Mental Health Supplement
The State Of Mental Health 2016 Challenges & Opportunities
Mental Health Promotion Requires Social Change: A Communication Challenge
In the field of mental health, the paradigmatic distinction between the treatment of diseases on the one hand and health promotion on the other hand has become particularly evident. Although the necessity to prevent mental diseases is obvious because the cost for mental health care have risen enormously in Germany in the last few years, the major part of the resources is invested reactively, that is when an increased risk disposition or a disease has been diagnosed.
Therefore, in terms of the pathogenetic approach it is primarily a treatment of diseases than the promotion of health. Strictly speaking, even the term ‘prevention’, aiming at the reduction of health risks and damages and therefore looking primarily at avoiding the occurrence or spreading of diseases, is associated with disease or potentially disease-causing factors. Health promotion, however, has another focus: From a salutogenetic perspective it looks at protective factors and resources and aims at strengthening the individual skills for coping with life and at building health-promoting environmental conditions1. A decisive point here is resilience. That is the ability to cope well with changes and the ups and downs of life and to develop oneself also under the most adverse conditions2. Sufficient resilience enables the individual to maintain a balance between the subjective perception of stress and one’s own coping resources. Such an approach has a special potential to sustainably improve the population’s mental health because in the development process of mental disorders it starts at the earliest possible time. So it should be possible to reduce not only the incidence rates and the individuals’ disease burden but also excessive treatment and follow-up cost as well as problems due to gaps in medical care. But addressing resilience only by emphasising the individual’s responsibility for preserving mental health carries the risk that relevant socio-contextual factors of mental health promotion are not sufficiently taken into account. This corresponds to wide experiences of health professionals con-cerned and involved, who clearly state that the current conceptions of mental health and resilience have to be extended and amended. Therefore, it is important to take this systemic and socio-ecological perspective into consideration whenever efforts of mental health promotion are developed3.
From Disease Communication to Health Communication
At its core, the promotion of health is a communicative challenge – at the individual level, at the level of the social environment as well as at the political level and at the level of the society as a whole. On every level it is necessary to initiate a ‘salutogenetic change of perspective’ and to first raise awareness for the value of and the need for resilience. Analogous to the way the health system is focusing on the treatment of diseases rather than on health promotion, communication efforts and public discourses are concentrating on aspects of diseases instead of health: ‘Disease communication’, which in the pathogenetic sense focuses on illness and risk factors, is dominating, while a salutogenetic perspective and, thus mental health and conditions promoting mental health are hardly made a subject of discussion. Accordingly, mainly mental stress and its consequences are recognised as important social topics. These ‘disease-accentuating discourses’ are supposed to be a major cause of the lack of public awareness, understanding of and support for measures to strengthen resilience and it calls for a change of thinking and acting in all social areas. These changes of perspective can only be initiated by communication. Consequently, any effort of mental health promotion requires a ‘resilience-oriented communication strategy’, that is to emphasise the importance of mental stability, the requirements and possibilities to strengthen mental health. This should stimulate public awareness and initiate changes in social discourses which can lead to political and programmatic innovations and, finally, make change happen4.
Hurrelmann & Richter, 2013, p. 14 Mandery & Bomke, 2015, p. 37 3 Bomke, 2015 4 Bomke & Kendall-Taylor, 2014, p. 179 1 2
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Mental Health Promotion Requires Social Change: A Communication Challenge
Cognitive Schemata and Cultural Models as Starting Points
Communicators face the challenge that frequently they do not even reach people with their messages or that messages are understood in a different way than intended. This often results from a large discrepancy between the health and communication experts’ demand for high quality standards of health information on the one hand, and the existing knowledge, problem awareness as well as the willingness and ability of information processing of lay people on the other hand. This particularly holds true for vulnerable and, thus, especially important, target groups. Therefore, the analysis of the factors influencing whether and how information reaches people is fundamental. It depends on the individual’s available cognitive scheme. Schemata are structured and quite stable patterns of knowledge, attitudes, and experiences regarding issues, events, situations, and objects which form a network of associations5. This association network has an impact on how people select, process and respond to information. A cognitive scheme that is culturally shaped and shared in a social group is referred to as a cultural model.6 Looking at the topic of resilience it is to be assumed that to date, for mental health no differentiated or only a rather biased cognitive scheme or cultural model exists; the awareness for resilience, for the importance of resilience-sensitive attitudes and for the need of promoting resilience has not been considered really relevant in the broad public.
