1.

The context of mental health practice

1.1 National mental health framework

1.1.1 Existence of legislation related to mental health.

Definition:
There is a need for developing proposals for new Mental Health Legislation in
UK. Children have dealing with mental health in childhood and adolescence. In
the Mental Health Act no specific sections are dealing with children and young
people though this is assessed for a treatment for a psychiatric disorder. How is
the use of these acts for children and adolescents, specifically when and where
each is used , and why. Instances and misuse of the acts.
Integration assistance for children and young people/ adolescents in a non –
residential form, day care establishments, day – and night – establishments and
other types of accommodation and through suitable child minders in distance to
`psychiatry` promote positive mental health.
There is a need for specific acts for treating children, young people and
adolescents with mental health problems.

Reference:
§ The Royal College of Psychiatrists, 2001.
§ The Child and Youth Service Act.
§ Ministry for Family Affairs, Senior Citizens, Women and Youth ( Social Code
Book VIII), 1996.
§ The Royal College of Psychiatrists,2001.
§ H. BERKELS, J. HENSERSON, N. HENKE et. Al. Mental Health Promotion
www.mmhe.eu
and Prevention Strategies for Coping with Anxiety, Depression and Stress
related disorders in Europe. Final Report 2001-2003, Collection Occupational
Safety, Fb 1011, Publication Series from the Federal Institute for
Occupational and Health, Berlin 2004.

1.1.2 Existence of national mental health plans (At regional or

national level)

Reference:
§ H. BERKELS, J. HENSERSON, N. HENKE et. Al. Mental Health Promotion
and Prevention Strategies for Coping with Anxiety, Depression and Stress
related disorders in Europe. Final Report 2001-2003, Collection Occupational
Safety, Fb 1011, Publication Series from the Federal Institute for
Occupational and Health, Berlin 2004.

www.mmhe.eu
1.1.3 Existence of written plans of mental health promotion
programs: (At regional or national level)

Reference:
§ H. BERKELS, J. HENSERSON, N. HENKE et. Al. Mental Health Promotion
and Prevention Strategies for Coping with Anxiety, Depression and Stress
related disorders in Europe. Final Report 2001-2003, Collection Occupational
Safety, Fb 1011, Publication Series from the Federal Institute for
Occupational and Health, Berlin 2004.

1.2 Social care infrastructure

1.2.1 Supply of and access to institutional/professional care/social

services:

Definition:
Social Service Assertive Outreach for adolescents and young people is an
example of good practice for clients with severe and enduring mental illness .
Joint working with social services, police, local groups and users coordinator is
important and effective.
Health education projects in institutions like schools etc. are effective and
promote positive mental health in adolescents.
Assertive Outreach Team offers support and takes care for adolescents /young
people with learning difficulties and mild to www.mmhe.eu
moderate mental illness and a
history of erratic and non engagement with health and social providers. It
enables the clients to lead a better quality of life.
General mass media projects of promoting health and especially positive mental
health are not effective , do not influence young peoples` behaviour etc.

Reference:
§ Threemilestone Primary Care Centre, 2004. BP
§ Risikoverhalten und Gesundheit : Individuelle und populationsbezogene
Perspektive.
§ Jeffery, R.W.: Huber ,1997. Summary report.
§ Assertive Outreach Team, Oxfordshire Learning Disability NHS Trust, 2004.
BP
§ Risikoverhalten und Gesundheit : Individuelle und populationsbezogene
Perspektive.
§ Huber,1997.

www.mmhe.eu
§ Weitkunat,R.,Haisch,J.& Kessler,M.: Public Health und
Gesundheitspsychologie.
§ Konzepte, Methoden, Prävention, Versorgung, Politik.

1.2.2 Interaction of systems of health care, social care, educational

system, handicapped care, police, justice, youth care.

Definition:
Outreach Service , working together with social services, integrated with local
social services mental health team, local networks, reflection and supervisory
practice is good practice for promoting positive mental health.

Reference:
§ Fareham &Gosport Outreach Service (FAGOS).

www.mmhe.eu

www.mmhe.eu
2. Pre school experiences and family support/childcare

2.1 Access to support from pregnancy and during the early years

2.1.1 Ante-natal support - onset of pregnancy to birth

Definition:
Number of places at ante-natal clinics available to every 10 000 people
Density of local health services in a geographical area.
Proportion of pregnant women who attend a check-up at 12 weeks of
pregnancy. The check-up should be carried out by a qualified medical
professional in a hospital or health centre and with the required medical
equipment.
Proportion of women who attend a minimum of 8 additional check-ups through
pregnancy. These check-ups should be carried out by qualified medical
professional in a hospital or health centre and with the required medical
equipment.
Proportion of women who are visited by a health professional
(doctor/nurses/health visitors or equivalent) once during pregnancy as a
minimum to discuss their own personal well-being.
Proportion of women who attend a course of ante-natal classes run by specialist
health professionals (doctor/nurses/health visitors or equivalent) covering the
following: the mother’s health, the neonate’s health, the birth, possible
complications, breastfeeding and immediate baby care after the birth.

Reference:
§ Government Agencies e.g. Department of Health,
§ Local Health Authority, www.mmhe.eu
§ Voluntary and private organisations
§ Charities and private enterprises.
§ Evidence of government and employment law to support attendance
§ Weissberg, Caplan & harwood, 1991
§ Seitz et al., 1985

2.1.2 Post-natal support

Definition:
Number of places at post-natal clinics available to every 10 000 people.
Density of local health services in a geographical area.
Proportion of mothers who undergo a simple assessment soon after giving birth,
to ensure they are capable of meeting the infant’s basic needs. Assessment
should be carried out by a health professional.
Availability of 24 hour, free medical consultation and whenever necessary
examination for mother and infant.

www.mmhe.eu
Proportion of mothers who attend a minimum of one appointment with a medical
professional to discuss both mothers and infant’s progress.
Proportion of mothers who are visited at home by a health professional
(doctor/nurses/health visitors or equivalent) within 10 days of the birth.
Proportion of women who attend a course of post-natal classes run by
specialist health professionals (doctor/nurses/health visitors or equivalent)
covering the following: long-term general care of the infant, developmental
milestones, attachment, breast-feeding, hygiene and quality early stimulation
including baby massage, baby signing, early reading activities, music etc.

