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Journal article (open access) This systematic review provides a narrative synthesis of the evidence on the effectiveness of mental health promotion interventions for young people in low and middle-income countries (LMICs). Commissioned by the WHO, a review of the evidence for mental health promotion interventions across the lifespan from early years to adulthood was conducted. This paper reports on the findings for interventions promoting the positive mental health of young people (aged 6 18 years) in school and community-based settings. peer-reviewed

Report Bridging the Digital Disconnect is a three-year program of research that aims to develop online resources for adults, including parents, youth workers, education, health and mental health professionals who wish to support the mental health of young people aged 12 to 25. This programme of research is being carried out by the Health Promotion Research Centre at the National University of Ireland Galway and Inspire Ireland Foundation in collaboration with the Young and Well Cooperative Research Centre, Australia. This report is the second in a series of reports that will inform the development of these online mental health resources. The first report examined findings from a needs assessment survey conducted with parents of young people in Ireland (Clarke, Kuosmanen, Chambers & Barry, 2013). This report outlines key findings from a needs assessment survey carried out with youth workers, education, health and mental health professionals in Ireland. The specific aims of this study were to: determine professionals current use of online technologies examine professionals needs in relation to youth mental health explore professionals views regarding the use of online technologies to assist them in supporting young people s mental health and wellbeing; and explore professionals needs in relation to using online technologies to support young people s mental health. A total of 900 professionals, including youth workers, secondary school teachers, guidance counsellors, general practitioners, health promotion officers, social workers, psychologists, psychiatrists and resource officers for suicide prevention completed an online questionnaire. The participants in this study, who were contacted through their professional bodies and associations, expressed positive views on the use of technologies to improve the mental health and wellbeing of the young people they work with and were supportive of the development of online mental health resources. The potential of online resources as a source of support was highlighted by the high percentage of youth workers, education and health professionals that said they would look for guidance on the internet or on a mental health website. Over 70 percent of youth workers, guidance counsellors, social worker and health promotion officers reported they would use one or other of these resources if a young person was going through a tough time. Younger respondents (18 to 25 years old) and female respondents were more likely to report using online resources. Resources requested by youth workers, education and health professionals centered around the need for accurate information and guidelines in relation to promoting positive mental health and wellbeing in young people and the identification of youth mental health problems. Youth workers and education professionals specifically requested youth friendly online resources and materials to support the implementation of mental health promotion classes. Mental health professionals needs differed from the other professional groups with an emphasis on guidelines around working with young people and their parents in the promotion of positive mental health, reliable information on mental health issues concerning young people and online, evidence-based self-help interventions that young people could use to support their own mental health. All professions requested information on the services and supports that are available locally. The importance of an online resource that pooled the evidence base in relation to mental health supports and resources was also highlighted by respondents. Of the 900 respondents that completed the survey, 98.8 percent reported that they would use the resource if it was made available. Participants in this study expressed a particular interest in the use of technologies in promoting positive mental health and wellbeing. However, mental health professionals cautioned against the development of mental health prevention and treatment resources for professionals not qualified to deal with mental health problems. All professions advocated enhancing the capacity of parents to enable them to better support young people s mental health and wellbeing. A reliable, evidence-based online resource to which professionals could refer parents was proposed across the professional groups. Youth workers and teachers emphasised the additional need for guidelines on communicating with parents and including parents in youth mental health activities. Concerns in relation to the development of online resources included the relevance of the resource to the specific needs of each profession, the broad age range for which the resources are being developed for (young people aged 12 to 25), and the need for the online resource to be used as an adjunct rather than a replacement of face- to-face services with young people. In planning and delivering online mental health resources to professionals, it is important to address these concerns and ensure that these issues are not overlooked. Findings in relation to potential barriers that would hinder professionals use of online mental health resources provided further insight into potential issues that need to be addressed. These barriers included being unsure about the reliability of the information provided, overload of information, resources not being updated regularly and the site being difficult to navigate. Respondents also referred to the need for additional training to enhance professionals IT skills. In addition, support from management in terms of providing time and access to the resource was regarded as essential to the successful integration of mental health promoting technologies within the services provided as part of the youth health workforce. Overall, the findings from this needs assessment demonstrate that there is a stong interest and willingness among professionals in utilising online technologies, particularly in combination with face-to-face supports, in their work with young people. non-peer-reviewed