Changing the Individual and the Public Agenda by Framing
Adequate communications strategies are capable to influence cognitive schemata or cultural models, impart knowledge and encourage an individual’s self-reference and, thus, open up new roads for our thinking. By using so called strategic framing7, certain aspects of reality are selected, emphasised and evaluated, while other elements are neglected. Aiming to modify attitudes and cognitive associations referring to resilience requires to emphasise health-related aspects and protective factors and to put this facet of the topic on the public and individual agenda by means of communication and public relations. A comprehensive framing strategy considers the existing perceptions and values of individuals and groups as well as the socio-cultural contexts by considering the people’s everyday reality and living environment when developing the message. Promising means are illustrative and narrative ways of communication breaking down complex scientific information to simple and low-threshold messages customised for each target group. For instance, metaphors can concretise abstract concepts in such a way that they are easy to understand and activate emotions. As a result, it is possible to reorganise information, fill in gaps of understanding, and, therefore, reframe existing frames and cultural models8. This framing process should take place on all levels of communication in order to change the social debate and initiate a change in the system towards the promotion of resilience.
References
Bomke, P. & Kendall-Taylor, N. (2014). Framing change. Pan European Networks, 11, pp. 178-179. Bomke, P. (2015). Tracking down the effect of resilience – a systemic view helps, in: http://www.adjacentgovernment.co.uk/special-reports/tracking-effect-resilience-systemic-view-helps/19212/ (downloaded on 03/31/2016) Brosius, H.-B. (1991). Schema-Theorie - ein brauchbarer Ansatz in der Wirkungsforschung. Publizis-tik, 36 (3), pp. 285-297. D’Andrade, R. (1987). A folk model of the mind. In D. Holland & N. Quinn (Editor), Cultural Models in Language and Thought (pp. 112–148). Cambridge: Cambridge University Press. Hurrelmann, K. & Richter, M. (2013). Gesundheits- und Medizinsoziologie (8th revised edition). Wennheim & Basel: Beltz Juventa. Lindland, E. H. & Kendall-Taylor, N. (2012). Sensical translations: Three case studies in applied cogni-tive communications. Annals of anthropological practice, 36, pp. 45–67. DOI:10.1111/ j.2153-9588.2012.01092.x Mandery, M. & Bomke, P. (2015). Der richtige Rahmen. GesundheitsWirtschaft, 9(4), pp. 36-37. Matthes, J. (2007). Framing-Effekte. Zum Einfluss der Politikberichterstattung auf die Einstellungen der Rezipienten. München: Verlag Reinhard Fischer. Scheufele, B. (2006). Frames, schemata, and news reporting. Communications, 31 (1), pp. 65-83. e.g. Brosius, 1991; Scheufele, 2006 D’Andrade, 1987, p. 112 7 Matthes, 2007 8 Lindland & Kendall-Taylor, 2012, p. 49 5 6
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Eva Baumann (right), PhD, Professor of Communication Studies at Hanover University of Music, Drama, and Media | Department of Journalism and Communication Research | Hanover Center for Health Communication Mareike Schwepe (left), B.A., Student Assistant at Hanover University of Music, Drama, and Media | Department of Journalism and Communication Research | Hanover Center for Health Communication The Hanover Center for Health Communication is a member of the “The Palatinate makes itself/ you strong - ways to resilience” initiative. Paul Bomke (3rd from left) Pfalzklinikum – Service Provider for Mental Health – Projectleader of the “The Palatinate makes itself/ you strong - ways to resilience” initiative Weinstraße 100 76 889 Klingenmünster www.pfalzklinikum.de
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Organisational resilience: corporate structures and strategies to cope with changes and crises