Reference:
§ Government Agencies e.g. Department of Health
§ Local Health Authority
§ Voluntary and private organisations
§ Charities and private enterprises.
§ Evidence of government and employment law to support attendance
§ Weissberg et al., 1991
§ Johnson, 1988
§ Durlak & wells, 1997
§ Broussard, 1982
§ Olds, Henderson, Chamberlin & Tatelbaum, 1986
§ Hodnett & Roberts, 2000
§ Fonagy & Higgit, 2000
§ Hamlyn et al, 2002

www.mmhe.eu

2.1.4 Days paid parental leave per birth

Definition: How many days paid leave per birth/adoption

2.2 Promotion of positive parent-baby interaction

2.2.1 Breastfeeding

Definition:
Proportion of women who exclusively breastfeed their infant for 4 months or
longer

Reference:
§ Government Agencies e.g. Department of Health

www.mmhe.eu
§ Evidence of government and employment law to support breastfeeding
§ Gómez, Cañete, Rodeo Baeza & Avila, 2003
§ Else - Quest, Hyde & Clark, 2003
§ Kuzela, Sifter & Worobey, 1990

2.2.2 Positive Touch and Baby Massage

Definition:
Number of baby massage demonstrations available per 1000 infants (1-12
months
Proportion of mothers who attend a baby massage demonstration with local
community settings e.g. baby clinic's
Proportion of mothers who carry out baby massage routines with their one
month old infans onwards for a few minutes on a daily basis
Availability of free leaflet's/books etc outlining the benefits of positive touch and
baby massage in community settings

Reference:
§ Government Agencies e.g. Department of Health
§ Local Authorities
§ Local councils
§ Voluntary and private organisations
§ Charities and private enterprises
§ Adamson, 1996
§ Vickers, Ohlsson, lacy & Horsley, 2004
§ Onozawa, Clover, Adams, Modi & Kumar, www.mmhe.eu
2001

2.2.3 Baby signing

Definition:
Proportion of mothers who attend a baby signing demonstration e.g. at their
local post-natal clinic
Proportion of mothers who implement baby singing (with a minimum of 5 words)
with their six month old – a year old infants.
Availability of free leaflet’s/books etc outlining the benefits of baby singing in
community settings.

Reference:
§ Government Agencies e.g. Department of Health,
§ Local Education Authority,
§ Local Authorities
§ Local councils

www.mmhe.eu
§ Voluntary and private organisations
§ Charities and private enterprises
§ Goodwyn, Acredola & Brown, 2000
§ Daniles, 1994
§ Moore, Acredolo & Goodwyn, 2003
§ García, 1999
§ Topshee-Johnston, Durieux-Smith& Bloom, 2003

2.3 Access to pre-school activities and services

2.3.1 Access to infant/toddler groups (music, play, activity groups

etc)

Definition:
Proportion of parents/carers who attend infant/toddler music groups in their
local community
Number of infant/toddler music group places available per 10 000 people

Reference:
Local Education Authority
Local Authorities
Local councils
Voluntary and private organisations
Charities and private enterprises
Rusack Music Inc, 2004 www.mmhe.eu

2.3.2 Access to child centred services for pre-school children

Definition:
Services that have been developed around the needs of the child: furniture that
is the appropiate size, timing, activities that are centred around the child, not the
adults.
Children and young people experiencing emotional and behavioural difficulties
get support by multi - professional community health service. Joint working with
school – health advisors and joint working with educational system is good for
support.
Proportion of schools offering counselling and emotional support to children
aged 5-16 years

Reference:
§ North Tyneside Child and Adolescent Mental Health Service, 2004.

www.mmhe.eu
§ Government Agencies e.g. Department of Skills and Education and
Department of Health
§ National Curriculum
§ Barnes, 1998
§ Comer, 1985
§ Cauce, comer, & Schwartz, 1987
§ Ofstead Report, 2004

2.3.3 Access to quality pre-schools

Definition:
Number of pre-schools per 1000 pre-school children
Proportion of children attending a pre-school
Hours children attend pre-school per week
Proportion of pre-school placements available free of charge before the age of
obligatory education
Density of pre-schools in a geographical are a

Reference:
§ Government Agencies e.g. Department of Skills and Education.
§ National curriculum
§ Social Services
§ Haskins, 1989
§ Weissberg et al., 1991
§ Schweinhart & Wekart, 1989
§ Sameroff, 1991 www.mmhe.eu
§ Seitz, 1991
§ Schweinhart, R., Barnett, S., & Weikart, 1985
§ Royce, Darlington, & Murray, 1983
§ Horacek, Ramey, Campbell, Hoffman & Fletcher, 1987
§ Department of Education and skills, 1999

2.3.4 Access to resources to promote enhanced parenting

Definition:
Number of places at parenting classes available to every 10 000 people
Density of availability of parenting classes in a geographical area.
Topics covered by parenting support programmes are relevant to the
developmental stage of the child and the skill level of the parent
Proportion of classes available after normal working hours (i.e. evenings and
weekends)
Availability of incentives to attend parenting classes in the absence of identified
parenting problems.

www.mmhe.eu
Reference:
§ Government Agencies e.g. Department of Health
§ Local Health Authority
§ Voluntary and private organisations
§ Charities and private enterprises
§ Evidence of government and employment law to support attendance
§ Barnes, 2003
§ Bone & Meltzer, 1989
§ Webster-Startton, 1998
§ Johnson & Katz, 1973
§ Rose, 1974
§ Barlow & parsons, 2004
§ Brofenbrenner, 1979
§ Olds et al., 1986ª
§ Kitzman et al., 1997

2.4 Childhood pro-social behaviour and networks

2.4.1 Proportion of children with responsibility for a pet

www.mmhe.eu
Definition:
Proportion of schools with a ‘classroom pet’

Reference:

 Government Statistics, the Census

 Local Education Authority
 Voluntary agencies and charities
 Friedman, Katcher, lynch & Thomas, 1980
 Barker, 1993
 Barker & barker, 1988
 Erikson, 1963
 Blue, 1986
 Brown, Rchards & wilson, 1996
 Bryant, 1990
 Robin & Ten Bensel, 1990
 Presky & Hendrix, 1990

www.mmhe.eu
  Van Houtte & Jarvis, 1995
 Salomon, 1995
 Toepltz, Matczak, Piotrowska & Zygier, 1995

2.4.2 Proportion of children involved in religious, spiritual and

faith based activities

Definition:
Number of children attending religion-based schools
Number of children attending a religious establishment on a weekly basis.