Report Advocacy has been identified as a key strategy for health promotion and public health and a powerful tool to promote equity. In the context of public health, advocacy strives to optimise health by addressing the environmental, social, political and economic factors that impact on health and seeks to influence the policies and practices that create the conditions for change [1]. This report is a rapid review of the evidence on public health advocacy for communicable diseases. Objectives This evidence review seeks to examine and encapsulate international evidence on public health advocacy initiatives, to identify gaps in the evidence, and to provide recommendations. Findings No evidence reviews of public health advocacy initiatives for communicable diseases were found in the literature. However, this review did identify a range of sources of evaluated health advocacy interventions, models and toolkits, and examples of best practice in the wider health advocacy arena that could be used to inform the development of effective strategies and resources for communicable disease. A North American review identified the characteristics of public health advocacy campaigns that were effective in changing industry practices that damage health [2]. The reviewers identified that most campaigns employed multiple strategies and that at least half the campaigns used the three strategies of coalition building, media advocacy and public mobilisation. The importance of the social context to the success of a campaign was underscored in this review. Toolkits have been developed by advocacy organisations to provide high quality resources for use by experienced and novice health advocates. These resources include templates for letters and publicity, advice on engaging the media and relevant stakeholders, and key messages about the issue of concern. An examination of a number of these toolkits identified a level of overlap that suggests a common base of core components and principles for effective advocacy across different topics. The methodological challenges of evaluating advocacy initiatives provide a forceful argument for adopting a more considered and systematic approach to evaluation. Recent developments have strengthened the knowledge base for such evaluations, and the recommended utilisation of a theory of change benefits the development of an advocacy initiative by making explicit the intended relationship between actions and outcomes. Conclusions Health advocacy for communicable diseases is clearly still at a nascent stage and the current evidence base is very underdeveloped. The duration and complexity of public health advocacy campaigns and initiatives makes the need for theory-based evidence imperative. The shared consensus in the literature about core components of health advocacy initiatives and the existence of templates and toolkits in the area means that foundations do exist upon which to advance advocacy for the prevention of communicable diseases. non-peer-reviewed

Report Bridging the Digital Disconnect is a three-year program of research that aims to develop online mental health anddigital literacy resources for adults - including parents, teachers, youth workers, social workers, general practitioners and mental health professionals - who wish to support the mental health of young people aged12 to25. This program of research is being carried out by the Health Promotion Research Centre at the National University of Ireland Galway and Inspire Ireland Foundation in collaboration with Young and Well Cooperative Research Centre, Australia. non-peer-reviewed

Report This review examines the current body of literature on risk communication related to communicable diseases, focusing on: (i) definitions and theories of risk communication; (ii) methodologies, tools and guidelines for risk communication research, policy and implementation; and (iii) implications, insights and key lessons learned from the application of risk communication principles in real-world settings. non-peer-reviewed

Report Health communication activities to inform and influence individual and community decisions are increasingly being used to support the prevention and control of communicable diseases. Research shows that properly designed media campaigns can have a significant positive impact on health-related attitudes, beliefs, and behaviour. However, the extent and nature of the use of health communication activities for the prevention and control of communicable diseases across Europe is currently unknown. To address this knowledge gap, the European Centre for Disease Prevention and Control (ECDC) commissioned a Research Consortium of universities to map current use and application of health communication activities, and to identify perceived needs for efficacious use of health communication, in particular in relation to the prevention and control of communicable diseases across the European Union (EU) and European Economic Area (EEA)/European Free Trade Association (EFTA) countries. The purpose of this report is to present the findings from the mapping exercise and needs assessment gathered across the 30 EU and EEA/EFTA countries. The information is derived from data collection via telephone interviews and an e-survey, as well as an expert consultation. Questions sought to identify and map the following: what is currently being done in health communication; how are activities used; who is involved; which specific disease groups are being addressed; what are the key target audiences and the channels used to reach them; what education and training programmes for health communication are available; and how health communication activities are being evaluated. Furthermore, the data collection also identified priority areas to improve health communication in the EU and the perceived needs of public health bodies in order to be able to practice health communication effectively. The report presents the methodology used for the data collection followed by the aggregated information gathered. The discussion considers some of the main results and observations from the data collected and assesses their relevance and implication in relation to published literature, best practice and areas for improvement. The report s annexes include specific health communication plans and policies identified by study participants, as well as examples of health communication initiatives for the prevention and control of communicable diseases. Specific health communication education and training courses identified by participants are also included, as well as identified stakeholder organisations in the area of health communication and communicable diseases. Framework Partnership Agreement Grant / 2009 / 007 non-peer-reviewed