The ability to advance personally even in times of crisis, to be able to cope well with changes and with the ups and downs of life – this is what is generally summarised under the term resilience. Resilience is of utmost relevance for individuals, but equally for organisations. The ability to advance personally even during times of crisis, to be able to cope well with changes and with the ups and downs of life is what is generally summarised under the term resilience. Resilience is of the utmost relevance for individuals, but equally for organisations. Organisations, very much alike individuals, operate in settings that undergo permanent changes. For instance, for companies that work within highly dynamic, globalised markets, their operations are impacted by ageing workforces equally as by the rapid pace of technological progress, to name only few of the many megatrends companies are faced with. These dynamics may trigger crisis situations in companies or organisations in general, which are cropping up at an ever more rapid pace, hence permanently increasing the pressure on them to adapt accordingly. Such crisis situations almost invariably call for rapid and comprehensive action to ensure an organisation’s survival in the long term. The ability of an organisation to cope with these external and internal changes is called flexibility. Flexibility can mean reacting to these changes, but also proactively preparing the organisation to foreseeable or likely risks and opportunities well in advance. Flexibility, however, can also mean to be open for new types of information and for different perspectives on, and new interpretations of, existing data and information. In a production environment, flexibility could mean the ability to adapt almost instantly to the production volume and capacity to meet customer demands, to produce variations of the product to better match customer needs, to speed up product delivery or increase the level of adherence to delivery dates, or to invent, produce and market tailored products with a competitive time-to-market. Similar criteria are valid for service environments, including administrations. Unfortunately, flexibility often is implemented by ‘privatising’ corporate flexibility requirements, that is by passing them through to each individual member of the organisation. Statistical data for Germany over the last 20 years show a continuous move of organisation towards this flexibility strategy. This is evidenced by a permanent increase of the rates of staff with temporary contracts, of marginal employment, part time workers and hired-out workers, but also of night and shift workers. As a consequence, factors that require and build upon an individual’s flexibility such as time pressure, area of responsibility, workload, restructuring measures and non-typical working times are among the top 10 factors of work strain from the employees’ perspective. Unfortunately, in some management literature, establishing organisational resilience is seen solely as a process to strengthen an individual’s capability to deal with these unfavourable conditions in organisations. Organisational resilience, in their perspective, is given if and when all members of an organisation have established a sufficient level of individual resilience. No doubt, increasing individuals’ levels of resilience is a good thing to do. But doing just this ignores the findings of prevention research, both in the field of mental health and of occupational health and safety, of the past several decades. Effective prevention requires a behaviour, but also a structural orientation. The above-mentioned strategies focus only on the behaviour component, and ignore that the work itself as well as the work environments and conditions are equally to be taken into consideration, as factors that can be assessed, changed, and ultimately be improved upon. But what does structural prevention with regard to resilience mean? If we would agree to the previous interpretation of organisational resilience as the sum of each individual’s resilience, then structural prevention would be a topic of corporate health management. It would be addressed by measures that improve the well-being of employees, such as decreasing workload, workplace health promotion activities and implementing in-house seminars to learn how to cope with unfavourable conditions and so on.
