No Health Without Mental Health

Part 1 - Mental Health Promotion for People with Mental Illness
From: The Canadian Health Network

Good health means having both good physical and good mental health. This is the first in a two-part series on mental health promotion, an umbrella term for strategies and activities aimed at having a positive effect on mental health. Part One explores mental health promotion for people with mental illness and Part Two, to be published on May 15th, shows how promoting mental health is good for us all.

• A group of mental health consumers gathers in North Bay, Ontario, for a training session about WRAP: a Wellness Recovery Action Plan designed to help them recognize signs of a relapse, and teach them techniques to help prevent them from becoming seriously ill again.



• In Medicine Hat, Alberta, the coordinator of a program that helps people with a mental illness find and keep mainstream employment speaks with patients at the regional hospital psychiatric ward about how the program can work with their wellness plan.



• At a meeting of a mental health consumer support group in Sudbury, Ontario, a valued board member's resignation is applauded when his peers learn the reason: the demands of his new job as a supervisor at a large company.

You might conclude that the common thread in all these scenarios is mental illness. That is true, but it's only one strand of a richly woven fabric. What links these people is that, in each situation, mental health promotion is at work, providing a range of supports and resources that help people with a mental illness gain control over their lives and build the resilience they need to cope and move forward.

What is mental health promotion (MHP)?

But what exactly is mental health promotion? Ask five Canadians, and chances are you will hear five different responses. Some people think it refers to public awareness and education campaigns. Others believe it means programs, while others see it more as a philosophy. The definition of MHP varies even among organizations that have a mandate to assist people with a mental illness or a mental health problem.

In fact, MHP encompasses all these elements and includes many key principles of health promotion theory and practice. In 1986, the Ottawa Charter on Health Promotion, produced by the World Health Organization, defined health promotion as "the process of enabling individuals and communities to increase control over the determinants of health and thereby improve their health."

This definition does not separate out people with a mental illness. "Mental illness and mental health are not mutually exclusive," points out Bonnie Pape, former Director of Programs for the Canadian Mental Health Association National office (CMHA). "People don't always understand that you can have an illness and at the same time have health." For example, a person with bipolar disorder can, with the help of treatment, learn coping skills that enable them to maintain healthy relationships and employment. The symptoms remain, but their effects on a person's quality of life can be reduced.

Mental illness in Canada – a growing concern

Mental illness affects all Canadians at some time, indirectly through a family member, friend or colleague, or directly through personal experience.

• One in five Canadians will develop a mental illness at some time in their lives



• Mood disorders affect an estimated 10% of Canadians



• Anxiety disorders affect approximately 12% of Canadians



• Stress and mental health-related problems represent 40-50% of the short-term disability claims among employees of some of Canada's largest companies



• In 1998, the total value of lost work time in Canada due to depression was $2.16 billion. The total economic burden of mental disorders was $14.4 billion.

Mental health promotion builds on strengths

For people with a mental illness, MHP focuses on a person's abilities and capacities to enhance strength, resilience and self-confidence. Effective MHP involves strengthening people's coping skills, and above all, their ability to take control over their lives, thereby improving their mental health.

Since mental health promotion applies to everyone in society, it follows that its ripple effect touches all aspects of our lives. The benefits of MHP include:

• improved well-being
• enhanced networks of social support
• greater social inclusion
• reduced stress
• better understanding of the needs and experience of people with mental illness.

Mutual support is key

Social inclusion is a recurring theme in any discussion about MHP. Ask Ellen Cohen why she is so passionate about the consumer/survivor network she helped create and she says simply: "It stopped the isolation." The North East Ontario Consumer Survivor Network (NEON) has 200-300 members, meets on a quarterly basis and offers peer support and training opportunities.

"It was very isolating when you didn't have a peer group to share with," says Ellen, NEON's North East Regional Coordinator. "People may be frustrated by developing their own organization, they might get mad and need a place to vent, but at the same time they're learning coping skills, they're learning skills to deal with conflict, to develop something positive."

NEON may have been launched with peer support as its primary goal, but that has since grown into skill development initiatives, such as WRAP and suicide/crisis prevention, as well as participation in the regional awareness campaign, We All Belong.

"Mutual support, to me, is just about the best example of MHP going," says Bonnie Pape. "Instead of being a recipient of services in an illness model, people are providers of health to one another and they're identifying their capacities and strengths and what they're good at."

A practical tool kit for communities

Mental health promotion is a positive approach to positive mental health. In the Mental Health Promotion Tool Kit, developed by CMHA, MHP is described as "any actions which are taken for the purpose of fostering, protecting and improving mental health."

From posters about depression to community-level advocacy for improved housing, from skills training to peer support groups – if improved mental health is the goal of any initiative, it qualifies as mental health promotion.

Mental health promotion helps people find jobs

Routes to Work, an initiative of CMHA National, started as a one-year program in 1996. Since then, it has expanded to seven sites across Canada, and has helped over 300 people with mental illness to gain employment, and over 425 to enhance their employability.

Employment has been identified as one of the prime determinants of health. As a source of money, social contacts and identity, work has a huge impact on our physical and mental health.

"Routes to Work fits the person to the job and offers so much support along the way," says Julie Flatt, Program Manager. Julie credits Routes' employment support workers (ESW's) for a tremendous amount of mental health promotion, especially in the area of public education. "Our ESW's sensitize people to the fact that mental illness is not a distant thing any more," says Julie. "It opens them up to the fact that maybe their workplaces have to change."

Sarah Carleton, a Routes to Work ESW in Kingston, Ontario, develops her portfolio of potential employers through meetings and by holding workshops about mental illness. "I try to demystify people with mental illness in the workplace," she says. Recently, banks, in particular, have demonstrated a willingness to accommodate diversity. "They've been open to offering interviews with my clients," she says. 'They're pretty educated about mental illness."

In Medicine Hat, Alberta, Routes to Work coordinator Duncan Dyer makes sure other community agencies know all about the program. "We're fortunate in having a really cohesive network," he says. "Most of our clients are referred by other agencies."

At NEON in northern Ontario, some members have found mainstream employment. "These are valuable people that were so beaten and so ill," says Ellen. "They were told they'd never be able to work, that they would always be on drugs, and now they're out and as a result of being involved in a consumer organization, many have become coordinators, executive directors, staff and peer support members."

Mental health promotion benefits everyone

"When we talk about the benefits of MHP for people with a mental illness, we use terms like recovery - and this is not like recovering from the flu, it's having the feeling that you can get on with your life, that you can cope," says Bonnie Pape. "The things people say contribute to their recovery are very similar to how we understand MHP: inclusion, feeling accepted, that someone believes in you."

And that leads to believing in oneself, like when members of NEON participated in the regional awareness campaign, We All Belong, from 2001-2005. They made presentations and held workshops across northern Ontario, and as they informed their communities about mental illness, their pride grew. "You could see people getting strong," says Ellen Cohen. "These were unexpected results, how it empowered people, how it made people well."