Background:Socially marginalised groups tend to have higher rates of mental disorders than the general populationand can be difficult to engage in health care. Providing mental health care for these groups represents a particularchallenge, and evidence on good practice is required. Thisstudy explored the experiences and views of experts in 14European countries regarding mental health care for six socially marginalised groups: long-term unemployed; street sexworkers; homeless; refugees/asylum seekers; irregular migrants and members of the travelling communities.Methods:Two highly deprived areas were selected in the capital cities of 14 countries, and experts were interviewed foreach of the six marginalised groups. Semi-structured interviews with case vignettes were conducted to exploreexperiences of good practice and analysed using thematic analysis.Results:In a total of 154 interviews, four components of good practice were identified across all six groups: a) establishingoutreach programmes to identify and engage with individuals with mental disorders; b) facilitating access to services thatprovide different aspects of health care, including mental health care, and thus reducing the need for further referrals; c)strengthening the collaboration and co-ordination betweendifferent services; and d) disseminating information onservices both to marginalised groups and to practitioners in the area.Conclusions:Experts across Europe hold similar views on what constitutes good practice in mental health care formarginalised groups. Care may be improved through better service organisation, coordination and information.

Report The promotion of health literacy is critical to active and informed participation in health and healthcare [1] and is identified as a key action to reduce health inequalities within the European Union [2]. Health literacy may be defined as a multi-level concept encompassing basic/functional literacy, communication/iterative literacy and critical literacy [3]. This paper reports on a rapid review of the evidence on the effectiveness of interventions to improve health literacy with a specific focus on communicable diseases and interventions for disadvantaged populations within the European region. Aims This review of reviews seeks to: identify and synthesise review-level evidence on effective strategies for improving health literacy, highlight gaps in the evidence and provide recommendations. Findings Five evidence reviews, published between the years 2000 and 2010, were identified. The vast majority of the intervention studies concerned written health information and/or use of other formats such as audiovisual material. The studies reviewed were predominantly located in North America and encompassed a very broad range of health concerns. No studies fell within the categories of low-literacy initiatives or targeted mass media campaigns. The only studies included in the reviews that referred to communicable diseases concerned HIV, and all three of these had medication adherence as an outcome of the intervention. The review exposed a paucity of research concerning disadvantaged or hard-to-reach groups. Most interventions identified in the reviews focus on the functional level of health literacy and work at the traditional health education level. There is little evidence of interventions targeted at the interactive or critical levels of health literacy. Not all reviews identified whether the study results were stratified across literacy levels, but from those that did, it is clear that few of the studies provided this analysis. Without such information it is impossible to measure impacts on people with varying levels of health literacy and to effectively target interventions to reduce disparities and inequalities. Two of the five reviews reported on the quality assessment of the included studies. In one, only half the studies achieved the good benchmark, while four of five did so in the other review. The lack of information from the other reviews leaves the issue of quality of evidence subject to uncertainty. Conclusions There are considerable gaps in the evidence reviewed concerning which interventions are most effective in improving health literacy, particularly with regard to communicable diseases and studies conducted in Europe. Further research is needed on the impact of health literacy interventions in the public health field, paying particular attention to evaluating communication about communicable diseases, and determining the most effective strategies for meeting the needs of population groups with low literacy levels, and those who are vulnerable, disadvantaged and hard to reach. peer-reviewed

Report This scoping study aimed to identify current capacity for Health Promotion and the priority education and training needs for capacity development in low and middle income countries (LAMICs). Despite a low response rate (35% comprising responses from 37 countries), the findings of the study provide a snap shot of current capacity for Health Promotion and the training and education needed to maintain and further build capacity in low and middle income countries across the IUHPE regions. The opinions of the respondents on the role which the IUHPE can play to support capacity development also provide a useful basis for future IUHPE strategies. International Union of Health Promotion and Education (IUHPE) non-peer-reviewed

