Mental Health Promotion For People With Mental Illness

Creating Healthy Public Policy

The Mental Health Commission of New Brunswick

Funded by: Health and Community Services, New Brunswick

In October 1988, the New Brunswick Minister of Health and Community Services announced the formation of a Mental Health Commission to implement the government's vision of a balanced mental health system, inspired by the Framework for Support's Community Resource Base. Informed by consumer and family advisory committees, the Commission was charged with implementing a policy framework, calling for, among other things:

• A balanced network of institutional and community-based mental health services
• The use of all possible community-based options before institutionalization
• The allocation of adequate resources to, in particular, community-based services
• The development and strengthening of informal support groups for mentally ill individuals
• An increased emphasis on prevention of mental illness

The Commission was successful in reallocating resources from the institutional sector to community mental health services and supports. Notably, the greatest percentage reallocation in the first two years of the Commission's operation was to alternatives to hospitalization, child and adolescent services, and the self-help movement. Although the Commission no longer exists, its impacts are still apparent in New Brunswick mental health policy where by far the lion's share of mental health resources is in the community sector, and a budget line continues to exist for "Activity Centres": consumer-run self-help programs (Niles and Ross, 1992).

Early Intervention

Funded by: UK Department of Health

Early psychosis intervention makes use of a variety of strategies which span treatment and health promotion approaches. Its protocols include treatment with anti-psychotic medications at low doses and small increments. However, it also entails enhancing family and adolescent coping skills according to a recovery model, as well as strengthening the capacity of community (such as secondary schools) to understand and respond to first episode psychosis.

In the UK, the government's agenda for early intervention includes a Service Framework, a National Health Service Plan, and a Mental Health Policy Implementation Guide. The need to reduce the period of untreated psychosis is clearly stated, and multidisciplinary early intervention teams are planned for regions across the country to provide treatment and active support to young people and their families. The goal is that by 2004 all young people with a first episode of psychosis will receive the early and intensive support they need (UK Department of Health, 2001).

Recommendations for the Federal Government

Based on the discussion to this point, there are a number of suggested steps the federal government can take to enhance the mental health of people with mental illness.

Creating Supportive Environments

• Disseminate accurate public information about mental illness and mental health to reduce stigma
• Pilot test models for promoting accommodations in work and education, and for promoting non-custodial housing options, and disseminate effective innovative strategies
• Develop policy guidelines for inclusive higher education settings and workplaces (in partnership with HRDC)
• Partner with justice to support development of human rights legislation and effective, equitable approaches for consumers who come into contact with the criminal justice system and the law
• Build collaborative interdepartmental and intersectoral relationships to address issues of poverty and exclusion; hold a national consultation on the impacts of income issues on consumers' quality of life (in partnership with HRDC, CCSD)

Strengthening Community Action/Advocating for Change

• Support the development and evaluation of various models of consumer self-help initiatives
• Enhance information sharing across Canada regarding consumer self-help models
• Support provincial and territorial self-help clearinghouses
• Maintain and enhance a national consumer organizational infrastructure
• Pilot test models for mobilizing generic community groups and organizations to support inclusion of people with mental illness

Building Individual Skills

• Promote research and information sharing on effective and innovative practices (such as cognitive behaviour therapy) for skills building among people with mental illness
• Disseminate information and tools for building skills for participation and advocacy by people with mental illness
• Promote consumer generated self-managed care models
• Develop and disseminate mental health promotion information and tools to persons with mental illness
• Establish a web site that provides information about mental health promotion and recovery, including mailing lists for access to information about upcoming events and opportunities to dialogue about recovery.

Reorienting Health Services

• In consultation with consumers, identify guidelines for best practice in promoting mental health for people with mental illness
• Pilot and support the development of "recovery" oriented service delivery models
• Research and develop mental health service system models that are not based solely on needs, but rather focus on individual and community strengths and capacities
• Encourage and implement cross-sectoral sharing of information about effective practice

Developing Healthy Public Policy

• Develop and incorporate a Mental Health Promotion framework to guide policy development, resource allocation and outcomes evaluation; include a policy on early psychosis intervention
• Promote and support consumer participatory action research on mental health promotion practices
• Hold consultations with consumers about mental health and recovery
• Support and host a public policy forum on mental health promotion for persons with mental illness
• Develop a Mental Health Secretariat that includes consumers within its membership

Conclusion and Moving Forward

It is clear that there is an important place for mental health promotion approaches when dealing with people with mental illness. As stated on the web site of Health Canada's Mental Health Promotion Unit:

"Mental health promotion is an approach that (applies equally to all people) regardless of psychological or medical diagnosis... It rejects reducing or confining individuals with vulnerabilities into a sickness, and emphasizes how important a mental health promotion approach can be to improve their well-being and quality of life, so as to help them overcome their difficulties. Thus, while a person may be identified as sick, needy or down-trodden, that person still has resources to draw on, skills to offer and talents to be nurtured" (Health Canada, Mental Health Promotion website, 2002).

Moving Forward

Our exploration of this area has revealed some significant fundamental concepts in regard to mental health, coupled with examples that demonstrate the potential for people with mental illness to benefit from mental health promotion strategies. What is needed now, therefore, is a coordinated strategic effort to apply these concepts to the population of those with mental illness.

As a start, let us highlight a need for more research. Although there are many interesting models being implemented in this country and elsewhere, few of these have been evaluated, and even fewer have made their way into the literature. A review of the current literature revealed no information specific to mental health promotion and persons with mental illness. Either it simply does not exist, or a lot of initiatives that are undertaken by consumers and community agencies do not get published in ways that make them easily identifiable within the research community and literature review environments. Efforts need to be made to enhance the literature on mental health promotion for people with mental illness. It is important to legitimize and promote consumer and community documentation on mental health, resilience, and recovery (Trainor, Pomeroy, and Pape, 1997).

Specifically, we have found calls for more studies that are controlled and systematically evaluated and for more research into the area of health promotion for specific mental illness where the illness or treatment factors may affect health behaviours (Sherr, 1998). There are also calls for research and evaluation that reflects the consumer perspective. "It is not enough simply to reframe any and every service provided for people diagnosed mentally ill as mental health promotion. To be consistent with health promotion principles, these must be demonstrably grounded in the concerns of service users themselves and evaluated accordingly. At present, needs assessment studies that reflect service users' concerns are rarely reported in the literature and evaluative research is scarcer still. Health promotion specialists could, therefore, make a significant contribution in this area by working with other interest groups to develop and implement appropriate needs assessment and evaluation research strategies" (Secker, 1998).

In addition, research that can demonstrate the cost effectiveness of mental health promotion approaches would be extremely valuable. Proponents of this perspective believe intuitively in its efficiency as well as effectiveness, but systematic studies are needed. This is an area for focus for the future.

We hope that the thoughts, tools, strategies and evidence in this paper will help guide further discussions and debates regarding mental health promotion related to persons with mental illness. The evidence presented confirms that mental health promotion can and does apply to this population. The challenge now is to operationalize this knowledge through policy and practice.

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