Mental Health Promotion For People With Mental Illness

Appendix A

Tools and Strategies for Mental Health Promotion

1. Consultation guide

A tool that facilitates consultation on mental health promotion must, first and foremost, be guided by the insights of persons with mental illness. This is in keeping with the fundamental principles of citizen engagement as well as federal, provincial and territorial mental health reform policies. With this in mind, the authors examined what currently excited that would assist in the development of a consultation guide. Interesting information come out of a 1995 project (Consumer-Led Education and Action for Reform project - CLEAR, Canadian Mental Health Association, NS Division) that has been augmented for the following proposed tool.

The CMHA Knowledge Resource Base model (A Framework for Support for Persons With Serious Mental Health Problems, 1993) was utilized to obtain consumers experiential knowledge about what mental health meant to them. Employing the methods used to solicit comments of consumers that participated in this project, the following questions are proposed for the guide:

Consumer Information

Regarding Personal Health

• What does mental health promotion mean to you?
• What do you do on a daily basis to promote your mental health?
• What does the term recovery from mental illness mean to you?
• Have you ever made a recovery plan for yourself?
• Do you practice any recovery methods?
• Where have you gained information about mental health promotion?
• Who in your life supports you the most to promote your mental health?

Regarding Community Support

• What are the resources in your community that help you promote your mental health?
• What are the barriers in your community that prevent you from promoting your mental health?
• What is missing in your community that would help you promote your mental health?

Regarding Other Supports

• Which of the following do you consider helpful to promoting your mental health:
  • Yourself?
  • Family member(s)?
  • Friends?
  • Other consumers?
  • Social services and personnel?
  • Mental health services and professionals?

Community Information

• What assets does your community have that would enhance mental health promotion for its citizens?
• What assets does your community have that would facilitate consumer participation in the community and in promoting their mental health?
• What resources exist in your community that would promote recovery?
• What barriers exist in your community that prevent mental health promotion?
• What barriers exist in your community that hinder consumer participation?
• What barriers exist in your community that hinder consumer recovery?

In addition, the use of a checklist, as presented below, will be useful in facilitating the consultation process. The checklist can be used for examining how various levels of government, communities, families and persons with mental disorders provide action or inaction regarding mental health promotion.

Mental Health Promotion Checklist

Component	Action	Inaction
Healthy Public Policies	__________________	__________________
Reorienting Mental Health Services	__________________	__________________
Building Individual Skills (consumer participation)	__________________	__________________
Supportive Environments	__________________	__________________
Advocacy	__________________	__________________
Community Action	__________________	__________________
Empowerment and Self-Efficacy	__________________	__________________
Coping Skills	__________________	__________________
Prevention	__________________	__________________
Health Promotion	__________________	__________________

2. Evaluation Protocols

The current methods for developing mental health indicators and systems outcomes, while they provide useful information regarding the effectiveness and appropriateness of systems and provide system information necessary for management purposes, they do not address issues of outcomes from the perspective of the user, persons with mental illness.

Many provinces, if not all, have developed consumer assessment tools to determine the level of satisfaction with services provided and to solicit recommendations on how services could be improved to address specific needs of consumers. The assessment tool that would provide clearer information and increased understanding of consumer perspectives and preferences is one that would include some of the following:

• Facilitate the meaningful participation of and input from persons with mental illness (consumers) in the development of mental health services in every province and territory;
• Provide feedback on services and programs to providers on consumer perception; and,
• Provide feedback to governments that would direct further study and research.

Such a tool would include some of these components:

• Consumer satisfaction
• Consumer perception of health status pre and post care
• Usefulness of non-medical services, programs and supports

In addition, a complete strategy around the use of the tool would include:

• Opportunities for consumer input into development of services and programs based on consumer preferences
• Opportunities for direct input to service providers from consumers about their particular care experiences

3. Self-help/Mutual Aid Group Development and Clearinghouse Models

Self-help/mutual aid has long been recognized as a method for enhancing the health/mental health status of Canadians. In fact, it is a world-wide phenomenon.

Self-help was first identified as a health promotion mechanism by Health Canada in 1986 (Achieving Health for All), but persons with mental illness have been involved in and have benefited from involvement in self-help groups across the country for over twenty years. Federal, provincial and territorial governments have been supporting self-help development since the late 80's. Some examples of provincial self-help structures include: The Self-Help Resource Centre of Greater Toronto, Ontario; The Self-Help Connection, Dartmouth, Nova Scotia; and, the Self-Help Resource Association of British Columbia.

Self-help groups are voluntary, small group structures for mutual aid and the accomplishment of a special purpose. They are usually formed by peers who have come together for mutual assistance in satisfying a common need, overcoming a common handicap or life-disturbing problem, and brining about desired social and/or personal change. The initiators and members of such groups emphasize face-to-face social interactions and the assumption of personal responsibility by members. They often provide material assistance, as well as emotional support; they are frequently "cause"-oriented, and promulgate an ideology or values through which members may attain an enhanced sense of personal identity (Romeder et al., 1990).

