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What is mental health?

The World Health Organization World Health Organization. (2018, March 30). Mental health: strengthening our response. World Health Organization.
(WHO) defines mental health as “a state of wellbeing in which an individual realizes his or her abilities, can cope with the normal stresses of life, can work productively and can make a contribution to his or her community”. Mental health is more than just the absence of illness and it is an integral part of your overall health. The
WHO further suggests World Health Organization. (2018, March 30). Mental health: strengthening our response. World Health Organization.
that “mental health is fundamental to our collective and individual ability as humans to think, emote, interact with each other, earn a living, and enjoy life”. Similarly,
the Government of Canada Government of Canada. (n.d.). About mental health. Canada.ca.
has explicitly acknowledged that “good mental health allows you to feel, think and act in ways that help you enjoy life and cope with its challenges”. Your mental health can be positively or negatively influenced by life experiences, relationships, school or work environments, the communities you live in, or even your physical health. The key message is that EVERYONE has mental health and, similar to physical health, there are things that you can do to take care of your mental health.

The Medicine Wheel Framework of Health

In 1998, Glen McCallum and Dr. Tom Hengen founded the Building a Nation Family Healing Centre (BAN), to provide clinical and traditional counselling, crisis, justice, and social assistance services for people of Aboriginal descent. BAN is widely recognized for
integrating the Medicine Wheel Twigg, R., Hengen, T., & Bennett, M. (2008). Going Back to the Roots: Using the Medicine Wheel in the Healing Process. First Peoples Child & Family Review, 4(1), 10–19.
into their services as a way to organize experiences, monitor growth, assess trauma, and manage health symptoms. In the context of health and wellbeing, the Medicine Wheel represents four facets of wellbeing that must each be fulfilled to find balance: Physical, emotional, mental/social, and spiritual/moral. These four facets
build a life of Health Canada (2015). First Nations Mental Wellness Continuum Framework: Summary Report [electronic source]. Ottawa: Health Canada.
purpose, belonging, meaning, and hope, respectively. When any of these facets is not attended to, you lose balance in life and experience poorer mental health. The Medicine Wheel framework for health and wellbeing continues to be studied and is now widely appreciated as a way to integrate traditional knowledge with Western science.
Dr. Grace Kyoon-Achan, Mayes, A. (2019, January 30). Look to the medicine wheel for mental health, Elders advise in First Nations study. University of Manitoba News.
a research fellow at the University of Manitoba, advocates for the medicine wheel framework for treating mental illness because, unlike the biomedical medical, which compartmentalizes mental illness, “the medicine wheel framework is holistic … [and] supports the person in achieving balance in their emotional, physical, spiritual, and mental health” to maintain wellbeing.

Medicine Wheel

To honour traditional knowledge, develop students' understanding and respect for indigenous traditions, and support reconciliation, the Medicine Wheel framework for health and wellbeing is taught throughout this program.

What is mental illness?

The
American Psychiatric Association Parekh, R. (2018, August). What Is Mental Illness?. American Psychiatric Association.
defines mental illnesses (also referred to as mental disorders) as “health conditions involving changes in emotion, thinking or behaviour (or a combination of these), [and suggests that] mental illnesses are associated with distress and/or problems functioning in social, work or family activities”. There are many different types of mental illness, with different presentations. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is used by clinicians to classify disorders, includes
over 295 different diagnoses. Ghaemi, N. (2013, July 18). Requiem for DSM. Psychiatric Times.


To help Canadians understand these mental illnesses, the Canadian Mental Health Association has compiled information and resources for the following categories of disorders: Anxiety disorders, Depression and Bipolar Disorder, Eating Disorders, Obsessive Compulsive Disorder (OCD), Phobias and Panic Disorders, Post-Traumatic Stress Disorder (PTSD), and Schizophrenia.


Unlike mental health, not everyone has a mental illness. The
risk and protective factors Rolf, J., & Garmezy, N. (1990). Risk and protective factors in the development of psychopathology. Cambridge University Press.
associated for mental illness are multi-layered and complex, but one thing is clear –
mental illness does not discriminate. Chamberlain, S. (2019, January 23). Mental Illness Doesn’t Discriminate. CanadaHelps.org.

What’s the difference between mental health and mental illness?

The terms “mental health” and “mental illness” are commonly used interchangeably as if they were on opposite ends of the same dimension.


