Developing a Common Community Language Concerning Youth Mental Health 

As critical as up-to-date information is in providing the proper context to a community-based problem, it is the language used and the method of delivering key messages that can truly reach a community and mobilize it to action. Given the various groups of individuals that make up a community, it is essential to be sensitive to the changes required in delivering the message to different audiences. We have to be prepared to take theoretical concepts and to put them into everyday words. 

Edwin Shneidman, who has worked in the area of suicidology for over half a century, provides one example of this. He declared: "I believe that suicide is essentially a drama in the mind, where the suicidal drama is almost always driven by psychological pain, in the pain of negative emotions, which I call psychache. Psychache is at the dark heart of suicide; no psychache, no suicide" (Shneidman, 2001). 

Community capacity building involves increasing skills, knowledge and understanding of the issue. Finding ways to promote youth mental health issues in the community depends on creating a common language. This is where the concept of psychache, a word to describe intolerable psychological pain, becomes an extremely valuable tool in youth mental health promotion. Further, the notion of eliminating the stigma relating to mental health issues needs to be addressed with even younger children, and finding ways to communicate with them becomes essential. 

Shneidman's extensive research has named the pain associated with mental health issues and behaviours. Shneidman proposed that the unbearable psychache that a person may experience is intensified by unmet psychological needs. He concludes that there is not one single type of suicidal person. This concept is important for youth mental health promotion. What causes one youth to "suicide" is very different from another. The common thread is that they are in pain. Shneidman states that in order to prevent suicide "one has to address the frustrated psychological needs of that particular person" (Shneidman, 1998). Awareness and education around warning signs of suicide are extremely important. However, it is of equal importance that we begin to help individuals identify their own psychache. Both youth and the community will not be able to understand this unless the community develops a common language. 

Using the concept of Shneidman's psychache, we were able to develop a comparison with a physical health issue that most community members can identify with, an earache. An easy-to-use exercise was developed that was presented to many different audiences and age populations. The goal was to find a way to use this common language no matter what the age of the listeners. 

Earache vs. Psychache Exercise 

• Ask the participants if they have ever had an earache. 
• Ask them to list the symptom son a flip chart/blackboard. 
• Symptoms usually identified include: can't eat, can't sleep, don't want to see their friends, want to stay in bed, hurts inside but you can't see it…etc. 
• Ask where they could go or to whom they could turn to if they had these symptoms. 
• Youth will list every walk-in clinic, parent, teacher, hospital, neighbour is a nurse, and the list goes on. 
• Ask how long they would let it go before you told someone or sought help? 
• Usually youth will say no more than a day. 
• What would happen if you told no one? 
• Youth will indicate that it would get worse and you could even die. 
• Erase earache and put the word "psychache." 
• Ironically the symptoms of an earache mimic that of depression, can't sleep, eat, don't want to see friends and it hurts inside but you can't see it. 
• Ask participants where they would go if they had a psychache. 
• Usually, there is very limited knowledge of where to go or what to do. 
• Indicate to the group that this is what we are here to change. 

Whether doing this exercise with children, youth or with adults, the lesson always seems to be the same. We have done a great job of teaching children and youth to recognize the symptoms of an earache (physical health) and to tell someone. In terms of youth mental health promotion, what we need to do is to teach the symptoms of psychache - to ensure that youth know what to do before the pain becomes intolerable. We need to use mental health promotion to begin a dialogue about psychological pain and as a community, find the "teachable moments" to address it. This is not limited to suicide prevention but all aspects of youth mental health promotion. By using this concept to "get the message across," community members can begin to understand key concepts as they have meaning to them at a personal level. 

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Defining Community Assets 

Capacity building is not confined by the geographical notion of "community." There are many communities within a community, including youth, school, business or government. Bringing these diverse groups together in a shared vision requires discovering essentially the expertise and abilities that each individual and group could bring to the table. In terms of mental health promotion, these diverse groups may not immediately perceive themselves as having the skills and knowledge to influence change. 

