Turn Awareness into Action: Why We Need to STOP Talking about Mental Health
An emerging trend of the past decade is the number of speakers – from royalty, to celebrities, to the average person – willing to tell their mental health story. These stories are always revealing and are a commendable step for speakers to take as they help dispel myths and misconceptions. By putting a face, name, and voice to mental illness in this way, this trend’s greatest impact on society is to slowly erode the social stigma associated with mental illness. Unfortunately, while this “contact-based education” can be enlightening and informative, or even entertaining, it rarely leads audiences to any significant further action.
Well Intentioned
In fact, the follow-on effect is more of the same: communications campaigns with posters, bracelets, pins, and social media themes, all expressing solidarity with the mentally ill. These gestures are well intentioned but they may devalue the everyday experience of those with mental health troubles. Worse still, these campaigns and gestures create a false sense of achievement in the improvement of actual delivery of mental health care.
When it comes to mental health, however, awareness is only half the battle. We have certainly talked extensively; now is the time to move beyond this talk and translate this favourable attitudinal shift into definitive action.
The methodology employed with mental healthcare delivery is different than conventional medicine, which generally focusses on a clinical, prescriptive approach designed to lead to a cure. With mental health, there often is no “cure.” There is coping, healing, and improvement, but a cure is often unobtainable. Recovery itself is poorly defined and realized on a personal, idiosyncratic basis. To adopt a new approach, we need only look at a proven example that already exists and has worked well for many people.
Community-Based Rehabilitation
Traditionally, mental health care is a low priority in most societies, and never lower than in developing countries. Pressed for resources when delivering health care, the United Nation’s World Health Organization (WHO) adopted “community-based rehabilitation” (CBR). CBR has been used since the 1970s, and was initially implemented to improve access to rehabilitation services for people with disabilities. Its scope has since broadened and now includes effective treatment for mental health and addictions.
CBR is the basis of the mental health “recovery model”, the one endorsed by the Mental Health Commission of Canada (MHCC). Here, the patient is at the centre of the model and is expected to play an active role in their own recovery. There’s a very specific reason for this: self-empowerment and agency (the ability to act freely and bring about change) are closely linked to recovery from mental health problems. When a definitive and measurable cure is elusive, it becomes important that the individual define what recovery looks like. In other words, mental healthcare greatly benefits by the patient’s own investment bias.
If the recovery model is to ever be activated and this patient-centred approach realized, it will likely be enabled through an initiative like Peer Support. This is the definition I use in training sessions:
“A Peer Supporter is someone who uses their lived experience with mental health (either personally, or through supporting a loved one) to inspire hope and empower others in similar situations by providing social and emotional support.”
Peer Support is one such method that best exemplifies how a community-based approach could be achieved in the first world. For patients to achieve greater control of their recovery they must develop their relationship with the health care system, which continues to struggle with integrating mental health into the continuum of care. Inside the medical-model based system, overburdened clinics and physicians can turn to peer supporters to encourage a greater patient understanding and allow peers to develop self-advocacy.
Transition
This struggle is seen plainly when looking at how we transition patients from the clinical setting back to society. Presently, what passes for transitioning services is often simply letting a patient just walk out the front door. Peer support can greatly improve this situation as was so clearly shown in a 2015 Ontario study on implementing the Transitional Discharge Model.
Change is not only overdue for the mental health system and community care. In the workplace, human resource and occupational health professionals value prevention and accommodating someone on the job, rather resorting to costly and unproductive sick leaves which have been clearly shown to reduce the chances for a successful return to work and/or recovery. Peer support can be an approach that helps to achieve more successful outcomes.
Meaningful Change
If this all seems impossible, it’s not. Consider that we’ve never been closer to a meaningful solution, as debilitating stigma has never been lower than they are at present. We now need to turn our talking towards influential audiences and decision makers, whether it is those in the workplace that can make focused, consequential change, or governmental leadership that shapes policies and programs in the wider healthcare system. This is where we can begin to bring meaningful change in how we care for the mentally ill, because all along, isn’t this really what we’ve all been talking about?
