Project Newsletter Number 2

Project Newsletter September 2011

by Scott Mitchell on September 26, 2011

No. 2, September 2011 — In this issue:

» Becoming diabetes-informed
» Interview with Betty Harvey
» What can a peer support worker do with the diabetes competency training provided by this project?
» Partnering with consumer/survivor initiatives
» Project Update

» Download PDF version


Diabetes and Mental Health Peer Support is a two-year project to provide competency training for Ontario mental health peer supporters in diabetes prevention and self-management strategies.

Becoming diabetes-informed

Prevention and self-management of conditions such as diabetes within the population of people who are also recovering their mental health and well-being is best facilitated by a circle of support that includes mental health peer supporters as well as diabetes health care providers.

Mental health peer supporters bring unique expertise to the table, combining their own lived experience of mental illness with specialized training in peer support. Their role is to support an individual’s expressed wishes in relation to their health and well-being.

The mental health peer supporter’s role may include supporting their peers in the prevention and self-management of diabetes. This aspect of their role requires a commitment from the peer supporter to gain a level of understanding about the condition — a commitment to become “diabetes-informed.”

Strong collaborative relationships between diabetes-informed mental health peer supporters and diabetes experts will support the prevention and self-management of diabetes in people recovering their mental health and well-being.

A peer supporter who is diabetes-informed:

• understands basic facts about diabetes
• has access to diabetes education resources
• is aware of diabetes services and specialists in their community
• has experience supporting peers to connect with the diabetes sector.

Interview with Betty Harvey

Betty Harvey is a Clinical Nurse Specialist/Nurse Practitioner with the Primary Care Diabetes Support Program at St. Joseph’s Health Care, in London, Ontario. Her work focuses on people with serious mental illness who need primary health care but are unable to access services, such as diabetes care, due to a lack of support. She has been specializing in diabetes as a nurse practitioner for 17 years and serves as a Canadian Diabetes Association expert advisor. Betty is also an Associate Professor with the Faculty of Nursing at the University of Western Ontario. Betty’s research interests include pediatric obesity, diabetes prevention, and diabetes management in high-risk, marginalized populations (ethnic groups and people living with mental illness.

Why is this project unique?

The project recognizes the incredible capacity within consumer/survivors to help one another. Empathizing with the consumer/survivor experience in the health-care system can be a real source of support, especially in an environment where the professionals are so far removed from this perspective.

The project offers a well-developed and thought-out training program. There is potential for tremendous harm if the people doing peer support are not trained, self-aware or committed to an ethical practice. The training and sensitivity work is critical to prepare a consumer/survivor to take on the peer support role. Peer support is not about being a fount of knowledge, but being a supportive person within boundaries.

What are the most common barriers that prevent consumer/survivors from receiving diabetes care?

Based on people’s stories, one of the big barriers is access. Diagnosis and treatment are hard to access for people who are not well or who are very anxious. There also needs to be support for self-management.Taking care of yourself is a very important part of living with diabetes. If you are struggling with things like depression and poverty, self-care is a huge challenge. The impact of long-standing mental illness can result in poverty and isolation: Many individuals have lost work and their ability to function in the workplace. Their relationships have broken down. Food security, transportation, informal support systems have disappeared. These are things that interfere with chronic disease self-management.

The other issue is the ebb and flow of mental illness. There are folks that are incredibly capable when they are well, but when they are not well they need supports to ramp up. Our systems are not well-designed to do that.

Our health-care system is designed to be triggered by patients themselves. However this can be overwhelming for those whose focus, internal motivation or energy are low, or suboptimal, due to mental illness. Without a proactive health system that reaches out to them, people can fall through the cracks.

How can a diabetes-informed mental health peer support worker help in overcoming these barriers?

A peer supporter can help with system navigation. A local peer supporter can develop and link others with community contacts who are best equipped to help around issues such as food security, health administering, etc. When peer supporters are linked with the health care system, they can help advocate for or with a person who lacks a personal support system.

Also, there is a sense of safety that is inherent in talking with someone who has had a similar consumer/survivor experience. There are sensitive issues to talk about (poverty, addictions, negative or self-destructive thoughts) and a level of credibility from shared understanding is important for these discussions.

How can peer supporters work in collaboration with other diabetes professionals, like yourself?

Peer supporters can provide advocacy for peers, system navigation and basic support. They support a patient to fulfill health goals and can help people get to a medical appointment if they are not well. And having the peer supporter by their side at an appointment can help encourage an individual to take an active role in decision-making.

Betty Harvey can be reached at

What can a peer support worker do with the diabetes competency training provided by this project?

The peer supporters who took part in our Diabetes and Mental Health Peer Support training sessions earlier this year are now beginning to translate their learning into action in their local communities. Peer support for the prevention and self-management of diabetes and mental health issues can take many forms. We asked a few of the participants to tell us about their recent activities.

