Mental Health Promotion in Public Health: Perspectives and Strategies PDF

GOVERNMENT, POLITICS, AND LAW Improving Uptake of Essential Services Mental Health Promotion in Public Health: Perspectives and Strategies From Positive Psychology Rosemarie Kobau, MPH, MAPP, Martin E. P. Seligman, PhD, Christopher Peterson...

GOVERNMENT, POLITICS, AND LAW Improving Uptake of Essential Services Mental Health Promotion in Public Health: Perspectives and Strategies From Positive Psychology Rosemarie Kobau, MPH, MAPP, Martin E. P. Seligman, PhD, Christopher Peterson, PhD, Ed Diener, PhD, Matthew M. Zack, MD, MPH, Daniel Chapman, PhD, and William Thompson, PhD Positive psychology is the MENTAL HEALTH PROMOTION developing personal skills (resil- positive psychology is a focus study of what is ‘‘right’’ about seeks to foster individual compe- ience), and reorienting health ser- on ‘‘positive mental health,’’ an people—their positive attri- tencies, resources, and psycholog- vices (postpartum depression empowering resource, broadly in- butes, psychological assets, ical strengths, and to strengthen screening) to enhance health.1,2,11---13 clusive of psychological assets and and strengths. Its aim is to community assets to prevent Public health has focused its efforts skills essential to human fulfillment understand and foster the fac- mental disorder and enhance well- on these health determinants pri- and well-being.1,3,4 Activities and tors that allow individuals, being and quality of life for people marily as they relate to preventing programs that foster positive mental communities, and societies to thrive. and communities.1---4 Positive psy- physical illness, injury, and disability, health also help to prevent mental Cross-sectional, experimen- chology is the study of such com- resulting in increased longevity.14,15 illness, highlighting the benefits of tal, and longitudinal research petencies and resources, or what is Similarly, clinical psychiatry and mental health promotion to overall demonstrates that positive ‘‘right’’ about people––their positive psychology have been successful population health.2 Assessment of emotions are associated with attributes, psychological assets, and in identifying, classifying, and positive mental health and related numerous benefits related to strengths.5 Its mission is to under- treating mental illness and disor- outcomes such as well-being can health, work, family, and eco- stand and foster the factors that der, resulting in better quality of help in supporting and evaluating nomic status. Growing bio- allow individuals, communities, and life for many. However, just as the health promotion and public health medical research supports societies to thrive.5,6 It comple- 1986 Ottawa Charter for Health wellness initiatives.17 Thus, positive the view that positive emo- ments theories and models of in- Promotion13 shifted greater atten- psychology deserves a place in tions are not merely the op- posite of negative emotions dividual, community, and organiza- tion in public health from disease health promotion, and health pro- but may be independent di- tional deficits with theories and prevention to health promotion, motion theory and methods can mensions of mental affect. models of assets.7 Positive psychol- positive psychology shifts attention enhance positive psychology re- The asset-based paradigms ogy offers new approaches for bol- from pathology and dysfunction to search and practice to improve of positive psychology offer stering psychological resilience and positive emotions and optimal population mental health.7,8,17---19 new approaches for bolstering for promoting mental health, and functioning. Underlying both of Whereas discourse on human psychological resilience and thus may enhance efforts of health these shifts are the fundamental fulfillment is rooted in ancient promoting mental health. Ulti- promotion generally and of mental views that health is more than Western and Eastern philosophy, mately, greater synergy be- health promotion specifically.1---4,7---10 the absence of illness and that as well as in more recent disciplines tween positive psychology Health promotion strategies, in fostering individual and social re- of human development and hu- and public health might help general, include implementing sources can lead people, organiza- manistic and educational psychol- promote mental health in in- novative ways. (Am J Public health-enhancing public policy tions, and communities to thrive. ogy, positive psychology applies Health. 