Case Study: The Link

Halina Shannan“It comes as a surprise to people how much work it is to manage your health…. The key to our success is our approach: Rah! Rah! We’re all in this together. I can’t make changes by myself, but if we’re all doing it together, I can be better about making the changes I need.” — Halina Shannan, Coordinator and Peer Supporter, The Link


Setting

The Mental Health Support Project (a.k.a. “The Link”) is a consumer/survivor initiative in Smiths Falls, Ontario, that serves the South East Local Health Integration Network (LHIN) region. With 200 participants in total and roughly 40 a day attending activities at The Link, this wellness and activity centre is hopping.

Integrating diabetes support into the activities at The Link

The Link has three diabetes-informed mental health peer support workers who run a weekly healthy living and diabetes program. The Link has also integrated healthy living practices into its regular activities. An ongoing men’s cooking group has introduced healthier foods and education about diabetes. The Link’s Friday lunches are integrating some fruits and vegetables into tried and true meals.

When the peer supporters at The Link had the opportunity to get trained in diabetes peer support, they immediately contacted the Rideau Valley Diabetes Services (RVDS) to see how the two organizations could partner. RVDS staff now offer a cooking group for Link members with diabetes at the nearby community health centre once a month. They also visit The Link once a week to chat with people in the drop-in group and answer questions.

The Link also partners with other organizations in the South East LHIN region. Lanark County Mental Health Services refers people to The Link’s diabetes and exercise programs. In other parts of the region, North Lanark Community Health Centre runs its own exercise and cooking programs and The Link provides an evidence-based recovery education program on-site for people living with mental illness. The Link has also educated the Perth Food Bank about recovery for people with mental illness and works with both the Food Bank and the Rideau Environmental Action League on gardening.

Successes

People with diabetes found the support group made a difference in their lives. Over the course of a few weeks their blood sugars dropped significantly. Many participants mentioned that after the group, when they were tempted to eat unhealthy foods, they remembered the struggles that others had to stay on track and it helped them to make a healthier choice. Very heavy people who had difficulty walking were doing a little bit of exercise. And many people began to walk daily with The Link’s daily walking group at the arena.

The program was so popular and so much fun that other Link participants have asked to join in the healthy activities and now the program is open to everyone.

Why diabetes support within a CSI is effective

For many people, exercise and a change in diet were intimidating. Exercising on your own or with others who don’t have the same life challenges can be difficult, especially for those who are extremely heavy. Introducing fruits and vegetables was very challenging for many people who had never eaten them. Many people had never drunk water on a regular basis. The diabetes group involved learning about diabetes, walking at the arena every day, doing stretch exercises, drinking water, being mindful about medications, eating better and supporting each other through the challenges of making changes.

Providing information about diabetes is more effective in this setting. People have the opportunity to see what that information means in their own lives, challenge it and bring back questions and concerns: “My doctor wants me to take more metformin, isn’t that too much?” “When I eat a whole bag of candy and test my blood right away, my blood sugar is fine, so what’s the problem?” Peer supporters are able to say, “I cannot advise you on medication but I can tell you I am taking the same amount as your doctor is suggesting to you.” They can remind the person that blood sugar levels take a few minutes to show the effects of the candy. Regular repetition and reinforcement of information about living with diabetes is crucial, says Halina Shannan, one of the two coordinators at The Link, and a diabetes-informed mental health peer supporter.

Challenges

The need for ongoing structured support became evident after the first eight-week diabetes group ended. After great success, people’s challenging lives — a psychotic break, problems with housing, other life events — made it difficult for them to maintain what they gained from the group. Informal support on an as-you-need-it basis wasn’t enough. The diabetes and healthy living group is now an ongoing program with a focus on supporting people to maintain the gains they have made as they go through the ongoing challenges of living in poverty and living with a mental illness.

Halina says changes in foods have to be done very slowly in order to be acceptable to participants, with small amounts of vegetables added to spaghetti sauce, for example.

Enablers

Participants in the diabetes group are finding that their fellow group members are helping them to accept their losses and get back on track. Developing skills in managing the ups and downs of life will also be a new focus for the program, which will include meditation and breathing exercises.

Exercise has now become a daily activity open to everyone. There is a draw open to anyone participating in exercise. The more you exercise the more chances you have to win and the prizes get bigger and better, from a free lunch to sports shoes and hockey tickets.

Halina says the presence of RVDS nurses in the drop-in has helped to break down the mistrust many participants have of doctors and nurses and their fear of going to places where they might be seen as different from others. The Link participants feel more comfortable now to go over to the health centre for programs and services.

Plans for the future

A recent roundtable on mental health and diabetes peer support has inspired some of these and other agencies to look at new ways to support diabetes prevention and self-management for people with mental illness in the South East LHIN. And with new funding, The Link is partnering with RVDS to produce evidence of their programs’ impact on diabetes through measuring A1C1, blood pressure, participants’ sense of well-being and their sense of their energy levels.


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