In a time when there is much debate over the future of health care in Canada, its high costs and ability of the system to sustain itself, self-help/mutual aid offers an effective, low cost mental health promotion mechanism that assists persons with mental illness. While self-help/mutual aid has proven to be highly successful in providing consumers with the knowledge and skills in coping effectively with their illnesses; enhancing their social support networks; increasing their advocacy capacity and involvement in service systems; and giving them a role in public education campaigns, more can to be done to its further growth of this health promotion mechanism. To enhance the potential of self-help, the use of clearinghouses is a viable option that need serious consideration by policy and decision makers and financial support for self-help clearinghouses must be maintained and enhanced by provinces and territories. Clearinghouses provide infrastructure, information and referral, support, self-help group development, service provider education, public education and expand the knowledge of the factors related to self-help development through research.

The following offers an example of the kinds of information clearinghouses can provide to enhance consumers' mental health through self-help by assisting them with some basic steps to starting a self-help group:

Don't re-invent the wheel

Tap into local or provincial resources that can assist in starting a group e.g. a self-help group, a self-help clearinghouse, a mental health organization. They will provide you with enough information that you don't have to start from scratch.

Think "mutual aid" from the start

Find others that are interested in starting the group. Work hard at working
as a team and sharing responsibilities.

Find a suitable meeting place and time

There a many local community organizations and groups that will provide free space for self-help group meetings e.g. churches, non-profit organizations, hospitals, service clubs. The time of the meeting must accommodate and be agreeable to the group members.

Publicizing the first meeting

Doing up flyers and posting them in community locations that a lot of people frequent is one approach. Free announcements in local newspapers and on local cable television, doctors' offices, church bulletins, libraries, hospital bulletin boards, community centres and radio are other method to publicizing your first meeting.

Define the purpose of the group

Defining why the group exists is one of the first steps that the members will deal with. It is important that the members know what the main focus of the group is. This is also important to attracting future group members.

Targeting the membership

It is important to decide who can and who cannot attend the group meetings. The reason for denying membership has to be as clear as the reason for allowing membership.

Deciding on a meeting format

It is a good idea to have some type of meeting format e.g. choice of discussion time, education, business, program planning, socializing.

Using professional help

Professional can often be relied upon to meet with self-help groups. They can play a variety of roles such as speakers, advisers, consultants and sources of continued referrals to the group.

Start projects

It is a good idea to get group members involved in project activities. This help to build the "team" and it allows members opportunities to do something besides going to meetings. It is a form of socializing that helps everyone.

Expect ups and downs

It can be expected that not everything will go without challenges. Attendance can get low as well as members enthusiasm. Assistance is available during these times through contacting other self-help groups or a self-help clearinghouse.

Some practical approaches to support the development of self-help clearinghouses include:

• hosting a provincial or local meeting of existing self-help groups to determine the viability of establishing a clearinghouse;
• targeting potential funding sources for staffing and operations of a clearinghouse;
• ensuring that the mandate of the clearinghouse addresses such basic components as infrastructure for self-help development, information and referral, support, service provider education, public education and research;
• establishing a democratic process for clearinghouse governance; and,
• ensuring that clearinghouse governance structures include a majority of self-helpers.

4. Steps for Developing a Cross-Sectoral Community Inclusion Project

"By defining the problems and needs of people with psychiatric disabilities principally as mental health problems, we have failed to recognize the strength of our communities, of our individual neighbours to become more accepting, to become enriched by the presence and participation of these individuals in their lives" (Carling, 1995).

Inspired by the thinking exemplified in the above quote, a two-year project to promote community inclusion could be planned at the community, provincial, or national level. For a national project, the following steps are suggested:

1. Laying the Groundwork 3 months

- Select five sites, based on mix of various criteria such as rural-urban, geographic, cross cultural representatives

- Hire project staff and develop evaluation sub-group. Develop key outcome indicators for evaluation.

Gather baseline data with focus groups and questionnaires

- Select advisory committee and "site historian" for each site, and train site historians in documentation

2. Completing the Training 2 months

- Plan and implement a two-day knowledge and skill development session with two participants from each of the sites

- Explore inclusion, mental health promotion concepts, practice implications, key outcome indicators, and community planning processes.

3. Engaging Local Partners 3 months

- Support each site to organize an initial one-day information and planning meeting with local consumers, families, community members, and site staff. Provide national support to lead the meeting.

- At the meeting, develop a local action plan and secure commitment to the plan from participants.

- Examples of local strategies might include:

• Supporting the development of consumer-run businesses
• Promoting and implement workplace or education accommodations
• Connecting with generic community services and groups and supporting them to provide supports and services to people with mental disorders
• Enhancing natural helping networks in the community

4. Supporting Local Activity 10 months

- While the local partners in each site work together to operationalize their identified strategy, the national project will provide support. Provide a follow-up visit by national staff during year one and two more visits in year two, ongoing support for identifying and overcoming barriers, and resource materials.

