Project Newsletter Number 4

Project Newsletter July 2012

by Scott Mitchell on July 25, 2012

No. 4, July 2012 — In this issue:

» Diabetes and Mental Health Evaluation Wrap Up
» Providing Impact with Diabetes-Informed Mental Health Peer Support
» Roundtables Completed Across Ontario
» Diabetes and Mental Health Peer Support Groups
» Sustaining the Project

» 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.

Diabetes and Mental Health Evaluation Wrap Up

Cheryl Forchuk Amanda Kurtz
Dr. Cheryl Forchuk (left) and Amanda Kurtz

The Diabetes and Mental Health Peer Support Project evaluation was completed in March 2012 by Dr. Cheryl Forchuk and Amanda Meier (Kurtz) of Lawson Health Research Institute. The final evaluation component was a follow-up online survey for the trained peer support workers. Thirty-one trained peer support workers completed the survey by providing information on what has supported them in using the diabetes training information in their consumer/survivor initiatives (CSIs), what has hindered them from using the information, what further supports they require, and how they would change the training in the future. Results were generally positive and consistent with those from the earlier evaluation components of the project (telephone interviews and focus groups).

When asked what had supported the trained peer support workers in using the diabetes training information at their CSI, the most common response was that reference materials from the project had been most supportive (e.g., CDs, literature, newsletter). The reference materials were viewed as beneficial for increasing knowledge, awareness and confidence in sharing information with peers.

The trained peer support workers were also asked what had hindered them in using their diabetes information. Results suggested that the main hindrance for participants was lack of opportunity to use the information. For example, time constraints due to other work responsibilities were a common hindrance expressed by participants. Participants did not discuss any particular hindrances from the training itself. There was a great deal of consistency among responses when participants were asked what further supports they needed. The majority of respondents believe continued education/training and updated materials are important for sustained support. Other suggestions included having the opportunity to share positive experiences with other trained peer support workers and providing more role playing opportunities (for difficult situations in particular). Results suggest that trained peer support workers would benefit from refresher courses that include updated information and more interaction with peers to better prepare them for situations they may encounter at their CSIs. Similarly, when asked what changes should be made to the module a common response was to include refresher sessions and to make the training longer (also a common response among focus group participants in 2011). Participants did not think the content of the training should change but that it should be spread out to allow more time for interaction.

Overall, the evaluation of the Diabetes and Mental Health project found promising results. The vast majority of participants enjoyed the training and had have utilized the training in their own CSIs. In general, the only negative feedback expressed was the lack of opportunities to use the training; there was very little negative feedback as to the training in itself. Common suggestions for the future include longer training, more time for interaction/role playing and refresher training. Resources that were provided during and after the training sessions have been particularly beneficial to participants and should continue to be utilized in the future.

Providing Impact with Diabetes-Informed Mental Health Peer Support

Rob D’Souza

80% of Ontarians over the age of 45 manage a chronic health condition; and 70% these people have the burden of managing two or more chronic conditions (Ontario Health Quality Council, 2007). Depressing.

It is well documented that people living with a serious mental health diagnosis face a higher burden of having to manage an additional chronic health condition over the course of their lifetime. Research has also revealed that people living with a diagnosis of bipolar or schizoaffective disorder(s) have a higher incidence of diabetes than the general population (El-Mallakh 2007 and Cassidy et al., 1999). Making matters worse, “health surveillance” — which includes regular check-ups or even linkage to a primary care physician — is seriously lacking for these folks. Really depressing.

CSIs can play a very important role in a person’s “life after a chronic health diagnosis.” Consumer/survivor initiatives (CSIs) are nonjudgmental safe-havens to people with lived experience, and members in the community who are looking for education, support and guidance on their journey of recovery.

There is enormous impact that a peer mentor can have on an individual, having themselves walked in the trenches of struggle and despair. A peer mentor can really understand where someone is coming from, but importantly, they are credible role models to others that recovery is possible after a major life setback.

I recently had a chat with an individual let’s call him Glen who recounted his own struggle after being diagnosed with diabetes. “Life just got a lot worse,” he tells me. “I felt hopeless and shameful because, you know, I thought I was doing pretty good (in life), and then I find out I have another disease… I felt like such a failure, I didn’t know what to do.” Glen mentioned that this new burden was like a “death sentence,” only “he didn’t know when he was going.” He opined that had he been able to receive some support and education from someone he trusted; moving forward could have been a lot easier.

The Diabetes and Mental Health Peer Support Project will make an impact to folks in need. What is important to note is that people with lived experience have been consulted and have participated throughout the project, which will ultimately provide meaningful context to the target audience. Empowering a cohort of diabetes-informed mental health peer supporters will allow CSIs to further support the members that they already know – the aforementioned population that is so vastly under-served and harder to reach. The prospect of CSIs and mental health peer supporters working with other community stakeholders (e.g. Diabetes Educators, Regional Diabetes Centres, Community Care Access Centres, Registered Dieticians , etc.), will provide create new opportunities for meaningful collaboration in communities across Ontario.

