The Impact of Syrian Refugee Arrivals on Local Systems of Support in Canada.

This article reports on the findings of a 10-month study designed to collaboratively explore the impact of the arrival of Syrian refugee newcomers in 2015-2016 on the way local communities support newcomers. Waterloo Region, a mid-size urban centre in Ontario, Canada, was the focus of study. The study used a mixed-method design involving four methods (document review, key informant interviews, organisational survey focus groups). Findings are presented following a systems change analytical framework that included (1) an emerging vision for local refugee support in the Waterloo Region, (2) the adaptation of local structures, (3) the emergence of collaborative processes and (4) an overall assessment of impact. Three main lessons are discussed. The first lesson demonstrates how local systems change is negotiated within a broader migration landscape (contextualizing local systems change). The second lesson acknowledges that a community's historical migration response can be a springboard for local change (initiating local systems change). The third lesson suggests that expanding and coordinating community engagement in the refugee support system is integral for lasting change (sustaining local systems change). Combined, these lessons provide a comprehensive analysis into how local communities can be adaptive in supporting refugee newcomers.

Taking culture seriously: ethnolinguistic community perspectives on mental health.

OBJECTIVE: Ethnolinguistic communities are underserved by mental health systems in immigrant-receiving, multicultural societies, but their perspectives are seldom elicited in mental health research or reform planning. This article helps fill this gap by presenting community perspectives on concepts of mental health, mental illness and mental health experiences with five ethnocultural communities (Latin American, Mandarin-speaking Chinese, Polish, Punjabi Sikh and Somali) in Ontario, Canada. METHODS: Data were collected from 21 focus groups as part of a large-scale, participatory action research project called Taking Culture Seriously in Community Mental Health. RESULTS: The analysis focuses on how mental health and mental illnesses are described, how mental health care is experienced and what recommendations community members provide to improve the mental health system. CONCLUSIONS: Study findings illustrate the importance of the social context of immigration and settlement in conceptualizing mental health and mental distress. We conclude that systemic changes are needed to formulate collaborative, community-based strategies for mental health promotion and interventions.

Developing theory from complexity: reflections on a collaborative mixed method participatory action research study.

Research studies are increasingly complex: They draw on multiple methods to gather data, generate both qualitative and quantitative data, and frequently represent the perspectives of more than one stakeholder. The teams that generate them are increasingly multidisciplinary. A commitment to engaging community members in the research process often adds a further layer of complexity. How to approach a synthesizing analysis of these multiple and varied data sources with a large research team requires considerable reflection and dialogue. In this article, we outline the strategies used by one multidisciplinary team committed to a participatory action research (PAR) approach and engaged in a mixed method program of research to synthesize the findings from four subprojects into a conceptual framework that could guide practice in community mental health organizations. We also summarize factors that hold promise for increasing productivity when managing complex research projects.

Building a community-based culture of evaluation.

In this article we argue for a community-based approach as a means of promoting a culture of evaluation. We do this by linking two bodies of knowledge - the 70-year theoretical tradition of community-based research and the trans-discipline of program evaluation - that are seldom intersected within the evaluation capacity building literature. We use the three hallmarks of a community-based research approach (community-determined; equitable participation; action and change) as a conceptual lens to reflect on a case example of an evaluation capacity building program led by the Ontario Brian Institute. This program involved two community-based groups (Epilepsy Southwestern Ontarioand the South West Alzheimer Society Alliance) who were supported by evaluators from the Centre for Community Based Research to conduct their own internal evaluation. The article provides an overview of a community-based research approach and its link to evaluation. It then describes the featured evaluation capacity building initiative, including reflections by the participating organizations themselves. We end by discussing lessons learned and their implications for future evaluation capacity building. Our main argument is that organizations that strive towards a community-based approach to evaluation are well placed to build and sustain a culture of evaluation.

Who uses consumer-run self-help organizations?

A multisite evaluation of community mental health services is used to answer two questions: (a) How do diagnosis, functioning, and self-assessments of consumer/survivor initiative (CSI) and assertive community treatment (ACT) participants compare?, and (b) What other supports/services are CSI and ACT participants using? The sample is from an Ontario evaluation of consumer/survivor peer initiatives in four communities (n=73). The reference group is new (n=48) and ongoing (n=134) clients of four ACT teams. Self-help organizations are serving a broader population of individuals who include a significant subgroup of persons with severe mental illness along with others with a mixed picture of higher functioning and greater instability. There is little overlap in the use of these modes of service delivery, which suggests that maintaining options within systems of care is critical to ensuring coverage and access for the broader population.

Moving forward: negotiating self and external circumstances in recovery.

This article presents a framework for understanding the concept of recovery from serious mental illnesses and other life struggles. The framework is based on findings from a longitudinal, qualitative study that involved in-depth interviews with 28 people who experienced serious mental health challenges. The purpose of this article is to clarify the concept of recovery by presenting a grounded theory analysis of the components of recovery. The framework recognizes the experiences of struggle constructed through the words of study participants and captures four main components of recovery: a) a drive to move forward, b) a spiral of positive and negative changes, c) the context of recovery, and d) a dialectical process of ongoing negotiation between self and external circumstances.

Sharing power and knowledge: professional and mental health consumer/survivor researchers working together in a participatory action research project.