Reference:

 Government Statistics, the Census

 Local Education Authority
 Briges & Anderson-Moore, 2002
 King & Furrow, 2001
 Hodgkinson & weitzman, 1997
 Fischer & Richards, 1998

2.4.3 Proportion of children who are a member of a team or club

Definition:
General physical activity participation is associated with positive mental health
outcomes, so it will be fair to say that being a member of, for example a football
team or gymnastics club would be beneficial www.mmhe.eu
to people's mental health.
Additionally, being a member of a team or club bring with it a sense of pride and
ownership to that club

Reference:
§ Herrlich & Süllworls 1992 al

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3. Promotion of mental health through schools and education

3.1 Curriculum-based activity promoting positive mental health

3.1.1 Proportion of schools with health promotion activities in their

curriculum

Definition:
A. Schools with health promotion activities in their curriculum (%)
B. Schools with parental skills development projects (%)

References:
§ CEROI, 2004
§ Weare & Gray, 2003. These authors suggest that schools consider the
following to most effectively develop children's emotional and social
competence and wee-being:
Initiatives should take a whole school approach, with a complimentary
focus on the needs of those with behavioural and emotional problems.
Initiatives shold start early, target early and take a long term
developmental approach.
The school environment should foster warm relationships. Encourage
participation; develop pupil and teacher autonomy and foster clarity about
boundaries, rules and positive expectations.
Behaviours and skills should be taught explicity and in participative and
empowering ways using a step-by-step approach. Generalising to real life and
making use of using cooperative group work and peer education as well as
whole class approaches
www.mmhe.eu
3.1.2 Proportion of schools with mental health promotion activities
in their curriculum

Definition:
Schools are natural settings for addressing emotional health and well being
needs.
School curricula are to be involved and changed. School projects are helpful for
preventing and promotion of positive mental health.

References:
§ NHSS : Promoting emotional health and well being, 1999. BP report.

3.1.3 Average number of hours dedicated to social skills and life

skills training in the school curriculum per week

www.mmhe.eu
Definition:
Training of social competence with different methods and strategies has a
positive training of social competence with different methods and strategies has
a positive effect on promoting positive mental health.
Training of the capability to express emotions has a positive effect on promoting
positive mental health.
Proportion of schools including social skills and life skills training in the
curriculum of children aged 5-16 years
Average number of hours dedicated to social skills and life skills training in the
curriculum per week

References:
§ Petermann, F. & Petermann, U.: Training mit sozial unsicheren Kindern.
Weinheim, 1989.
§ Petermann, F. & Petermann, U.: Aggressionsdiagnostik. Göttingen, 2000.
§ Hinsch,R.& Pfingsten,U. : Gruppentraining sozialer Kompetenzen.
Weinheim, 2002.
§ Jugert,G., Rehder, A., Notz,P. & Petermann,F.: Soziale Kompetenz für
Jugendliche. Weinheim, 1994.
§ Government Agencies e.g. Department of Skills and Education.
§ National curriculum
§ Durlak & Wells, 1997
§ Fonagy & target, 1997
§ Spivak & Shure, 1974, 1982,1988
www.mmhe.eu
§ Schure, 1997
§ Greenberg & Kusche, 1997

3.2 Activities to promote a mentally healthy school culture

3.2.5 Proportion of schools providing access to family support

services

Definition:
Schools (%) providing access to free time occupation based on sport or cultural
activities (in non academic hours), cantinas and other services that are
supposed to keep children occupied during parents work time.

References:

www.mmhe.eu
  “(…) The expected benefits of increased enrolments are being
undermined by significant levels of drop-out, an acute symptom of school
wastage” (CEROI, 2004)
 “Children enrolled in school that drop out before completion fail to gain
the intellectual, social, cultural and ethical knowledge and skills that
schooling should provide (…). School wastage is linked to poverty and
child labour.” (CEROI, 2004)
 “Use communities’ resources to stimulated behaviour changes” (WHO,
2001: Recommendations for better mental health)
 “Communities, families and consumers must take part in policies,
programs and services’ orientation to adapt them to their needs and to
improve their utilization.” (WHO, 2001: recommendations for better
mental health)
 ICLEI (1998)

3.3 Related demographic and legislative measures

3.3.1 School Attendance Rates

www.mmhe.eu
Definition:
Public school attendance (%): Pupils from ages 12-15 that attend public schools
versus the total number of pupils from ages 12-15 that are required to attend.

References:
§ (Faith in the city; 1985) cit in Russel & Killoran (2000)
§ World Bank (1999) Development Data Group
§ UNCHS
§ WHO (1997) - Healthy Cities Indicators
§ ICLEI (2000) - Measuring progress
§ Grzywacz, Almeida, Neupert, Ettner (2004)
§ Gresenz, Sturm, Tang (2001)

3.3.2 Existence of legislation requiring mental health promotion

activity through schools

www.mmhe.eu
Definition:
Social Service Assertive Outreach for adolescents and young people is an
example of good practice for clients with severe and enduring mental illness .
Joint working with social services, police, local groups and users coordinator is
important and effective.
Health education projects in institutions like schools etc. are effective and
promote positive mental health in adolescents.
Assertive Outreach Team offers support and takes care for adolescents /young
people with learning difficulties and mild to moderate mental illness and a
history of erratic and non engagement with health and social providers. It
enables the clients to lead a better quality of life.
General mass media projects of promoting health and especially positive mental
health are not effective , do not influence young peoples` behaviour etc.