The professionalization of "helping" has unintentionally created stumbling blocks for youth to seek assistance and has significantly eroded a community's natural capacity to be supportive. John McKnight, in The Careless Society - Community and Its Counterfeits (1995), further explores this concept of how to look at a community's ability to support each other. He describes the way that communities are viewed by society as being inadequate, with an increased reliance on "professionals." McKnight uses the common metaphor of the glass being either half-full or half-empty to describe communities. The underlying message of how community needs are perceived depends on how community members look at it. 

"We are partly empty.
We have deficiencies.
We are also partly full.
We have capacities" 

(McKnight, 1995) 

Youth mental health promotion activities must take on the philosophy that the glass is always half full. There are ways to engage communities in discovering and using their own capacities in youth mental health promotion. It does not always take an "expert" to be the one with the pitcher to fill up the glass. Through innovation and creativity, communities possess a limitless capacity to fill their glasses, no matter what the issues are. 

Two essential resources identified and mobilized through the West Carleton experience were youth themselves and the business community. Each required a specific strategy in order to be engaged and each contributed in their own way. The challenge was to facilitate innovative ways for them to contribute, even beyond what they originally envisioned their role to be. 

Youth as Mental Health Promoters 

"Adolescence is an optimal period for prevention because it is
the stage of life that can most readily permit modification of internal
and interpersonal life. Given the many changes that occur during this
period (physical, cognitive, social) the potential for health promotion
initiatives to have an impact may be at a peak. It is not surprising then
that, for youth, prevention has become a priority in the reorganization
of mental health resources." 

(Villeneuve et al; 1996) 

Adolescence is derived from the Latin verb adolescere that means to grow to maturity and is characterized by psychological, biological, intellectual, moral and social development. One of the developmental tasks of the adolescent is to achieve independence not only from parents but also from other significant adults in the community. This results in a moving away from the influence of adults to one of their peers. Parents will describe that they do not understand these developmental changes and, at times, lose the ability to communicate with their children. Understanding the important role that a peer plays in a teen's life is essential to developing appropriate mental health promotion tools. It is important to understand the first point of contact for youth regarding their mental health issues. 

Research on "who adolescents talk to if they have mental health concerns" validates the importance of the peer group. Youth Net/Reseau Ado, a regional mental health promotion program in Eastern Ontario and Western Quebec, conducted focus groups regarding youth mental health issues with 9563 youth from 1995 to 2001. These findings highlight the importance of engaging youth in mental health promotion. 

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Who Youth Talk to About Mental Health Concerns
(By Gender)

Source: Youth Net/Reseau Ado, 2001 

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Given normal adolescent development, it is not unexpected that the majority would identify their friends as those to whom they would most likely turn to talk about mental health issues. The opportunity therefore exists to enlist peers as key partners in promoting health and well-being and to help reach out to those who may be most at risk. In many ways, youth themselves represent the greatest untapped resource in mental health promotion. 

What must be of great concern to a community is the percentage of youth that indicate that they would tell no one about mental health concerns. This is particularly the case for young men who are more likely to be socialized to "take things like a man" and to "suck it up and handle it on their own." The challenge of engaging young men in mental health promotion initiatives therefore may be even more daunting. Also very significant in this research is the data that suggest that youth would only turn to professionals a little over 1 percent of the time. The dissatisfaction with the formal mental health system is evident from this research and it mirrors similar findings seen nationally in the Canadian Youth Mental Health and Illness Survey (Davidson and Manion, 1996). There are many reasons for this dissatisfaction. Youth indicate that they want services that are both youth friendly and accessible. They do not want to be treated like children. They also mention the importance of confidentiality and reliability in order to trust the system that is already in place (Youth Net/Réseau Ado, 2001). In a rural community this concept becomes even more relevant. 

Historically, peer support or peer helping programs have existed in communities and are usually offered through the education system. Youth peer helpers are usually recruited through school personnel and not by their actual peers. These programs are useful but can be limiting, as representation from the different peer groups may not be reflected. Keeping in mind that youth reported that they would talk to their own friends, it is important that they have a voice in determining who the peer helpers may be. 