Report The purpose of this literature review is to provide an overview of research studies published from 2006 to 2010 in the English language on online health information-seeking behaviour by adults from the perspective of both the health consumer and the health professional. Interest in the internet as a communication tool for health-related information is growing rapidly [1]. The profile of online health consumers can be broadly defined as patients, patients friends/relatives, and citizens in general [2]. Health information-seeking behaviour varies depending on type of information sought, reasons for, and experience of, searching [3]. Research shows that women are more likely than men to search for health information [4,5] and online health consumers tend to be more educated, earn more, and have high-speed internet access at home and at work [6,7]. Internet-based health information is accessed from a variety of sources, including websites run by organisations, homepages run by individuals, and online support groups where people actively exchange health information and blogs. As more people use the internet as a source of health information the issue of source credibility and trust in websites becomes important [8]. Research shows that health professionals use of the internet to obtain health and medical information has increased [9 11]. Furthermore, in a cross-sectional survey, 80% of physicians reported experience of patients presenting printed internet-sourced health information at visits [12]. Thus, the traditional doctor patient relationship is being challenged. The internet is a resource available to an increasing number of European citizens but, as with other information sources, differential access and use is apparent both within countries and between countries in the European Union. A lack of research in the European context means that the potential of the internet as a source of health information may not be fully understood. Nevertheless, the internet would appear to provide the ideal medium for the provision of information targeted at the prevention and control of communicable disease for both health consumers and health professionals in Europe. peer-reviewed

Report This rapid review analyses the evidence on the effectiveness of mental health promotion interventions in low and middle-income countries (LAMICs). The review provides a narrative synthesis, based on a systematic review of the evidence under four key areas; interventions targeting individuals, communities, the health sector and intersectoral actions. Searching a range of electronic databases, a total of 46 studies employing RCTs or quasiexperimental designs, were identified. Of these studies, 38 evaluating 35 separate interventions were assessed employing the Quality Assessment Tool for Quantitative Studies developed by the Effective Public Health Practice Project (EPHPP). The findings indicate that effective mental health promotion interventions which lead to improvements in mental health, and related health and social gains, can be effectively implemented in LAMIC settings. There is robust evidence concerning the effectiveness of interventions promoting maternal and child mental health and school-based programmes. There are promising findings concerning community-based interventions and the potential of intersectoral actions in LAMICs deserve further investigation and support. Evidence for the sustainability and effectiveness of these interventions when integrated into routine settings in LAMICs needs to be strengthened. The implications of the review findings for future research, policy and practice in LAMICs are discussed. World Health Organisation peer-reviewed

The focus of the PROMO project (Best Practice in Promoting Mental Health in Socially Marginalised People in Europe) is on the delivery of health and social care for people with mental health problems in 14 EU member states who belong to one of the six following groups: (1) long-term unemployed; (2) homeless; (3) prostitutes/sex workers; (4) asylum seekers/refugees; (5) illegal immigrants; (6) travellers. The project reviews legislation and policies, and ¿ focussing on major cities - assesses systems of health and social services for the people concerned. non-peer-reviewed

The overall aim of the project is to define guidelines for best practice in promoting mental health amongst socially marginalised people, to highlight barriers for the implementation of the guidelines and suggest solutions, and to disseminate the findings widely among the relevant stakeholder groups in Europe. non-peer-reviewed

This report presents the main findings on the evaluation of the Zippy's Friends emotional wellbeing programme in Irish primary schools. The Zippy's Friends programme is designed to promote the emotional wellbeing of children aged five to eight years of age by increasing their repertoire of coping skills and by stimulating varied and flexible ways of coping with problems of day-to-day life. The programme is based around a set of six illustrated stories about a group of children, their families, friends and an imaginary stick insect called Zippy. Comprised of six modules, the programme addresses the following themes: feelings, communication, making and breaking relationships, conflict resolution, dealing with change and loss, and general coping skills. Structured into sessions, the programme is supported by a teacher's manual and an attractive set of teaching materials, which are designed to actively engage the children in a range of child-centered activities. Teachers participate in a structured training programme before implementing the programme in class. non-peer-reviewed