References:
§ Threemilestone Primary Care Centre, 2004. BP
§ Risikoverhalten und Gesundheit : Individuelle und populationsbezogene
Perspektive.
§ Jeffery, R.W.: Huber ,1997. Summary report.
§ Assertive Outreach Team, Oxfordshire Learning Disability NHS Trust, 2004.
BP
§ Risikoverhalten und Gesundheit : Individuelle und populationsbezogene
Perspektive.
§ Huber,1997.
§ Weitkunat,R.,Haisch,J.& Kessler,M.: Public Health und
Gesundheitspsychologie.
www.mmhe.eu
§ Konzepte, Methoden, Prävention, Versorgung, Politik.

3.3.3 Proportion of population completed tertiary education

Definition:
Per cent of working age population with tertiary diploma/degree
Tertiary Education: University or college level.
A. Years of formal education (Average number of years)
B. Adult literacy (male and female)(%)
Availability of information in community settings for mothers to increase their
awareness of the benefits of reading to their child. E.g. ‘Book packs’.
Number of libraries per 10 000 people (related to urbanisation indicators)

www.mmhe.eu
Proportion of mothers who take up library membership for their infants before
they are a year old.
Proportion of adult who read to their infants (from the age of 9 months) and
children on a regular basis.

References:
§ Cramer, V and others (2004): Quality of life in a city: The effect of population
density. Social Indicators Research, Vol. 69, Issue 1, 103-116.
§ WHO, 2001: Recommendations for better mental health
§ WHO, 2001: Recommendations for better mental health
§ Local Education Authority
§ Local Authorities
§ Local councils
§ Voluntary and private organisations
§ Charities and private enterprises
§ DeLoache & DeMwndoza, 1987
§ Bus, Belsky, Van Izendoorn & Crnic, 1997
§ Bus & Van Izendoorn, 1995
§ Baker, Scher & mackler, 1997
§ Neuman, 1996

www.mmhe.eu

www.mmhe.eu
4. Employment and workplace mental health

4.1 Flexible working practices

4.1.2 Access to flexible hours

Definition:
% workforce with access to flexible hours working:
a. annualised hours: % workforce with access to annualised hours
b. compressed or reduced hours: % workforce with access to reduced hours
working
home working: % workforce with access to home working

References:
§ Donaldson - Feilder, E. J. And Bond, F. W. (2004): The relative importance of
psychological acceptance and emotinal intelligence to workplace well-being.
British Journal of Guidance & Counselling, Vol. 32, Issue 2, 187-203.
§ Hobson, C. J. And others (2001): Compelling evidence of the need for
corporate work/life balance initiatives: Results from a national survey of
stressful life-events. Journal of Employment Counseling, Vol. 38, Issue 1, 38 –
44.

4.1.4 Opportunity to work from home

Definition: www.mmhe.eu
% workforce working from home

References:
§ Hill, E. J. And others (2003): Does it matter where you work? A comparison
of how three work venues (traditional office, virtual office, and home office)
influence aspects of work and personal/family life. Journal of Vocational
Behavior, Vol. 63, Issue 2, 220 – 241.

4.2 Mentally healthy work environments

4.3 Related demographic measures

4.3.1 Proportion of people available for work

References:

www.mmhe.eu
§ Wheaton, Blair - The nature of stressors in Horwitz & Sheid (1999)
§ UNCHS
§ WHO (1997) - Healthy cities Indicators
§ UNCHS
§ WHO (1997) - Healthy Cities Indicators
§ Warr's "vitamin model (1987)
§ Schwefel, Svensson, Zollner (eds.) (1987)

4.3.2 Proportion of people seeking work

References:
§ Wheaton, Blair - The nature of stressors in Horwitz & Sheid (1999)
§ UNCHS
§ WHO (1997) - Healthy cities Indicators
§ UNCHS
§ WHO (1997) - Healthy Cities Indicators
§ Warr's "vitamin model (1987)
§ Schwefel, Svensson, Zollner (eds.) (1987)

4.3.3 Proportion of people without work

References:
§ Wheaton, Blair - The nature of stressors in Horwitz & Sheid (1999)
www.mmhe.eu
§ UNCHS
§ WHO (1997) - Healthy cities Indicators
§ UNCHS
§ WHO (1997) - Healthy Cities Indicators
§ Warr's "vitamin model (1987)
§ Schwefel, Svensson, Zollner (eds.) (1987)

4.3.4 Stability of employment (Levels of temporary employment)

Definition:
Per cent of workforce in temporary employment

References:
§ D’Souza, R.M., and others (2003): Work and health in a contemporary
society: demands, control, and insecurity. Journal of epidemiology and
Community Health, Vol. 57, Issue 11, 849-859.

www.mmhe.eu
4.4 Related legislative measures

4.4.1 Statutory income for long term unemployed as a % of average

income

References:
§ Evandrou, M.; Glaser, K. Combining work and family life: the pension penalty
of caring, Ageing and Society, 23, 583-601

4.4.2 Statutory income for long term sickness / disability as a % of

average income

References:
§ Evandrou, M.; Glaser, K. Combining work and family life: the pension penalty
of caring, Ageing and Society, 23, 583-601

www.mmhe.eu

www.mmhe.eu
5. Social capital: mentally healthy communities

5.1 Positevly networking

5.1.1 Community stability - Measure of the size of out-migration

from an area

5.1.2 Trust in people

5.1.3 Volunteering

Definition:
Participation in organizations, church, local library,...
Share a skill with someone

References:
§ Greenfield EA, Marks NF. (2004 ) Formal volunteering as a protective factor
for older adults' psychological well-being. Journal of Gerontology Series B
Psychological Sciences and Social Sciences, 59(5): 258-264.

