1. Promoting Mental Wellness In Canadian Populations Canadian Public Health 2008 Annual Conference Halifax, June 3, 2008 Gillian Mulvale, PhD Senior Policy Advisor, National Strategy

2. TODAY’S OBJECTIVES: 1.To give an overview of the Mental Health Commission of Canada (MHCC) 2.To discuss key concepts of mental health/wellness and mental illness 3.To discuss mental health promotion: for the general population for people with a mental illness 4.To illustrate some key initiatives of the MHCC and its 8 advisory committees in these areas 5.To encourage you to be involved through your own work and through developing research to support the Commission’s work

3. MENTAL HEALTH COMMISSION OF CANADA (MHCC)

4. MENTAL HEALTH COMMISSION OF CANADA The MHCC is a non-profit organization at arm’s length from all levels of government. created by the federal government of Canada based on a Senate Standing Committee report: “Out of the Shadows at Last – Transforming Mental Health, Mental Illness and Addiction Services in Canada.” Funding to create MHCC announced in March 2007.

5. BOARD OF DIRECTORS chaired by the Honourable Michael Kirby 11 non-government directors, 6 government-appointed directors 1.Represents an array of interests, geographies and demographic diversity eight Advisory Committee Chairs who advise the Board and support the Commission in engaging with stakeholders: Children/youth Seniors First Nations, Inuit, Métis Family Caregiver Workplace Science Service Systems Law

6. THREE KEY INITIATIVES 1.Develop a National Strategy for Mental Health Reform 2.10-year Anti-Stigma/Anti-Discrimination program Children and youth key foundational piece 3.Knowledge Exchange Centre

7. MENTAL HEALTH, ILLNESS, AND WELLNESS CONCEPTS

8. MENTAL ILLNESS AND MENTAL HEALTH “…mental illness and mental health are not mutually exclusive...both have to be addressed through new kinds of policies and practices.” (Pape and Galipeault, 2002) Goes beyond being either “mentally healthy” or “mentally ill”:  a person can experience mental well-being in spite of a diagnosis of mental illness  a person can be free of a diagnosed mental illness but still be experiencing mental distress  challenges rise and fall and change over time. One’s mental health can be enhanced regardless of a diagnosis of mental illness.

9. MENTAL HEALTH/WELLNESS Many definitions: “... A state of well-being 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) Influenced by individual experience and expectations, cultural and religious beliefs Affects capacity to learn, communicate, form and sustain relationships Influences how we think and feel about ourselves and others and how we interpret events Central to all health and well-being; how we think and feel has a strong impact on our physical health. (UK DOH)

10. INFLUENCERS OF MENTAL WELLNESS Individual level: Genetic inheritance Childhood experiences Life events Individual ability to cope Levels of social support Stigma, discrimination Community level: Schools Neighbourhoods Organizations Adequate housing Employment Financial security Access to appropriate health care Gender Physical, social, cultural security Determinants of health are at work here

11. MENTAL HEALTH PROMOTION AND RECOVERY

12. MENTAL HEALTH PROMOTION “Mental health promotion involves any action to enhance the mental well-being of individuals, families, organisations or communities.” (UK Department of Health) Looks at how individuals, families, communities think and feel, what influences this, and the impact on health and well-being. It applies to:  the whole population in the context of everyday life,  subpopulations, e.g. those living with a mental illness. Stresses the importance of informal relationships, social support in communities, sense of belonging.  Recognizes diversity of cultures in communities.  Needs active citizen involvement. (CMHA MHP Toolkit)

13. EFFECTS OF MENTAL HEALTH PROMOTION IN GENERAL POPULATION Helps in preventing mental health problems, e.g. anxiety, depression, drug and alcohol dependence and suicide. Helps in identifying problems earlier, intervening earlier and promotes better outcomes. Wider health and social benefits: Physical health Emotional resilience Social inclusion and participation Productivity Changing discrimination against individual with mental illness Increasing understanding of mental health issues. (UK DOH)

14. MENTAL HEALTH PROMOTION FOR PEOPLE LIVING WITH MENTAL ILLNESS Focuses on individuals’ strengths, capacities and recovery capabilities Recovery will be a key theme in MHCC work to ensure: Individuals have power, choice and control over their lives and mental health Communities have strength and capacity to support individual empowerment and recovery Environments foster social inclusion, social support and participation in decisions about one’s life and health.