Roundtables Completed Across Ontario

Barbara Neuwelt
Barbara Neuwelt

Between December 2011 and February 2012, the DMHPS Project held eight regional roundtables across Ontario. The purpose was to bring together mental health providers, mental health peer supporters and the diabetes/primary care sectors in each region to discuss how mental health peer support can improve diabetes prevention and self-management for people with mental illness. Each roundtable was intended to be a catalyst for local action.

The roundtables were small enough to generate a good discussion but large enough to include representation from a range of organizations including LHINs, diabetes services, home and community care, CCACs, public health, community health centres, family health teams, food banks, mental health services and consumer/survivor initiatives. Between 14 and 20 regional participants attended each roundtable. Through presentations, sharing and discussion, the roundtables created an opportunity for participants to make connections with people from organizations across sectors.

“95% of the people at the round table, I met today for the first time. It was great making new connections.” Best take away from today: “Community networking” “Making connections” “Glad this community of care is there.”

People learned about each other’s programs and services and perspectives around diabetes and mental health and mental illness.

“Better understanding of the diabetes resources available in our community and how they could be playing a role in our patient health education.” Best take-away from today: “The resources available in the community and the roles of peer support.” “That more agencies are prepared to work together to serve our constituency.”

The presentations and discussion with CSIs furthered diabetes/primary health care participants’ understanding of the contribution of mental health peer support and of the role it can play in the prevention and self-management of diabetes.

“Completely unaware of the program before. I would like to learn more.” “Exceptional!!! I had no idea just how involved peer support was and the education modules they have done.” “This has opened my eyes.”

The conversations generated ideas and next steps to improve diabetes prevention and self-management, including the expansion of the role of mental health peer supporters. Some ideas:

  • A mental health housing organization, a diabetes program and a CSI are going to look at how best to collaborate to create a support group for all their clients/participants with diabetes and mental illness.
  • Some mental services that offer health care services will consider including diabetes peer support in their programs.
  • A Diabetes Regional Coordinating Centre is going to explore how to link mental health peer support with primary care.
  • As a result of the support from one roundtable a proposal has gone in to the Ontario Diabetes Strategy Self-Management Project to train more mental health peer supporters and educate health care providers about peer support in two LHINs.
  • A diabetes network that runs educational events for health care providers is willing to provide training to other programs and broaden education events to include people in the mental health sector.

Many organizations shared what they are already doing to collaborate to address healthy living – particularly eating, exercise and access to health care. The involvement of food banks in addressing healthy food was a welcome addition at some roundtables. The lack of access to all services, including peer support, in rural areas was a topic of concern. Transportation is one of many issues and there was some interest in looking at how organizations can collaborate to address this, such as having a shared vehicle.

Feedback from participants on the roundtables was overwhelmingly positive. Sharing information about the project, about peer support, learning about the CSIs in their communities, meeting people from the CSIs and from the diabetes and other sectors generated energy and excitement about mental health peer support and its role in diabetes.

“I learned [about] the multitude of [diabetes] resources available [and] what they want to expand.” “I learned a whole lot about [the local CSI]. I can now recommend their programs to my clients.” “Gaining knowledge regarding peer support and diabetes will open lots of doors.” “There are more opportunities for providers to work together than I was aware of.”

There were many comments that the best take-away of the roundtable was breaking the silos of diabetes and mental health — the opportunity for networking, building bridges and the spirit of cooperation that came out of the day.

Diabetes and Mental Health Peer Support Groups

Christine Grace McMulkin
Christine Grace McMulkin
Project Consultant

The Diabetes and Mental Health Training Program strengthens the capacity and confidence of mental health peer supporters to assist their peers in the prevention and self-management of diabetes.

Successful completion of the Diabetes and Mental Health Training Program equips peer supporters with the knowledge and skills needed to support peers in many ways, including facilitating Diabetes and Mental Health Peer Support groups. Diabetes and Mental Health Peer Support Groups offer forums for peers to gather, share experiences and exchange support, as they take steps towards strengthening their physical, as well as their mental health and well-being.

The role of Diabetes and Mental Health Peer Support Group leader has emerged as a key trained peer supporter activity. Several peer supporters took the initiative post training and have successfully launched Diabetes and Mental Health Peer Support Groups within their consumer/survivor initiatives. The role established within an award winning metabolic clinic, at Waypoint Centre for Mental Health Care. Health care providers within diabetes services as well as Family Health Teams are committed to incorporating a Diabetes and Mental Health Peer Support Groups within their service continuum.

The newly created Diabetes and Mental Health Peer Support Group Guidelines, a supplement to the training program, will serve as a practical and standardized resource for trained peer supporters. The group guidelines include strategies for promoting, launching and facilitating groups, suggested topics and timelines, and highlight the importance of partnering with diabetes service providers.

