Le Modèle global de santé mentale publique et les mentors de rétablissement

Résumé

Publié pour la première fois en 2009 et révisé en 2013, le Modèle global de santé mentale publique (MGSMP) est d’abord une hybridation conceptuelle entre le rétablissement et la promotion de la santé selon l’OMS. Le MGSMP sert à paramétrer l’intervention des mentors de rétablissement en tant que traceurs de changement en santé mentale publique. Le changement peut être d’ordre personnel, interpersonnel, culturel, socio-économique ou politique. Ce modèle est en effet dit global notamment du fait que les niveaux supranational et individuel se renforcent mutuellement en se relayant avec ; a) un ensemble de règles juridiques et de conventions internationales relatives aux droits de la personne ; et b) les mentors de rétablissement qui canalisent leur savoir expérientiel en évoquant ces conventions pour le développement d’une capacité de changement continu. D’un forum citoyen à l’autre, cette capacité d’influence transformationnelle s’est affirmée au profit d’un effet d’émulation en cascade. Les résultats de cette intervention sont ici rapportés sous forme de recommandations intersectorielles visant à sensibiliser et mobiliser la communauté pour une meilleure prise en compte des déterminants sociaux de la santé et du rétablissement que sont tout particulièrement l’emploi et le travail. Tandis que la révision du MGSMP de 2013 prenait appui sur le 3^e forum citoyen consacré au logement, celle-ci s’articule au 4e forum citoyen de 2016. Intitulé « La santé, ça nous travaille ! », il fut animé du début à la fin par des mentors de rétablissement selon une approche méthodologique par cas traceurs, ici traceurs de trajectoire de rétablissement inter et multisectorielle.

Mots clés : modèle global de santé mentale publique, mentors de rétablissement, conseil citoyen en santé, table de quartier, plan d’action en santé mentale

Abstract

The Global Model of Public Mental Health and Recovery Mentors

Objectives The aim of this paper is to revisit the Global Model of Public Mental Health (GMPMH) in light of the 4th Civic Forum. Recovery mentors of the University of Recovery chaired this public event, which was held in East-end Montreal, Canada, in 2016. The University of Recovery is a concept of co-learning among its members.

Methods Being able to refer to international conventions and human rights standards is a key component of a genuine global approach that is supportive of individuals and communities in their quest for recovery and full citizenship. The GMPMH was inspired by the ecological approach in public health and health promotion programs, while adding to that approach the recovery mentors, as agents of mental health policies and legislation transformation. The GMPMH integrates recovery- and citizenship-oriented practices through the Ottawa Charter for Health Promotion of the World Health Organization. Indeed, here the GMPMH is said to be global in that the supranational and individual levels reinforce each other, taking turns with a) a set of legal rules and international conventions on human rights, including those of disabled persons, and b) the active involvement and agency of recovery mentors who can evoke these rules and conventions as part of a plea for the recognition of their personal and collective capacity for change; they acted as tracers of recovery trajectories during the Civic Forum. The GMPMH was first published in 2009, and revisited in 2013. While this latter revision was based on the 3rd Civic Forum, in this paper we use the same approach to revisit the GMPMH as underpinned by the findings and recommendations of the 4th Civic Forum, which discussed questions related to work and employment.

Results Updating the GMPMH in light of the Civic Forum underlines the need for a more inclusive type of governance regarding policy and systems transformation. Local communities and persons in recovery can reach each other to promote change and capacity building, for instance through quality assessment, and evaluation of human rights’ level of respect in healthcare facilities and more broadly. People with mental health challenges ought to be “included in the community” – as this is a right, not a reward (UN Convention on the Rights of Persons with Disabilities, art. 19). This is achievable if the community is informed and welcoming, for instance in getting involved with a Civic Forum and its organizing committee. The degree to which a transformational agenda is participatory is revealed as a predictor of the degree to which the broader community can be reflexive about its own inclusiveness for a genuinely global approach of public mental health, and with a cascading emulation effect.

Conclusion Transition from social marginalization to full citizenship represents a daunting challenge in public mental healthcare. Creating access to the valued roles which individuals will be able to occupy in community and workplace settings requires capacity building and inter-sectorial synchronicity, as suggested by recovery mentors who can act as tracers to reveal obstacles and gateways in the recovery journey. Public intervention and debate are required to promote and monitor the bond of citizenship that connects people to their communities, and the quality of this bond needs to be included in the scope of public mental health for continuity and equity of access.

Keywords: global model of public mental health, recovery mentors, civic health council, neighborhood consultation table, mental health action plan