Arif is a peer support trainer with People for Equal Partnership in Mental Health (PEP), a consumer/survivor initiative in North Bay. Arif encourages fellow members to use their peer support skills in the community. Arif and others from PEP provide presentations and table displays on diabetes and mental health at a Home for Special Care facility and a related drop-in centre. PEP also launched a support group for people with diabetes and lived experience of mental illness where people talk about nutrition while exchanging healthy recipes.

Janie Ann from North Bay is developing a community garden for peers. She is collaborating with a nutritionist and a chef to form a small organizing committee — they call themselves People Empower / Assist / Recover (PEAR). “It will be about people with diabetes and mental health issues empowering each other with education, assisting with acceptance and recovering with respect.”

Jean from Parry Sound has been providing mental health and diabetes workshops in community halls to consumer/survivors in more than one town in her area. She is helping to orient peers to the types of services available within each community, such as diabetes education centres. This leads others in the group to add their local knowledge of the best services for each other. “I’m managing to snowball my activities to encourage the group’s capacity for peer support.” This work is supported through the grassroots organization RISE: Resource Centre for Independent Living. Jean supports healthy eating through a poverty lens: “I provide some information and then set them loose. The sessions involve peer support brainstorming to overcome poverty barriers and we’re recording all the information to put together a resource manual.”

Partnering with consumer/survivor initiatives

A consumer/survivor initiative (CSI) is an organization run by and for people with lived experience of mental illness. Every CSI in Ontario is unique. Some have funding for staff, others are run by volunteers. They vary in size, resources and range of activities offered. Common services include drop-in centres, social-recreation programming and support groups. What they share is a focus on personal empowerment, social support and improved quality of life for their members.

At a community level, CSIs often work with service providers, funders and health-system planners to develop, implement and evaluate mental health services and supports. They play a role in advocating for change to support recovery, resilience and mental health human rights. CSIs may also educate people in the community about the myths and realities of living with a mental illness.

For the past 20 years, CSIs across Ontario have been providing peer support to improve the quality of life for people with lived experience of mental health problems. As their peer support workers gain diabetes competency training, CSIs are well-positioned to become key partners in diabetes prevention and management initiatives. Watch for regional roundtables in your region for partnership opportunities.

To find out more about partnering with CSIs, see Partnering with Consumer/Survivor Initiatives.

Project update

The Peer Supporter Diabetes and Mental Health Training Module will be released publicly in early 2012 after a full evaluation of the module is complete.

The module, developed by Christine Grace McMulkin of Christine Grace and Community, was pilot-tested by peer support trainers in eight locations across Ontario. More than 80 peer supporters took the training in March and April 2011. During the past few months, they have been applying what they learned within their own communities. An evaluation of the training module and its application in the field is being carried out by Cheryl Forchuk, a scientist at the Lawson Health Research Institute in London, Ontario. The evaluation will provide information about how successfully the training has increased participants’ knowledge of diabetes and confidence in their peer support role. Focus groups are being held in August and September 2011 with the participating peer supporters to understand how they have applied the training in their communities.

The diabetes and mental health training module is designed as a specialty module that builds on peer support fundamental training, such as the OPDI Peer Support Core EssentialsTM Program created by the Ontario Peer Development Initiative. “The best case scenario is for peer supporters to have a solid foundation in the role and boundaries of peer support through quality training,” says Deb Sherman, executive director of OPDI. “People need the core skills of peer support before applying the diabetes module.”

The project team has now begun reaching out to the diabetes sector and consumer/survivor initiatives to promote the training module and share the lessons learned. Following are a few of our recent and upcoming activities:

  • Spring /summer 2011: Presentations were made to diabetes regional coordination centres to increase awareness about the role of mental health peer support workers and explore opportunities for collaboration between diabetes professionals and peer supporters.
  • June-September 2011: Discussions were held to explore how mental health and diabetes peer support can be advanced through the self-management strategies being implemented by the LHINs, which have regional training opportunities in chronic disease self-management and an interest in peer support.
  • October 12, 2011, 11 am-12:30 pm: A webinar, open to all consumer/survivor initiatives in Ontario, will be delivered to raise awareness of the training module and to discuss future and ongoing engagement with CSIs on the diabetes and mental health issue.
  • Fall 2011: Formal presentations and workshops are planned for several mental health, primary health care and diabetes conferences.
  • October 2011–February 2012: Regional roundtables are being organized to build connections between CSIs and local diabetes and related health professionals. The roundtables will take place in many of the regions where mental health peer supporters have been trained in diabetes self-management support. The roundtables will be a way to highlight local issues related to diabetes and to explore opportunities for mental health peer supporters to collaborate with others in the community. If you are interested in being involved, contact Zarsanga Popal at

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