Uloa: A model of practice for working with Tongan people experiencing mental distress
Definitions of HealthIn 1946, the World Health Organization (WHO) defined health as "a state of complete physical, mental and social well being and not merely the absence of disease or infirmity" (World Health Organization, 1946: 100) This definition has been heavily criticised on numerous grounds. For instance, the inclusion of the word "complete" as the requirement for complete health would leave most people defined as unhealthy (Capstick, Norris, Sopoaga, Tobata, 2009; Huber et al. 2011) This focus on 'complete health' including social well being, shifted the focus to medicalised health, a consequence of the dominant influence of biomedical science, and may be a danger when the "nature of a problem is seen to be medical, its cause is said to be medical, and a medical solution is looked for, rather than any other type of solution" (Boddington Raisanen, 2009: 54).As social well being is often overlooked in service provision, the WHO definition leaves unanswered questions about the direct relationship between poor mental health and high levels of social needs and therefore the service boundaries of health, illness, disease and well being. The Mental Health Commission (2011) reported 80% of people with long term mental health problems are unemployed the highest of any disabled group. Poor housing is common (Office of the Deputy Prime Minister, 2004; Peace, Kell, Pere, Marshall, Ballantyne, 2002; Peterson, 2007) as are high levels of threats and actual violence in mental health communities (Mental Health Commission, 2011).The notions of illness and disease from the WHO definition are unclear, and Hofmann (2001) highlights the complexities of disease by explaining its different concepts and extensions:"Disease concepts do not always have the same extension. Sometimes the concept refers to theories of disease, while in other instances the ascription of disease is the issue, and sometimes they are intermingled. Correspondingly, a wide variety of terms is applied in the debate, e.g. such as "concept of disease" "disease concepts" "disease entities" "disease identity" "disease status" "disease condition" "disease category" "disease event" "disease process" The relationship between them is not always clear." (p. 218)Clarification of the boundaries of health is not only important to define health but also identify what is referred to as illness and disease. Health is a complex concept that extends to defining disease leaving complicated and muddled concepts, health and disease, which need to be untangled and identified. In their work with rural Canadians, Thomlinson, McDonagh, Crooks, and Lees (2004) broaden the definition of health to include spirituality, explaining being healthy as:".a holistic relationship between the physical, mental, social and spiritual aspects of one's life; a balance that included 'the big picture' Being able to do what they wanted to do, to cope, to enjoy themselves, to not be bored and to feel they were productive citizens was important." (p. 261)The inclusion of the spiritual aspects expands the definition of health and Thomlinson et al. (2004) highlight ability as a key theme in the capacity concept of health. This was extended by Makoul, Clayman, Lynch, and Thompson's (2009) work in the United States on the definition of health which identified four elements: physical, psychosocial, capacity, and control. The physical elements includes the body and biomedical; the psychosocial refers to the mental, emotional, spiritual, and social elements; capacity refers to ability and living an active life and control refers to impulse and self control (Makoul et al. 2009) For Schmidt and Frohling (2000) the concepts of capacity and control emphasise the relationship between one's level of "functions and well being" (Schmidt Frohling, 2000: 236) Rather than focusing on the absence of disease, Schmidt and Frohling describe individuals' health in terms of their responsibility to the society.