Mental Health Promotion For People With Mental Illness

Executive Summary

With a growing emphasis, supported by the literature, on promoting health by focusing on individuals' strengths, capacities, and recovery capabilities, mental health promotion is becoming an increasingly relevant concept. This paper explores the potential of mental health promotion for people with mental illness. In the first section it discusses related concepts and builds these into a proposed conceptual model. It then proceeds to examine mental health promotion strategies for people with mental illness: first, general strategies corresponding to identified action areas for health promotion, and then some specific examples of national or provincial programs. The paper ends with a set of recommendations for the federal government and an appendix offering specific tools and implementation methods for governments or communities to use in pursuing this issue.

A number of concepts are germane to the discussion. Some of these pertain to health in general (such as population health, health promotion, sense of coherence) and others deal more specifically with mental illness (such as Health Canada's two-continuum model, the bio-psycho-social approach, CMHA's Community Resource Base and Knowledge Resource Base models, the Effort Spectrum in Mental Health, recovery and resiliency). These concepts contribute to a perspective that the goal of mental health promotion for people with mental illness is to ensure that these individuals have power, choice and control over their lives and mental health, and that their communities have the strength and capacity to support individual empowerment and recovery.

The Ottawa Charter for Health Promotion outlines a number of actions and strategies that can serve as an organizing principle for taking action with this specific population. These are: strengthening community action/advocating for change, building individual skills, creating supportive environments, reorienting health services, and developing healthy public policy. For each of these action areas, there are related strategies that are specifically geared to people with mental illness. These include promoting self-help; building skills for daily living, participation and advocacy; combating stigma and promoting community inclusion; shifting the focus of services toward promoting autonomy and connecting with community; as well as ensuring that policies support consumer capacity, citizenship, and recovery.

The strategy suggestions are not just theoretical. It is possible to find numerous examples of past or current mental health promotion programs for this population, although they may not always have been labelled as such. This paper describes several of these examples. They include programs geared toward promoting inclusion in community and higher education, community development initiatives, self-help approaches, a recovery-oriented evaluation system, and promotion-oriented policies.

There are many ways the federal government can help to support the mental health of people with mental illness. Specific strategies for each action area of health promotion are suggested in the paper. In general, by actively involving consumers, pilot testing models, promoting research and information sharing, holding consultations, identifying guidelines, and developing policy, the federal government can play a leadership role in this area.

This paper demonstrates conclusively that mental health promotion, which applies to the entire Canadian population, is a relevant and appropriate enterprise for persons with mental illness.

Introduction

The Issue

With a growing emphasis, supported by the literature, on promoting health by focusing on individuals' strengths, capacities, resiliency and recovery capabilities, mental health promotion is becoming an increasingly relevant concept.

The Ottawa Charter on Health Promotion, produced in 1986 by the World Health Organization, is recognized internationally as a key instrument for focusing policy and program discussions on how health is created, and how health can be achieved equitably by a society as a whole. Its definition of health promotion as the process of enabling individuals and communities to increase control over the determinants of health and thereby improve their health persists to this day.

Viewed through the lens of the 21 st century, it is clear that this description combines key elements of what are now two separate concepts: the notions of health promotion as a process for enabling people to take control over and improve their health, and population health as an approach that addresses the entire range of factors that determine a population's health.

With the concepts of health promotion and population health becoming generally accepted around the world, attention is now being paid to their application to specific population groups. But to which groups does mental health promotion apply? Specifically, what about people diagnosed with a mental illness? Mental health promotion efforts are not intended to cure, treat, or prevent major mental illnesses. If mental illnesses are most effectively addressed through treatment and formal services, then the mental health promotion approach is not the appropriate one to take in those situations. What then is the place, if any, of mental health promotion for this population?

The response, that mental health promotion applies to the entire population, including those with mental illnesses, is generally based on the belief that mental illness and mental health are not mutually exclusive and that both have to be addressed through new kinds of policies and practices. It draws on research that demonstrates how a mental health promotion approach to service delivery and community development is possible, but generally outside the realm of medical treatment. Focusing on the person's abilities and capacities, this approach can result in enhanced strength, resilience, and self-confidence among persons diagnosed with a mental illness, and an overall reduction in their dependency on financially burdened mental health systems.

This paper will present a conceptual framework for understanding mental health promotion for those with mental illnesses. Based on the framework, it will explore how mental health promotion strategies can be applied to persons diagnosed with a mental illness and will examine the policies and methods of implementation needed to support these approaches. It will conclude with a set of specific recommendations to the federal government in implementing national policies and action steps that will enhance mental health promotion for this population, and some specific tools and strategies for a national level approach for mental health promotion for people diagnosed with a mental illness.

The paper will thus make the case that people with mental illness must not be excluded from the enterprise of mental health promotion. It illustrates strong and effective strategies that enhance the mental health of this population, and, drawing on recovery research, underscores the power and potential of mental health promotion approaches for protecting and restoring the mental health of those with mental illness.

Who The Authors Are

The authors, Bonnie Pape and Jean-Pierre Galipeault, share a particular passion for self-help/mutual support and mental health promotion, and for applying that philosophy to people who have experienced serious mental health problems. Bonnie's work experience in mental health has been at the Canadian Mental Health Association National Office for the past 16 years, where she is currently Director of Programs and Research. Jean-Pierre's experience in the field during the past 13 years includes that of Director of Programs, Policy and Research with the National Network for Mental Health in St. Catharines , Ontario and former Programs Manager at the Self-Help Connection in Dartmouth , Nova Scotia . Currently he is co-owner/manager of The Empowerment Connection, a mental health consumer/survivor-run business in St. Catharines , Ontario .

Acknowledgments

Special thanks to Barbara Neuwelt and Glen Dewar for carefully reviewing this paper and providing extremely helpful and valuable suggestions. Also, to Sylvia Berkhout for her personal and technical support.

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