In this article we document and reflect on the process and outcomes of consumer/survivor researchers' involvement in a community mental health research project. The study used a participatory action research approach that challenges traditional assumptions of how to conduct research. Research roles and relationships were reexamined by both professional and consumer/survivor researchers. Four values were central to the research process: consumer/survivor empowerment, supportive relationships, learning as an ongoing process, and social justice. The benefits of this value-driven approach were seen in terms of positive impacts on the lives of individual researchers and also in the quality of the research itself. Our reflections on the research process have led us to see the importance of building relationships as a means to share power and knowledge among professional and consumer/survivor researchers.

From our perspective: consumer researchers speak abut their experience in a community mental health research project.

People who have experienced the mental health system were hired and trained as researchers in a community mental health research project. Throughout the course of the project, these consumer researchers reflected on what they learned about their research experience. This article is a window into this learning process and offers an opportunity to see research through the eyes of consumer researchers. We begin by giving an overview of the research project and introducing the research team. Then the consumer researchers in our project share their experiences and insights about involving mental health consumers in research projects. We hope that ourproject's experiences will help other projects that involve consumers in ways that are empowering for the consumer and beneficial to the research.

Bridging the gap between dreams and realities related to employment and mental health: implications for policy and practice.

Access to valued resources, especially to employment and income, is a critical issue in community mental health. Appropriate public policy and services are needed to bridge the gap between dreams and realities related to employment for people with a serious mental health illness. This article reviews current literature in the area of employment and mental health, and describes the findings of a research study focusing on these issues in one community in Southern Ontario. This study used a participatory, action-oriented approach to understand the ideal employment situation for people with a serious mental health illness, and to explore the barriers preventing them from finding, getting, and keeping work. Concrete areas for action (generated by people with a serious mental health illness working with service providers in this field) are suggested in order to respond to employment barriers at various levels and to make employment a reality for people experiencing a serious mental health illness.

From social liminality to cultural negotiation: Transformative processes in immigrant mental wellbeing.

The underlying psychosocial processes that produce immigrant mental wellbeing are understudied in anthropology and medicine. This paper provides insights into these processes by describing culturally diverse immigrants' perceptions of mental health and adaptation strategies. Qualitative data were collected from 21 focus groups as part of a large, multidisciplinary, participatory action research project about mental health with five ethnolinguistic groups (Mandarin-speaking Chinese, Polish, Punjabi Sikh, Somali and Spanish-speaking Latin American) in Ontario, Canada. In framing the analysis, transformative concepts are applied to address dimensions of power and culture - social liminality and cultural negotiation - to the ongoing psychosocial processes of coping with mental distress. 'Social liminality' describes how immigrants perceive themselves to be in a psychologically stressful, transitional state, whereas 'cultural negotiation' describes how they actively cope with cultural tensions and respond to mental health challenges. Study findings show that while social liminality and cultural negotiation are stressful, they also have the potential to help individuals adapt by producing a positive synthesis of ideas about mental health in new social and cultural contexts. The study contributes to the shift from problem identification using a biomedical model of mental illness to a more psychosocial and ecological approach that reveals the potential for resolving some mental health problems experienced in immigrant communities. Describing active psychosocial process of adaptation also reinforces the therapeutic and educational value of partnerships between practitioners and clients and immigrant communities and mental health systems.

Putting values into practice: public policy and the future of mental health consumer-run organizations.

The purpose of the paper is to reflect on value dilemmas in mental health consumer-run organizations and to discuss implications for research, policy, and practice. We review the roots of consumer-run organizations in the self-help movement and the psychiatric survivor liberation movement, focusing on the distinctive values espoused by consumer-run organizations. We also discuss evidence-based and value-based approaches to mental health policy formulation and mental health reform, noting the particular importance of value-based approaches and the role that consumer-run organizations can play in mental health reform. Based on our experiences conducting a participatory action research study of four mental health consumer-run organizations, we identify and examine several value dilemmas, discuss the lessons that we learned about these value dilemmas, and note their implications for future directions in research, policy, and practice.

Inspiring knowledge mobilization through a communications policy: the case of a community university research alliance.

Taking Culture Seriously in Community Mental Health is a community-based participatory action research project in Ontario devoted to developing, pilot testing, and evaluating mental health service models grounded in the concept of "cultural empowerment." To ensure that the knowledge generated in the project is shared and used, the research collaborative places a heavy emphasis on communicating with stakeholder groups. This paper provides an overview of a communications policy designed to facilitate such sharing and use. It describes the development and key features of the policy, focusing on the broad issues of principles, authorship and acknowledgment, and planning and procedures.

Capturing system level activities and impacts of mental health consumer-run organizations.

Since the 1970s mental health consumer-run organizations have come to offer not only mutual support, but they have also adopted agendas for broader social change. Despite an awareness of the need for system level efforts that create supportive environments for their members, there has been limited research demonstrating how their system level activities can be documented or their impacts evaluated. The purpose of this paper is to feature a method of evaluating systems change activities and impacts. The paper is based on a longitudinal study evaluating four mental health consumer-run organizations in Ontario, Canada. The study tracked system level activities and impacts using both qualitative and quantitative methodologies. The article begins by describing the development and implementation of these methods. Next it offers a critical analysis of the methods used. It concludes by reflecting on three lessons learned about capturing system level activities and impacts of mental health consumer-run organizations.