elements.

The question is how to distinguish such a key element. Of course, different authors may propose different paths of inference, and distinguish other factor suspected of having a substantial importance.

There are not many publications discussing the methodology of distinguishing such a key factors. In this article we would like to raise such a discussion. It is important to emphasize that our deliberations are limited to countries that have a democratic tradition. The situation in authoritarian or even totalitarian states may be discussed, but we are not considering them here.

In order to formulate an adequate description of the determinants of public mental health, in this commentary we propose discussing a recurrent sociological and psychological phenomenon that we should be aware of. To discuss this important factor shaping the mental state, it is necessary to recall the findings made by neuroscientists. Namely, they argue that in each population there are people with opposing liberal and conservative views because it is conditioned by the regularities of brain development [35-39].

Thus, our basic assumption, taken in the formulation of the essence of this phenomenon, is the recognition that in a society characterized by good mental health public health, the citizens have knowledge about this neurophysiological regularity and they recognize the equal rights of persons representing the attitudes and views of the left and right wings.

When we distinguish from among all the ways of organizing societies, so-called democratic countries and considering their historical development, we can see a regularity that usually left and right wing political camps are formed, which alternately take over power from each other. Of course, this division is not always completely bilateral. There are often smaller, diverse political parties. Nonetheless, the political game between the Democrat and Republican Parties in the United States or the Conservatives and the Labor Party in Great Britain can serve as examples of alternating gaining of power.

Sometimes, however, the natural balance between the relation of citizens adopting the ideological attitude of the left and right wings, in a certain period of social development, in a particular country can be disturbed. There may be a sharpening of this natural difference of attitudes so that one can speak of unleashing the ideological ‘left – right wing war’. This situation of relative balance can, however, evolve. It can happen that the proponents of one side of the dispute gain a dramatic predominance. This implies an inevitable political change.

The leaders of the dominant social group may aspire to authoritarian change in the country and to consolidate their power by changing the electoral law. The prevailing group of citizens can also promote discrimination of minority groups of the society.

The above considerations lead to the conclusion that the so-called “social illness” results either from considerable intensification of the dispute between left and right wings, sometimes accompanied by the emergence of populism, nationalism, xenophobia and, above all, as we have mentioned considerable susceptibility to manipulation by politicians, journalists, and mass media.

Unfortunately, however, it is necessary to note that the growth of irrational social phenomena leading to this “social illness” is often initiated by a particular politician or a group of people who have decided to implement a certain unfriendly political program. Then, during the election campaign, populist and xenophobic slogans leading to intensification of the above mentioned irrational social attitudes are promoted.

It seems that at the same time, the basic factor favorable for the spread of the enumerated irrational phenomena is the occurrence, at a given moment, of significant naivety of members of the community. Only when a significant proportion of people in a given population are naive is it possible that power will be seized by a group which lies and manipulates during the electoral campaign. This so-called propaganda is effective only if many people are susceptible to arguments that are untrue. That is when you can convince the citizens of a given country to populist promises and promote nationalist and xenophobic ideas.

Naivety is often accompanied by irrationality and susceptibility to arousing emotions. Additional disadvantages of the mental state of members of the population that favor the dissemination of populism are the attitudes of selfishness (egocentrism, greed). As we have already mentioned, the leaders of populist movements often try to seize and maintain power through social manipulation based on a false appreciation of dignity or in other words to raise an unjustified sense of superiority.

Is it possible to counteract the spread of an unfavorable set of character traits that favor social diseases?

This raises the question of what is able to make people not to be naive, gullible, irrational and selfish. Almost all readers will probably answer that the right dose of skepticism and good quality education could prevent the development of such disadvantageous character traits. The problem comes to the question of what actions would intensify so-called moral virtues (in the Aristotelian sense) and a skeptical attitude as well as other features that increase resistance to manipulation.

In our opinion this important issue requires research and discussion. It is necessary to determine the possible mass influences. Several authors at least considered how to implement the principles of positive psychology in schools [40-42]. There are also some websites, which promote the application of the tools of positive psychology in relation to the entite population [43-45]. TED and the Institute of Art and Ideas can be an example of a tool that promotes criticism [46,47]

It is worth considering all the influences that affect millions of citizens. It is necessary then to consider modern mass media and contemporary cultural influences. Sometimes it happens that a novel or movie which fosters healthy skepticism, hampers irrationality and promotes tolerance and altruism reaches millions of audiences. As examples, one can enumerate for instance books sold in millions of copies or such influential movies like Star Wars or Avatar. The well-known publicist Cass R. Sunstein devoted a book to the meaning of Star Wars films for shaping positive attitudes [48]. Examples include also TV series such as Star Trek, ‘The Good Wife’ or even series showing the opposite attitudes like ‘House of cards’, “Black mirror”.

