Promoting mental health through community collaborations in research

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Promoting mental health through community
collaborations in research

• Ann Marie White, Ed.D.
• Dept. of Psychiatry
• URMC

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Goals

• Describe Purpose of the Meeting
• Reach Common Definitions
• CBPR in Suicide Prevention Beyond Clinic Walls

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Your Experience With Collaborative Relationships
What are these like?

• Group Exercise

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Levels of Participation

• High Power Self-Managing Participation
• Representation Consultant Token
• Low Power None
• -Forum for Youth Investment

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Community Participation in Research

• IN.
• University research conducted IN communities
• Community Advisory Board Input sought
• WITH.
• Research Partnerships self-labeled,
  give-and-take but task of science is priority,
  and research planning can be before community
  involvement is sought (expert not locally
  driven)
• Community-Based Participatory Research, and
  others where mutual, equal influence occur (e.g.,
  PAR to promote social change, liberation)
• 
  
  see Trickett
  Ryerson Espino, 2004
• OF.
• Community Manages and Owns its own research
• Who benefits? test mankind not enough
• Community IRB Ethics first test
• a) IHRDP, U of T de-colonize knowledge
  stop re-privileging western science by keeping
  traditional knowledge and indigenous methods
  informal or unincorporated into publicly-funded
  health initiatives
• b) EJ - West End Revitalization Association, NC

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What does CBPR Mean to You?

• Is scientific inquiry conducted in communities in
  which community members, persons affected by
  condition or issue under study and other key
  stakeholders in the community's health have the
  opportunity to be full participants in each phase
  of the work conception - design - conduct -
  analysis - interpretation - conclusions -
  communication of results - NIH CBPR-SIG
• A collaborative approach to research that
  equitably involves all partners in the research
  process and recognizes the unique strengths each
  brings. CBPR begins with a research topic of
  importance to the community with the aim of
  combining knowledge and action for social change
  to improve community health and eliminate health
  disparities. - Minkler Wallerstein,
  2003 Kellogg Foundation, 2001

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Support Implementation of CBPR

• Practice of CBPR theory, skills, expertise
• Collaborative Partnerships
• Each Partners Capacities and Resources to
  Conduct Research, Evaluation Training
• Evaluate Institutional Environments and
  Infrastructure
• Broader Social, Political, Economic,
  Institutional and Cultural Issues
• Wide Range Prevention Activities Organizer,
  Educator, Leader of Change and Planner
• Career development of individual practitioners
• Essential resources training, mentoring,
  grantsmanship

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Australia An Example
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Causes of Disparities
Physical and Social Risk Factors
Living in Poverty/Absolute Conditions Low in
Hierarchy High Demand versus Low Control
Physical/Psychological Chronic Stressors Low
Social Support/Social Capital Racism/Segregation R
elative Inequality Lack of Resources Stressors
disrupt neuroendocrine system/allostatic load
Nina Wallerstein, 2007, Community-Based
Participatory Research (CBPR) A Strategy to
Reduce Health Disparities?, New Mexico Public
Health Association, http//www.nmpha.org/documents
/conferences/200720conference/NMPHA20disparities
20and20CBPR2007..ppt476,12,Strategy to Reduce
Disparities Empowerment
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WHAT WORKS

• Public Health and Population-Level Prevention
  Framework
• Requires strong leadership in planning,
  implementation and partnership-building
• E.g., Air Force Suicide Prevention (Knox et al.)
• Communities that Care (Hawkins, Catalano
  Arthur 2002)
• II. Framework of Social and Economic
  Determinants of Mental Health
• Social inclusion, including
• social and community connections stable and
  supportive environments
• variety of social and physical activities a
  valued social position
• access to networks and supportive relationships
• Freedom from violence and discrimination,
  including
• the valuing of diversity physical security
• opportunity for self-determination and control
  of ones life
• Access to economic resources and participation,
  including

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Mental Health Promotion
Suicide Prevention
CBPR
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Burning questions for this week on developing
collaborative suicide prevention research?
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Definitions

• Mental health is a state of wellbeing in which
  the individual realizes his or her own abilities,
  can cope with the normal stresses of life, can
  work productively and fruitfully, and is able to
  make a contribution to his or her community (WHO
  2001,p 1).
• Mental health is the embodiment of social,
  emotional and spiritual wellbeing. Mental health
  provides individuals with the vitality necessary
  for active living, to achieve goals and to
  interact with one another in ways that are
  respectful and just (VicHealth 2005b, p 7).

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Mental Health Promotion Definition cont.

• Aims to strengthen psychological well-being and
  satisfactory adjustment to society and the
  demands of life
• Draws on a positive orientation - it aims to
  enhance, protect, support and sustain personal
  skills and supportive environments to promote
  emotional and social well-being and satisfactory
  adjustment by emboldening people and communities
  while showing respect for culture, equality,
  justice and factors that defend dignity and
  rights.
• Both individual (e.g., teaching skills -
  problem-solving, coping and adaptability, etc.)
  and community-level approaches (e.g., social
  policies to ensure fair, equitable treatment) can
  foster, protect and strengthen mental health
  outcomes that give people the ability to function
  well and can remove barriers that prevent people
  having control over their lives.
• Trans-disciplinary transcends disciplinary
  approaches (e.g., cannot be accomplished in the
  framework of disciplinary research).