Forebyggelsespakke - Mental Sundhed 2018 i et forandringsperspektiv - En adressering af social ulighed i dårlig mental sund-hed og forebyggelsen heraf: En adressering af social ulighed i dårlig mental sund-hed og forebyggelsen heraf

Abstract

Baggrund: I Danmark er forekomsten af dårlig mental sundhed stigende samt ulige fordelt, hvil-ket både har samfundsmæssige- og individuelle konsekvenser. Dårlig mental sundhed har siden siden 2012, haft en særlig opmærksomhed da Sundhedsstyrelsen udgav Forebyggelsespakke - Mental Sundhed 2012. Trods dette fokus er den sociale ulighed i dårlig mental sundhed stadig sti-gende. Dette kan skyldes kompleksiteten af underliggende faktorer i social ulighed i dårlig mental sundhed. Dermed er det væsentligt at Sundhedsstyrelsen, med den nyeste generation af forebyg-gelsespakken formår at tage højde for kompleksiteten. Formål: Formålet med specialet er at identificere eksisterende evidens i forhold til forebyggelsen af social ulighed i dårlig mental sundhed, at udlede hvorledes Forebyggelsespakke - Mental Sund-hed 2018 definerer og adresserer social ulighed i dårlig mental sundhed, samt hvordan denne råd-giver kommunerne i forebyggelsesarbejdet af social ulighed i dårlig mental sundhed. Denne viden skal bidrage til forslag om forandring af Forebyggelsespakke - Mental Sundhed 2018. Metode: I dette speciale er der anvendt tre metoder, som samlet skal besvare problemformulerin-gen. Systematisk litteratursøgning blev anvendt for at finde eksisterende evidens omhandlende hvordan social ulighed i dårlig mental sundhed kan forebygges. Kvalitativ dokumentanalyse af Forebyggelsespakke - Mental Sundhed 2018 blev foretaget, for at adressere dennes forståelses-ramme samt menneske- og sundhedssyn, i forhold til social ulighed i dårlig mental sundhed. En-deligt blev der anvendt semistrukturerede kvalitative interviews, med informanter fra to forskelli-ge kommuner, med det formål at opnå viden om kommunernes anvendelse af og erfaring med Fo-rebyggelsespakke - Mental Sundhed 2018. Resultater: I Forebyggelsespakke - Mental Sundhed 2018 er der et overordnet sundhedsfunda-mentalistisk syn på dårlig mental sundhed, og der anbefales hovedsageligt individrettede tiltag. Endvidere forekommer der en uklar definition af dårlig mental sundhed samt en dikotom og snæ-ver forståelse af social ulighed i dårlig mental sundhed. Dette afspejles ligeledes i kommunernes erfaringer med forebyggelsen af social ulighed i dårlig mental sundhed, hvor der ses begrebsfor-virring samt et overordnet arbejde med individrettede tiltag. I den systematiske litteratursøgning afspejles det, at politiske domæner former måden hvorpå mental sundhed defineres, og at social ulighed i dårlig mental sundhed skal forebygges gennem både distale og proksimale faktorer. Konklusion: Det kan konkluderes at Sundhedsstyrelsens adressering af social ulighed i dårlig mental sundhed i FMS18, mangler at definere social ulighed samt dårlig mental sundhed, har et overordnet fundamentalistisk sundhedssyn, hovedsageligt anbefaler individrettede tiltag på indi-viduelle-, sociale- og strukturelle niveauer, og mangler anbefalinger i forhold til rekruttering og utilsigtede konsekvenser. Disse adresseringer og anbefalinger afspejles i de italesættelser, infor-manterne i kommunerne fremlagde i forhold til deres forebyggelsesarbejde af social ulighed i dår-lig mental sundhed. Derfor ses der et forandringspotentiale, ved at Sundhedsstyrelsen klart skal definere henholdsvis, social ulighed og dårlig mental sundhed, rekruttering og utilsigtede konse-kvenser, at adressere de yderste distale niveauer samt eksplicitere hvilken rolle Sundhedsstyrelsen ønsker at have i kommunernes forebyggelsesarbejde.

Background: In Denmark the incidence of poor mental health is increasing and unevenly distrib-uted, which has social- and individual consequences. Poor mental health has gotten special atten-tion since 2012, when Sundhedsstyrelsen published Forebyggelsespakke - Mental Sundhed 2012. Despite this attention, social inequality in poor mental health is still increasing. This may be due to the complexity of underlying factors in social inequality in poor mental health. Thus, it is im-portant that Sundhedsstyrelsen, with the latest generation of the prevention package, take the complexity into account. Aim: The purpose of the thesis is to identify existing evidence in relation to the prevention of so-cial inequality in poor mental health, to derive how Forebyggelsespakke - Mental Sundhed 2018 defines and addresses social inequality in poor mental health and how it advises the municipalities in the prevention work of social inequality in poor mental health. This knowledge will contribute to proposals for changing Forebyggelsespakke - Mental Sundhed 2018. Methods: In this thesis three methods have been used, which in combination with each other an-swer the research question. Systematic literature search was used to find existing evidence on how social inequality in poor mental health can be prevented. A qualitative document analysis of Fore-byggelsespakke - Mental Sundhed 2018 was undertaken to address the understanding framework as well as human and health views, in relation to social inequality in poor mental health. Finally, semi-structured qualitative interviews were used with informants from two different municipali-ties, with the aim of gaining knowledge about the municipalities' use of and experience with Fore-byggelsespakke - Mental Sundhed 2018. Results: In Forebyggelsespakke - Mental Sundhed 2018 there is an overall fundamentalist health view of poor mental health, and mainly individual-directed initiatives are recommended. Fur-thermore there is an unclear definition of poor mental health as well as a dichotomous and narrow understanding of social inequality in poor mental health. This is also reflected in the municipali-ties' experiences with the prevention of social inequality in poor mental health, where conceptual confusion is seen and an overall work with individual-directed initiatives. In the systematic litera-ture search, it is reflected that political domains form the way in which mental health is defined and that social inequality in poor mental health must be prevented through both distal- and proxi-mal factors. Conclusion: It can be concluded that Sundhedsstyrelsens addressing of social inequality in poor mental health in FMS18 lacks definitions of social inequality and poor mental health, has an over-all fundamentalist health view, primarily recommends individual-directed initiatives at individu-al-, social- and structural levels and lacks recommendations in relation to recruitment of citizens and unintended consequences. These addressings and recommendations are reflected in the state-ments, the informants in the municipalities, presented in relation to their prevention work of so-cial inequality in poor mental health. Therefore the health authorities must clearly define social inequality and bad mental health, recruitment and unintended consequences, address the outer-most distal levels as well as explain the role that Sundhedsstyrelsen desire to have on the munici-palities' prevention work.

A master thesis from Aalborg University

Forebyggelsespakke - Mental Sundhed 2018 i et forandringsperspektiv - En adressering af social ulighed i dårlig mental sund-hed og forebyggelsen heraf: En adressering af social ulighed i dårlig mental sund-hed og forebyggelsen heraf

[Forebyggelsespakke - Mental Sundhed 2018 in a changing perspective - Addressing social inequality in poor mental health and its abilities for prevention: Addressing social inequality in poor mental health and its abilities for prevention]