Climate change can be viewed as human-induced change to climate and depletion of natural systems. It potentially the biggest global health threat of the 21st century.1 It is predicted to have wide-ranging impacts upon human mental health and well-being, through changes and challenges to people’s environment, socioeconomic structures and physical security. Even the most conservative estimates of the health impacts are extremely alarming. Increasingly, the causes of poor human health and environmental damage are related. This implies that there are common solutions. For example, there are co-benefits to human health and biodiversity from mitigating and adapting to climate change (e.g. promoting active transport and reducing car use reduces CO2 emissions, benefits our environment and reduces morbidity and mortality associated with a sedentary lifestyle). This article outlines how climate change impacts upon mental health and well-being. It introduces ecological concepts, applies these to public health and outlines their implications in transforming the way that we prioritize and deliver public health in order to promote both environmental and human health. Evidence, from psychology and neuroscience, suggests that the perception of being disconnected from our inner selves, from each other and from our environment has contributed to poor mental and physical health. We argue that we must transform the way we understand mental health and well-being and integrate it into action against climate change. We describe a Public Health Framework for Developing Well-Being, based on the principles of ecological public health.

Smoking is the largest single cause of preventable illness in the UK. Those with mental health problems smoke significantly more and are therefore at greater risk. The new Health Act (2006) will require mental health facilities in England to be completely smoke-free by 1st July 2008. This article reviews the current literature regarding how smoking affects both the physical and mental well-being of people with mental health problems. It also considers the effects of smoke-free policy in mental health settings.

This article reviews the current literature regarding treatments for smoking cessation in both the general population and in those with mental health problems. The gold-standard treatment for the general population is pharmacotherapy (nicotine replacement therapy, bupropion or varenicline) coupled with individual or group psychological support. This is also effective in helping people with mental illness to reduce or quit smoking, but care must be taken to avoid adverse medication interactions and to monitor antipsychotic medication in particular as cigarette consumption reduces.

Objective: This paper presents a public health model of mental health which places wellbeing at its centre and illustrates how wellbeing is influenced by the inter-relationship between risk, protective and environmental factors. This model should encourage a more comprehensive approach to wellbeing promotion and will assist in developing appropriate mental health public health initiatives. Methods: The model considers how different social and individual risk factors impact negatively upon mental health and how these risk factors can be addressed. It explores the need for active development of protective factors in order to increase an individual's resilience to deal with stresses of life and the additional input required to promote resilience in those with existing mental health problems. This approach to wellbeing balances addressing risk factors with promoting protective factors and uses a public mental health approach to wellbeing promotion within particular settings and the wider environment, supported by both local-level and regional policy. It also suggests that considerable economic savings could be achieved by implementing such integrated management programmes.

OBJECTIVE:To increase understanding of how the prison environment influences the mental health of prisoners and prison staff.DESIGN:Qualitative study with focus groups.SETTING:A local prison in southern England.PARTICIPANTS:Prisoners and prison staff.RESULTS:Prisoners reported that long periods of isolation with little mental stimulus contributed to poor mental health and led to intense feelings of anger, frustration, and anxiety. Prisoners said they misused drugs to relieve the long hours of tedium. Most focus groups identified negative relationships between staff and prisoners as an important issue affecting stress levels of staff and prisoners. Staff groups described a "circle of stress," whereby the prison culture, organisation, and staff shortages caused high staff stress levels, resulting in staff sickness, which in turn caused greater stress for remaining staff. Staff shortages also affected prisoners, who would be locked up for longer periods of time, the ensuing frustration would then be released on staff, aggravating the situation still further. Insufficient staff also affected control and monitoring of bullying and reduced the amount of time in which prisoners were able to maintain contact with their families.CONCLUSIONS:Greater consideration should be given to understanding the wider environmental and organisational factors that contribute to poor mental health in prisons. This information can be used to inform prison policy makers and managers, and the primary care trusts who are beginning to work in partnership with prisons to improve the mental health of prisoners.

# Cultural shift is needed {#article-title-2} EDITOR—The systematic review of Ramsay et al makes a valuable contribution to the debate on whether to screen for domestic violence.1 This debate also needs to consider some of the wider cultural issues influencing the acceptability of the existence of domestic violence in society. ![][1] The taboo of recognising, acknowledging, and bringing into the open issues surrounding domestic violence has led to resistance by the health profession in dealing with what is increasingly becoming understood as an important influence on the health of women.2–5 Domestic violence is not unique: the recent history of the denial of the existence of child sexual abuse has undergone a major societal and cultural shift in the past 20 years, resulting in a heightening of awareness and recognition by health professionals and society at large. A similar cultural shift is starting to take place in attitudes towards domestic violence—for example, with its inclusion within the community safety plans of local authorities. Although clear needs exist for research in determining the effectiveness of interventions for the prevention of domestic violence, part of the resistance towards screening for domestic violence seems to be related to negative attitudes held by health professionals. To address this, more work needs to be done in assessing the training needs of health professionals in relation to domestic violence. Furthermore, the approach to dealing with domestic violence in the health sector may benefit from creating an environment whereby health professionals are seen not to support the use of violence as a means to deal with interpersonal conflict in any setting. A stronger emphasis needs to be placed on becoming a part of the cultural shift … [1]: /embed/graphic-1.gif