2011;101:e1–e9. doi: (employment opportunities, anti- In public health, this shift has a common language and an em- 10.2105/AJPH.2010.300083) discriminatory laws), creating also become evident in the field of pirical approach to the study of 4 supportive environments (parent- mental health promotion, seen as areas: (1) positive emotions (happi- ing interventions), strengthening an integral part of health promo- ness, gratitude, fulfillment), (2) community action (participatory tion practice.1---3,12,16 Common to positive individual traits (optimism, research, media campaigns), both mental health promotion and resiliency, character strengths), (3) August 2011, Vol 101, No. 8 | American Journal of Public Health Kobau et al. | Peer Reviewed | Government, Politics, and Law | e1  GOVERNMENT, POLITICS, AND LAW positive relationships among with adaptation, goals, tempera- et al.39). Although sometimes According to the Broaden and groups, and (4) enabling institu- ment, heritability, forecasting, confused with related affective Build theory, resilient people expe- tions (schools, worksites) that recall biases, and accurately states such as short-term sensory rience positive emotions more fre- foster positive outcomes.5,18,20---24 measuring or intervening on pleasure (e.g., satiety, warmth) quently and recover more quickly This contrasts with post---World well-being. 29---36 Research from and longer-lasting positive from specific life stressors.6,38,39 War II psychology, which concen- multiple disciplines suggests that moods, positive emotions are trated on repairing damage using positive mental health and well- typically brief and result from Biological Markers of Positive the prevailing disease model of being can be measured relatively personally meaningful circum- Emotions human functioning (i.e., mental ill accurately and that appropriately stances (e.g., joy from a social Positive emotions have numer- health), while largely ignoring psy- targeted interventions can affect encounter). ous health, job, family, and eco- chological assets (e.g., courage, well-being.4,24,30,35,36 However, nomic benefits.31,42---44 In numer- kindness) and positive aspects of more research in positive psychology Broaden and Build ous cross-sectional studies, positive behavior (e.g., responsibility, com- that generalizes to the broad pop- The Broaden and Build theory emotions and positive evaluations passion) that could also assist in ulation is warranted. Given the of positive emotions proposes that of life are associated with de- therapy.25 The focus on mental ill benefits of positive emotions, pos- positive emotions broaden peo- creased risk of disease, illness, health––its causes, symptoms, and itive psychology parallels efforts ple’s attention, expand cognition and injury; healthier behaviors; consequences––resulted in stigma in mental health promotion to (e.g., curiosity, creativity) and be- better immune functioning; speed- associated with these factors, eu- advance the value of positive men- haviors (e.g., exploration, play), ier recovery; and increased lon- phemistic use of the term ‘‘mental tal health in individuals and soci- and consequently foster physical, gevity.31,40,43---46 Longitudinal and health’’ to describe treatment and ety.1---4 We present a brief overview intellectual, and social resources experimental studies show that support services for people with on the benefits of positive emotions, (e.g., intelligence, mastery, social positive emotions precede many mental illness, and vague lan- the recognition and impact of pos- competence) for optimal function- successful outcomes related to guage, especially among the pub- itive individual traits for mental ing.6,37,38 So, whereas negative work, social relationships, and lic, about what mental health health promotion, and the influ- emotions are adaptive in the short physical health.44 Growing bio- means.1 ence of enabling social-environ- term, positive emotions may be medical and related research sup- Positive psychology does not mental factors on positive mental adaptive in the longer term by ports the view that positive emo- claim that mainstream psychology health. building personal resources that tions are not merely the opposite of is negative or less important function as psychological reserves negative emotions but independent because it focuses on pathology POSITIVE EMOTIONS for continued growth.6,38,39 dimensions of mental affect.47,48 and mental illness. Its aim is not Positive emotions and negative to deny the distressing or un- Many people know about the Regulating Negative emotions appear to have different pleasant aspects of life; the value benefits of negative emotions such Emotions determinants, consequences, and of negative experiences on hu- as fear, disgust, and anger in securing Moreover, positive emotions correlates, but differentiating these man development, coping, and our personal safety and survival can more quickly quell or undo requires more study.44,49,50 creativity; or the critical need to (e.g., fight or flight), and the harms the adverse effects of negative Positive emotions are partially ameliorate distress.23,26 Despite of increased stress levels, nar- experiences