Citizens shaping policy: The Canadian Mental Health Association's framework for support project.

Abstract

Abstract Fifteen plus years of work in mental health policy development from a community development perspective under the aegis of the Canadian Mental Health Association are described. The evolution of a model de-emphasizing formal mental health services and emphasizing partnerships between consumers, family members, the community at large, and mental health service providers is presented. Particular attention is paid to the value of re-investing in natural support systems both through the diversion of funds to such groups and the recognition of such systems as integral components of the cultural response to serious mental illness. This paper is a description of a long-term policy development process undertaken by the Canadian Mental Health Association (CMHA) at the national, divisional (provincial/territorial), and branch (local) levels, focusing on the problem of serious mental illness in Canada. It is presented in this context because participation in the project over time played an essential role in the first author's nomination for the CPA award for distinguished contributions to community or public service. It is hoped that the presentation will encourage some psychologists to broaden the perspectives they have of mental illness and serve as encouragement to others who have already begun the shift from a medical to a community-centred understanding. This presentation in no way assumes that the project approaches a final understanding of the complex matter of mental illness but rather that the CMHA's Framework for Support, (Trainor, Pomeroy, & Pape, 1999) can serve as a tool for coming to richer understandings than have perhaps been the case. The discussion which follows is retrospective and is but one of many possible characterizations of the development of the Framework Project over time. In many respects it differs significantly from the characterization of the project in the above volume. The CMHA is Canada's oldest and largest non-- government organization focusing on the situation of persons with serious mental illness. Founded at the beginning of the 20th century, it has its roots in the mental hygiene reform movement associated with Clifford Beers (1917) in the United States and Clarence Hincks in Canada (Griffin, 1989). Later in the century it produced the landmark policy document, More for the Mind (Tyhurst, 1963), advocating the process of de-institutionalization and the development of appropriate forms of community care. The formulation in More for the Mind paralleled developments in the U.S. that came to be known as the Community Mental Health Movement. The widely recognized shortcomings of the process of deinstitutionalization and the failure to build a viable community mental health system subsequently led to a re-examination of the principles set forth in More for the Mind. Through the efforts of the CMHA Mental Health Services Committee, a kind of in-house think-tank drawing on volunteer mental health experts, a new charter document, A Framework for Support (Trainor & Church, 1984), was developed. Throughout the process of developing the document and the nearly 20 years of initiatives that have sprung from it, an iterative process of ideas and concerns from local communities being modified, interpreted, and animated by projects emanating from the national office has characterized the project (Morwood, 1999). If one wishes to locate the project conceptually in methodological space, it stands as a rich exemplar of the action research tradition described in the Canadian context by Sommer (1999). While it embodies the principles he identified, it moves beyond in attempting to make research learnings a tool in subsequent policy development. The Framework for Support Project can, in retrospect, be seen as having gone through three overlapping phases, the third of which continues to be played out at this time. In the first phase, the locus of activity was largely within CMHA and was directed towards the creation of the charter document (Trainor & Church, 1984) and teasing out its implications. …