As well as assisting peers in the prevention and self-management of diabetes, leading Diabetes and Mental Health Peer Support Groups further establishes the integral role of the mental health peer supporter within health care.

Sustaining the Project

Deb Sherman
Deb Sherman

As the Diabetes and Mental Health Peer Support Project, funded by Lawson Foundation, was initially being developed and now as it is coming to a close, one of the considerations of the steering committee has been to address sustainability of the project and the issue.

We have provided diabetes competency education to eighty peer supporters across the province, but that is only the beginning. The trained peer supporters need opportunities to utilize their skills. This can be done through existing employment or through the creation of additional opportunities. The goal is to maximize the learnings and knowledge that trained peer supporters already have. On the other hand, more peer support workers will be needed in parts of Ontario that were not able to attend the trainings the first time they were being offered. How will we meet that need? We have seven trainers who are prepared to deliver the diabetes competency training module and we will look for additional opportunities to provide additional training.

As part of the sustainability of the issue, the project steering committee has agreed that CMHA Ontario will continue to host the website and OPDI will take over the tasks of posting updates and information.

OPDI will offer the diabetes and mental health peer support training, on a cost recovery basis, whenever and wherever there is a critical mass of peer supporters requiring the training and a source of funding to support it. Ideally, training opportunities will be offered using hosts that are collaborating OPDI member organizations or CMHA branches and other community mental health organizations with peer support programs attached. Host sites would provide training space, offer logistical support and organize lunches and breaks, likewise recovering any costs from partner organizations sending participants.

Meanwhile, other ways and means will be sought to train more peer supporters in diabetes competencies. Currently, the steering committee has a proposal submitted, to provide and evaluate the training in two regions — a funding/project model which, if successful, can easily be duplicated in other areas. OPDI will pursue other local, regional or provincial funding opportunities in collaboration with interested local partners.

A critical consideration with any training program is to ensure not only the availability, but also the integrity of the training and of those who receive it. It is imperative that everyone providing treatment, advice, services and support to people with diabetes and mental health issues should stick to their level of knowledge and expertise. Peer supporters must be recognized as people who can offer mental health/diabetes support from diabetes informed perspectives — they should not be positioned, nor position themselves, as experts on the subject. A well trained peer supporter will always know better than to give medical advice. Safe, successful implementation of diabetes/mental health peer support will require peers who understand boundaries and limitations when supporting people with physical ailments.

This diabetes training module is meant for people who have already received good-quality basic training in Peer Support, and have demonstrated through practical work experience, that they are able to observe boundaries. There are a number of peer support training programs available nationally and internationally, any number or combination of which OPDI member organizations may have used to train their peer workers. The project has undertaken an inventory to list and suggest which programs we will recommend as good bases on which to add Diabetes competencies. The Diabetes module is patterned after, and developed by the same people who created the OPDI Peer Support Core Essentials™ Program, which is one such pre-requisite. To date, seven of the ten qualified trainers of Core Essentials are also qualified to provide training in the Diabetes Module.

We cannot recommend strongly enough that in order to achieve safe and successful implementation of peer support for Diabetes (or any other chronic disease) programs will need to connect to a workforce of well trained and well supported peer workers. Such a workforce exists and can be accessed and grown through partnership and collaboration with local Consumer/Survivor Initiatives and Peer Support Organizations. We recommend that peer support workers be engaged through contract or secondment from your local consumer/survivor initiative or psychiatric survivor organization (CSI or PSO). This will strengthen collaborative ties among programs, strengthen the consumer run organizations, and most importantly, ensure the peer workers have access to the individual support they need from their peers, while providing flexibility and nimbleness to programs that have part time hours to offer. Having peer workers maintain strong connections to these organizations will help them to access any continuing education or updated learning about the Diabetes module, the OPDI Core Essentials, and any new specific skills modules that will be developed as opportunities arise.

One of the difficult aspects of posting training manuals to a public website is the concern that individuals or organizations may be tempted to self-train or to assume having access a manual equates to having the skills to train others. The Diabetes and Mental Health Peer Support training is meant to be delivered by people with lived experience of mental health issues, and preferably, lived experience of diabetes as well. We strongly recommend that the Diabetes module be delivered only by qualified peer support trainers who are linked to Diabetes experts. The training manuals will be posted to the website to allow for knowledge exchange. If organizations would like to work with OPDI to receive training, OPDI will manage the registration process and issue certificates of completion to participants who successfully complete training delivered by OPDI licensed trainers. We will maintain a database of those who complete our training programs, and successful training participants are welcome to refer prospective employers to confirm their training credentials. OPDI will also train more trainers, as needed and where funding permits, to deliver the Diabetes module.

For information on future training opportunities, check in often at or subscribe to OPDI’s electronic bulletin, NewsToGo, by emailing If your organization or a group of organizations has critical mass of trained peer supporters ready to enhance their skills with the Diabetes and Mental Health module, (ten to fifteen is the most effective class size) contact and let’s discuss offering a class.

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