[no abstract available] non-peer-reviewed

The interest in competencies, standards, and quality assurance in the professional preparation of public health professionals whose work involves health promotion and health education dates back several decades. In Australia, Europe, and North America, where the interest in credentialing has gained momentum, there have been rapidly evolving efforts to codify competencies and standards of practice as well as the processes by which quality and accountability can be ensured in academic professional preparation programs. The Galway Consensus Conference was conceived as a first step in an effort to explore the development of an international consensus regarding the core competencies of health education specialists and professionals in health promotion and the commonalities and differences in establishing uniform standards for the accreditation of academic professional preparation programs around the world. This article describes the purposes, objectives, and process of the Galway Consensus Conference and the background to the meeting that was convened. peer-reviewed

This paper reports the outcome of the Galway Consensus Conference, an effort undertaken as a first step toward international collaboration on credentialing in health promotion and health education. Twenty-nine leading authorities in health promotion, health education, and public health convened a 2-day meeting in Galway, Ireland, during which the available evidence on credentialing in health promotion was reviewed and discussed. Conference participants reached agreement on core values and principles, a common definition, and eight domains of core competency required to engage in effective health promotion practice. The domains of competency are catalyzing change, leadership, assessment, planning, implementation, evaluation, advocacy, and partnerships. The long-term aim of this work is to stimulate a global dialogue that will lead to the development and widespread adoption of standards and quality assurance systems in all countries to strengthen capacity in health promotion, a critical element in achieving goals for the improvement of global population health. peer-reviewed

This paper reports the outcome of the Galway Consensus Conference, an effort undertaken as a first step toward international collaboration on credentialing in health promotion and health education. Twenty-nine leading authorities in health promotion, health education, and public health convened a 2-day meeting in Galway, Ireland, during which the available evidence on credentialing in health promotion was reviewed and discussed. Conference participants reached agreement on core values and principles, a common definition, and eight domains of core competency required to engage in effective health promotion practice. The domains of competency are catalyzing change, leadership, assessment, planning, implementation, evaluation, advocacy, and partnerships. The long-term aim of this work is to stimulate a global dialogue that will lead to the development and widespread adoption of standards and quality assurance systems in all countries to strengthen capacity in health promotion, a critical element in achieving goals for the improvement of global population health. peer-reviewed

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Background: The combination of four protective lifestyle behaviours (being physically active, a non-smoker, a moderate alcohol consumer and having adequate fruit and vegetable intake) has been estimated to increase life expectancy by 14 years. However, the effect of adopting these lifestyle behaviours on general health, obesity and mental health is less defined. We examined the combined effect of these behaviours on self-rated health, overweight/obesity and depression. Methods: Using data from the Survey of Lifestyle Attitudes and Nutrition (SLÁN) 2007 (), a protective lifestyle behaviour (PLB) score was constructed for 10 364 men and women (>18 years), and representative of the Republic of Ireland adult population (response rate 62%). Respondents scored a maximum of four points, one point each for being physically active, consuming five or more fruit and vegetable servings daily, a non-smoker and a moderate drinker. Results: One-fifth of respondents (20%) adopted four PLBs, 35% adopted three, 29% two, 13% one and 2% adopted none. Compared to those with zero PLBs, those with four were seven times more likely to rate their general health as excellent/very good [OR 6.8 95% CI (3.64-12.82)] and four times more likely to have better mental health [OR 4.4 95% CI (2.34-8.22)]. Conclusions: Adoption of core protective lifestyle factors known to increase life expectancy is associated with positive self-rated health, healthier weight and better mental health. These lifestyles have the potential to add quality and quantity to life. peer-reviewed

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This paper reports on the implementation and evaluation of the JOBS programme in Ireland. The JOBS programme is designed as a training intervention to promote re-employment and improve mental health among unemployed people. This intervention was implemented on a pilot basis in the border region of the Republic and Norhtern Ireland in collaboration with regional training and employment and health agencies. peer-reviewed