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Organisational resilience: corporate structures and strategies to cope with changes and crises
But there is a problem in this approach because it implies the rule that ‘more is always better’, and that the employees’ resilience is the only resource an organisation can resort to at difficult times. The reason is that this approach is completely decoupled from the triggers that necessitated an increased flexibility of the organisation and that it focuses solely on the individual level. But the reality is that the an organisation’s management always has to optimise along at least two dimensions, the individual and the corporate ‘well-being’. Hence, management decisions require a balancing out of these dimensions. Unfortunately, the repertoire of measures managers avail themselves of is composed of reorganisation measures to implement their corporate strategy (that often focuses on the external effects and ignores the impact on members of the organisation) and of corporate health management measures (that often focus on the individual well-being but are not mirrored against corporate requirements). Our hypothesis is that organisational resilience constitutes the missing piece between corporate health management and strategic management & reorganisation. It influences corporate health management and extends its offers and structures to improve individual resilience, but also impacts on strategic planning. In the same way, it enriches strategic planning by taking individual and organisational resilience on its agenda, as relevant optimisation dimensions to be considered, with implications also on corporate health management. The missing piece seems to be the balancing process that explores an - organisation-specific - optimum between individual and organisational resilience. It is the structures that are needed for a discussion and agreement process between management and employees on eye-level, the rules of communication between them, and the binding character of the outcomes of this process. Filling in this missing piece will result in – possibly – different decisions both in health management as well as in strategic planning, yet these decisions will equilibrate individual and organisational requirements with regard to improving resilience on both levels. The implementation of organisational resilience requires a letting-go in many areas of classical management and organisational principles. The combination and balancing of individual and organisational resilience thereby becomes a key characteristic of sustainable companies and mentally healthy employees. The ultimate effect will be an organisation that gains a competitive advantage because it is more resilient against internal and external changes and crises, backed by – but not solely based upon - the resilience of the members of the organisation. But also each individual in an organisation will benefit from an organisation that is able to cushion external crises or that provides a stabilising context during times of personal crisis. It seems that organisational resilience has the potential to generate a real, tangible and meaningful win-win. Harald Weber (PhD), Senior researcher Regina Osranek, Researcher Institut für Technologie und Arbeit (ITA), University of Kaiserslautern Trippstadter Straße 110 D-67663 Kaiserslautern www.ita-kl.de Birgit Fuchs, Pfalzklinikum – Director Community based Mental Health Services Dr. Andres Fernandez, Pfalzklinikum – Medical Director Clinic for General Psychiatry. Psychotherapy and Psychosomatic Rockenhausen Paul Bomke CEO Pfalzklinikum and Founder of the Initiative “The Palatinate makes itself/you strong - ways to resilience” Pfalzklinikum für Psychiatrie und Neurologie Weinstraße 100 76 889 Klingenmünster www.pfalzklinikum.de this project is part of the Initiative “Die Pfalz macht sich/dich stark -Wege zur Resilienz” “The Palatinate makes itself/you strong - ways to resilience”
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The Future of Mental Health in Europe
Mental Health Europe is an umbrella organisation which represents associations, organisations and individuals active in the field of mental health and well-being in Europe, including (ex)users of mental health services, volunteers and professionals. As such, MHE bridges the gap between its 73 member organisations and the European institutions, and keeps its members informed and involved in any developments at European Union level. MHE’s work takes different forms. As the main mental health organisation active in Brussels, MHE is committed to advocating for its cause, whether this takes the form of submitting amendments to legislation, consulting with the European Commission, forming alliances with other organisations or being part of expert groups. In an interview with the firm’s acting director, Akiko Hart, she reveals what MHE are doing to promote the awareness of mental health to policymakers, young people in education, employees and the general public in Europe. First of all, could you explain the aims and objectives of MHE & your role within the organisation? We are a European umbrella mental health organisation with over 70 national, local and regional members. In terms of our aims and objectives, there are three of them. The first is parity of esteem- so for mental health to be treated equally with physical health, both in terms of funding and policy priorities. The second is advocating better community-based services for all. Thirdly, we promote the recovery model and a human-rights based approach towards mental health. Can you talk us through, in brief, any major campaigns or projects MHE is involved in at the moment? The main campaign we are running at the moment is called ’Each of Us’ (https://eachofus.eu/) which is a Europe-wide anti stigma campaign aimed at raising awareness of mental health issues and debunking myths around mental health. We are targeting policymakers, young people, employees and the general public in order to engage them to think about mental health in a different way and to understand that each of can be part of the solution in changing minds and ending stigma towards mental health. In a previous eBook (http://www.onebigsociety.co.uk/public-health/2016/2/25/tackling-mentalhealth-problems-in-the-workplace), MHE discussed the importance of collaboration in Mental Health provision, particularly the involvement of employers and workplaces in improving outcomes. What more could be done, do you think, to aid the integration of Mental Health services? We think it is important that mental health is mainstreamed and is integrated into many different areas, rather than being an ‘add on’ to policymaking. MHE very much believes in collaborating with employers and workplaces to improve mental health at work, and we are in the process of designing some training around this. We also advocate for mental health to be integrated in education, within settings such schools and universities. Across Europe, there is an increase in political emphasis on person-centred care provision, something relatively commonplace in transport planning or infrastructure design. Are you aware of any projects or initiatives, around person or service user centred service design? Co-production is an innovative practice in Mental Health Services, which involves designing and delivering services with service users as equal partners in the process. It is very much about correcting the imbalance that has been there, and still is, where the service user can be a passive recipient of services. Co-production empowers service users, and ensures that services are tailored around what people actually need.