5.1.4 Confidence in institutions

5.1.5 Social support networks

www.mmhe.eu
5.1.6 Political participation

5.1.7 Level of philanthropic activities

5.1.8 Self help groups to cope with adversities

General Refernces:
· Bélanger, Jean-Pierre, Robert Sullivan, and Benoît Sévigny. Capital
social, développement communautaire et santé publique : réflexions sur
l'amélioration de la santé et du bien-être de la population. Montréal: ASPQ
Éditions, 2000. 224 p.
· Berkman, Lisa, and Leonard Syme. Social networks, host resistance,
and mortality: a nine-year follow-up study of Alameda County residents.
American Journal of Epidemiology 1979;109(2):186-204.

www.mmhe.eu
· Boswell-Purdy, Jane. Social Variables as Predictors of Health and
Mortality. Policy Research Division, Health Canada, 2001. Internal
Discussion Paper.
· Campbell, C., B. Williams, and D. Gilgen. Is social capital a useful
conceptual tool for exploring community level influences on HIV infection?
An exploratory case study from South Africa. AIDS-Care 2002;14 (1):41-54.
· Canadian Council on Social Development. Social Cohesion in Canada:
Possible Indicators. Report prepared for the Social Cohesion Network,
Department of Canadian Heritage (Strategic Research and Analysis) and
Department of Justice Canada (Research and Statistics Division), 2000.
Reference: SRA-542, 132 p.
· Dunn, James, and Nancy Ross. Metropolitan Socio-economic Inequality
and Population Health. Research Program Request, Institute of Population
and Public Health, 2000.
· Frankish, C. James, and Ann Bishop. Measuring Health of Communities
in the Canadian Community Health Survey. Report on the inclusion of
health indicators in the Canadian Community Health Survey prepared for
Health Canada as part of an agreement with the Institute of Health
Promotion Research, University of British Columbia, 1999.
· Hancock, Trevor, and Ronald Labonté, with Rick Edwards. Indicators
that Count! Measuring Population Health at the Community Level. 1998.
Unpublished report prepared for Health Canada.
· Health Canada. Toward a Healthy Future: Second Report on the Health
of Canadians. Prepared by the Federal, Provincial and Territorial Advisory
Committee on Population Health, 1999. xxii, 230 p. www.hc-
sc.gc.ca/hppb/phdd/report/toward/index.html
· House, James S., Cynthia Robbins, www.mmhe.eu
and Helen L. Metzner. The
association of social relationships and activities with mortality: prospective
evidence from the Tecumseh Community Health Study. American Journal
of Epidemiology 1982;116(1):123-140.
· Julien, Marie, Danielle Julien, and Pierre Lafontaine. Environnement de
soutien. Enquête sociale et de santé 1998. Québec. Institut de la statistique
du Québec, 2001;499-522. www.stat.gouv.qc.ca/publications/sante/e_soc-
sante98_pdf.htm
· Kawachi, Ichiro, Bruce Kennedy, and R. Glass. Social capital and self-
rated health: a contextual analysis. American Journal of Public Health
1999;89(8):1187-1193.
· Kreuter, Marshall, Laura Young, and Nicole Lezin. Measuring Social
Capital in Small Communities. 1998. Study conducted by Health 2000 Inc.,
Atlanta, in cooperation with the St. Louis University School of Public Health.
· OECD (Organization for Economic Co-operation and Development).
The Well-being of Nations: The Role of Human and Social Capital. Paris,
2001. 136 p.

www.mmhe.eu
 · Pope, Jeanette. Social capital should not be incorporated into surveys
designed to monitor population health. Australian and New Zealand Journal
of Public Health 2000;24(3):341.
· Ross, Nancy. Income Inequality as a Population Health Determinant.
Seminar organized by the Health Analysis and Modeling Group, Statistics
Canada, April 6, 2001.
· Wilkinson, Richard G. Income inequality, social cohesion and health:
clarifying the theory. A reply to Muntaner and Lynch. International Journal
of Health Services 1999;29(3):525-43.
· www.worldbank.org/poverty/scapital/library/wilkins1.pdf

5.2 Social inclusion

5.2.1 Society’s knowledge of and attitude towards mental health

Definition:
Information about promoting positive mental health is on the European Mental
Health Agenda for different target groups, including children, young people and
adolescents.
The process of promoting positive mental health as a human right is to put on
the political agenda of each country . The message no health without mental
health is necessary for integration of mental health services and social services.
Societies need information about indicators of mental health and proposal for a
European mental health agenda and joint mental health indicators. Mental
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health is a resource for life and an integral part of health. This includes
adolescents and young people.

References:
§ Stakes, 1999 (Ministry of Social Affairs and Health).WHO Report
§ Kristian Wahlbeck, Stakes,2004.WHO report.
§ Lehtinen, Ville : International Seminar on Mental Health in Helsinki on 17 –18
November 2000: Proposal for a European mental health agenda and joint
mental health indicators. Stakes, 2000. Report

5.3 Related demographic measures

5.3.1 Proportion of population married

Definition:
Per cent in legally sanctioned relationship

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References:
§ Cramer, V and others (2004): Quality of life in a city: The effect of population
density. Social Indicators Research, Vol. 69, Issue 1, 103-116.

5.3.3 Proportion of population living in poverty

Definition:
The percentage of women and men-headed households situated below the
poverty line (national and EU defined poverty line):
A. Households below the poverty line (%)
B. Homeless people (%)

References:

 “Poverty and poor housing clearly go together.” Russell & Killoran (2000)
 “Poverty is not only about shortage of money. It is about rights and
relation-ships, about how people are treated and how thy regard
themselves, about powerlessness and exclusion, and loss of dignity.”
(Faith in the city; 1985) cit in Russell & Killoran (2000)
 World Bank (1999) Development Data Group
 UNCHS
 WHO (1997) – Healthy Cities Indicators
 ICLEI (2000) – Measuring Progress
 “(…) the results clearly indicate that the stressor-health association
cannot be considered independent of www.mmhe.eu
socioeconomic status.” Grzywacz,
Almeida, Neupert, Ettner (2004)
 “The association between individual income and mental health is strong.”
Gresenz, Sturm, Tang (2001)
 “Economic hardship is related with poor mental health and difficulties to
coping (socioeconomic hardship)” Wheaton, Blair – The nature of
stressors in Horwitz & Sheid (1999)
 UNCHS
 WHO (1997) – Healthy Cities Indicators
 UNCHS
 Warr’s “vitamin model” (1987)
 Schwefel, Svensson, Zollner (eds.) (1987)

5.4 Related legislative measures (new)

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5.4.1 Existence of legislation to combat effects of discrimination
(against age, gender, race, mental health status, etc)

Definition:
Integration assistance for children and young people/ adolescents in a non –
residential form, day care establishments, day – and night – establishments and
other types of accommodation and through suitable child minders in distance to
`psychiatry` promote positive mental health.
There is a need for specific acts for treating children, young people and
adolescents with mental health problems.

