Issues and Challenges The mental disease in many countries is concentrated in hospital based psychiatry.

But recently there is an increasing awareness to shift the mental health services to the community and to give more emphasis to the community based mental health programmes. The same is the case regarding substance abuse. This too has to be dealt in community level from the first level of substance abuse. The ill effects caused as a result of excess alcohol and substance consumption has become a major problem in the communities. This is considered as a public health problem. So there is an urgent need to make the government aware of the ill effects of this and to ensure the government has taken adequate measure to control the problem to an extent, because the substance can gradually lead to mental health problems and thus social problems. So the community based mental health programme also includes dealing with the substance abuse cases. The mental health services should be integrated with the overall primary health care services of the primary health care centers and community based health care programmes. So the programme is aimed at reducing the rate substance dependence aiming the individuals. Health Promotional Models There are several approaches or models related with the heath promotion. There are four main models which are related to this. They are medical approach, educational approach, empowerment and social change. The detail study of this will help to understand the importance and advantages of each model. The medical approach The medical approach is aimed at reducing the premature mortality and morbidity level. The population is mainly aimed at the population of high risk group. This model supports the medical intervention in the problem situations, which will prevent the individuals from ill health and from premature death. The medical approach becomes popular because of two main reasons. They are; It high status which is caused by the use of scientific methods It provides the early detection of disease and its prevention. It is is also cheaper than giving treatment for the people with illness. The medical approach is conceptualized in the absence of any diseases. It is not promoting the positive health, so it can be criticized for ignoring the situation prevailing in the environment. Another negative of medical approach is, it supports the dependency on medical knowledge. It does not give much importance for the healthy decisions and life style of the people. It mainly target at preventive services and like immunization and screening. They also target to particular groups, who suffer from any diseases. Another drawback of this method is when comparing to the medical treatments, which are attempting to detect and prevent any kind of diseases is very costly. It also need a good infrastructure for providing the immunization and screening programmes for all the individuals. So if the infrastructure is week there are chances of risk for the provision of the service. This approach also needs trained personnel, medical equipments like laboratory and other devices, good information system to decide who all are eligible for the procedures and updating of records and for the information regarding the effective vaccine needed for immunization.

The educational approach The educational approach is aimed at providing information and awareness to the people. So that they can identify the symptoms of diseases and can have needed medical treatments without much confusion. This is also aimed to teach the public the health leaving styles and to ensure the health lifestyle among them. The education al approach is something different from the behavioral change approach. Because the behavioral change approaches they people are persuaded and motivate any particular kind of life styles

and behavioral patterns. But in educational approach one the information is delivered to the people. Nevertheless the education is given to have any outcome from the people. The educational approach is based on certain assumptions, which are about the relationship between the knowledge and behavior. This approach says that, a change in the level of knowledge will lead to a change in the behavior, which is most probably a positive one. In the educational approach, the health information is provided to the clients, so they will be well informed about their health behaviors. The information can be delivered through leaflets, pamphlets, one to one advice, and visual displays and so on. The clients are also given opportunities to share their experiences and attitudes and to clarify their doubts. This opportunity is given through debates, group discussions and one-to-one counseling. The educational programmes will help to develop the clients decision making skills about their skills. There are also role plays and other activities which can achieve it in a good level. The clients can also clear doubts related to the real life situation. The increase in the knowledge is easy to measure. The education can be also give through mass media. However all the kinds of educational services have showed an increase in the level of health information among the public. Awareness about the risk factors also is found. Only by providing information one cannot change the behavioral pattern of an individual. It needs good desire and the ability to change ones own behavior. But there is no guarantee that the individual will respond in such a way. So good encouragement and support is needed to make the people adapt the behavioral changes as said in the health education

Empowerment The health promotion in the words of WHO is promoting the people to adapt healthy lifestyles and to have a control over their lives. SP this approach will help people to understand more about the healthy life style and to adapt it. They will be more concerned about their health and life styles. Through this the people will identify and develop their own life styles, identify their own problems and will gain enough confidence to act upon them. Unlike all other approaches, in this approach the role of health promoters is the role of facilitators. They act as a catalyst and help them to get things done and withdraw from the situation. To describe the approach, sometimes the term self-empowerment is used. The approach is mainly promoting the health awareness by counseling or any other non-directive client-centered approaches. These all are aimed to help people to have a control over their lives. For making the people selfempowered, they need to; Recognize as well as understand their powerlessness Should have a strong feeling that their situations should be changed. Should have enough confidence that they are capable of changing the situations, with the support of the information they have acquired Evaluating this process may be a bit difficult, because this empowerment process is a long process. So it is very difficult to recognize the changes which are made due to the intervention, because changes can be happened due to other factors also. The positive result will be very hard to recognize also, especially when compared with the outcome of other approaches, because the changes in behavior cannot be measured in the terms of quantity. The evaluation will be the measurement of how much the group has changed on the basis of the intervention and how much the group has been empowered. This approach is not very applicable and suitable for the target group.

Social change The social change approach deals with the effect of social and economic changes to the health of the individuals. The main focus of this approach is at the policies and the environment levels. So by influencing them the approach is trying to bring changes in the health of the public. The physical changes can make changes in the overall health of the people. The economic, social and physical environments have a vital role in influencing and promoting the health. So this approach is focusing on changing the society for a health life, and it is not concentrating on changing the behavioral pattern of the individuals. The target of social change is groups and population. The method it adapts is a top-down method of working. For the successful implementation of such a project in the public, however it needs the support of the public who are aware of the project and its needs. This method is limited than the traditional behavioral and medical approaches for the health promotion workers. This approach is not considered as a successful one because, rather than dealing with the health promotion directly, it is trying to change the society and the practices by approaching the political system and the law and policies. This is concentrated on changing the society rather than changing the individual health styles. This promotional approach may be so effective and significant, but sometimes it may not be capable to change the individual health behavior in large scale.

Conclusion In summary the use of the two health promotion models have worked well to help produce a self awareness leaflet to promoted testicular cancer. The artefact was aimed to be a fun way of promoting a serious disease, to enable men to discreetly access relevant information. It would, however, be hard to measure the effectiveness of this leaflet. The only way it could be measured is by monitoring the volume of males contacting their local doctor or NHS service seeking more advice on this subject and presenting the early stages instead of later ones. My goal of changing the target populations behaviour and educate them about the importance of TSE was hopefully achieved. I have learned the importance of empowerment and health promotion, and how a nurse uses these health aspects to improve an individuals health.