Discussion
ill
Efforts to address and prevent mental ill health among youth have garnered widespread attention and growing investment in recent years, while a focus on strengthening positive mental health and wellbeing – the purview of mental health promotion – has remained more limited. Resultantly, there is a paucity of empirical evidence detailing the potential impacts achieved through adopting and implementing strengths-based and upstream mental health promotion initiatives. Drawing on mixed-methods data, this study offers important insights. Our findings, grounded in youth and adult ally perspectives, illustrate the promise and utility of mental health promotion While further evaluation will be conducted in Phase 2, these Phase 1 findings emphasize the need for expanded investment in mental health programming explicitly guided by mental health promotion theory and principles. Many youth and adult ally participants articulated profound shifts in their understandings of mental health, moving from an illness-oriented, biomedical framing to one that now also includes an appreciation for, and application of, the social and structural determinants. Indeed, it is well recognized that the “drivers” of mental health and illness comprise the “complex interplay between neurobiological and psychosocial systems, risk and protective factors, and mental health systems and service utilization” (Another key finding of this study centered on the opportunities that Agenda Gap created to demonstrate youth citizenship or capacity for “belonging, independence and equality, responsibility and participation, and shared existence and identity” (Additionally, our study provides much-needed evidence on the processes and impacts of adopting a socioecological approach to mental health promotion intervention. Much of the mental health promotion literature describes programming targeted at changing intrapersonal behavior (While socioecological mental health intervention represents an important path to pursue, it is not without its challenges. It is a complex undertaking and requires thoughtful development of aligned measures and metrics to monitor effect. This challenge is not unique to mental health promotion. It is a struggle shared by scholars within the broader public and population health field, where demonstrating the impact of community-based, multi-level (particularly structural) intervention is a priority methodological pursuit (While this study makes important contributions to guide the science and practice of mental health promotion intervention, there are limitations to acknowledge. The data presented represent the perspectives and experiences of youth from one provincial region of Canada. While these participants were intentionally diverse in their social positions, identities, and lived experiences, future research will benefit from the inclusion of youth from other geographical contexts to confirm the transferability of findings. Furthermore, while we argue that previous research, and our results here, support the notion that youth-led policy engagement and advocacy can yield mental health benefits, we acknowledge that such efforts could take multiple forms. More broadly, while a focus on social justice and addressing health and social inequities through the social determinants of mental health has deep roots in Canadian public health (Additionally, while the mixed methods design of this study provides rich and nuanced insights into participants' perceptions of Agenda Gap impacts, this was a Phase 1, exploratory study and was underpowered to support quantitative analyses beyond those presented. This was compounded by the presence of ceiling effects for many of the measures used. As Agenda Gap is refined and tested with additional groups of youth in Phase 2 activities, the sample sizes will grow and it is anticipated that this will permit realist analyses to explore the causal mechanisms of program effects, including how these may vary by participant characteristics and context (Mental health promotion – particularly that which adopts a socioecological orientation – holds untapped potential for strengthening positive mental health and wellbeing for youth, as well as their families, communities and society at large. Yet research, policy and practice in this field remains under resourced, with the burden for this work largely falling to individual schools and community organizations. To leverage the full potential of this approach, there is a need for a radical shift in the ways in which mental health is conceptualized (i.e., acknowledging the social and structural origins of mental health and illness, individually and collectively). This must be accompanied by bold actions by government and other decision makers to commit to realizing a population approach to mental health, inclusive of promotion, alongside prevention, treatment and recovery. It will also require ongoing efforts to challenge prominent (problematic) beliefs about youth capacity and to create spaces where their voices and perspectives are actively sought, valued and actioned. Without such efforts, solutions to youth mental health will remain illness-centric and reactionary, failing to progress in attending to the upstream determinants of good mental health and equity.