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The Future of Mental Health in Europe
Beyond that, are you aware of any initiatives centred around civic engagement, I.e. engagement of the general public in the design, structure and commissioning of services or the planning process? This could include civic engagement groups, advocacy services and market research. MHE is not aware of any initiatives that engage the general public in the design of these things, but there is a growing movement of working collaboratively with service users. For example, in Europe there is the European Network of (Ex)-Users and Survivors of Psychiatry (ENUSP) and here in the UK there is the National Survivor User Network (NSUN), which are two examples of service-user led organisations which are lobbying for service-users. In addition to the aforementioned co-production in mental health services, there is another initiative called peer support, which is increasing popular within and outside of services. Peer support is about people providing support, knowledge or experience to each other, but it’s also an ethos, a different way of working, which values personal experience, and which is based on equality and mutual respect. It can be provided through both individual and group-based support, and it means that the person providing the support is generally not a professional but an expert with experience. It’s a really empowering and effective model, which is being adopted within some services such as the NHS. The challenge here is to ensure we do not create a two tiered system, where peer support is seen as the cheaper alternative, or the poorer cousin to professional support. We are in an age of significant challenge to health services, specifically mental health services – with funding disruption, a growing elderly population, rising rates of lifestyle related conditions. Part of the solution to such challenges, is to support the self-management of mental wellbeing and health promotion. How do we effectively communicate complex solutions, complex science and still maintain a strong concise message – have you any comment to make, or are you aware of any initiatives in civic communication or public health promotion in Europe? There is a huge challenge there in terms of how we communicate around mental health. At MHE we do not believe that mental health is solely a medical diagnosis which has accompanying symptoms and treatment. Mental distress can be a normal, understandable human reaction to complex or difficult life events such as bereavement, unemployment or divorce. It can also have wider socio-economic causes such as poverty or relative poverty. It can also boil down to personality differences, or how resilient we are. So the causes or triggers for mental distress can vary hugely, but what is important to emphasize is that mental distress occurs on a continuum. We all go through difficult life events, and at some point, we all need additional support. There is no us and them, the mentally healthy and mentally unwell. So it’s important that the support we provide, within and outside of services, reflects this- that these experiences are human, that each of us has different experiences and makes sense of them in different ways, and that when we need support, it needs to be based on respect, recovery and hope. To summarise all of that, we would say that mental health is a human experience which demands a human response. Finally, what do you feel the future might look like for mental health in Europe? The future is both challenging and exciting. On the challenge side, there are growing health inequalities and huge cuts in funding to mental health which is all very worrying and we can see this taking place across Europe. On the other hand, there is a growing awareness of mental health issues and within services we are seeing more creative and innovative movements. For example I have spoken about peer support, but I could also mention Open Dialogue which originated in Finland and is now spreading across Europe and is being trialled on the NHS. Open Dialogue works collaboratively with people who have a diagnosis of psychosis, alongside their families and support networks, and as much as possible within their own homes. Soteria is another example- it’s a non-medicalised community care based approach for people living with psychosis. These are just two small examples of really exciting developments that are happening across Europe, which is exciting, but we need to continue highlighting the importance of funding mental health services and delivering good quality community-based care, which is human-rights compliant and which promotes hope and recovery.