References:
· The Child and Youth Service Act.
· Ministry for Family Affairs, Senior Citizens, Women and Youth ( Social
Code Book VIII), 1996.
The Royal College of Psychiatrists,2001.

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6. Physical Environment

6.1 Safety and security

6.1.1 Existence of physical security targeted on people at risk

Definition:
Programs that are directly targeted on people at risk, or on social and urban
manifestations of criminality, referring also at housing and neighbourhood
management strategies programs.
A. Programs related with people at risk (per 10000 inhabitants)(target children
and/or families at risk)
B. Problem oriented policing (% of problem oriented policing in total police work
in urban environment)
C. Housing and neighbourhood management strategies programs (per 10000
inhabitants)

References:

 Millward; Morgan; Kelly (2003)

 “Environments need to protect a person against physical threat and to
provide an adequate level of security (…)” Warr (1997)
 EC, Directorate General Environment (2000)
 “The expression of psychic uneasiness is linked to the previous violence
they have felt.” Ginot, Ait-Bouali, Besse, Chevalier, Goldberg, Buisson
(1997)
 “40% of crime occurs in 10% of areas and these are the ones marked by
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(…) higher levels of ill-health.” Russell & Killoran (2000)
 “Both victims and non-victims reported ill-health effects such as stress,
depression, problems in sleeping, increased use of cigarettes, alcohol or
drugs, and loss of confidence” Russell & Killoran (2000)
 “The spatial concentration of crime (…) can weaken social ties and
undermine social cohesion” Russell & Killoran (2000)
 EF (1998) – Urban Sustainability Indicators
 UNCHS
 ICLEI (2000) – Measuring Progress

6.1.2 Prevalence of road safety initiatives

Definition:

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Percentage of streets within 300 meters of urban villages, schools and others
social services that have sidewalks, number of striped bike lanes; Number of
road calming initiatives:
A. Number of striped bike lanes (per 1000 inhabitants) (a)
B. Streets within 300 meters of urban villages, schools and other social services
or sport and leisure facilities with sidewalks (%) (a)
C. Streets within 300 meters of urban villages, schools and other social services
or sport and leisure facilities with road calming initiatives (%)Tempo 30
zones(continental Europe) or 20 mph zones (UK) (a)

References:

 “Pedestrian – and bicycle – friendly streets are vital public amenities,

contributing to sustainability, social interaction and enabling people to
engage in physical exercise.” (CEROI, 2004)
 Millward; Morgan; Kelly (2003)
 “Environments need to protect a person against physical threat and to
provide an adequate level of security (…)” Warr (1997)
 EC, Directorate General Environment (2000)
 EF (1998) – Urban Sustainability Indicators
 UNCHS
§ ICLEI (2000) – Measuring Progress
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6.2 Access to public amenities

6.2.1 Proportion of people using public transport

Definition:
This indicator is measured by transport mode: Proportion of trips by private
cars, train or tram, bus or minibus, motorcycle, bicyle, walking or others:
A. Bicycle (%)
B. Bus or minibus (%)
C. Foot (%)
D. Motorcycle (%)
E. Private car (%)
F. Train or Tram (%)
G. Other modes (%)
The average time in minutes for a one-way work trip; This is an average of all
modes of transpoprt. Train and bus times should include average walking and
waiting times and car times should include parking or walking to the workplace.

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H. Travel time (minutes) (Commute)
I. Persons access to public tranportation within 500 meters (%)
J. Number of public transport seats (per 1000 inhabitants)

References:
§ CEROI, 2004
§ Hoffmmann 2000 (The existence of public transport systems and the
personal ability to use it can be important for people to have social contact.)

6.2.2 Proportion of green spaces with public access

Definition:
A. Built-up area(%): Percentage of parks, green spaces, open areas and
playgrounds in a built-up area
B. Green spaces with public access (m²/inhabitants): Total number of m² green
spaces with public access to the total number of inhabitants.
C. Annual investment in green area per city product (%): Investments in green
area maintenance as a percentage of city product

References:
Studies have shown that while living in rural areas had a much lower
prevalence of mental disorder, people living in a built up area with access to
gardens or green open spaces had a lower prevalence than people in these
same areas with no such access. The results of such studies suggest that
certain interventions need to address environmental factors in the community to
help promote positive mental health www.mmhe.eu

§ Public Health Alliance (1991) cit in HEA (1998)

§ CEROI; 1998
§ CEROI, 1998
§ UNCHS
§ EEA (2000) - Are we Moving in the Right Direction
§ EF (1998) - Urban Sustainability Indicators
§ OECD (1997) - Better Understanding Our Cities

6.3 Housing conditions

6.3.1 Noise

Definition:

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Harmful environmental noise is defined as daytime (65dB), evening (60 dB) and
nightime (55dB) noise levels:
Exposure to noise (% of population)

References:
§ CEROI, 2004
§ WHO, 1997 – healthy cities indicators
§ UNCHS
§ ICLEI, 2000 – Measuring progress
§ Tarnopolsky e Clark (1984, 261 cit in Williams, 1994)

6.3.2 Heating

Definition:
A. Households with heating mechanisms (%)
B. Price of heating (Euro/year) Average cost of heating by household.

