Case Study: Krasman Centre and North York General Hospital Participants’ Council

Theresa Claxton-Wali“People are familiar and comfortable within the CSI, and feel freer to talk about some of the challenges and fears around living with diabetes than they might in a more formal diabetes education group.” — Theresa Claxton-Wali, Co-chair of the North York General Participants’ Council


Setting

Two consumer/survivor initiatives (CSIs) in Ontario’s Central Local Health Integration Network (LHIN) are collaborating to provide mental health and diabetes peer support in a community setting and within outpatient psychiatric services at the local hospital. The Krasman Centre and the North York General Hospital Participants’ Council are offering a peer-led weekly wellness program that addresses physical and mental health together. Take the Extra Step integrates Wellness Recovery Action Planning (WRAP) — a mental wellness self-management program for people living with mental health challenges — and chronic disease prevention and management (physical activity, diabetes education and diabetes peer support). Two programs are run simultaneously — one at the hospital and one at a community location such as the library.

Take the Extra Step was developed through a partnership between the Participants’ Council, a mental health agency (Community Resource Connections of Toronto) and a diabetes education program (South Riverdale Community Health Centre) in Toronto several years ago. The diabetes and mental health peer support training has enabled trained peer supporters to integrate diabetes and mental health peer support into the program.

Why diabetes support within a CSI is effective

The diabetes education provided in a peer-led program has an aspect to it that can’t be achieved in a professionally led program, Theresa Claxton-Wali says. Theresa, a co-facilitator of the program, is a peer support worker at the Krasman Centre and the co-chair of the North York General Participants’ Council.

“People are familiar and comfortable within the CSI, and feel freer to talk about some of the challenges and fears around living with diabetes than they might in a more formal diabetes education group. We allow people to say they are angry, frustrated, this is hard. You get told you have to make a dozen different lifestyle choices and this can be overwhelming. We need to take it one step at a time, gain success, be motivated and move on to the next step. Professionals don’t always understand that people are saying ‘Help us to be successful with this’ when people are expressing their anger and frustration.”

A peer leader demonstrates that it can be done. “There is strength in relating to someone that can stand up and say ‘I’m living with diabetes and mental health challenges’ and seeing that they have been successful.” Participants recognize that they too have knowledge and wisdom about living with diabetes and wellness and they share that with each other. “We learn and practice prevention strategies to improve our health. It’s not just about living with diabetes but about striving [for wellness]. It’s not just about your mental health or losing weight, but looking at wellness and providing opportunities to move forward on that.”

Something that is dear to Theresa’s heart is educating people about their rights within health care. One topic of discussion is how to talk to your doctor so that the doctor can hear you, in order to develop a better relationship and work collaboratively on improving your health. Many people say their doctors have never talked to them about what they need to do to prevent the onset of diabetes, particularly for those who take psychotropic medications that may put them at risk for diabetes and other metabolic disorders, like the need for a more active lifestyle to counteract weight gain. The program helps them to understand that they have a right to that information. They learn how to ask for information and how to explain that they can’t do everything at once. “I can’t stop smoking, take medications for mental illness and change my diet all at the same time, but with support, encouragement and education I can manage to do it one step at a time, gaining success and moving towards my wellness goals.”

Challenges

One of the challenges when the program began was that people would avoid the physical activity component. Now when they sign up for the program, the expectation that they participate in both the discussion and the physical activity is made clear. Peer supporters ask what people need to be successful and how they can support them to participate. Everyone is now participating.

Theresa says it has been a challenge for health professionals to understand Take the Extra Step as part of the comprehensive continuum of care, rather than something separate or extra. Theresa hopes the program will increase awareness of the role mental health support workers can play in diabetes prevention and self-management support. She encourages diabetes educators and other health professionals to refer people who are living with mental health and/or addiction challenges and who are living with diabetes, or at risk of developing diabetes, or who just want to increase their overall wellness, to the peer-led diabetes program.

It was also a challenge to be clear with health care providers and physicians what “self-management” means when Theresa met with them to encourage referrals to the outpatient Take the Extra Step program. “Self-management” is not familiar language in the mental health sector. Theresa realized some thought it would result in more compliance with treatment. It was important that she clarify that providing support for self-management does not necessarily result in people agreeing to follow their health professional’s treatment plan more readily. In fact, its goal is to support people to take more control of their health, and they may question their treatment more. People become empowered health consumers and make the best informed decisions from themselves to ensure their wellness and the best quality of life for themselves.

Successes

The program has been going for over a year and has proven to be successful. As soon as each program ends another begins and registration is always full. “Our goal is to hopefully embed this as an on-going dedicated program,” explains Theresa. “Participants have found it so enjoyable and helpful they wanted more.” Weekly support in each location is now available to people who have completed the program and want to return for continued mutual support to maintain this integrated approach to mental and physical wellness.

The wellness focus of the program has been a big success. For example, people are realizing that physical exercise makes them feel better mentally. “It [physical activity] is not often a prescription we get from our [mental health service] providers. We get medication but we don’t know that if we get active and get those hormones going we’ll feel better. Having people make that connection between the physical and the mental has been really important.”

For Theresa, success is in the little things that make a big difference in people’s lives. One participant was riding his bike everywhere and was getting discouraged because he wasn’t losing weight. He was going to stop riding but in talking with the group he realized how cycling helps his wellness overall. He now shares that realization with others to encourage them. A big coke drinker set a goal to reduce intake and is now not drinking coke at all. The resulting loss of weight and saving of money is a story this person tells others. Some people were enjoying the weekly physical activity and wanted more, so the program has now connected them to the YMCA or a local recreation centre.

Another indicator of success is what participants have to say about the program: “Why haven’t we found out about this before? Why aren’t our doctors doing more about helping us with these issues? If the medications cause weight gain, why aren’t doctors helping us with this?”

Enablers

“Strong leadership at Central LHIN and at the hospital that has believed in and supported us in providing another choice for people.” For example:

  • Central LHIN brought together Theresa and the coordinators at the Self-Management Program in Central LHIN.
  • The Self-Management Program in Central LHIN (funded by the Ministry of Health and Long-Term Care Ontario Diabetes Strategy) partnered with the Krasman Centre and provided funding for self-management programs for people living with mental illness who are at risk of or who have had diabetes for the past year.
  • Local diabetes and primary health care service providers provide guest speakers.
  • The Krasman Centre, the hospital participants’ council and diabetes and primary care services are providing cross-referrals to each other’s programs.

Lessons learned

  1. The peer supporters learned that they had to be very clear that you didn’t have to have diabetes to benefit from the program, that it is about wellness. The first program was promoted with a focus on diabetes and few people registered. When the promotion was changed to a focus on wellness, it took off.
  2. The need for diabetes education doesn’t end. People who had taken diabetes education before found the program helpful. “It’s a lifelong condition and we need lifelong education and support around dealing with this.”
  3. A 12-week program wasn’t long enough for everything the peer supporters and participants wanted to talk about, so other topics are covered in the weekly group for people who have completed the program.

Plans for the future

Theresa is part of a team coordinating a new project, PREFER (Peer Recovery Education for Employment and Resilience), a partnership between Krasman Centre, Gerstein Centre and Houselink to train peers in recovery education. Theresa is hoping to integrate diabetes and mental health peer support into PREFER, continuing the Central LHIN CSIs’ focus on addressing physical and mental wellness together.


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