7. Adapting Interventions to Local Contexts and Needs in a Holistic, Ecological Approach

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The training program highlights the fact that interventions to promote mental health must be adapted to local contexts and needs (taking into account the context in which people live) and to the individuals involved. From the individual’s perspective, this means treating specific mental health objectives in a holistic manner, taking into account the particularities of the community and the physical environment the individual lives in, and taking into account different cultures, socio-economic and educational situations, age, gender, sexual orientation, health and abilities. The training program is built around health promotion objectives that are measurable and can be evaluated; and the communities or individuals in question are involved in this process of evaluation: assessing local needs, choosing objectives and indicators and evaluating results.

 

What this criterion means for care professionals

 

Training should encourage and enable participants to take into account local community contexts when putting into place mental health promotions strategies in the community in question. This requires having good knowledge of the social structures and values in the local context in which the programme is going to be implemented. On an individual level, this involves taking into account the needs of the whole person, in their individual context. People who are ill for example cannot be defined by their illness; they are not just a body or a mind; they have bodies, minds, family, a psychosocial context, an environment, a culture, etc. In the counselling relationship, the care professional must take into account peoples’ needs at all these different levels - physiological, psychological, social and spiritual - in a comprehensive manner, as well as the person's living environment (family, neighbourhood, city, region).

 

It is important to avoid practices which shape people’s needs and projects into the existing offer and supply of services, and to understand how to develop responses/interventions which are shaped around local situations of need. Interventions that have proved their worth elsewhere need not only to be adapted to local contexts but also to the available resources, at both individual and community levels. Mental health promotiong also involves searching for and organising resources. This task requires partnership with the populations involved in mental health promotion and cooperation and coordination between service providers.

 

Illustrate how this criterion could be respected for initial training

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Students must master techniques for the assessment of needs in a holistic way, both on an individual and a community level, as a basic element in effective programs in the health promotion area. Students should understand that evidence-based programmes that have worked in one area with one population may not work in another area with another population.

 

Ideas for training modules/exercises

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• Include modules on the holistic approach to individual care from day one. Study the determinants of individual and community mental health, on biological, psychological, sociological and ecological levels. Focus also on sociological factors (e.g. family conflict, poverty, unemployment, poor housing, having a baby) and stress the need for adapting the interventions to promote mental health to the contexts in which people live.

• Study the determinants of the mental health of specific populations in specific social contexts (for example, migrant populations, the homeless, people with low income, etc.)

• Include a module on the ecological approach to community actions, including methods for identifying the determinants of mental health, assessing the specific needs of the community in question, selecting evaluation criteria adapted to local contexts and involving the community in question in assessment.

• Ask students to design a mental health promotion scheme for the university itself, with students and staff participate in assessing needs by identifying all the factors that could impact on mental health in the student population at that specific university: housing, income, finances, social networks, physical activity, leisure activities, transport, exams, etc.

 

Illustrate how this criterion could be respected for continuous training

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The trainer may face greater reluctance among specialists who have developed specific work habits, for example hospital nurses who are used to apprehending the individual as a "patient" to be understood in terms of their "pathology".

 

Ideas for training modules/exercises

• Incorporate role play approaches where participants play the role of:

  • a patient with dual diagnosis confronted with a care service which only takes into account, for instance, his/her psychiatric problem.

  • a homeless patient confronted with a mental health service professional who only takes into account his/her mental health problem.

  • a young mother seeking information on parenting skills in a child care service which completely neglects her social, cultural, economic and community context.

  • a client who has other priorities (cultural, spiritual, family...) more important to him/her than the one that seems most obvious in terms of personal physical health.

 

Consult the following Resource Kit for further information, relevant legal and policy texts, and examples of posters, slides and training programmes that respect this criterion:

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