- Obtain and circulate ongoing reports of local activities

- Hold an all-site meeting early in year two for site representatives to share progress, challenges, strategies and renew goals and workplans for remainder of the project.

- Obtain feedback on draft of final report ("Guide to Local Action")

5. Producing a Guide to Local Action 3 months

- Develop a guide to support continuing activity in participating sites and Encourage similar initiatives in other communities

- Disseminate guide to relevant groups and organizations

6. Completing Evaluation 3 months

- Hold a meeting in each site to evaluate progress and learnings.

- Plan strategies for continuity after the project's formal completion date.

- Conduct post-project focus groups and administer questionnaires.

5. Outline for a National Forum on Mental Health Promotion for People With Mental Illness

A national forum on mental health promotion for persons with mental illness is recommended as a next step to acquiring the necessary information, from consumers and others, for developing appropriate federal mental health promotion policies.

Purpose:

The purpose of the National Forum is:

a) To contribute to the current knowledge base about mental health promotion as it applies to people with mental illness;
b) To begin building a national consensus about the importance of mental health promotion;
c) To provide federal, provincial and territorial policy makers with a better understanding of these issues; and,
d) To identify future action steps and strategies.

Process:

It is suggested that the following stakeholders be invited to participate: consumers; policy-makers; mental health service providers; family members; and, community groups.

Agenda:

A two-day event is recommended that would contain the following proposed agenda:

Day I - Morning Session

• Exploration of concept of Mental Health Promotion and Population Health Promotion
• How it applies to persons with mental illness
• Benefits of mental health promotion

Day I - Afternoon Session

• Mental health promotion practical applications (guest speakers)

Day II - Morning Session

• Small group work
  • What are the implications for policy?
  • How to get mental health promotion for people with mental illness on federal, provincial, territorial and local policy agendas

Day II - Afternoon Session

• Concrete Plans: advocacy, practice, new partnerships, research
  strategies.

6. Report Card/Discussion Guide on Mental Health Promotion

If mental health promotion for persons with mental illness is to be incorporated within a mental health reform context, a report card or discussion guide would be useful for engaging stakeholders in discussion and monitoring the activities and progress. Amongst the target groups using the guide, people with mental illness would be key resources for providing direct input and feedback into policy development. We suggest following a format similar to the one presented in the Canadian Mental Health Association's Discussion Guide on Mental Health Reform (1995). Some of the concepts to be included in a Report Card or Discussion Guide include:

1. Policy

Existence of A Mental Health Promotion Policy

A Clear Policy

• Is there an explicit, free-standing mental health promotion policy or policies in place? How was it developed?
• Who was involved in the development? Were consumer groups involved? If not, does the policy need to be modified to reflect the views of these and other stakeholders?

Vision

• Is the mental health promotion policy supported by an explicit vision? What is the vision? Are the various stakeholders aware of and in agreement with and supportive of it?

Principles

• Are there articulated principles? Do they reflect a commitment to: adequate services, consumer rights, consumer involvement, mental health promotion?

Targets

• Does the policy define concrete, measurable targets for reform? What are these?

Ongoing Policy Direction

• What is the basic structure for mental health policy decision-making within federal government ministries?
• Have the various points of responsibility for mental health promotion policy development been clearly identified?
• Is the full range of stakeholders, including consumers, involved in the ongoing development and evolution of policy?
• Is the mental health promotion policy modifiable? Is it evolving and continually being refined?
• What are the evolving connections between mental health promotion, mental health reform and overall health reform?

2. Monitoring and Evaluation

• Is there a mechanism in place to monitor the mental health promotion and policy development process according to its stated principles, goals and timelines?
• Does the mechanism involve consumers and reflect the full range of stakeholders?
• Is there a communications strategy for feeding information about mental health promotion back to:
  • consumer/survivors
  • families
  • mental health service providers
  • other important service providers (who are not in the mental health system)?

Support For Consumer/Survivor Initiatives

• In recent years, the concept of what consumers can do for themselves has grown and developed, and now includes at least seven areas:
  • self-help
  • business development
  • knowledge production and skills training
  • advocacy
  • public education
  • educating professionals
  • artistic and cultural activities.

Initiatives that are run and controlled by consumers represent an aspect of reform which is different from involvement in service system planning. This section refers to those activities, emanating from the concept of self-help, which people do by and for themselves outside the professional service system.

Are mental health dollars being invested directly in mental health promotion strategies for persons with mental illness?

If financial support is being provided, then to what degree? What percentage of the mental health budget is allocated to mental health promotion for persons with mental illness?

Are resources available to allow these groups to hold conferences, develop networks, and initiate other self-directed activities to strengthen their mental health promotion knowledge and skills?

Is organizational support and technical assistance available to consumer groups?

Is there skills training for mental health promotion?

Is service usage before and after participation in mental health promotion activities being tracked?

Are the numbers of people in consumer organizations being monitored?

Are there inventories of groups and their activities, self-reported stories?

[Back] [Table of Contents] [Next]