References:
§ Russel & Killoram (2000)

6.4 Related demographic measureswww.mmhe.eu

6.4.1 Household density

Definition:
Per cent living in one person households
Ratio of total living space to number of inhabitants (m²/inhabitants)
Links, connections and relationships that help a person giving him technical
assistance, emotional support, self-esteem and a sense that is being cared.
Families with more than 3 members
Structure and composition of family
Number of friends
Structure of neighbourhood
Not feeling alone, in solitary isolation

References:
§ Cotten, S. R. And others (2003): The mediatingb effects of attachment to
social structure and psychosocial resources on the relationship between

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 marital quality and psychological distress. Journal of Family Issues, Vol. 24,
Issue 4, 547-577.
§ Cramer, V and others (2004): Quality of life in a city: The effect of population
density. Social Indicators Research, Vol. 69, Issue 1, 103-116
§ Russel & Killoram (2000)
§ Cornman, J.; Goldman, N.; Glei, D.; Weinstein, M.; Chang, M. (2003). Social
Ties and Perceived Support: Two Dimensions of Social Relationships and
Health Among the Elderly in Taiwan. Journal of aging and health, 15(4): 616-
644
§ Plan Gerontológico de Euskadi (2004). Eusko Jaurlaritza-Gobierno VascoDpt
de Justicia, Trabajo y Seguridad Social
§ Buys LR. (2001) Life in a retirement village: implications for contact with
community and village friends. Gerontology, 47(1):55-9
§ Plan Gerontológico de Euskadi (2004). Eusko Jaurlaritza-Gobierno VascoDpt
de Justicia, Trabajo y Seguridad Social

6.4.2 Population density

Definition:
Urban population versus total built-up area:
A. Population density (people/km²): Registration of work at the local municipality
level witch can be defined within the Local Agenda 21 framework as a LA21
activity:
B. Number of activities
C. Number of plans, programs or sets of actions on environmental issues
D. Protected area (km²) as a % of total area
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References:
§ Russel & Killoram (2000)

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7. Leisure activities

7.1 Physical activities

7.1.1 Number of sports facilities per 1000 inhabitants

Definition:
Number of sport facilities (Gymnasiums, Swimming-pools, and other facilities)
(per 1000 inhabitants/year)

References:
§ EC, Directorate General Environment (2000)
§ Ginot, Ait-Bouali, Besse, Chevalier, Goldberg, Buisson (1997)
§ Russel & Killoran (2000)
§ EF (1998) – Urban Sustainability Indicators
§ UNCHS
§ ICLEI (2000) – Measuring Progress

7.1.2 Number of hours spent playing sport

Definition:
Proportion of children participating in a minimum of 2 hours sport and physical
education per week
Proportion of schools that include an hour of compulsory exercise a week in the
school curriculum

References: www.mmhe.eu
§ Government Agencies e.g. Department of Health,
§ Department of Sport,
§ Local Education Authority
§ Local Authorities
§ Local councils
§ Worl Health organization/Federation Internationale de Medecine Du Sport -
Comittee On Physical Activity for Health, 1995
§ Sallis & owen, 1999
§ Dishman, 1995
§ Hassman, Koivula & Uutela, 2000
§ Page & Tucker, 1994
§ Sanders, Fieñd, idego & Kaplan, 2000
§ Weiss & Bredemeier, 1990
§ Piaget, 1954
§ Snyder & Sprietzer, 1977

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§ Thomas, Landers, Salazar, & etnier, 1994

7.1.3 Being a member of a team

Definition:
General physical activity participation is associated with positive mental health
outcomes, so it will be fair to say that being a member of, for example a football
team or gymnastics club would be beneficial to people's mental health.
Additionally, being a member of a team or club bring with it a sense of pride and
ownership to that club.

References:
Herrlich & Süllworls 1992 al

7.2 Cultural Activities

7.2.1 Number of cultural centres (cinemas, museums, libraries,

theatres) per 1000 inhabitants

Definition:
A. Number of thatres (per 1000 inhabistants)
B. Number of cinmeas (per 1000 inhabitants)
C. Number of museums (per 1000 inhabitants)
D. Number of public libraries (per 1000 inhabitants)

References: www.mmhe.eu
§ “Healthy community has (…) amenities (including sports and leisure facilities
and attractive public spaces.” Page (1993) & Gowman (1994) cit in Russell &
Killoran (2000)
§ “Public libraries and community centres fosters personal and community
development by making learning, knowledge, health and fitness accessible to
all” (CEROI, 2004)

7.2.2 Number of hours spent in cultural activities (cinema / theatre /

dancing)

Definition:
A. Library circulation per capita (yearly books per capita)
B. Entrance in theatres (per capita/ year)
C. Entrance in cinemas (per capita/ year)
D. Entrance from local inhabitants in museums (per capita/year)

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References:
§ Page (1993) & Gowman (1994) cit in Russell & Killoran (2000)
§ CEROI, (2004)
§ Viererbe & Bach 1999 (People who are engaged in leisure activities like
reading, hearing music, cooking are more satisfied with the quality of their
private life. It can be assumed that it is also a factor for promoting positive
mental health, although not very specific.)
§ Hoffmmann et al. 2000 (People who are able to do all these activities show
less mental illness than people who are not able to do that.)
§ Neuman, S., B. (1996) Children engaging in storybook reading: The influence
of access to print resources, opportunity and parental interaction. Early
Childhood Research Quarterly, 11, 495-513.
§ Biddle, S. H., Fox, K. R., & Boutcher, S. H. (2000). Physical activity and
psychological wellbeing. London: Routledge.