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Mental Health Europe Akiko Hart info@mhe-sme.org www.mhe-sme.org Mundo B- Rue d’Edimbourg 26, 1050 - Bruxelles +32 289 30 881
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The Alberta Family Wellness Initiative (AFWI)
According to research conducted in Alberta, there is a lack of wide spread, deep understanding about mental health and addiction amongst the province’s citizens. In particular, the connection between these health issues and early brain development and life experiences is not well understood. The Alberta Family Wellness Initiative (AFWI) – where science meets real life to strengthen mental health and prevent addiction Several years ago, the Palix Foundation set out to reduce this knowledge gap as a way to improve mental health and addiction outcomes for all children and families in Alberta. A survey, from one of AFWI’s first events that brought together addiction and mental health system administrators and front-line practitioners in the province, showed just how significant a gap there was to fill. Over half of the participants lacked knowledge about the brain and brain development as it relates to addiction and indicated that a barrier to system change was this lack of knowledge. There was (and still is) much work to be done. Given this, AFWI, in collaboration with a wide variety of partners in the province, set out on a collective journey to improve Alberta’s mental health and addiction system based on knowledge. This short case example describes the AFWI initiative and recommendations for action that are arguably, applicable to other contexts, as well. AFWI - Closing the gap between what we know and what we do in Alberta’s mental health and addiction system The Palix Foundation is a private foundation established in Alberta in 1997. In 2007, the foundation created the Alberta Family Wellness Initiative (AFWI). Through this long-term systems change initiative, the foundation works with a variety of partners to improve the health and wellness of all children and families in the province. It contributes to this goal by sharing and promoting the application of knowledge about early brain and biological development as it relates to child development, mental health, and addiction. This knowledge base is the foundation of the AFWI program. It represents the most current research about early brain development that has been translated into the “core story of brain development” to make it easier to understand and communicate to a variety of audiences1 (See Table 1). The FrameWorks Institute2 developed the “core story” approach to communications. It is a well-tested, proven, effective way to shift long-held beliefs, in this case about addiction and mental health and early childhood development that are not consistent with what we now know from science. Tested in Alberta, the core story of brain development is shifting public understanding based on knowledge. This approach is in contrast to communication methods that remind people of what they currently believe and then try to refute these beliefs. This is not an effective way to build understanding and frequently does more harm than good by further engraining and entrenching unhelpful cultural myths, such as what can happen through anti-stigma campaigns.3 In short, according to FrameWorks, it is more effective to tell people what things are, rather than what they are not. That is why AFWI is actively telling the core story of brain development far and wide. The AFWI knowledge base also integrates an understanding that: • Addiction and mental health issues often go hand in hand; • Addiction includes substance abuse, as well as other human pursuits, like gambling; • Mental health and addiction outcomes can be transmitted from generation to generation; • Addiction is a chronic condition and, as such, requires a long, supervised course of treatment, peer support and a family centred approach; • The mental health and addiction system should span from prevention, to early intervention, treatment and recovery. It involves a collaborative approach across health, human services, education, justice, the private sector and community. 1 See a synthesis of the knowledge in 13 Working Papers by the National Scientific Council on the Developing Child based at the Harvard Center on the Developing Child at this link: http://www.albertafamilywellness.org/resources/ search?keys=&subject%5B%5D=1&subject%5B%5D=2&resources_cat%5B%5D=42&=Apply 2 http://www.frameworksinstitute.org/ 3 Read about The Stigma Trap on page 23 http://www.albertafamilywellness.org/system/files/report-files/addiction_messagememo_final.pdf
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The Alberta Family Wellness Initiative (AFWI)
Table 1: The Core Story of Brain Development The basic architecture of the brain is constructed through an ongoing process that begins before birth and continues into adulthood. Brains are built from the bottom up: basic circuits lay the foundation for more complex circuits and behaviours that follow (skill begets skill) (brain architecture). Brain plasticity and the ability to change behaviour decreases as we mature: getting it right early is easier and less costly to society and individuals than trying to fix it later. Interaction between genes and experience shapes the developing brain, and relationships are the active ingredient in the serve and return process (serve and return). Serve and return describes the interaction between a child and caring adult. The back and forth communication between a child and caring adult constitutes serve and return. Cognitive, emotional and social capacities are inextricably intertwined: learning, and behaviour, are inter-related with physical and mental health over the life course (can’t do one without the other). Toxic stress damages the developing brain and leads to problems in learning and behaviour, and to increased susceptibility to poor physical and mental health over time. The accumulation of multiple adverse childhood experiences over time in the absence of a caring adult contributes to toxic stress (toxic stress). Executive function and self-regulation skills that develop in childhood are the mental processes that enable us to plan, focus attention, remember instructions, and juggle multiple tasks successfully. Just as an air traffic control system at a busy airport safely manages the arrivals and departures of many aircraft on multiple runways, the brain needs this skill set to filter distractions, prioritize tasks, set and achieve goals, and control impulses (air traffic control). The combination of supportive relationships, adaptive skill building and positive experiences constitutes the foundations of what is commonly called resilience. One way to understand the development of resilience is to visualize how protective experiences and adaptive skills both counterbalance significant adversity and produce positive outcomes (the resilience scale). Understanding the upstream and downstream influences that might tip the scale in the positive direction is critical to devising more effective strategies for promoting healthy development. Resilience can be built through “serve and return” relationships, improving self-regulation and executive functions, and giving children and youth a sense of mastery.
