Reality Check

1
Reality Check

• Planning and Delivering Programs for Participants
  with Mental Health Concerns
• Presented by Val Mayes, Executive Director,
  Edmonton Chamber of Voluntary Organizations

2
Why am I here?

• Background in program planning, recreation
  therapy, working with individuals with
  disabilities, adult education, working in the
  community, and in particular, work with a Health
  Canada funded project in 2003-2004.
• Active living is good for people.
• Many people are challenged by mental illness
• Helping those with mental illness benefit from
  active living may take some extra work and
  creativity
• We should be aware of potential barriers when
  planning programs and services

3
Understanding the impacts

• Mental illness can be a short-term or long-term
  experience, range of severity
• Mental illness affects a large segment of the
  population
• Traditional programming may not be effective
• Does it even work for those without mental
  illness?
• Case Study approach will help us see the
  realities

4
Determinants of Health

• Income and Social Status Income and social
  status influence peoples access to housing and
  food, and their sense of control over life
  decisions. Health status generally improves as
  income and social status improve
• Individuals with chronic mental illness are often
  unable to work or unable to maintain ongoing
  employment and therefore tend to be economically
  disadvantaged

5
Determinants of Health

• Social Support Networks Support from family,
  friends and the community contribute to better
  health
• Disability, and in particular chronic mental
  illness, can be an isolating experience. The lack
  of a network of supportive family and friends can
  be the result of some of the symptoms associated
  with certain kinds of mental illness

6
Determinants of Health

• Personal Health Practices and Coping Skills-
  peoples knowledge, behaviours and abilities to
  handle outside influences and stressors affect
  health
• Individuals with chronic mental illness tend to
  be more sedentary and have poorer eating habits
  than the general population. Motivation may be an
  issue, and the ability to access services may be
  affected

7
Determinants of Health

• Social Environments Social stability,
  recognition of diversity, good working
  relationships and cohesive communities contribute
  to healthy social environments
• Individuals with chronic mental illness often
  struggle with societys lack of acceptance and
  understanding of the challenges associated with
  their illness, and assumptions about mental
  ability

8
Determinants of Health

• Culture language and beliefs influence peoples
  health-related behaviours, access to health
  information and the way people interact with the
  health system
• Certain ethnic groups are at a higher risk of
  developing mental health concerns, especially
  recent immigrants. Multicultural issues can
  complicate existing barriers, for example lack of
  proficiency in English

9
Determinants of Health

• Biology and Genetic Endowment Peoples genetic
  endowment contributes to their predisposition to
  certain diseases. Biology influences responses to
  stress
• For those with mental illness, use of medication
  (or not using) may be a factor. As well, recent
  research has indicated a correlation between the
  use of certain medications to control mental
  illness and an increase in the likelihood of
  developing diabetes

10
Expectations?

• It should not be surprising that individuals
  faced with low income or other stress inducing
  issues such as unemployment or underemployment,
  racism, insecure or unaffordable housing would
  have difficulties maintaining healthy
  lifestyles.
• Raphael et al, 2003, International Journal of
  Health Care Quarterly, p.xv

11
Case Study

• Diabetes prevention program for individuals with
  chronic mental illness
• Many living in approved homes operated by
  landlords
• Individuals not responsible for preparing their
  own food, limited income
• Program aimed to educate and support, in order to
  encourage healthy lifestyle choices
• Intent to respect needs of learners

12
Addressing the Barriers

• Affordable, preferably free, no expensive
  equipment required
• Accessible, close to public transportation,
  non-threatening
• No special skills required to participate
• Trained staff patience, appropriate background
  and sense of humour required
• Plain language, lots of graphics in advertising
  materials
• Work closely with caregivers/gatekeepers
• Include (appropriate) food/prizes

13
Reality of actual program

• Attendance was poor to dismal Diabetes
  Awareness Day (9), Bowling (12), Yoga (1),
  Walking (0)
• Public was less than welcoming staff at bowling
  alley asked group not to come early
• Caregivers were less than supportive did not
  accompany clients, or set example

14
Reality of Changing Health Care System

• Caregivers, community workers, program
  coordinators, and especially those who work in
  the mental health area, have had their workplaces
  and work assignments changed and disrupted in the
  last year, and this has affected their ability to
  participate enthusiastically.
• Caregivers at the approved home operator level
  also have felt the impact of changes, and some
  are skeptical of yet another new program.

15
Reality of Changing Health Care System

• Linking with a rural community for the project
  did not happen
• Health care workers have been affected by the
  realignment of boundaries during the creation of
  new health authorities, and by the shifting of
  mental health from a provincial to a regional
  responsibility. Evidence of the challenges this
  creates can be found in the difficulties the
  project coordinator encountered in trying to make
  contact with a logical partner in Vegreville.
  Each person contacted would recommend someone
  else, eventually leading back to the original
  contact!

16
Reality in partnership situations

• Working with House Next Door attendance was
  16 clients and 2 staff
• Working with Pathways attendance was 75
  people
• Suggests that working with the familiar has
  potential
• Suggests that working with established
  programs/services has potential

17
Insights and Reflections

• With any program, be clear about intended
  outcomes, funder expectations and availability of
  resources (Health Canada deadlines, SSHRC)
• Building partnerships takes time and trust, but
  collaborations do bring more resources to the
  table and do enrich those who take part
• Strive for authentic engagement of participants,
  even when considered a vulnerable population
• Realize that you can do everything right and
  still not reach the target population (politics,
  personal issues)