This report describes the evaluation of the MindOut programme that was implemented in Youthreach Centres in the HSE West (Galway, Mayo and Roscommon). The MindOut programme was originally developed as a resource to promote mental health in Irish secondary schools. Since then it has been adapted to suit the out-of-school setting. The programme aims to provide an opportunity for trainees in Youthreach Centres to develop an awareness of mental health issues and to acquire skills in relation to dealing with stress, emotions, relationships and being a support to others. non-peer-reviewed

This study reports on the evaluation of a youth-led initiative on the promotion of emotional well-being among young people aged 16-25 years. Over a six month period, the Getting it Together project worked with a group of 12 young people from both the Republic and Northern Ireland in building their understanding of emotional well-being and developing a youth friendly, needs-led resource. Employing a mix of research methods, including participatory methods, this evaluation documents the process of actual project development, partnership working and overall experience and the impact of project participation for the young people. Following the development of the resource, its pilot implementation by the peer educators with 58 young people in the region was also evaluated. The evaluation findings indicate that the key objectives of the project were achieved and that it resulted in an intense, positive and productive experience for the participating young people, which enhanced their understanding of emotional well-being. A resource package was successfully developed and designed with direct input from the young people, and was assessed by their peers to be youth friendly. The young people were successfully trained to deliver the resource to their peers, who assessed very positively both the resource and their experience of the training. The implications of the evaluation findings for developing this peer-led initiative are discussed. peer-reviewed

Understanding the process of programme implementation plays a critical role in advancing research, practice and policy in mental health promotion. This paper focuses on theimplementation of community mental health promotion and considers the challenges presented in implementing and evaluating complex, multifaceted interventions carried out in the context of dynamic community settings. peer-reviewed

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Mental health is fundamental to good health and quality of life and also infl uences social and economic outcomes across the lifespan. In the UK, Europe and globally, there has been an increasing recognition of the importance of mental health and wellbeing to overall health in recent years (WHO, 2001; 2002, 2004a; 2004b; Jané-Llopis and Anderson 2005; Mental Health Foundation, 2005; NIMHE, 2005). The WHO European Mental Health Declaration and Action Plan (WHO, 2005) and the EC Mental Health Green Paper and Strategy (European Commission, 2005) highlight two emerging themes: 1) the social and economic prosperity of Europe will depend on improving mental health and wellbeing; 2) promoting mental health will also deliver improved outcomes for people with mental health problems. peer-reviewed

In Ireland, a country of just over 4 million people, there is now a strong infrastructure for health promotion with over 300 dedicated health promotion specialists working at the national and regional levels implementing health promotion policy and practice, a smaller number of whom have a remit for mental health promotion (McKenna, Barry & Friel, 2005). The national mental health policy A Vision for Change (Department of Health and Children, 2006) incorporates mental health promotion as part of a comprehensive mental health policy: 'a comprehensive model of mental health service provision for Ireland' includes a framework for building and fostering positive mental health across the entire community.' peer-reviewed

Implementing Mental Health Promotion provides a comprehensive overview and practical guide to implementing mental health promotion programmes with different population groups across a range of settings. It shows how information from research can be used to inform programme development and best practice. The text is written from a 'how-to' perspective, combining an exploration of current research with practical advice to support the planning and implementation of programmes. The book provides examples of successful international programmes illustrating the process of implementation. Case studies of practical aspects of project development and delivery from different countries are included in order to illustrate the real life application of programmes. non-peer-reviewed

Understanding the process of program implementation plays a critical role in advancing research, practice and policy in mental health promotion. This paper focuses on the implementation of community mental health promotion and considers the challenges presented in implementing and evaluating complex, multifaceted interventions carried out in the context of dynamic community settings. The Rural Mental Health Project is presented as a case study to illustrate the practical and research challenges encountered in implementing and evaluating a community mental health promotion initiative. This case study highlights the factors that contributed to the successful implementation and evaluation of a community-based intervention for rural communities on the border region in the Republic and Northern Ireland. Among the factors identified are: a partnership model of working; local co-ordinating structures and consultation mechanisms; use of a structured planning model to guide program planning and implementation; mobilisation of cross-community and inter-agency support; and a comprehensive logic evaluation framework to assess the input, process, impact and outcomes of the project as it unfolded. peer-reviewed