Given the cross-sector and multi-disciplinary nature of what AFWI is aiming to achieve, the initiative is a knowledge mobilization effort that engages and catalyzes relationships across stakeholders from science, policy, and practice domains. The purpose is to reduce the gap between the knowledge base and what is done in practice. In other words, to ensure that the knowledge base drives change and is integrated into all aspects of mental health and addiction system improvements. Ultimately, AFWI uses its resources to: • Convene, inform, educate, and create engagement across diverse stakeholders from academia, health, human services, justice, and education sectors so that relevant knowledge can become embedded in all levels of policy, funding, programming, professional education, and practice and; • Support and facilitate the understanding and application of this knowledge to catalyze system-level, integrated change in policy, service provision, and on-the-ground practice rooted in cross sector collaboration for the ultimate benefit of children and families.
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The Alberta Family Wellness Initiative (AFWI)
What changes could be made to strengthen mental health and prevent addiction beginning in early childhood? Given what AFWI has been aiming to achieve in Alberta and lessons learned and progress to date, we recommend the following four actions be made to improve the mental health and addiction system in other jurisdictions, as well, underpinned by a set of principles. Principles • Changes should be based on the core story of brain development, knowledge about what constitutes quality addiction treatment and on well tested, effective communication approaches to changing public understanding about mental health and addiction (anti-stigma campaigns are not recommended); • A research and evaluation plan should be integrated into mental health and addiction system improvements with support for developing and testing policy and practice innovations; • A significant amount of addiction and mental health care happens in the community so effectively collaborating / partnering across all relevant players and sectors is critical; • The focus of change should be on improving and measuring outcomes – outcomes should drive investments; • There is a need for a balanced approach between providing access to high quality acute care for citizens with addiction and mental health problems while also focusing on prevention strategies, early intervention, children and youth. Recommendations for Action • Provide basic knowledge about brain development for everyone o To ensure a common framework of understanding when it comes to the roots of mental health and addiction, implement a professional development and training initiative with a standardized, common curriculum based on the core story of brain development for everyone who works in the addiction and mental health system, broadly defined (including education, health, human services, justice, community, academia). • Focus on preventing adverse childhood experiences (ACE) and use the ACE score as a standardized part of practice o Implement the standardized use of the ACE questionnaire in primary and other care settings with appropriate follow up for adults with high scores. Developing appropriate interventions for adults with high ACE scores is an important way to influence the intergenerational transmission of poor outcomes while providing care and treatment for adults who need help. • Support research and innovation to develop and test new policy and practice interventions o Support interdisciplinary, cross sector teams from science, policy and practice to continue to develop and test new interventions in the mental health and addiction system. There is ever increasing demand and momentum to support “space” for innovation in this area, including generation, incubation and testing of new ideas and scale up of the most promising interventions. • Focus on partnerships and collaboration o Integration of all parts of the mental health and addiction system requires collaboration and partnerships. The common knowledge and language base in the core story of brain development brings stakeholders together within the same framework. Process and practice improvements based on collaboration are the next step in integrating the system.