by reducing stressful heritable (estimates of heritability what its critics say, positive psy- rowed responses for action, and reactions (e.g., increased blood range from 0.36 to 0.81), suggest- chology seeks to provide a more withdrawal associated with neg- pressure) and returning the body ing a genetically determined set complete scientific understanding ative emotions. Fewer know that to a balanced state.6,40,41 For point for emotions such as happi- of the human experience––includ- positive emotions (e.g., joy, in- example, in previous studies, indi- ness and sadness.51---55 The expres- ing positive and negative experi- terest, contentment) quell auto- viduals in whom positive emotions sion of genetic effects, however, ences––to better integrate and nomic arousal, signal approach such as contentment and mild joy often results from environmental complement existing knowledge and safety, and prompt indi- were prompted immediately after stimuli; social context matters be- about mental illness with knowl- viduals to engage with their a stressful situation had faster car- cause it can affect the opportu- edge about positive mental physical and social environments diovascular recovery (e.g., reduced nity for, and the frequency of, health.23,24,27,28 Researchers have by exploring new objects, people, heart rate, peripheral vasoconstric- expressing positive emotions.30,53 addressed these critics’ objections, or situations (for reviews, see tion, and blood pressure) than (The frequency of positive emotions which are primarily concerned Fredrickson6,37,38 and Tugade did those in a control group.6,40 predicts well-being better than does e2 | Government, Politics, and Law | Peer Reviewed | Kobau et al. American Journal of Public Health | August 2011, Vol 101, No. 8  GOVERNMENT, POLITICS, AND LAW their intensity.44) Furthermore, buffer against psychological disor- be relevant for public health in- thoughts, and challenging negative individuals’ circumstances and social der and other adversities, and terventions aimed at schools, beliefs by considering alternative contexts are amenable to interven- promote mental health.18 Several worksites, health care settings, and interpretations.70,71 Students also tion by public health, mental health, methods exist to help individuals Area Agencies on Aging. For ex- learn how to negotiate, make and positive psychology practi- improve their resiliency and iden- ample, individuals can change decisions, and relax. In 21 studies tioners. Several interventions tify their positive dispositions. their ‘‘explanatory style’’––that is, (most of which used randomized described in this essay and else- how they interpret day-to-day controlled designs) that comprised where have succeeded in boosting Resiliency and Optimism events and their interactions with about 3000 children, the PRP pre- positive emotions and minimizing Resiliency is the process of others.4,63---65 Specifically, they can vented disruptive behaviors for up negative affect and depression positive adaptation in the context learn skills for more optimistic ways to 36 months and depression and over time.36,53,56 of adversity or risk.1,4,60 Resiliency of thinking and reacting to improve anxiety symptoms for up to 2 years, This growing literature demon- helps people to cope with life’s their resiliency.4,63 Besides certain especially in students with more strates that positive emotions are challenges and confers a sense of personality characteristics (e.g., dis- severe symptoms.70---73 Thus, important psychological resources mastery over one’s life.1,4 Promo- positional optimism) and the physi- a mental health promotion inter- to be nurtured, rather than only tion of resiliency can occur within cal and social environment, explan- vention like the PRP may reduce enjoyed as brief, elusive out- persons (e.g., coping, optimism), atory style can predict depression the likelihood of onset of mental comes.4,6,31,37,38,44 Positive psy- among persons (social support), and and other negative physical health illness in children, but it requires chology interventions (e.g., those across social levels (public health or outcomes.66,67 Skills based on more study.74 The PRP works that promote resiliency, optimism, educational systems).60 Studies of learned optimism––such as chal- equally well among boys and girls or gratitude) may enhance the value resiliency focus on positive adapta- lenging beliefs, avoiding thinking and for children of various racial/ of public health interventions based tion and achievement and stress the traps, calming and focusing, and ethnic backgrounds.70,74 Similar on effective behavioral science importance of promoting compe- putting things in perspective––can school-based interventions have theories (e.g., Stages of Change)57 tence (e.g., autonomy, goal-directed improve psychological resiliency