Addressing the support needs of sole mental health community development practitioners: A reflection

Mary E Whiteside
Research Officer, School of Population Health, University of Queensland, QLD

PP: 106 - 112

Abstract

Workers employed as sole practitioners in both government and community settings are at risk of feeling unsupported and disconnected if appropriate support structures are not in place. Recognition of this led the Mental Health Branch of Queensland Health to create the new position of a resource officer to provide support to 13 mental health community development officers (CDOs) employed in nongovernment agencies to implement the Queensland Mental Health Community Development Strategy.

The strategy had been implemented to address the needs of people with (or at risk of) a defined mental illness, as well as their carers, their families, and the general community. The CDOs were at increased risk of isolation, given their geographical location and the abstract, often ill-defined nature of their work.

Keywords

mental health, social support, community development

Article Text

This paper is a reflection of the experiences and challenges facing the resource officer in establishing and developing this new position. It was written 15 months after I had started in the position of resource officer and followed a review of the role undertaken with the CDOs. The review explored how well this position had supported the CDOs, and whether it was the best means to support their further learning.

Background

The Queensland Mental Health Community Development Strategy was developed as a response to the Commonwealth's First and Second Mental Health Plans (Australian Health Ministers 1992a, 1992b, 1998; Commonwealth Department of Health and Aged Care, 2000). Under the Strategy, Queensland Health established 12 community development projects in key locations across Queensland to facilitate the development of sustainable, locally coordinated community responses to the needs of people with (or at risk of) a defined mental illness, their carers, families, and the general community.

Developing a strategy to address the needs of people living with mental illness in Queensland had presented a particular set of challenges. Queensland is a highly decentralised state, covering vast distances, and containing groups with very specific needs, including people living in rural and remote regions, indigenous communities, people from non-English-speaking-backgrounds, and newly arrived refugee populations.

Evaluation of this strategy by the University of Queensland, in 1998, highlighted the significant achievements of the strategy, the value of a community development approach, and the potential of the strategy to further develop its scope through addressing broader community mental health promotion and prevention (Bush, Donald, & Madl, 1998). Queensland Health considered that the CDOs would require additional support and education to undertake an increased role in mental health promotion and prevention. A decision was made to create the position of Resource Officer (Mental Health Promotion and Prevention) to facilitate this process. Consequently, a full-time resource officer was appointed in 2000. The objectives for the position were to:

• Assist CDOs to implement local strategies aimed at enhancing community awareness of mental health issues
• Assist CDOs in their role of facilitating the development of the capacity of community organisations and services to respond to people with mental illness and their carers
• Provide professional development for CDOs in relation to mental health promotion and prevention.

In developing a framework for the resource officer position, the overall approach of the CDO Strategy was maintained. This approach acknowledged the importance of maintaining a commitment to principles of community development, such as community participation and ownership, empowerment, social justice, and a 'bottom up' approach rather than 'top down' approach. The position was designed to enable the resource officer to work alongside, support, and empower CDOs, rather than to have any line management role. As with each of the CDO positions, the resource officer position was to be under the auspices of a nongovernment organization, in this case, the University of Queensland, Health Equalities Promotion Unit, in Cairns.

Getting Started

When I first started in the position, I had many more questions than directions. The workers with whom I was to work had, in most cases, considerable expertise in their area of work and local contexts. The positions were spread throughout the state in regional centres. Most were located along the eastern seaboard, and in outlying areas of Brisbane along with positions in Roma and Mount Isa. Some had been working for up to 6 years in their communities and their role had involved:

• Identifying the needs of consumers and carers
• Promoting the development of intersectoral links with government and nongovernment and community agencies to meet the needs of the community
• Improving participation of consumers and carers in the process
• Promoting public awareness of mental illness through community education programs
• Promoting service development
• Facilitating access to services through providing information, education, and training for service providers.

I was unsure as to what I would have to offer these workers with their extensive experience. How did mental health promotion and prevention relate to what they were already doing? Was it a new concept for them and, if so, how did they see this new focus relating to their existing role? How did the concepts of mental health promotion and prevention, health promotion, and community development interrelate? Did workers have clear expectations of the role that a resource officer could play?