Palix Foundation, Alberta Family Wellness Initiative Michelle L. Gagnon, MBA, PhD, President mgagnon@palixfoundation.org http://www.albertafamilywellness.org/ #540, 1100 1 Street SE, Calgary, Alberta, Canada, T2G1B1 403-648-2214
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Challenges the Alliance against Depression Landau-Südliche Weinstraße e.V. is facing in 2016 and our answers to them
The aim of the Alliance’s work is to provide information on depression and its treatment possibilities, destigmatization as well as information on concrete contact points and help offers in the city of Landau and the district of Südliche Weinstraße. It is not our task to establish treatment offers although they seem to be insufficient in the day-patient area in so far as long waiting times for an appointment with a specialist or a psychotherapist have become the rule. The primary topic in 2016 will thus remain the counselling on treatment possibilities and bridging offers since early recognition of treatment-requiring depression and a fast start of treatment shortens the time of suffering, gives hope and enables survival with every-day life. By giving telephonic advice, handing out our information flyer at public places and being present with regular information booths at various events we want to inform those concerned and their relatives about the different possibilities of getting help and finding ways out of depression. Rich information and a survey on the regional help offers contributes to achieving a reduction of helplessness and powerlessness often arising in those concerned, their relatives and other persons of contact in view of the health system regulations. The challenge will be to increase the bridging help offers. In the first place, self-help groups have proven to be successful and we want to strengthen and expand them. A self-help group that could meet at the clinic in Klingenmünster would be closer for the people in the southern area and during an in-patient stay a group visit could be realized. In cooperation with the Regional Center for Health Promotion a regional runners and movement group with the motto “Make depression get a move on” is supported. After the one-year model phase it shall become a regular offer. The possibility to make a short-term appointment for consultations and crisis meetings at the Pfalzklinikum Admission and Information Center (AIZ) in Klingenmünster and at the Regional Psychosomatic Center (RPZ) in Landau shall be made better known in the region. The Alliance continues to offer training for family physicians as well as information events for multipliers at schools, parishes and clubs. We want to achieve destigmatization, which is always the target and the foundation of successful alliance work, by being present at regional events, identifying various contact partners, using cultural media and raising sensitivity for depression in close cooperation with the political representatives in order to contribute to a good development of psychiatric care. In summer 2016, the “Mood Tour“ a tandem bicycle tour across Germany, is stopping off in Landau. By organizing a warm welcome, providing information and organizing activities at the Rathausplatz (Landau’s central town hall square) the Alliance wants to give the public the opportunity to take an objective look at depression, approach it and finally accept it as a treatable disease. One challenge for the Alliance will be to organize the planning, preparation and realization together with all participants from various institutions, voluntary organizations and self-help groups so that we can arouse enthusiasm for our work and find new fellow campaigners. Along with the regional contact person for Relatives about Suicide (AGUS e.V.), we focus our attention every year on the annual World Suicide Prevention Day, September 10. Each year, we make a different offer to get the necessary attention for this topic. This year it is going to be a film presentation followed by the possibility to ask questions, discuss and exchange personal experiences. After a suicide the family, friends and colleagues have open questions and find themselves thrown off the track. They need support, understanding, answers and the courage to live.
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Another topic is the relation between the working environment and mental health. An increase of sick days due to mental burden is noted. We receive inquiries from companies in our region and there is a great readiness to actively tackle this issue in the enterprise. The Alliance offers lectures and executive manager counselling and they are gladly accepted by these companies. As a result of last year‘s information forum on the topic of depression in children and adolescents we want to promote preventive offers in schools. It is clearly very important to inform the citizens that depression can appear in childhood and adolescence and that there are treatment possibilities. Beside this message, we want to put the focus of our activities on prevention so that we can prevent the emergence of depressions at school age. It’s for this reason we take part in a regional resilience program carrying out, among other things training in social skills and emotional regulation. The up-to-date topic of fleeing people, their hardships and their traumatic experiences present completely new challenges, not only to us, for which there are no routine answers. However, our experience in alliance work comprising networking, integration of persons concerned, use of various media, identification and integration of cooperation partners should enable us to find answers to these challenges.
Dr. Sylvia Claus, President Alliance against Depression Landau-Südliche Weinstraße e.V. Head physician of the Clinic for Psychiatry, Psychosomatics and Psychotherapy Klingenmünster at Pfalzklinikum http://www.buendnis-depression.de/
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