demonstrated improvements in and methodologies (e.g., motiva- behavior) through interventions.4,61 in individuals. These skills closely empathy, cooperation, assertive- tional interviewing) in improving Substantial public health efforts resemble ‘‘cognitive symptom ness, self-control, coping skills, health outcomes. Framing individ- are designed to promote resiliency management,’’ effectively used in resilience, and other social compe- ual and population health commu- among persons and across social interventions such as the Chronic tencies aligned with positive mental nication messages around positive levels. For example, prevention Disease Self-Management Pro- health outcomes.2,70 experiences and emotions may fos- programs that safeguard against gram.68 However, expanding the The US Army is applying re- ter behavior change better than illness and injury might promote use of skills like learned optimism siliency training modeled after the using messages based on fear.8 For resiliency directly (e.g., vaccinations, to the broad population holds PRP through its Comprehensive example, Kaiser Permanente’s nutritional fortification of foods) or promise for promoting mental Soldier Fitness Program75 to sup- ‘‘Thrive’’ campaign links its brand indirectly (e.g., after-school pro- health.63,64,69,70 port the optimal mental and physi- and its health services with the grams).1 The US Administration on The Penn Resiliency Program cal health of soldiers. As of October theme of living life fully and hap- Aging supports congregate meal (PRP) is a group intervention de- 1, 2009, the Army has supported pily, and may be morale boosting programs through its network of livered to children aged 8 to 15 resiliency training for its entire staff. for some.58,59 Area Agencies on Aging, not only to years after school that teaches re- The Comprehensive Soldier Fitness provide meals to older adults but siliency skills based on learned Program focuses on 5 dimensions POSITIVE INDIVIDUAL also to promote social interaction optimism. The PRP has been ef- of functioning: physical, emotional, TRAITS and social support that may confer fectively implemented in the spiritual, family, and social. It in- greater psychological resiliency.62 United States, United Kingdom, cludes an anonymous, confidential, Positive individual traits include Parenting interventions and pre- Australia, China, and Portugal, online self-assessment for all sol- a number of positive dispositions school interventions are effective in providing evidence of its effec- diers and will include a similar as- present in individuals to dif- boosting resiliency in mothers and tiveness in diverse cultural set- sessment for family members that ferent degrees, such as creativity, children.1,2,4 tings.2,70,71 Students learn to adopt will guide training needs. Resiliency bravery, kindness, perseverance, Positive psychology offers more optimistic explanatory styles skills to be taught include problem and optimism, which, when culti- several approaches for improving by detecting inaccurate thoughts, solving, energy management, ex- vated, can increase resiliency, individual resiliency that may evaluating the accuracy of those planatory style, and putting things August 2011, Vol 101, No. 8 | American Journal of Public Health Kobau et al. | Peer Reviewed | Government, Politics, and Law | e3  GOVERNMENT, POLITICS, AND LAW a research team to develop a scien- Criteria Used by Positive Psychologists for Classifying Strengths of Human tific classification scheme compara- Goodness and Excellence of Character ble to the DSM-IV as well as as- A character strength–– sessment strategies to identify 1. Is ubiquitous: is widely recognized across cultures (e.g., bravery, kindness). psychological strengths.79 After ex- 2. Is fulfilling: contributes to individual fulfillment, satisfaction, and happiness broadly construed. tensively reviewing literature from 3. Is morally valued: is valued in its own right and not for tangible outcomes it may produce. multiple disciplines, this team 4. Does not diminish others: elevates others who witness it. considered cross-cultural validity, 5. Has a nonfelicitous opposite: has obvious antonyms that are negative. possible unintended political 6. Is traitlike: is an individual difference with demonstrable generality and stability. consequences of their effort (e.g., 7. Is measureable: has been successfully measured by researchers as an individual difference. value-laden applications, such as 8. Is distinct: is not redundant (conceptually or empirically) with other character strengths. selecting people on the basis of 9. Has paragons: is strikingly embodied in some individuals. strengths), and the implications of 10. Has prodigies: is precociously shown by some children or youths. creating a classification system 11. Can be selectively absent: is missing altogether