Possibilities of incorporating social media into shaping social attitudes

It is conceivable that instead of the negative impact of social media that was revealed in recent election campaigns, it would be possible to plan reverse actions promoting values of criticism, rationality, moral virtues, positive psychology.

This possibility is indicated by the recent declaration of Mark Zuckerberg, who in his February manifesto announced that Facebook would soon create a new “social infrastructure” that will give us all the power to “build a compatible global community” [49]. However, it seems to us that after the experience of the last few years, we cannot give social media companies such Facebook and Twitter a free hand, though, on the other hand it is worth remembering about the possibilities which these media create for people of “goodwill”.

In our opinion, the hope for shaping the right social attitudes should still be associated with the activity of publicists, journalists and writers having high authority, who write in independent renowned magazines or books published by them. Perhaps a greater role could be played by specialists in the field of public health, formulating the principles of population influences forcing the favorable mental features. It should be noted that since it turned out that the planned action carried out by social media may affect the election campaign or the result of a planned referendum regarding important social issues, it should be possible to plan an action promoting positive psychology, favorably affecting the state of public health.

Action of a network of people of goodwill on a pro-community and pro-social attitude

The quality of public mental health in a given country depends on the extent to which it is possible to create a stable structure (network) of pro-social activists, fully realizing that decisive activity is necessary in this respect [50].

It should be noted that starting such activities can be spontaneous and rely on bottom-up activities rather than those imposed by authorities. It is possible just by reason of the existence of the mentioned social media platforms. It is important, however, to spread constructive, consistent and accurate messages, instead of a frequent exchange of hateful, retaliatory responses.

Therefore, it seems to us that taking action to improve public mental health can be realized by any public health institution without looking at the actions of “offices of authorities” that we have no influence on.

In each country, there are “offices of authorities” that have powerful channels of ideological influence (e.g. the Ministry of Education, TV channels controlled by the government, church authorities). Unfortunately, many times the activities of these institutions do not meet citizens’ expectations.

It appears from the inference presented in this text that instead of waiting for the activity of these institutions, we can take our own actions, if we can manage to create a network of people of goodwill, and when we are able to involve clever recognizable people with considerable authority. It is possible even to give real, actual examples of such activities related to particular topics important for public mental health [43-47,51-56]

It seems to us that considering and analyzing the events in Poland, the US and to some extent in Great Britain and Spain can be useful in search of appropriate social and technological solutions because in these countries which had a favorable profile set by the World Justice Project, recently there have been signs of increased credulity, irrationality, selfishness, populism, nationalism and intolerance among many citizens.

Figure 1. The replica of the profile for Poland taken from the Word Justice Project Rule of Law Index

Figure 2. The replica of the profile for Venezuala taken from the Word Justice Project Rule of Law Index

Conclusion

  1. Intense ideological confrontation, populist movements and nationalist and xenophobic attitudes which have spread recently in several countries impair the state of public mental health.

  2. It is relatively easy to propose principles of counteracting, based on so-called cognitive behavioral therapy and “positive psychology”, affecting particular individuals, however, it is much more difficult to formulate ways of influencing a chosen community or the whole population.

  3. The ability to counteract the deterioration of public mental health depends on the understanding of contemporary social processes that cause this phenomenon. The attempt to define the causes of the deterioration of public mental health can be based on the concepts of unfriendly political programs, derivative irrational, abnormal social phenomena and the spread of such mental characteristics as naivety, credulity, egocentrism, selfishness and also the contemporary impact of social media.

  4. The results of eventual counter actions depend on understanding the nature of social processes and considering the ways of using recognizable, popular cultural creations. The results also depend on the creation of a network of goodwill people having pro-community and pro-social attitudes.

  5. Actions aimed at improving the state of public mental health can be taken by any group of people or a public health institution without waiting for appropriate action of authorities. This is desirable because the deterioration of public mental health results usually from inappropriate or ineffective activity of the current power (administrative) structures.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Availability of data and materials

Not applicable.

Competing Interests

The authors declare that they have no competing interests.

Funding

The work was funded by means for statutory research performed in 2017 by the University of Applied Sciences in Nysa, Poland.

Authors’ Contributions

AB formulated the topic of the submitted article and presented it to the co-authors, discussed with them the outline of the reasoning, gathered the conclusions and wrote the manuscript. RZ discussed the main messages of the text, searching for the key causes of deterioration of public mental health. AR-M organized the focused discussion with members of the staff and students of the University and presented these opinions during our discussion. All the authors read and approved the final manuscript.

Acknowledgements

We express our gratitude to Ms Christine Frank–Szarecka for the linguistic correction of the manuscript.

Authors’ information

Not applicable.

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Received: June 09, 2018;
Accepted: August 10, 2018;
Published: August 13, 2018;

To cite this article : Brodziak A, Renata Złotkowska R, Myrta AR. How to Improve Population Mental Health on the Community and Country Level. HealthEducPublic Health. 2018: 1:1.

© Armentia A. 2018.