Promotion of Mental Health

Volume 7, 2000

Michael C. Murray, Colin A. Reed

• Publisher: Taylor & Francis
• Year: 2017
• eBook ISBN: 9781351750820
• Edition: 1
• Topic: Social Sciences
• Subtopic: Social Work
• Index: Social Sciences

This title was first published in 2001. Addressing a range of key theoretical and practical issues, this volume is the latest in an important series proceeding from the Annual Conference on the Promotion of Mental Health. It will be essential reading for policy makers, researchers and practitioners in the field.

1 Mental Health Promotion in a Rural Context: Research and Realities from a Community-based Initiative in Northern Ireland

MARGARET M. BARRY, ELAINE O’DOHERTY AND ANN DOHERTY

Abstract

This paper describes the development of mental health promotion strategies for rural communities in a Northern Ireland setting. The initial phase of a community-based project targeting depression and suicide is examined. The paper brings together practitioner and research perspectives on an analysis of the factors that made this initiative possible and facilitated its development to date. This includes the process of establishing policy support for the initiative, consultation with stakeholder groups, and the carrying out of a needs assessment study. The paper is written in two sections. Section one describes the process and practical experience of planning and implementing the initial phase of the project. It details the background factors which helped to resolve the difficulties and challenges encountered in developing mental health promotion practice in a community health and social services trust setting. Section two reports on the community needs assessment study. The research approach adopted in the needs assessment is outlined and the implications of the findings from a community study on perceptions and beliefs concerning mental health issues are discussed.

Background to the Project

Northern Ireland’s Regional Strategy for Health and Wellbeing 1997–2002 (DHSS, 1996) has identified the need for a strategy for mental health promotion for Northern Ireland. This is a challenge that various agencies are currently working to meet. Homefirst is a community trust serving a largely rural population (305,000) in Northern Ireland. In line with recent developments, the Trust has sought to develop mental health promotion strategies to meet the needs of the population it serves.

The initiative reported here arose from a community development project known as the Rural Community Development and Health (RCDH) project, which was a three year pilot project set up to explore community development and health approaches in a rural setting (HCT, 1998). This project highlighted the growing problems encountered by people living in rural areas. These include social isolation, unemployment, poor housing, lack of public transport, and lack of public amenities. In addition, recent years have brought a succession of farming crises that have led to financial stresses and further job losses. Against this background there is a steadily rising incidence of depression and suicide (Foster, Gillespie and McClelland, 1997). Focus group research conducted in the Republic of Ireland (Hope et al., 1998) has also highlighted the growing concern among members of the farming community about the rising rates of suicide and depression.

The current project was developed in order to devise innovative and effective strategies for delivering mental health promotion programmes to rural communities. The community-based project is modelled on an existing study designed to promote health and wellbeing in rural communities in the Republic of Ireland (Barry, Hope, Kelleher and Sixsmith, 1998). This paper focuses on stage one of the project which entails the process of engaging the community and local professional groups, undertaking a community needs assessment and developing a plan of action for the intervention phase. The next section traces the project’s development in terms of the policy background and the practical experience to date of planning and implementation in a small rural community in mid-Ulster.

Section One: The Process of Project Initiation and Development

Throughout the initiation phase comprehensive documentation was maintained, of all steps taken and all contacts made, as part of monitoring the process of developing the project. While it is too soon to draw conclusions about effective approaches for project replication, it is possible at this stage to identify some of the elements that have contributed to moving mental health promotion forward at a strategic and operational level in the Trust.

A key factor is the infrastructure of health promotion within the Trust. As recommended by the 1995 Review of Health Promotion in Northern Ireland (Neuberger, 1995), Homefirst adopted a range of measures aimed at achieving better integration of health promotion into the Trust. For mental health promotion this means liaising regularly with the Mental Health Senior Management Team to discuss initiatives being undertaken, and explore ways of moving towards a strategy for mental health promotion for the Trust. Many of the difficulties so often encountered in promoting mental health, such as those arising from different conceptualisations and interpretations of mental health, highlighted by MacDonald and O’Hara (1998), have been reduced by the structural arrangements developed within the Trust.

An important element in moving mental health promotion forward strategically in the Trust was the decision by the Senior Management Health Team sub-group to adopt a local community-based initiative as a flagship project. In this way the development of mental health promotion practice is promoted at a concrete project level rather than solely at the more abstract level of a strategy document. This is an approach supported by Secker (1998) which would seem to merit further investigation.