in some individuals. versus a taxonomy.79 Team mem- 12. Has enabling institutions: is the deliberate target of societal practices and rituals that try to bers assumed that character, like cultivate it. traits, was stable and general and Source. Peterson and Seligman.79 that character strengths were not bound to culture. They then iden- tified explicit criteria that guided their classification system to identify in perspective. The Army is train- excessive worry, rumination, or illness using the Diagnostic and character strengths of human ing master trainers to help other spirals of negative thinking.63,64 Statistical Manual of Mental Dis- goodness and excellence of char- soldiers learn resiliency techniques. Resiliency interventions such as the orders, Fourth Edition (DSM-IV).77 acter (see box on this page). Additional pre- and postdeployment PRP might be disseminated more However, the DSM-IV is explicitly Finally, they developed and boosters will be implemented.75 broadly in schools, worksites, and designed to diagnose and treat validated the Values in Action Learned optimism is not about other community settings.1,2,4 mental illness but provides no Inventory of Strengths (VIA-IS) to looking at the world through guidance to assess positive measure these character strengths. rose-colored glasses or having Character Strengths thoughts, emotions, or behav- The VIA-IS includes 6 core or unrealistic or self-deceptive ex- With respect to mental illness, iors.78,79 In 2000, with growing ‘‘signature’’ strengths, each with 3 pectations.76 Instead, it is about professionals have applied a com- interest and support from the field to 4 component definitions (Table teaching skills needed to pro- mon language and diagnostic cri- of positive youth development, 1). Signature strengths are the mote mental health and to avoid teria to identify and treat mental Peterson and Seligman organized mental and physical activities that TABLE 1—Core Strengths of Human Goodness and Character as Recognized by Positive Psychology Core Strength Components 1. Wisdom and knowledge—cognitive strengths that entail the acquisition of knowledge Creativity; curiosity; judgment and open-mindedness; love of learning; perspective 2. Courage—emotional strengths that involve the exercise of will to accomplish goals in Bravery; perseverance; honesty; zest the face of opposition, external or internal 3. Humanity—interpersonal strengths that involve tending and befriending Capacity to love and be loved; kindness; social intelligence 4. Justice—civic strengths that underlie healthy community life Teamwork; fairness; leadership 5. Temperance—strengths that protect against excess Forgiveness and mercy; modesty; prudence; self-regulation 6. Transcendence—strengths that forge connections to the larger universe and provide meaning Appreciation of beauty and excellence; gratitude; hope; humor; religiousness and spirituality Source. Peterson and Seligman.79 e4 | Government, Politics, and Law | Peer Reviewed | Kobau et al. American Journal of Public Health | August 2011, Vol 101, No. 8  GOVERNMENT, POLITICS, AND LAW we perceive as natural and desir- offers good face validity for use in scope of this essay, practicing by opportunities for autonomy, able and that energize rather than communities. For example, among gratitude, performing acts of social inclusion, and freedom from exhaust us.78 The VIA-IS, com- 383 African American adoles- kindness, and mindfulness relaxa- discrimination and violence; and pleted by a million individuals in cents surveyed with the VIA- tion (nonjudgmentally focusing taxation of addictive substances to more than 200 nations since 2002, Youth, love of learning was related awareness on thoughts, sights, and prevent abuse.1---4 Institutions such has acceptable construct validity, to self-reported abstinence for sounds) can increase positive as schools, homes, worksites, discriminant validity, convergent boys and self-reported avoidance emotions and well-being.36,56,87 places of worship, and health validity, stability and internal con- of drug use for boys and girls.86 In Gratitude helps people to savor care settings that have been tra- sistency reliability, and test-retest a Department of Veterans Affairs their life experiences and situations, ditional targets for public health reliability.21,80---83 The VIA-IS has psychiatric rehabilitation program maximize satisfaction and enjoy- disease prevention and health also been modified and validated to promote recovery from mental ment from those experiences, and promotion interventions also for use in youths aged 10 to 17 illness, simply taking the VIA-IS was minimize adaptation.54 Gratitude are settings for evidence-based years (VIA-Youth).83 described as an intervention itself, might also help people to cope with mental health promotion inter- The VIA-IS is available for with