A simple research-based model for mental health promotion in practice could improve mental health and wellbeing in the whole population
With mental health declining in most Western countries, there is a need for population-wide strategies to promote and protect mental wellbeing. Whilst both universal mental health promotion and targeted prevention approaches have the potential to prevent deteriorating mental health, universal approaches may reach and impact larger segments of a population. However, universal mental health promotion strategies are scarce and not widely implemented.
Act-Belong-Commit – or the ‘ABCs of Mental Health’ – is the world’s first comprehensive, population-wide, community-based mental health promotion campaign and framework. The Act-Belong-Commit campaign essentially provides three research-based messages that are known to contribute to mental wellbeing and can be used by everyone, regardless of their mental health-status.
Act-Belong-Commit
- Act (Do something):
- Keep mentally, socially, spiritually, and physically active.
- Belong (Do something with someone):
- Develop a strong sense of identity and belonging by keeping up family relationships and friendships, joining groups, participating in community activities and inviting others to do so.
- Commit (Do something meaningful):
- Do things that provide meaning and purpose in life, such as taking up challenges, supporting causes and helping others.
The overall strategic framework is a community-based social franchising approach that encourages individuals to engage in mentally healthy behaviours, while also collaborating and campaigning with organisations that offer mentally healthy activities.
The campaign originated in Australia (campaign video) and has subsequently been adapted and implemented population-wide in Denmark, Faroe Islands, and Norway (and recently in the Swedish region of Östergötland). In Australia, the campaign is implemented via a hub based at Curtin University, with ongoing funding from the Health Promotion Foundation of Western Australia (Healthway) and the Mental Health Commission of Western Australia.
What does the campaign do?
It has around 270 community and organisational partners in Western Australia and several partners in other Australian states. The campaign has a wide range of supporting resources (in print and online) including a self-help guide, and a website search tool to find clubs and organisations of interest by geographic area, organisers and planners, factsheets, curriculum materials for schools, and print and video advertisements. Ongoing evaluation of the campaign in Western Australia shows widespread awareness of the campaign (approximately 80% of the adult population), with 10–15% of those aware taking specific actions to improve their mental health as a result of exposure to the campaign.
Follow-up research from Australia has revealed that the campaign effectively attracts the attention and involvement of those with and without a mental health problem, supporting the universal approach. The campaign is also seen to reduce stigma against mental illness, increase openness about mental health issues, increase help seeking behaviours, and is changing people’s perception of mental health, from a passive ‘illness’ perspective to a belief that they can proactively enhance their mental health.
Europe and its mental health alliances
In Denmark (as in the Faroe Islands, Norway, and Sweden) the campaign is called the ABCs of Mental Health (in the native language). The ABCs of Mental Health in Denmark is organised as an interdisciplinary and intersectoral partnership. The ABC partnership is led by the University of Copenhagen and has grown significantly since beginning in 2014 and currently
A simple research-based model for mental health promotion in practice could improve mental health and wellbeing in the whole population comprises 67 partners, including 40 municipalities and one region in Denmark (the Region of Southern Denmark). Just recently, the Danish Government decided to support the Danish ABCs of Mental Health and include it in the Ministry of Health’s 10-year plan for improving the psychiatry and mental health in Denmark.
Apart from raising awareness about the ABC-messages through various campaign materials (see the Danish campaign video with English subtitles under ‘activities’ here), the ABC partnership works with a structural approach (e.g., capacity building) to improve inter-sectoral collaboration and societal factors that may provide better conditions for mental health promotion. Impact evaluations from Denmark show that about 8-12% of the Danish population has heard about the ABCs of Mental Health campaign.
As in Australia, the campaign in Denmark has increased reflection and openness about mental health and provided new knowledge about how to enhance mental health. Of those reached by the campaign, 16% have done something actively to enhance or maintain good mental health. Process evaluations and qualitative research studies are conducted on a regular basis to evaluate and improve the campaign reach, effectiveness and relevance of the partnership. These evaluations show that the ABC messages provide a practical and easily understandable language and framework for working with mental health promotion across sectors and disciplines.
The ABC-campaign’s outreach to the Faroe Islands and Norway
In Faroe Islands, the ABC-campaign began in 2016. During the first years, the main emphasis was on creating awareness of the ABC messages in the population via advertising, lectures and media coverage. In 2018, an interdisciplinary and intersectoral partnership comparable to the Danish partnership was initiated and spearheaded by the Faroese Board of Public Health. This initiative has around 25 partners ranging from the largest municipalities and the psychiatric department at the national hospital to various leisure organisations and educational institutions. Thus, the ABC model is now implemented at national level and is defined as a main focus area in the strategic plan for mental health promotion from 2018 by the Ministry of Health. The ABC messages have also been evaluated in the national health survey from 2019 (Faroese Board of Public Health, 2019), demonstrating close associations between ABC activity levels and general health status.
In Norway, a regional ABC-campaign began in 2018 launched by the Trøndelag Public Health Alliance, a bottom-up interdisciplinary and intersectoral partnership of now 43 public and voluntary organisations (the County Council, municipalities, hospitals, universities, church parishes, leisure organisations). The organization of the campaign is similar to the initiatives in Denmark and Faroe Islands. Recently, the Ministry of Health in Norway decided to support the initiative as a pilot for a national mental health campaign.
The ABC campaign in educational setting
Act-Belong-Commit is also used specifically in education settings. The campaign is implemented to promote mental health in the university context at Curtin University in Australia, Copenhagen University in Denmark, NTNU and Nord University in Norway, and Elon University in the USA. Moreover, the campaign is implemented across a large number of schools in Western Australia, where results have shown that both students and staff benefit from the campaign messages (see video about Mentally Healthy Schools). Overall, there are many good, evidence-based reasons for jurisdictions to adopt and implement the Act-Belong-Commit ‘ABCs of Mental Health’ campaign (we have listed 21 of them) and the model may be considered a design for mental health promotion that works in theory and practice.