7.2.3 Proportion of people participating in community festivals /

community celebrations

Definition:
Institutions and people implied in a sisteatic way in the preparation of
communitary festivals
Number of institutions (groups, masquerades, fraternities..)
Number of participants

References:
§ Local Authorities www.mmhe.eu
§ Voluntary and private organisations
§ FONTA, E.,, "El tiempo libre en el proceso de enculturación", en VV.AA.,VIII
Congreso E.L.R.A. Ocio y nueva ciudadanía, Bilbao, Junio 1992, pp. 336-347.
§ GIL CALVO, E.,, Estado de fiesta, Espasa-Calpe, Madrid, 1991.
§ MERCE CAROL, X.,, La Festa com a Expressió Lúdica d'una Comunitat, en
Interacció 84. Diputación de Barcelona. Vol. III, Barcelona, 1984.

7.2.4 Involvement of programmes that help intercultural

integration

Definition:
Type of leisure where everyone can participate no matter therir age, sex or
health state.
Number of programs that helps intercultural integration
Number od culture centres with facilities for leisure of people with some tiype of
limitation

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References:
§ Local Authorities
§ KRAUS, R. & SHANK, J.,, Therapeutic recreation service. Principles and
practices, Wm. C. Brown, United States, 1992, 397 pp., LIBRO
§ LARRÍNAGA, V. & SÁNCHEZ, J.,, "Salud mental: una experiencia de
intervención dentro de un programa de ocio", en VV.AA., VIII Congreso
E.L.R.A. Ocio y nueva ciudadanía, Instituto de Estudios de Ocio, Bilbao, 1992,
pp. 79-84, PONENCIA
§ LEIJALA, M., "Art activities in Finnish institutions for the elderly", en VV.AA.,
International conference arts in hospital, Commission Française pour
l'UNESCO, Ministère de la Santé et de l'Action Humanitaire, Toulon, Mayo
1992 (Inédito), pp. 30-36, PONENCIA
§ APRAIZ, J.A.,, Deporte y salud. Manual para mejorar la salud con la práctica
deportiva, Diputación Foral de Álava, Departamento de Cultura, Vitoria-
Gasteiz, 1995,
§ DENCH, S.,, "Women in sport", en TOMLINSON, A. (ed.), Sport in society:
policy, polics and culture, Proceedings of the leisure, Studies Association 2ed
International Conference (Junio-Julio de 1988), (LSA), Eastbourne, 1990, pp.
105-118,
§ COHEN, G.L. & JOYNER-KERSEE, J., Women in Sport, Issues and
controversies, Sage, London, 1993
§ GODBEY, G.,, Leisure in your life: an exploration (5th edition), Venture, State
College, 1999.

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8. Mental health and older people

8.1 Levels of participation

8.1.1 Access to social clubs, centres, etc for older people

Definition:
Going out to cinema, theatre, dancing...
Watching TV, listening to the radio, playing cards…

References:
§ Lawton, MP.; Moss, MS.; Winter, L.; Hoffman, C. (2002). Motivation in later
life: personal projects and well-being. Psychology and aging, 17(4): 539-547.

8.1.2 Proportion of people over 65 engaged in training or education

(eg university studies, local classes, etc)

Definition:
Not compulsory school studies

References:
§ Kemper, G.; Brilma, E.; Ranchor, A.; Ormel, J. (1999). Morbidity and quality
of life and the moderating effects of level of education in the elderly. Social
Science & Medicine: 49: 143-149
§ Murrell SA, Salsman NL, Meeks S. (2003). Educational attainment, positive
psychological mediators, and resources for health and vitality in older adults. J
Aging Health, 15(4): 591-615.
www.mmhe.eu
§ Plan Gerontológico de Euskadi (2004). Eusko Jaurlaritza-Gobierno VascoDpt
de Justicia, Trabajo y Seguridad Social
§ Lawton, MP.; Moss, MS.; Winter, L.; Hoffman, C. (2002). Motivation in later
life: personal projects and well-being. Psychology and aging, 17(4): 539-547.
§ Mitchell RA, Legge V, Sinclair-Legge G. (1997) Membership of the University
of the Third Age (U3A) and perceived well-being. Disabil Rehabil, 19(6): 244-8

8.1.3 Proportion of over 65’s who are still employed

Definition:
Remaining active in the labor force

References:
§ Altmaier, EM; Cutrona, CE; Aquino Daniel, JA; Russell, W.
(1996).Employment Status, Social Support and Life Satisfaction Among the
Elderly. Journal of Counseling Psychology, 43(4): 480.

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§ Fitzpatrick, TR; Bosse, R. (2000) Employement and Health among older
bereaved men in the normative aging study: one year and three years
following a bereavement event. Soc Work and Health Care,: 32(2): 41-60
§ Plan Gerontológico de Euskadi (2004). Eusko Jaurlaritza-Gobierno VascoDpt
de Justicia, Trabajo y Seguridad Social

8.1.4 Responsibility for a pet/animal

Definition:
Proportion of households with a pet

References:
§ Government Statistics, the Census
§ Local Education Authority
§ Voluntary agencies and charities
§ Friedman, Katcher, lynch & Thomas, 1980
§ Barker, 1993
§ Barker & barker, 1988
§ Erikson, 1963
§ Blue, 1986
§ Brown, Rchards & wilson, 1996
§ Bryant, 1990
§ Robin & Ten Bensel, 1990
§ Presky & Hendrix, 1990
§ Van Houtte & Jarvis, 1995
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§ Salomon, 1995
§ Toepltz, Matczak, Piotrowska & Zygier, 1995

8.2 Services for people in later life

8.3 Related demographic and legislative measures

8.3.1 Adequacy of pensions

Definition:
Payments a person receives upon retirement that should be enough for living
satisfactorily and to maintain person’s lifestyle

References:

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§ Yakoboski P. (2000) Retirement plans, personal saving, and saving
adequacy.
EBRI Issue Brief, (219):1-21

8.3.2 Legislation enabling flexible participation in the labour market

for over 65’s

Definition:
Alternative activities for retirement

References:
§ Motley, DK (1978) Availability of retired persons for work: findings from the
retirement history study. Soc Secur Bulletin, 41(4): 18-29.

8.3.4 Statutory income for long term carers as a % of average

income

References:
§ Evandrou, M. And Glaser, K. (2003): Combining work and family life: the
pension penalty of caring. Ageing and Society, Vol. 23, 583-601.


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