Health for all? Why health promotion matters for recovery |
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| Thursday, 16 June 2011 |
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In her latest contribution for SRN Heidi Tweedie examines the key role of health promotion in recovery. The article highlights how important it is to take a holistic view of view of health and warns about the risk of health promotion being seen as a luxury item at a time of cuts.  “Health promotion is missing some individuals with experience of mental illness,” states Wendy Halliday, Mental Health Improvement Programme Manager for NHS Health Scotland, “and it’s of great concern to us.” Indeed it should be of great concern to anyone interested in mental health recovery as the two are inexorably linked. Those in recovery from mental health problems often say that gaining more control of their health and wellbeing is key to their journey. Health promotion initiatives have the potential to increase and support recovery and yet there are many barriers to this. Wendy continues: “We have just finished a review of literature exploring the issue based on the three major differences between the general population and those with mental health problems: increase in smoking; weight issues (often linked to medication); and decreased opportunities to participate in activity due to stigma or accessibility.” As well as the literature review, the research also involved a mapping exercise of health improvement activities for people over 16 with longer term mental health problems. Susan Byrne of Rocket Science, one of the researchers involved in the project, gives an example of some of the learning gained from the study: “Smoking cessation in hospital or care settings can be very challenging. It emerged that if you want to run a successful scheme you need to involve both staff and clients, as having staff who still smoke at work makes it more difficult for their clients to stop.”  This inclusive, recovery-focused style of working is core to the user-led Caterans walking group based in Coupar Angus. “It started in 2009 with a discussion between people who were using our service,” mental health nurse Annmarie Gorrie, coordinator for the group, explains. “They had the initial idea and because I’m keen on walking I organised the group for them.” Once day walks were established, Annmarie suggested a longer walk over three consecutive days to promote recovery. This May they completed their second long walk along the Fife Coastal Path. “I do think groups work better when ideas and organisation come from the membership. In the past we have tried to run health promotion groups that we thought were a good idea, for example for things like self-esteem, but the uptake was really poor. This is not the case with the walking group as people are motivated.” Group member Clive Barton explains his motivation for joining: “Last time I was in hospital I made a conscious decision to use every group and service I could to help my recovery. I found the more things I did the more my recovery was helped.” There are plenty of health promotion initiatives available to all members of the general public, not just those aimed at people with mental health problems. However, for a variety of reasons uptake is low amongst this particular group. The NHS Health Scotland research has found that “[v]arious health improvement activities that are effective in the general population can be appropriate for those with severe and enduring mental health issues. However, to gain maximum benefit, individuals are likely to require additional education and support to participate, sustain involvement in, and benefit from, health improvement activities.”  Jayne Kettles, PLUS Perth member, has wide experience of both health promoting groups for the general public and those focusing on people with mental health problems. “With different stages of recovery different things helped. I feel groups work best if they are mixed, not only for those with mental health problems, as mixing with different people helps to reduce internal stigma.”Clive has a different perspective: “Our group is not just about walking; the friendships and camaraderie are also important. People in the group have insight into what we are all going through. I don’t feel that I could have joined an ordinary walking group as they would probably not have the patience for me.” “Stigma is still a big issue in Scotland”, explains Wendy Halliday. “We were concerned that we may need a raft of specific resources aimed at this group (people with experience of mental health problems), but the research shows that the main barrier is delivery. Practitioners need to treat people holistically. Whether they are GPs, psychiatrists, smoking cessation specialists or walking group leaders, people need to feel supported in more than the specialism of that practitioner.” She adds: “Some professionals are unaware of what they can advise, what support they can offer and where to guide or signpost individuals; there is something here for me about the level of engagement of professionals with other partners and services.” It’s not only participants that have barriers to overcome in successful health promotion. Despite the success of the Caterans walking group Annmarie has a constant fight to prove its worth. “Running a walking group does not fit in with a standard nursing shift or others’ preconceived ideas about what your role ought to consist of. Every time I plan a walk I get funny comments, and feel I have to fight my corner to make other professionals understand that this is work and that it is part of my role: I’m not off for a jolly.” Securing funding for the project means gathering evidence of positive change. This poses a problem for groups like the Caterans: “It’s tricky to evidence something informal like this group; it’s a fine line to get the right paperwork completed but not make the group formal for the members. That would turn them off.” Wendy Halliday echoes this sentiment, “My concern is that if budgets are to tighten there is every likelihood that some mental health services will cease to focus on wider health promotion issues, given that their capacity is already limited. I think there is some really good practice in places across the country where services are being much more responsive to the needs of the individual in the round. This is often as a result of committed staff who see the benefit of it, rather than being a service imperative.” Making health promotion work for those in recovery requires effective and empathic communication between professionals and their clients, as well as inter-disciplinary communication to share ideas and best practice. “There’s a real need for professionals to be educated on health promotion; saying lose weight or stop smoking is easy but doing it is not. Sometimes we can use our medication as an excuse for our weight, deluding ourselves and blaming it instead,” Jayne points out. “The trick is getting people to believe that they can do something about their health, especially those who have been in the system a long time.” Comments (0)
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