Briefing note; November 2023
(This is an accompanying brief to the Community Mental Health Care Model briefing note).
Good mental health is inextricably linked to good health. An individual’s state of good mental health equals their quality of life. There are multiple factors that are at play that can ensure or deny this equation. There are individual, social, and societal factors, all interacting and interdependent, encompassing biological, psychological, and sociocultural perspectives (Eriksson et al., 2018).
The ecological model of mental health explains these processes well. It shows how an individual’s mental health and well-being is influenced by individual, family, organizational, community and societal factors. It stems from the ecological theory applied to changing human behaviours by psychologist Urie Bronfenbrenner in the 1970s.It is especially useful for relating the idea that the “influence of all contexts, systems, environments on an individual and family must be recognized to completely understand and support healthy development among individuals and families “(Eriksson et al., 2018).
The model is conceptualized in nesting, concentric circles, representing the connectedness and influence of all the systems upon the individual. It helps to encourage a perspective of mental well-being instead of mental illness by allowing for a depiction of multiple factors that can influence mental health, instead of focusing on a solitary aspect of mental illness. It emphasizes that interventions can be made at a variety of points along the pathway, such as strengthening resilience or mitigating adverse mental health concerns. This reveals the scope of possibilities and strategies available to an individual to promote mental well-being throughout their life (Singh et al., 2019).
The ecological model considers mental health through a multiple-level prism. It focuses on mental health interventions, both at the population level and the level of the individual level, and how they all interact interdependently. The five levels include intrapersonal, interpersonal, community, service and system (which can include institutional and governmental policies and laws). All areas are equally significant and through their interplay help determine both the mental health of the individual and the functionality of the system as a whole.
An example of the ecological model working effectively in a health context is that of tobacco consumption reduction: “The combination of environmental, policy, social, and individual intervention strategies is credited with the major reductions in tobacco use in the United States since the 1960s” (Task Force on Community Preventive Services, 2001). No one intervention was responsible for this reduction. There were many, including: medical interventions intended for individual health such as nicotine cessation therapies, interpersonal, community, service and system level interventions like package labelling, mass media campaigns, school education initiatives, as well as legislation in the areas of taxes, age restrictions, and public consumption of tobacco (Zaza et al., 2005).
Canadian Mental Health Association and the ecological model of community mental health
Canadian Mental Health Association in Alberta provides community mental health care in an ecological model: programs and services span from a focus on individuals out to the system-level. Each category is distinct and separate, yet all are interconnected. The following is derived from the infographic: Community Mental Health Care.
- Intrapersonal (individual) level = Preventing deterioration. This level focuses on building capacity in individuals directly. It includes initiatives that coach and educate people to help them manage their own wellness, meet basic needs and acquire life skills. This is often through peer support, peer groups, networks and supportive housing. Program and service examples include Recovery College, OSI-CAN peer groups, Skills for Safer Living, a spectrum of supportive living options, advocacy, wayfinding and system navigation, Healthy Campus Alberta, and the Rural Mental Health Network.
- Interpersonal level = Making people stronger. Initiatives at this level influence how people interact with each other. These are initiatives that strive to change attitudes, promote help-seeking and help-offering, and provide training for the four-in-five to better recognize and respond to the one-in-five who is struggling. Programs and services include suicide intervention training, community and school mental health programs, mental health training for select groups, suicide bereavement support groups and peer support groups. Specific offerings include: Rural Mental Health Network, Healthy Campus Alberta, Mental Health First Aid, ASIST and other suicide prevention training workshops, Talk Today, workplace mental health programming, Buddy Up campaign, program co-development with Indigenous communities, knowledge translation, advocacy, school-based mental health and suicide prevention programming, including Community Helpers, KidSmart, YouthSmart and Equipped, and Means and Media suicide prevention programming.
- Community level = Keeping people well. Initiatives at this level provide direct support to people in community. Examples include providing therapy or counselling, peer support and integrating peer, cultural, and social supports. Program and service examples include OSI-CAN peer groups, suicide bereavement support groups, peer support, School of Peer Support, Peer-staffed Welcome Centres, outreach and follow-up, advocacy and wayfinding, Circle of Support, Skills for Safer Living, suicide bereavement counselling and support groups, case management, homeless prevention, school-based mental health and suicide prevention programming.
- Services level = Complementing care. This level provides additional supports before, during and after, medical care, resulting in wrap around support and smooth transitions for people through their recovery. This also includes supporting family caregivers and peer groups. Program and service examples include OSI-CAN family support groups, Caregiver Connections, supportive living programs, Post- discharge supportive living, peer support, 211, and family peer support in emergency rooms.
- Systems level = Responding to crisis. This is the umbrella level that transcends the whole community with provision of 24/7/365 on demand crisis support and advocates for improved crisis team options. These services are provided through phone/text/chat lines, mobile response teams, and community stabilization (suicide respite/crisis beds). Program and service examples include: suicide and mental health crisis lines, community stabilization beds, CARE Team and other crisis diversion teams, Crisis Intervention Teams, and crisis counselling.
References
Eriksson, M., Ghazinour, M. & Hammarstrom, A. (2018). Different uses of Bronfenbrenner’s ecological theory in public mental health research: what is their value for guiding public mental health policy and practice? Social Theory and Health, 16, 414-433.
Singh, A., Ali, A., Deingdoh, I. & Gujar, N. (2019). The socio-ecological framework of mental health. India Journal of Social Work, 3(2). https://aiamswp.org.in/the-socio-ecological-framework-of-mental-health/
Task Force on Community Preventive Services. (2001). Recommendations regarding interventions to reduce tobacco use and exposure to environmental tobacco smoke. American Journal of Preventive Medicine, 20 (2), 10-15.
University of Victoria & Canadian Institute for Substance Use Research. (2023). Positive mental health and health promotion perspective. https://www.heretohelp.bc.ca/sites/default/files/mental-health-and-a-health-promotion-prespective-2023.pdf
Zaza, S., Briss, P. & Harris, K. (2005). Tobacco: Reducing initiation, increasing cessation, reducing exposure to environmental tobacco smoke. In Zaza, P. Briss & K. Harris (Eds.), The guide to community preventive services: What works to promote health? (pp.3-31).