Mental Health Promotion For People With Mental Illness

Program Examples

Following are descriptions of selected national and provincial programs that illustrate a mental health promotion approach to people with mental illness.

Creating Supportive Environments

Higher Education (CMHA National, 1993-2002)

Funded by: HRDC

While the role of employment, housing, and social support as factors affecting mental health has been generally acknowledged, the importance of regular education in a post secondary institution for people with mental disorders has often been overlooked. CMHA first broke ground in this area in 1993 with a publication, "Learning Diversity" which identified the problems consumers face in higher education and raised awareness of successful academic accommodations.

Next, research conducted in partnership with Brock University in Ontario illustrated actual experiences of consumers in higher education. It resulted in "The School Book", which contains descriptions of the experiences of consumers who are succeeding in higher education, examples of accommodations, and the role of informal and formal supports in making the education experience a successful one.

The School Book led to partnerships with six universities and colleges across Canada for the purpose of implementing creative strategies for including and accommodating students with mental health problems. These partnerships allowed CMHA to identify "best practice accommodation strategies" and the role of various constituencies: students, faculty, administration and the broader community, can play in making higher education fully accessible. Information about accommodations, rights, and responsibilities is currently being made available, with the help of consumer groups across Canada, on the web.

Whether for the purpose of upgrading qualifications for the workforce, or as an end in itself as a fulfilling, empowering experience on the road to recovery, education is an important element of mental health promotion in the context of community life. Many people who have experienced mental disorders are, or would like to be, joining the ranks of students in higher education; many others experience their first episode of a mental disorder while engaged in higher education. Working with policy makers, educators, students, and communities to make higher education more accessible and accommodating for those with mental illness is an important mental health promotion strategy for this population.

Inclusion in Community (CMHA National, 1993)

Funded by: Health Canada and Trillium Foundation (Ontario)

Inclusion in Community was a two-year project born out of the Canadian Mental Health Association's Framework for Support model. Instead of viewing traditional mental health services as the only response to mental illness, the Framework shifts the balance towards the many natural supports already existing in the community.

One category of these resources, "generic community services and groups", was the focus of "Inclusion in Community". This category represents resources not geared to mental illness, but existing to meet the needs of the general population: welfare benefits, parks and recreation services, service clubs, interest groups for example. The point of the "Inclusion" project was to demonstrate that these generic groups could enhance or even replace formal mental health services while fostering people's integration into regular community life. The project attempted to shift from the "service paradigm", where, for example, social needs must be met through participation as a client in a specialized mental health recreational program, to a "community process paradigm" where the same needs could be met through, for example, attending a dance at the "Y", or joining a community bowling league.

The challenge for the eight Inclusion sites across Canada was to make generic services and groups more accessible to people with mental illness. The approach was to bring together a range of cross-sectoral community partners to jointly identify and implement inclusion strategies. Partners across the different communities, besides those from the mental health sector, included business people, community colleges, government, religious leaders, recreation personnel, and many more.

Different approaches in the various sites included:

• Community theatre troupe illustrating mental health issues of concern
• Various kinds of mainstream employment initiatives
• Consumer/survivor outreach to peers in hospital to connect them to community
• Expanding volunteer opportunities for consumers in generic community groups such as food bank and Navy Vets
• Expanding consumers' access to recreational services at the YMCA
• Consumer-run bakery

Inclusion in Community turned the principles of the Framework into action, and developed new kinds of partnerships that could sustain the momentum beyond the scope of the project.

Strengthening Community Action; Advocating for Change

Mental Health Consumers In Action project (National Network for Mental Health and the Self-Help Connection, Nova Scotia, 2000)

Funded by HRDC, Nova Scotia Departments of Health and Community Services

This three-phase project was designed to develop mechanisms and strategies for enhancing the leadership, capacity, and advocacy skills of consumer/survivors. The project is currently operating in Nova Scotia, Manitoba and British Columbia where consumers are being trained in the areas of: self-help; leadership; participation in community; maintaining mental health; advocacy; and, policy development. The project has also developed guides on the components listed above that are being distributed to consumers in the three provinces. Project staff and participants are individuals diagnosed with mental disorders. Mental health promotion approaches are built into the entire project as the training components address the determinants of health, enhance individual capacity, attempt to change public policy, and have led to decreased reliance on mental health services and social service systems.