There was also a broader context. Given that a state strategy for implementation of the Second National Mental Health Plan was about to be released, where were CDOs seen to fit within this? Were they to maintain a focus on the needs of people at risk of, or suffering from, mental illness, their carers, and their families, or were they to work solely in community mental health promotion? If so, where should they start, especially as sole workers in some areas covering vast geographical distances? Mental health promotion and prevention has such a broad perspective. Did this mean they should be 'saving the world'? If so, how do you evaluate whether this has occurred? Also, what was meant by the term 'resource officer'? What should one do? Should they function as a librarian, should they locate or develop 'resources', should they play a program support role, and if so, what might this involve?

Utilising a process consistent with community development principles, I first consulted with those people that the project was designed to support, the CDOs. I then had discussions with other key stakeholders, in particular Queensland Health, and reviewed relevant literature. The CDOs had many of the same questions. As they had not been involved in the planning for the resource officer position, they were unsure what to expect. Many were unsure what the role should be and, in some cases, ambivalent about whether they really wanted to be involved. Most workers did, however, have opinions on what they hoped and expected the resource officer might do. Some thought the role would assist in the process of clarification of how Queensland Health saw the CDO role in relation to the national framework for mental health promotion and prevention. Other expectations involved providing support with planning, providing information about ideas and other programs in mental health promotion and prevention, facilitating communication and information sharing between CDOs and supporting documentation and local evaluation processes.

These initial discussions with the CDOs provided me not only with an indication of workers' individual needs and issues, but also some knowledge of other contextual issues, such as levels of professional training, previous experience, current support and supervision available, and the nature of each 'auspicing' organisation.

In my consultations with Queensland Health, the CDOs were seen to have a role in mental health promotion and prevention but as needing support, resourcing, and training to undertake this. It was acknowledged that what the resource officer role should be was not clearly defined, but it was anticipated that the project focus would develop over time.

I next explored the literature on health promotion, public health, and mental health promotion and prevention, including the Ottawa Charter (1986), the Jakarta Declaration (1997), and the Second National Mental Health Plan (1998). A key framework for mental health promotion and prevention in the Australian policy is a system originally developed by the United States Institute of Medicine (Mrazek & Haggerty 1994, cited in Commonwealth Department of Health and Aged Care, 2000). It portrays the continuum of mental health interventions within a population health framework addressing prevention, early intervention, treatment, and continuing care. Mental health promotion should occur throughout this continuum.

The CDO strategy was initially conceived (though only on a small scale) as consistent with the health promotion principles of the Ottawa Charter, where community development is seen as an important strategy. Also consistent was the strategy focus on intervening at different levels, for example, supporting and empowering those with illness and their support networks as well as working for change at service and community levels. It became apparent that the terminology associated with health and mental health promotion, including terms like primary health care, mental health promotion and prevention, and community development were not always clearly articulated; nor were strategies clearly defined. Differing perceptions of terminology appeared to exist among both the bureaucrats and the workers involved, which created some anxiety and confusion. Clarification of terms and the development of an understanding of how promotion and prevention linked to existing activity were important to enable workers to confidently work within the policy frameworks. What seemed to be limited within the mental health promotion and prevention literature were interventions informed by principles of community development. Thus, it appeared that if their experiences were documented and published, CDOs could make an important contribution to the knowledge base of this field of practise.

Outcome

This initial process of review and consultation gave me some directions as to where to start. To accommodate specific as well as common issues, I initiated both individual and group learning processes and structures to address the worker's identified needs. These structures included at least one visit to meet with each of the workers in their own worksites, ongoing individual telephone contact, 6-weekly group meetings via tele- or videoconference facilities, newsletters, and where possible, face-to-face workshops. Queensland Health allowed some funding for state forums, providing an opportunity for some of the group professional development.

As indicated in the tide, the role was not envisaged to take on any management capacity, merely to provide a support person. This has been important in regard to the development of relationships with the CDOs. Initially, several CDOs expressed some anxiety regarding whether they were to be accountable in any way to the resource officer and they were therefore relieved when this was not the case. This context of neutrality and confidentially has enabled CDOs to be more open about their frustrations and concerns. The decision to locate the resource officer's position with a nongovernment organisation also proved to be beneficial, as I am able to separate from the tensions that arose between the funding and policy body and workers on the ground. It enabled me to provide neutral support to workers, though at times workers were frustrated by my lack of power to address the difficulties. One potential difficulty was accessibility, given that the position was located in Cairns and the majority of the CDOs were located through Southern Queensland. Most feedback during the position review process relating to accessibility indicated that this was, in part, overcome by my being seen as an approachable person with an ability to respond to requests quickly. However, one worker did state that the lack of availability due to distance is a constraint and that teleconference contact is not as effective as face-to-face (Whiteside 2001).