most participants reporting stress and trauma by positively ventions.2 Policy initiatives that af- public use84 and, as part of the positive outcomes associated with reinterpreting negative life experi- fect social and economic determi- survey assessment, provides users the experience.9 The study investi- ences.33,88 Relative to control nants of mental health (e.g., housing, with their strengths’ rankings (so gators encouraged veterans to use groups, participants who were employment) and that support the they can see where their strengths prompts such as a ‘‘strengths card,’’ asked to write down 5 things for integration of evidence-based men- rank compared with other which they carried with them as which they were grateful (e.g., tal health promotion programs in strengths), along with examples of a reminder of their positive attri- cherished interactions, overcoming community settings are warranted methods to enhance strengths. butes and as help in their daily obstacles) once a week for 10 weeks to improve population health.1,4 Park and Peterson83 have pro- recovery. reported greater life satisfaction, For those interested in fostering vided information on scoring, and Applying the VIA-IS could also more optimism, and fewer health community or organizational Peterson21 has described methods be useful to those coping with other complaints.56 Other gratitude exer- change for mental health pro- to practice using signature strengths chronic diseases. For example, par- cises improved positive affect and motion, Appreciative Inquiry, in new and different ways (i.e., ents might devise ways to use their physical activity,36,56,88 sleep qual- a method closely aligned with reinforcing the strength) for mental children’s VIA strengths to help ity,89 and prosocial behavior.90 positive psychology, holds prom- health promotion. One Internet- them better manage chronic illness. Students who performed and ise.92 Appreciative Inquiry is a sys- based intervention encouraging Additional studies of character tracked random acts of kindness in- tematic development and improve- people to use their strengths in new strengths may show that these creased their happiness relative to ment process for management and ways increased happiness and de- strengths buffer against risky health that of a control group.36,91 Addi- organizational change based on creased depressive symptoms for behaviors or adverse health out- tional examples of interventions deliberately positive assumptions 6 months.24 Such strengths-based comes. Such studies may help target that have been shown to increase about people, organizations, and development has been linked to health promotion messages and individual positive emotions and relationships.92 Its processes shift many positive outcomes in educa- health marketing strategies to moti- well-being are available,22,36 as are the focus and dialogue from prob- tional and workplace settings.85 vate groups in ways that comple- examples of their use in schools.70 lem solving to fostering assets by The public availability of the VIA- ment their self-perceived strengths. seeking to examine the strengths in IS, its broad approach to character- However, because the VIA-IS is SOCIAL-ENVIRONMENTAL a group, thus providing the starting izing individual strengths, and its based solely on self-report, it is still FACTORS AND ENABLING point for positive change. In a typi- psychometric properties make it unclear whether and how it relates INSTITUTIONS cal Appreciative Inquiry session, potentially appealing for behavioral to more objective measures of participants are led through a series science intervention research as strengths, whether the strengths it Social and economic factors in- of systematic and provocative but well as for health communication identifies are enduring, and whether fluence health and mental health, affirming questions to identify what messaging. strength-based interventions are including access to employment; is positive in the group and to connect Although more research is effective over the long term. safe working conditions; education, people in ways that heighten energy, needed regarding its psychometric Although a comprehensive re- income, and housing; stable and vision, and action for change.92,93 properties in diverse sociodemo- view of interventions that improve supportive family, social, and com- Appreciative Inquiry has been graphic subgroups, the VIA-IS positive emotions is beyond the munity environments characterized successfully and innovatively used August 2011, Vol 101, No. 8 | American Journal of Public Health Kobau et al. | Peer Reviewed | Government, Politics, and Law | e5  GOVERNMENT, POLITICS, AND LAW TABLE 2—Use of Appreciative Inquiry as a Health Behavior Change Intervention Between a Clinician or Health Educator and a Client Phase Appreciative Inquiry Question Discover—examining