Consumer-Led Education and Action for Reform project, (Canadian Mental Health Association, NS Division,1995)

Funded by: Federal Department of Health, Atlantic Region

The purpose of this initiative was to increase the involvement of consumers in mental health system reform in Nova Scotia. To accomplish this, a mental health promotion approach was developed by getting consumers to think about mental health as opposed to mental illness. Project participants were challenged to think about what mental health meant to them, what they did to keep themselves mentally healthy, what barriers existed in their community to staying mentally healthy, and what existed in their community that assisted in keeping them mentally healthy. Consumer participants were trained on self-managed care methods and had the opportunity to develop their knowledge and skills in mental health promotion and mental health policy development. In addition, the CMHA, Community Resource Base model was used to develop a partnership model for mental health system reform that focused on mental health promotion.

Building Individual Skills, Strengthening Community Action

Ontario Peer Development Initiative (1991 - present)

Funded by: Ontario Ministry of Health

The Ontario Peer Development Initiative (OPDI), formally the Consumer/Survivor Development Initiative, was established in 1991 to offer consumers, throughout Ontario, alternative methods to maintaining their mental health beyond the medical/clinical approaches that they had been offered in the past. That year, 36 consumer/survivor projects including local, regional and provincial organizations were funded. There are now over sixty Consumer/Survivor projects throughout Ontario.

The OPDI was established to address consumer issues as set out in provincial policy document such as Building Community Support for People: A Plan for Mental Health in Ontario (1988) and Putting People First: The Reform of Mental Health Services in Ontario (1993). The OPDI is a consumer-run and controlled initiative. All funded projects are consumer-run and operate under a democratically elected board of directors. All staff and board members are consumers. The OPDI Team worked with projects to develop a set of basic operational guidelines that would ensure the following:

• The creation of positive opportunities for consumers in Ontario;
• That projects continue to reflect the innovative aspects of health and social policy set out by government; and,
• That the initiative as a whole continues to reflect a high degree of compatibility with Ministry of Health policy.

The projects offer a variety of opportunities for consumers including:

• Developing and maintaining self-help groups and offering peer support;
• Developing and operating small community-based businesses;
• Providing education, sensitization and training to the public and to mental health professionals;
• Promoting better mental health and related social services;
• Providing opportunities for skills development by consumers;
• Creating and distributing resources based on the knowledge of consumers; and,
• Pursuing artistic and cultural activities.

Through the creation of projects such as: self-help groups, employment programs, educational programs, knowledge and skills development programs, and cultural programs, consumers' capacities were tapped into and they were able to greatly decrease demands on formal mental health services. At the same time, mental health promotion guided their efforts through building individual capacity, enhancing social support networks, personal health practices and coping skills, increasing educational opportunities, enhancing income and social status, and generating work.

The extensive evaluation that was conducted between 1991 and 1995 reveals that participants in these projects reported:

• Feeling better about themselves;
• Being involved more in their communities;
• An improved ability to cope with their mental health issues;
• A decrease in use of more costly traditional mental health services;
• Increased involvement inside and outside the mental health system; and,
• Supports planned and run by consumers were the most helpful alternatives to formal mental health services.

The Self-Help Connection, Nova Scotia (1987)

Funded by: Nova Scotia Department of Health, Mental Health Services

The Self-Help Connection was established in 1987 as a demonstration project of the Canadian Mental Health Association, Nova Scotia Division. It used a mental health promotion approach in its philosophy and in its activities as a self-help clearinghouse. Its purpose is to enable Nova Scotians to improve control over their health by increasing their knowledge, skills, and resources for individual and collective action.