Some CDOs have expressed their concerns regarding various issues with the program funders, Queensland Health. These issues included a perceived lack of clear direction, particularly following the shift in program emphasis toward broader community mental health promotion and prevention, funding uncertainty, and changing departmental personnel. It appeared that these difficulties, in part, related to the challenge of developing clear performance indicators and outcome expectations for a program based on a community development framework, compounded by departmental restructuring, and funding uncertainty. I am not sure how the tensions can be fully resolved; it may not be possible, given the differing constraints facing government bureaucrats and community development workers. What required consideration was how to improve communication between the two groups to enhance mutual understanding and provide an opportunity to work together to address challenges.

The utilisation of my services has varied between workers. In several sites, workers appeared to feel confident and self-directed in this area of their work. For example, one worker, anticipating the change to her role, had already undertaken an extensive process of community consultation, developed a strategic plan, and with a community-working group, commenced its implementation. In other sites, workers appeared less confidant and took longer to both trust and be sure how to use a resource officer. In looking back, I think I could have been more proactive. However, these same workers are now requesting that I become more involved in their projects; it appears that by not imposing myself and giving them the chance to get to know me and how I worked, has paid off.

A further challenge has been the enormity of the potential scope of mental health promotion and prevention, and keeping abreast of the ever-expanding literature base. What has needed to be balanced for workers has been information dissemination versus information overload. I addressed this in a number ways. Firstly, I saw the workers within the project as the greatest resource for information, resources, and innovative ideas. Ensuring this knowledge base was shared via newsletters, email, and peer discussion sessions was a high priority. I used the newsletters to filter and disseminate other ideas, and to alert workers to resources and information available if and when they are ready for it. While a couple of workers have asked for the development of a resource database, I believe it may be more useful to develop some form of resource-location strategy, and to upskill and support workers to know where to start to find information as it is needed.

While accessing and disseminating information is clearly an important aspect of the resource officer role, it has also proved to be important in reducing worker isolation and maintaining worker morale. For example, the development of a regular and ongoing professional development program offered the opportunity for sharing new and stimulating information, CDO experiences, approaches to universal challenges, and ideas for new initiatives. Such a program is most effective if structured and task oriented; to date, I have received the most positive feedback for sessions that explored issues in-depth and provided an opportunity for people to analyse and critique their own work.

I have had my own crises of confidence. At times I wondered what, if anything, had been achieved, and progress seemed slow for the time involved. As with all community development work, the development of the role has taken time: to identify direction, to build trust, and a clearer understanding of the scope and boundaries of the role. One year into the project, people are starting to use me more and more. The ongoing challenge is to keep people motivated to prioritise taking time out to discuss and reflect on work over more immediate issues in their workplaces. This requires considerable effort and time, and I am attempting to build a group culture around this issue. Busy workers need to be really convinced that this time is useful for them. Motivation for involvement has also been enhanced by the workers' own experience that this activity does make a difference, as well as by consultation and review processes, which have provided the workers with a sense of ownership and control of the position. Finally, a further issue that has been important has been the support available for myself. My location within the University of Queensland Health Equalities Unit in Cairns has provided me with invaluable collegial support and supervision. My work colleagues have greatly contributed to the vision and the success of the project. In addition, this has provided an important link between CDOs and a university context, which has enabled increased resourcing and support for CDOs in writing for publication, project evaluation, and accessing relevant research.

Conclusion

Although still relatively new, the establishment of a position to provide support to the workers involved in the Queensland Mental Health Community Development Strategy has been shown to have been of real benefit in facilitating learning and reducing worker isolation and boosting morale. Not only do workers have the support of a resource officer but the role has facilitated ongoing support and discussion among members. CDOs themselves are often now in closer contact with, and using, their own network. Comments have been made that 'there is a better sense of camaraderie and support within the CDO group' and 'it has brought me closer to other CDOs and helped to overcome the tyranny of distance' (Whiteside, 2001). Several factors incorporated in the initial design of the role have enhanced its success. These include envisaging it as a support rather than a management role, locating it in an organisation not connected with the funding body, and having a link to an academic setting. Approaches used in the development of the role embraced the community development model that builds on worker skills and knowledge, and the combination of individual and group learning processes responsive to evolving needs. In addition, the link forged within a university context has started to provide the strategy with an increased focus on reflective practise.

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