Continuum

However, mental health is distinct from mental illness. Improper use of these terms contributes to the prevalence of mental health related stigma and prevents people from simultaneously addressing mental health and mental illness. In reality, mental health and mental illness are best understood as separate dimensions. The Two Continua Model of Mental Health and Illness was
first introduced in 1996 Tudor, K. (1996). Mental Health Promotion: Paradigms and Practice. Routledge.
and was further developed by
Corey Keyes in the early 2000s. Keyes, C. (2002). The Mental Health Continuum: From Languishing to Flourishing in Life. (2002). Journal of Health and Social Behavior, 43(2), 207–222.

Keyes, C. (2005). Mental illness and/or mental health? Investigating axioms of the complete state model of health. Journal of Consulting and Clinical Psychology, 73(3), 539–548.
This model was one of the first models to recognize the possibility of flourishing with mental illness, and it has now been widely adopted across the mental health community. In general, someone who is struggling to succeed is described as languishing, whereas someone who is thriving in their everyday life is described as flourishing. An individual’s mental wellbeing depends on their position on BOTH the mental health and mental illness continuums.

When you hear the term “mental illness” it’s easy to think of someone who is languishing with mental illness (bottom left quadrant). However, with the right resources, skills, knowledge, and support, many people with mental illness manage to flourish (top left quadrant). Similarly, the absence of mental illness is often associated with optimal mental health (the top right quadrant), but this negates the fact that even people without mental illness can languish when they have poor mental health skills (bottom right quadrant).


2 Continuum

In an
American (USA) study Keyes, C. (2005). Mental illness and/or mental health? Investigating axioms of the complete state model of health. Journal of Consulting and Clinical Psychology, 73(3), 539–548.
of over 3,000 people between the ages of 25 to 74, Keyes found that only 18% of participants were flourishing (i.e. low mental illness and high mental health) and only 14% were classified as languishing with mental illness. The majority of people (56.6%) were classified as moderately mentally healthy, which represents low mental illness and medium mental health. These results emphasized the need to prioritize mental health promotion and mental illness prevention (rather than the treatment of mental illness) to maximize wellbeing. In 2012, the
Mental Health Commission of Canada Mental Health Commission of Canada [MHCC] (2012). Changing directions, changing lives: the mental health strategy for Canada. Calgary, AB: Mental Health Commission of Canada.
(MHCC) supported this view by noting that treatment alone will not reduce the negative impact of mental illness – instead, Canada must focus on “the promotion of mental health… and the prevention of mental illness wherever possible”.

Why does mental health matter?

Mental health affects all areas of your life, and poor mental health, especially the development of mental illness, can have devastating effects. In a 2009
Public Health Report titled “Mental Health Matters” Galson, S. (2009). Mental Health Matters. Public Health Reports, 124(2), 189–191.
the author and physician, Steven Galson, clearly outlines the links between mental illness and chronic diseases such as cancer and obesity, the billions of dollars invested in mental health care, the unraveling of families and friendships, and even the end result of suicide. It’s time to stop talking separately about mental health and physical health; to stop thinking of mental health as being less important, less legitimate, and less respected than physical health. Everyone has mental health. Everyone has the potential to be affected by mental illness. Everyone can take proactive steps to care of their wellbeing.

The lack of mental health awareness has contributed to a devastating reality: In any given year,
1 in 5 Canadians Mental Health Commission of Canada [MHCC] (2013). Making the case for investing in mental health in Canada. Ottawa, ON: Mental Health Commission of Canada.
will experience a mental illness, and only
20% Mental Health Commission of Canada [MHCC] (2013). Making the case for investing in mental health in Canada. Ottawa, ON: Mental Health Commission of Canada.
of those receive the care they need. In 2011, this meant that
6.7 million Canadians Mental Health Commission of Canada [MHCC] (2013). Making the case for investing in mental health in Canada. Ottawa, ON: Mental Health Commission of Canada.
were living with mental illness, and more than one million of those were children. Moreover, Canada’s youth suicide rate is the third-highest in the industrialized world and accounts for
24% of all deaths among Canadians aged 15-24. Navaneelan, T. (2017). Suicide Rates: An Overview. Canadian Vital Statistics Death Database: The Government of Canada.
In the
United States, Campo, J. (2017, May 31). It’s time to recognize mental health as essential to physical health. STAT.
suicide is responsible for more deaths in adolescents and young adults than the combination of cancer, heart disease, congenital anomalies, respiratory disease, influenza, pneumonia, stroke, meningitis, septicemia, HIV, diabetes, anemia, and kidney and liver disease. The
need for mental health care is rising Canadian Institute for Health Information. (2015). Care for Children and Youth with Mental Disorders: Report
and it has become clear that “our overall response to youth mental health has been
inadequate and inappropriate”. Malla, A., Shah, J., Iyer, S., Boksa, P., Joober, R., Andersson, N., … Fuhrer, R. (2018). Youth Mental Health Should Be a Top Priority for Health Care in Canada. The Canadian Journal of Psychiatry, 63(4), 216–222.