Report prepared on behalf of the IUHPE/EURO Sub-Committee on Training and Accreditation in Europe including Professional Standards and Competencies. non-peer-reviewed

Report Within the Republic of Ireland, there has been increasing recognition in recent years, at both policy and practice level, of the importance of mental health promotion and prevention of mental disorders for overall population health and well-being. The National Health Strategy 'Quality and Fairness: A Health System for You' (2001) calls for the development of a new action programme for mental health including mental health promotion and stigma reduction. An Expert Group on Mental Health Policy was established in 2004 to devise a new national mental health policy. A sub-group on Mental Health Promotion and the Prevention of Mental Ill-health was set up in April 2004 in order to inform the Expert Group's recommendations in relation to the inclusion of mental health promotion and prevention as an integral part of the new Mental Health Policy. The National Health Promotion Strategy (2000-2005) includes, as one of its strategic aims, the promotion of positive mental health through identifying models of best practice, and initiating research into the development of a national positive mental health strategy. The Report of the National Task Force on Suicide (1998) makes several recommendations concerning the use of mental health promotion and primary prevention strategies in preventing suicide, now the leading cause of death among young men in Ireland. A National Strategy for Action on Suicide Prevention 'Reach Out' was published in 2005 and a National Office for Suicide Prevention was established within the Health Services Executive. A number of strategies and initiatives have also been developed by national voluntary organizations (e.g. Mental Health Association of Ireland Strategic Plan 2000-2005) and the Health Promotion departments in the regional health service areas e.g. a specific regional Mental Health Promotion Strategy and Action Plan (2005-2010) is being implemented in the North West region.

Positive mental health is a value in its own right; it contributes to the individual¿s well-being and quality of life; and also contributes to society and the economy by increasing social functioning and social capital. Positive mental health refers to human qualities and life skills such as cognitive functioning, positive self-esteem, social and problem solving skills, the ability to manage major changes and stresses in life and to influence the social environment, the ability to work productively and fruitfully and to make contributions to the community, and a state of emotional, spiritual and mental well-being (Hosman, 1997; WHO, 2001). Mental health is an integral part of overall health and well-being and in a broad sense, reflects the equilibrium between the individual and the environment (Lethinen et al., in press). peer-reviewed

When designing a comprehensive strategy for mental health promotion, as that called for in the European WHO Action Plan for Mental Health (WHO, 2005), one possible effective framework for such a strategy is to take a settings approach. The Ottawa Charter (WHO, 1986) for health promotion emphasises a settings-based approach in creating supportive environments for health, as reflected in the statement that 'health is created and lived by people within the settings of their everyday life; where they learn, work, play and love..'. An overview of effective mental health promotion programmes across different settings has been presented by Jané-Llopis and colleagues (Jané-Llopis, Barry, Hosman and Patel, 2005) in this volume, and in other recent reviews (WHO, 2004a; WHO, 2004b). The following section describes why the home, the school, the workplace and the community are four crucial settings for intervention, and describes a set of health and mental health determinants that are addressed through interventions in these settings. peer-reviewed

The evaluation of programme implementation has a critical role to play in advancing knowledge and practice in mental health promotion. While much progress has made in recent years in establishing a sound evidence base for mental health promotion (Hosman and Jané-Llopis,1999; Friedli, 2003), research on programme implementation has been relatively neglected. The published research studies and systematic reviews are mainly concerned with programme outcomes and provide little or no data on implementation or the quality of programme delivery necessary for positive outcomes to be produced (Durlak, 1998; Dane and Schneider, 1998; Domitrovich and Greenberg, 2000). As a result there is a dearth of published information to guide practitioners and decision-makers regarding the practical aspects of programme adoption and replication. From those studies that have monitored implementation, it is clear that implementation is often variable and imperfect in field settings. Durlak (1998) cautions that programmes may not be implemented with a high degree of fidelity and that between 23% to 81% of programme activities may be omitted. When implementation is documented it is clear that the level and quality of implementation influences programme effectiveness and that higher quality implementation is associated with stronger, more positive outcomes (Dane and Schneider, 1998; Durlak, 1998; Domitrovich and Greenberg, 2000; Mihalic, Fagan, Irwin, Ballard and Elliott, 2002). peer-reviewed