15. RECOVERY In mental health, the term recovery has a different connotation than when applied to physical illness: “...a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills, and/or roles. It is a way of living a satisfying, hopeful and contributing life. It may take place with or without professional intervention. It involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of psychiatric illness or the social consequence of illness.” (Anthony, 1993 and 2002) Founded on hope, it is an ongoing, individual process that entails: 1.positive relationships 2.meaningful daily activity 3.spirituality 4.personal growth (Deegan et al, 2000)

16. ELEMENTS THAT CAN SUPPORT RECOVERY “A home, a job, a friend.” (Mental Health Consumers) Mutual support :self-help groups Social opportunities:church groups, drop-in centres Personal development: hobbies, self-education, exercise, goal-setting Self awareness:self-monitoring, recognizing when toseek help, recognizing accomplishments/failures Medication

17. ELEMENTS THAT HINDER RECOVERY Stigma/discrimination Financial hardships Unemployment Lack of closeness, understanding and acceptance from family members Lack of information

18. DETERMINANTS OF HEALTH FRAMEWORK Necessary element for recovery-focused mental health care system Poverty and alienation result in the marginalization of individuals living with mental illness High rates of unemployment, employer discrimination and splintered family support are barriers to staying healthy

19. MHCC and ADVISORY COMMITTEE INITIATIVES

20. MENTAL HEALTH PROMOTION INITIATIVES All three of the MHCC’s strategic directions will contribute to mental health promotion: 1.Knowledge Exchange Centre  a focal point for knowledge exchange, including research  will help people understand nature of problem, where to get help. 2.10 year anti-stigma, anti-discrimination campaign  will promote social inclusion  will normalize and make help-seeking easier  will foster development of supportive communities  will overcome discrimination in employment, housing, education. 3.National Strategy

21. SCOPE AND ELEMENTS OF A NATIONAL STRATEGY A Mentally Health Society PromotionPreventionResilience CONSTITUENCIESCONSTITUENCIES Adult National Strategy Content Anti-Stigma Cross-cutting Issues Child/YouthDiversity SeniorsResearch FamilyLegal Issues AboriginalHR GovernmentalFunding ChoiceCommunityContinuum A Recovery-Oriented Mental Health System

22. ADVISORY COMMITTEE AND OTHER INITIATIVES  Overall:Mental Health Literacy, education  Housing:Homelessness Project  Employment: Workforce Advisory Committee  Safety:Physical and Cultural for Consumers  Security:Physical and Cultural  Income:Workforce Advisory Committee  Access to Services :Service Systems Advisory Committee

23. A FEW EXAMPLES:

24. EDUCATION, MENTAL HEALTH LITERACY MHCC is looking to develop partnerships with provincial governments to develop new initiatives: e.g. possibilities for programs like Mental Health First Aid (Australia) Pilot project being developed in Manitoba schools School-based education programs for teachers and youth. Workplace education of senior management, employees about mental health, mental illness, prevention and support for workers.

25. HOMELESSNESS PROJECT Federal Budget announced $110 M to MHCC to undertake five research demonstration projects in mental health and homelessness:  Moncton, Montreal, Toronto, Winnipeg, Vancouver, each with particular subgroups of interest. Will provide evidence about what service and system interventions best achieve housing stability and improved health and well-being for those who are homeless and mentally ill a collaborative, integrated KT process involving stakeholders service and evaluation capacity will endure after project ends.

26. CHILDREN/YOUTH Key group because of early onset of mental illnesses: 50% have onset before age 14 Additional 25% before age 24. Early intervention maximizes likelihood of people getting the services they need to improve outcomes. School-based education initiatives: Mental health literacy for children and teachers Mental health promotion materials Recognize importance of peer group Role of schools in providing services, links to programs in primary health care, community services to help families in navigating the system.

27. FIRST NATIONS, INUIT AND METIS The suicide rate of Aboriginal Canadians is roughly 3 times that of the general population; (5 to 6 times higher for youth) Protective factors: community control over land; schools, health services, cultural facilities, fire and police services BC study shows suicide rate is negligible in communities where these are present(Chandler & Lalonde) Adopt a strengths-based approach, rooted in community and individual strengths Address social determinants of health

28. WORKPLACE ADVISORY COMMITTEE Can be a source of illness (stress) But employment can be a protective factor:  being productive,  social connection,  financial security. Promotes recovery for individuals with serious mental illness. Employers are eager to develop solutions. Management leadership, as well as education and supports:  for those in the work force already and  for those with serious mental illness who aspire to be.

29. CONCLUSIONS Mental health promotion is a key element of MHCC activities. Integral to three strategic initiatives and work of the 8 advisory committees. Will be geared to the population as a whole and to foster recovery in those living with a mental illness. We are at the early stages and there is much to learn in this developing field. We encourage you in your work and invite you to participate with us, as we further develop our strategies and activities geared to promoting the mental wellness of Canadians.