Perhaps the concept of proactive mental health care can be better understood through a game of “Would You Rather”: If you didn’t know how to swim, would you rather have a lifesaver, thrown into you after you’re already drowning, or a lifejacket, to help protect you from drowning? The answer seems obvious: Most people would prefer a lifejacket. However, the current mental health care system takes a reactive approach by responding to crises (i.e. throwing in a lifesaver), rather than a proactive approach, which involves prevention and preparation (i.e. using a life jacket). Mental health education is analogous to giving students a lifejacket: It equips children with the knowledge, skills, and resources needed to overcome future challenges. Better yet, it teaches them how to swim.  

Where can I learn more?

World Health Organization – Mental Health

Canadian Mental Health Association – Positive Mental Health and Well-being

Canadian Mental Health Association – Understanding Mental Illness

Children’s Mental Health Ontario – Facts & Figures

Psychology Today – The Difference Between Mental Health and Mental Illness

Medicine Wheel Model of Mental Health

Government of Canada – First Nations Mental Wellness Continuum Framework [Summary Report]

HealthyDebate Opinions – How I use the teaching of the Medicine Wheel in my healing journey

What will students learn?

By the end of this lesson, students will be able to…

  • Clearly define mental health and mental illness
  • Understand the distinction between mental health and illness using the Two Continua Model of Mental Health and Illness
  • Describe the significance of this distinction for their everyday life; namely that everyone has mental health  
  • Appreciate the four facets of health and wellbeing with regards to the Medicine Wheel
  • Identify personal examples for each of the four facets of the Medicine Wheel that, collectively, contribute to balance and wellbeing
References
Beecuz

Campo, J. (2017, May 31). It’s time to recognize mental health as essential to physical health. STAT.

Canadian Institute for Health Information. (2015). Care for Children and Youth with Mental Disorders: Report Chamberlain, S. (2019, January 23). Mental Illness Doesn’t Discriminate. CanadaHelps.org.

Galson, S. (2009). Mental Health Matters. Public Health Reports, 124(2), 189–191.

Ghaemi, N. (2013, July 18). Requiem for DSM. Psychiatric Times.

Government of Canada. (n.d.). About mental health. Canada.ca

Health Canada (2015). First Nations Mental Wellness Continuum Framework: Summary Report [electronic source]. Ottawa: Health Canada.

Keyes, C. (2002). The Mental Health Continuum: From Languishing to Flourishing in Life. (2002). Journal of Health and Social Behavior, 43(2), 207–222.

Keyes, C. (2005). Mental illness and/or mental health? Investigating axioms of the complete state model of health. Journal of Consulting and Clinical Psychology, 73(3), 539–548.

Malla, A., Shah, J., Iyer, S., Boksa, P., Joober, R., Andersson, N., … Fuhrer, R. (2018). Youth Mental Health Should Be a Top Priority for Health Care in Canada. The Canadian Journal of Psychiatry, 63(4), 216–222.

Mayes, A. (2019, January 30). Look to the medicine wheel for mental health, Elders advise in First Nations study. University of Manitoba News.

Mental Health Commission of Canada [MHCC] (2012). Changing directions, changing lives: the mental health strategy for Canada. Calgary, AB: Mental Health Commission of Canada.

Mental Health Commission of Canada [MHCC] (2013). Making the case for investing in mental health in Canada. Ottawa, ON: Mental Health Commission of Canada.

Navaneelan, T. (2017). Suicide Rates: An Overview. Canadian Vital Statistics Death Database: The Government of Canada.

Parekh, R. (2018, August). What Is Mental Illness?. American Psychiatric Association.

Rolf, J., & Garmezy, N. (1990). Risk and protective factors in the development of psychopathology. Cambridge University Press.

Tudor, K. (1996). Mental Health Promotion: Paradigms and Practice. Routledge.

Twigg, R., Hengen, T., & Bennett, M. (2008). Going Back to the Roots: Using the Medicine Wheel in the Healing Process. First Peoples Child & Family Review, 4(1), 10–19.

World Health Organization. (2018, March 30). Mental health: strengthening our response. World Health Organization.

World Health Organization. (2019, November 28). Mental disorders. World Health Organization.

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