This project started after links were established between the Rural Community Development and Health Project and the Centre for Health Promotion Studies, National University of Ireland, Galway (NUI, Galway) which was undertaking a major health promotion initiative with agri-workers. The Trust’s Senior Mental Health Team facilitated the RCDH project to engage with the researchers in developing a similar initiative in a matched location in Homefirst’s area. Senior management support has given the project priority status, thus ensuring support and co-operation from local health and social care staff.

A further factor was the intersectoral nature of the project. Gillies (1998) demonstrates that alliance or partnership initiatives do work in tackling the broader determinants of health. The RCDH project was carried out by a partnership of community, voluntary and statutory sector organisations, including Homefirst Community Trust. Undoubtedly the partnership of the organisations and agencies prepared to support this project has enhanced the status and credibility of mental health promotion, assisting the process of reorienting the health services.

Resourcing is a factor crucial to the success of any initiative and this project is no exception. The fairly long term funding (i.e. three years) for the RCDH project facilitated the building of social capital (Gillies, 1998) in the form of a supportive infrastructure of networks and groups. Networks established through the RCDH project provided immediate access to representatives of the local community and key voluntary and statutory agencies. This existing infrastructure was a key element in progressing the current project.

The community development principles of consultation, participation, communication and sustainability which were purposely incorporated into practice, contributed greatly to the level of local support for the project. A research assistant from the local University of Ulster, Jordanstown (UUJ) was employed to help with local consultation, data collection, informing the local community and preparing a report on the RCDH project. A Project Steer-ing Group comprising representatives from the community, health and social care staff, farming organisations and the voluntary sector was established.

Perhaps, most importantly, the research-based approach adopted in the project ensures that programme development and implementation will be built on a sound empirical base. The needs assessment study focusing on current perceptions and attitudes in the community helps to ensure that the programmes developed will be both meaningful and relevant to community members. In addition, the process and outcome evaluation will help inform both policy and practice in this developing area.

Section Two: The Needs Assessment Study - Community Perceptions and Beliefs Concerning Mental Health Issues

A research framework to support the development and implementation of the mental health promotion project was developed by the Centre for Health Pro-motion Studies (NUI, Galway). The Centre was already undertaking a re-search-based health promotion in four rural communities in the Republic of Ireland. A small rural community in mid-Ulster, similar in size and profile to that of the rural communities participating in the larger study across the border (i.e. less than 2,000 population), was selected for participation in the study. The research methodology was adapted from the larger study (Barry, Hope, Kelleher and Sixsmith, 1998) in order to allow comparison across the different settings.

The needs assessment study consists of a cross-sectional survey of the attitudes, beliefs and practices of rural people in relation to mental health issues, with a particular focus on depression and suicide. The aim of the study is to inform the development of appropriate interventions and also to provide baseline data against which to measure the success of the intervention strategies. The exploration of community beliefs is also intended to ground the mental health promotion programme in the values and beliefs of the local community and to facilitate community involvement at the early stages of programme development. This approach embraces the implicit theories and views held by community members in order to build the project on the social meanings and understandings of mental health current in the community (Barry, 1998). To this end a cross-sectional survey was carried out in the Autumn of 1997. A summary of the findings of this study will now be presented. Full details of the study are reported in Doherty, Barry and Sixsmith (1998).

Method

Sample

The sample point for the survey was taken as the village centre and interviewers covered an area of a radius of five miles from this point. Households were randomly selected by the researchers calling to every second house in the village area and every house in the open countryside. Quota sampling procedures were used, stratifying according to age and sex. The response rate was 69% and a total of 242 people were surveyed. The characteristics of this sample can be summarised as follows: 43% male, 52% under 40 years of age; 21% had attained a primary standard of education only, with 46% secondary level and 33% third-level. The sample was equally divided between manual and nonmanual occupations and only 10% were categorised as having had a high level of previous contact with mental health problems.

Measures

The main survey technique was an interviewer-administered questionnaire which explored;

(i) levels of awareness and knowledge of depression and suicide;

(ii) current practices and attitudes concerning mental health matters;

(iii) perceived barriers and benefits of service up-take;

(iv) perceived confidence in dealing with mental health issues;

(v) stigma;

(vi) sources of information and influences on personal views and beliefs.

One-third of the respondents (N=88) were also questioned using a vignette portraying a person displaying signs of depression and suicidal ideation. The vignette, a short, hypothetical case description written in non-technical language, devised by Barry (1994), was used in order to obtain data of a more qualitative nature concerning the perception and interpretation of depression.