The Self-Help Connection dedicated a full-time staff person in 1993 to work specifically with people with mental disorders. Its approaches includes: encouraging consumer participation; strengthening communities through self-help; promoting mental health through the acquisition of knowledge, skills and resources; promoting choices for enhancing health; foster partnerships; and, do "with" people, not "to or for." Its efforts in the area of mental health promotion through capacity building for people with mental disorders was recognized nationally as a mental health Best Practice in 1999.

Upon analysis, the evidence presented by these programs and initiatives demonstrates that people with mental illness can and do promote their mental health and it supports the Mental Health Promotion conceptual model as outlined earlier. The approach to development and implementation is focused on the individual who has a mental illness, the factors that impact her/his life and on the individual's mental health rather then on the person's illness.

Reorienting Services

Salmon Arm, Adult Mental Health System Progress Report (Canadian Mental Health Association, BC Division,1998)

Funded by: Adult Mental Health Policy Division, BC Ministry of Health and the North Okanagan Health Region and the Coast Garibaldi Health Services Society

What Is It?

The Mental Health System Progress Report is a community-based, action-oriented approach to local and regional mental health system monitoring. The Progress Report process is directed by a local steering committee comprised primarily of consumers, families, hospital and community service providers and mental health managers. In some instances, particularly rural settings, key external groups (family doctors, religious leaders, others) may also be represented. The steering committee is involved in all stages of the Progress Report including necessary adaptations to the process and/or content of survey tools, data analysis, recommendation development and follow-up.

The Progress Report seeks information about the functioning of the mental health system for people aged 19-64 from a broad range of respondents including consumers, families, service providers and key external groups such as family doctors, RCMP, income assistance workers and other government and not for profit agencies and organizations within the community. Data is collected primarily through the use of tailored survey instruments that are consistent with both the National and Provincial Best Practices materials.

The Progress Report is based on the Community Resource Base (CRB) outlined in CMHA National's A New Framework for Support. This model supported the development of a Progress Report based on the way mental health systems are experienced by consumers and families. Using the Community Resource Base as a foundation, three core questions emerged for the Progress Report to address:

• How well does the mental health system work as a discrete system. That is how well do each of the services and supports within the mental health system work together?
• How well does the system, as a whole, interact and respond to other key parts of the community (generic community services and groups such as family doctors, police, drug and alcohol counselors, other)?
• How well does the system support people with mental illness and their families to optimize their recovery?

What It Offers

• Meaningful Change

To date, meaningful changes within the mental health system have begun to occur throughout the North Okanagan as a result of the Progress Report. There is an ongoing commitment in this region to continue to use the Progress Report as one key instrument in ongoing mental health system improvement.

• Local Ownership

The participatory approach allows a wide range of local people to be involved in the development and implementation of the Progress Report thus creating local ownership of the findings and recommendations and increasing the likelihood that the findings will be meaningfully incorporated into future planning and monitoring activities. The participatory approach also allows for considerable creativity in the development of solutions to problems identified.

• Consumer-Focus

The Progress Report maintains its consumer-focus by using survey instruments that collect information that is both relevant and meaningful in consumer's day to day lives. Through the Progress Report process, a community can move beyond decision-making based on anecdotal information to decision-making based on systematically gathered information about people's direct experiences with the local mental health system.

• Community-Focus

Through the involvement of external groups, the Progress Report effectively situates the mental health system within the community in which it operates and thereby captures critical information about system functioning. This information is instrumental in developing practical and concrete recommendations for improving working relationships beyond the mental health system. Outreach to community groups and organizations beyond the mental system helps to strengthen and build on existing relationships.

• Team Building

The Progress Report pulls together perspectives from a variety of key groups (consumers, families, service providers, externals) on system performance in a number of critical areas. The process focuses on creative problem-solving and removing blame by involving service providers throughout and focusing on the future.

• Local Skill Development

The inclusive process builds understanding of evaluation and its importance among consumers, families and service providers involved. Peer interviews, including peer interviewer training and support are also an integral part of the process.

The Salmon Arm approach is a good example of mental health promotion in practice in several ways. It encouraged people's meaningful participation in evaluating their own mental health services. It looks beyond how a system functions to focus on how services impact broader aspects of people's lives. And it builds in community ownership for the results.

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