aspects of health people most Describe a time when you had an exceptionally healthy lifestyle. value and want to promote What did you appreciate about the experience? What was it about you that made this happen? What was it about others that made this happen? What other situational factors supported this positive experience? Tell me a story of when you felt particularly healthy and alive. Why was it so powerful? What are the good things about you that helped make this a special time? Did you learn anything new about yourself? Who else was involved and how did they help? Dream—challenging the status quo by envisioning a more Imagine a world where everyone could be in charge of his or own health and care. What are the most valued and possible future important things you would need to take care of your own health and care? Your health and the health of your family are affected by what happens in your community. Imagine that you live in a truly healthy community. What would be different from the way things are now? What role do you see for yourself? What steps could your community take to ensure a healthy future? Imagine that you are so physically active that you feel very fit and healthy. What would you feel like on a daily basis? What would you be doing? What would you see yourself doing for exercise that would make you feel good while doing it? What could you do that would be different from the way things are now? What steps would those around you need to do to help you? Design—a collaborative construction of bold statements What could you do now to be more in charge of your own health and care? of ideal possibilities Who would you go to for help? Is there anything the people you go to now for help could do differently so you could take more charge of your own health and care? Deliver—consensus is reached regarding principles and priorities; What are some short-term goals for you to try related to improving your health? strategies are designed to accomplish short- and What are your long-term goals? long-term goals Who can help you achieve these goals and how can they help you? Note. Discover, dream, design, and deliver are the 4 phases that guide Appreciative Inquiry.92 Source. Modified from Moore and Charvat.7 by numerous private and govern- For example, health care pro- daily settings or to more formally health partners offer greater reach mental organizations, including viders, health educators, and structure an Appreciative Inquiry for positive psychology practi- the Cleveland Clinic, the National other caregivers might incorporate summit for groups or organiza- tioners to implement and evaluate Aeronautics and Space Adminis- Appreciative Inquiry in their in- tions.92,93 The implementation and their interventions across diverse tration, the US Navy, Save the teractions with patients, clients, effectiveness of Appreciative In- sociodemographic subgroups and Children, the United Nations families, or groups to help them quiry in health promotion warrants community settings that currently Global Compact, Imagine Chicago, focus on capabilities and compe- more thought and study. receive little attention. Likewise, Imagine Nagaland (India), and tencies related to a healthy life- the asset-based and affirmation the United Kingdom’s National style. A provider might ask a pa- CONCLUSIONS paradigms of positive psychology Health Service.92---94 Nursing has tient a few questions from an offer additional strategies for also frequently used Apprecia- Appreciative Inquiry perspective Positive mental health is a re- mental health promotion. Mental tive Inquiry to enhance education, to help motivate behavior change source for everyday living and re- health promotion and positive management, and clinical care out- or to help assist in sustaining be- sults from individual and commu- psychology offer the public (1) an comes.95---99 It may supplement havior change (Table 2). Extensive nity assets. The health promotion updated way of thinking about current health behavior change resources exist to incorporate Ap- theories, methodologies, and pop- mental health that provides for the models for health promotion. 7 preciative Inquiry principles into ulations available through public richness of human experience, (2) e6 | Government, Politics, and Law | Peer Reviewed | Kobau et al. American Journal of Public Health | August 2011, Vol 101, No. 8  GOVERNMENT, POLITICS, AND LAW additional ways to describe and Human Participant Protection First International Conference on Health 25. Seligman MEP. Positive psychology, No protocol approval was needed be- Promotion, Ottawa, 21 November positive prevention, and positive therapy. value the full spectrum of mental cause no human participants were in- 1986. Available at: http://www.who.int/ In: Snyder CR, Lopez SJ, eds. 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