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Visions Journal

A reminder that this article from our magazine Visions was published more than 1 year ago. It is here for reference only. Some information in it may no longer be current. It also represents the point of the view of the author only. See the author box at the bottom of the article for more about the contributor.

Mental Health Literacy Improves Service Delivery

Alex Berland

Reprinted from the "Health Literacy" issue of Visions Journal, 2013, 8 (2), pp. 22-23

For non-experts like me, staying current with new thinking in mental health and addictions is challenging. Although my nursing education included an overview of mental illness, this was very basic. Moreover, mental health is not my only subject, so other topics compete. I am not always sure what is important or just trendy. As a discipline, mental health seems vulnerable to unstable theories. I always seem to have another article or website to read.

Back in the last century, when I was appointed to lead Riverview Hospital (RVH) after many years in general hospitals, I found myself in a foreign environment. The first thing I did was to visit every ward, meeting staff and patients. I spoke with everyone, including a very active family group. I also read every government report and every relevant article in the literature—many sent by people advocating competing viewpoints. Then I went out into the community, meeting the acute and community mental health teams, touring Vancouver’s Downtown Eastside services, and meeting with patient groups and officials in health authorities and local government around the province.

From these direct contacts I learned much, but a profound experience came from an on-site disaster. Leaving RVH late one winter evening, I was phoned about a fire in a building that housed many adults with serious and persistent mental illness. As we shepherded them to safety, I saw that most were severely limited in their functioning, with deficiencies in orientation, judgment and mobility.

After this experience, I began referring to the effect of mental illness as “disabling.” Journalists, mayors and community members get this. They understand and empathize with disability as a condition. This description helped me to describe the functional level of our patients in a way that evoked compassion rather than uncertainty or even fear. I described their needs in terms of activities of daily living and accessibility, the help they needed to feed and house themselves, to get and keep a job. Mental health literacy is critical for interpreting to the general public the knowledge of experts (be they patients, family or service staff).

I found that mental health literacy was also invaluable in conveying the information needed by other officials in terms they understood. Many policy-makers do not have the benefit of a clinical service background. This can make it hard for them to understand clinical problems such as the unpredictability of how young adults respond to their first course of anti-psychotic medication, and the implications for services such as length of hospitalization and type of follow-up needed. As with any audience, officials benefit from a balance of data and anecdotes. Data help explain the scale of a problem and why it is important; personal stories convey the impact, urgency and scope.

Sometimes the issues are administrative rather than clinical. For instance, speaking with senior health authority executives during my RVH days, I explained how brain disorders affected their bottom line: people with mental illness, stroke, brain injury and dementia spend a long time in hospital. Community treatment may cost as much for clinical staff, but avoids the very high fixed costs of institutional settings.

For service providers, the purpose of advancing mental health literacy is “doing what we know works best.” During my RVH work, acting on the advice of Dr. Rick Hudson, I allocated Mental Health Plan funding to adapt a World Health Organization publication, Management of Mental Disorders by Professor Gavin Andrews. This summarizes the wisdom and expertise of clinical management gathered over many years. We gave a copy to every psychiatrist and community mental health team in BC. With the benefit of hindsight, I wish we had given it to every GP (general practitioner) as well. Nowadays, the internet provides such information, maybe too much. One of the most important tasks of experts is translating their knowledge about “better practice.” Translation works best if it can be applied by various levels of users, accessible in a form they can use, exactly when they need it. (Hurrah for www.heretohelp.bc.ca.)

In principle, good policy analysts can apply their skills to any topic. In reality, officials may become dependent on external experts contracted for specific tasks. However, there are risks. Firstly, mental health promotion and mental illness/addiction prevention and treatment cut across many different health and social service areas. In-house expertise helps to ensure these concerns are reflected in various forums. Secondly, when senior decision-makers (elected and staff) do not know much about a topic, they are vulnerable to persuasion by vested interest groups.

I have discussed this topic from my own perspective of course: mental health literacy involves much more than service delivery for mental illness. But because service delivery affects many lives, it is important we get this right. By the way, my most lasting reference from the RVH years was Impossible Jobs in Public Management by Hargrove and Glidewell—still a good read.

I have discussed this topic from my own perspective of course: mental health literacy involves much more than service delivery for mental illness. But because service delivery affects many lives, it is important we get this right. By the way, my most lasting reference from the RVH years was Impossible Jobs in Public Management by Hargrove and Glidewell—still a good read.

 
About the author
Alex is a senior manager and planner with experience in government and all sectors of the health care industry. Presently, Alex lives in the West Kootenays and runs a private consulting firm specializing in improving strategy and delivery of health care and social services. Prior to this he was a senior official in England’s Department of Health, and from 1992-97 he was responsible for all clinical programs at one of Canada’s largest teaching hospitals. From 1998-2000, Alex was CEO of Riverview Hospital while at the same time Provincial Director of Adult Mental Health Services with the Ministry of Health

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