Results

Questionnaire findings Levels of awareness were generally high in the community with 81 % of respondents aware of the rise in the suicide rate in Northern Ireland in the last decade. Some 53% of respondents were concerned about levels of both rural suicide and depression, and 43% reported concern in relation to access to mental health services in rural areas. Ofthe respondents, men (F = 7.06, p<.01) and those under 40 years of age (F= 13.1, p<.01) were the groups least concerned about levels of suicide in rural areas. The same pattern was found in relation to concern about depression.

With regard to advising someone with depression, 35% of the respondents recommended seeking help from a GP, with 24% also advising nonprofessional support, e.g. from a close friend or family member. Of the remaining responses, 10% endorsed the ‘pull yourself together’ option and 8% recommended seeing a psychiatrist, 5% recommended the Samaritans and 6% a member of the clergy. Almost half the respondents (46%) said that they would find it difficult to advise someone who was depressed, and 68% reported little confidence in their own ability to advise someone who was suicidal.

In relation to attitudes to services, 59% of respondents felt that going to the GP would be an effective action if depressed. The psychiatrist was endorsed by 67% of respondents. In general, the GP was the professional that people would have the least hesitation in consulting if depressed (72% would not hesitate), followed by the psychiatrist (55%), the psychologist (53%) and the Samaritans (42%). Men was significantly less likely than women to believe in the effectiveness of the GP (F=6.25, p<.05) for treating depression. Again, the under-40 age group was most hesitant about consulting a GP and was also significantly less likely to seek help from a psychiatrist ( F = 8.48, p<.01).

Open-ended questions concerning barriers to seeking help revealed that social stigma was the most frequently cited barrier (35%). Respondents also referred to reluctance to disclose their problems (22%) and distrust of the services (7%). Non-recognition of the need for help (3%) and lack of knowledge of where to go for help (2%) were also cited. Analysis of the demographic variables revealed that younger respondents were more likely to cite ‘social stigma’ as a barrier to help seeking (x²=15.01, p<.01).

Further exploring perceptions of the stigma attached to mental health problems revealed that the majority of respondents would not talk openly about someone close to them receiving treatment for depression. Only 27% reported that they would talk openly, 15% would keep it hidden and 38% would talk only to close friends. These figures are much lower than those reported by Sogaard and Fonnebo (1995) in a recent Norwegian Mental Health Survey where 66.6% declared that they would talk openly about the matter. Concerning disclosing personal matters with others, just over half the respondents (57%) reported that they had discussed their ‘joys and sorrows’ with members of their families in the last month. Slightly fewer (53%) had discussed the same matters with members outside their families. Women (x²=11.13, p<.01) and those with third-lev...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• List of Contributors
• Acknowledgements
• 1 Mental Health Promotion in a Rural Context: Research and Realities from a Community-based Initiative in Northern Ireland
• 2 Mental Health Promotion
• 3 Representations of ‘Schizophrenia’ in Television News: A Comparative Analysis
• 4 Promoting Mental Health in Media: in Search of an Effective Methodology
• 5 Same Sex Attraction in Young People: Health, Happiness and Homophobia
• 6 Weaving the Threads of Mental Health Promotion in South Australia
• 7 Social Integration and Mental Health Promotion
• 8 Enhancing Parenting Skills
• 9 From the Margins to the Mainstream: the Public Health Potential of Mental Health Promotion – or Mental Health Promotion – what works?
• 10 Three Aspects of Mental Health Promotion in the Department of Mental Health Rome E
• 11 The State of the Art of Prevention in Italian Psychiatric Services
• 12 ‘Mental Health’: A Contested Concept
• 13 Lay Perspectives of Mental Health: A Summary of the Findings
• 14 Men and their Travails: Breaking the Silence
• 15 The Need for Supportive Strategies for the Person who Self-Harms
• 16 Implementing Mental Health Promotion: A Health Education and Promotion Perspective
• 17 Stress in the Workplace: A Risk Assessment Approach to Reduction of Risk
• 18 Developing Strategic Partnerships
• 19 Comparing Paradigms in Mental Health Promotion Evaluation and Research
• 20 Mental Health Promotion: Theory and Practice Insights from a Literature Review
• 21 The Odin European Research on Preventing Depression: A Different Perspective
• 22 Selling Mental Health Promotion
• 23 Socio-Cultural Adaptation and Social Support in Cross-Cultural Junior High School Classes
• 24 Mental Health Promotion: Reflections on Future Challenges and Opportunities
• 25 Developing Respectful Relationships With Young People Through Mental Health Promotion: Youth Partnership Accountability
• 26 Mental Health Promotion Within the Primary School Setting – Lanarkshire’s Experience
• 27 Just Because I Like it Doesn’t Mean it has to Work: Personal Experience of an Antenatal Psychosocial Intervention Designed to Prevent Postnatal Depression