Youth Community Mobilization 

"Peer groups are an untapped resource in reaching and treating
adolescents' mental health problems"  

(Villeneuve, 1996) 

Increasingly, youth are being viewed as key assets in addressing their own mental health issues. One of the gifts that youth possess is their ability to envision what is possible. They are great idealists who have largely been untapped by the adult community. In West Carleton, the youth helped to organize a committee entitled "Positive Futures for Youth Committee." This group comprises primarily youth, with some school personnel and social service members. The committee came together with the goal of increasing awareness on mental health issues and to engage in mental health promotion activities. 

The creation of the committee played an invaluable role in the design and implementation of youth initiatives. It also tapped into the youth voice of the community for understanding the reality of their experiences. All of the youth on the founding committee were survivors of suicide. Some were struggling with their own mental health problems. They became the "experts" in their own lives and that of their peers. This resulted in their ability to contribute to the framework of both postvention and prevention activities. Essentially, the youth became both participants and consultants in community mobilization. Several initiatives were designed and implemented by this committee, which, highlight the many different ways that youth capacity can translate into mobilization if given the chance. In terms of youth capacity building, it is important to create various opportunities for youth involvement. 

Youth Mental Health Speakers 

Youth were trained in media relations to become spokespersons for youth mental health issues and appeared both on television and in print. As noted, they were also speakers and workshop facilitators at the Community Forum on Youth Suicide. The youth also began to make presentations at workshops and conferences as well as visiting other high schools to inform them of the community action plan. 

Through their own healing and willingness to help others, these youth became mental health promoters. They assimilated the material and training regarding mental health into their own style. As well, they were able to become a voice for the youth community. 

Postvention Assembly on Stress and Depression 

The youth advocated for their peers' request to find a way to come together to address anxiety in their school. This resulted in three school assemblies, organized by grade levels, which addressed mental health and stress. Students were reminded of the community resources that are available should they, or a friend ever need them. Many youth-serving agency representatives acted as community gatekeepers in the audience, following the assemblies, these representatives set up information booths in the school foyer so that the youth could interact and access information. 

Compilation of Youth-friendly Service Providers Contacts Information Lists. These lists were posted in classrooms and in all student day planners. 

Pars and Stars Golf Tournament 

Youth had previously reported a lack of connection with adults in the community. This youth/mentor golf tournament was hosted by a local golf club to raise awareness on youth mental health issues and to bring together the youth and those who had actively been raising funds. This event was designed not as a fundraiser but as youth friendly and an opportunity for youth and adults from the business community to spend time together in a way that was interactive. It became a community-based opportunity to strengthen the community connections between the youth and community leaders. It was also a vehicle to get the message out about the shared vision in addressing youth mental health issues. 

Whether a youth participated only once in a fundraising initiative or as a very involved member of a committee, their contributions were equally valued as community assets. Successful efforts at engaging youth in mental health promotion not only increases a community's capacity but creates a multiplier effect whereby youth reach out and respond to other youth to promote health and well-being. Furthermore, youth become the most credible spokespersons to engage other members of the community, including the business sector. 

Engaging the Business Community 

Many people in the business communities are also considered to be community leaders. Historically however, their skills and knowledge may have only been tapped into regarding youth mental health issues if a fundraising campaign were being considered. Many companies report that they receive countless requests for financial contributions from various youth-serving agencies. Community-based partnerships with business must be about more than money. They must be about relationships between the key players and the creation of a shared vision. "In community-based partnerships, the community is actively involved in all aspects of the process including identifying needs and making decisions"(HRDC, 2000). 

With community capacity building, an emphasis is placed on grassroots leadership development. It is not as difficult as one might think to engage the business community in a shared vision in youth mental health promotion. What becomes a challenge is finding a common language to understand mental health concerns. This does not simply imply the words to use, but the attitudes as well. In the community of West Carlton, attitudes about youth mental health issues had to change at many levels in order to build capacity and encourage mobilization. There was evidence at the onset of capacity building that youth, parents and the community at large believed that it was just a matter of the professionals "fixing this." Ironically, this sentiment also prevailed within the business community. Community capacity building required that this belief be challenged. 

To illustrate this point further, consider the creation of the Brady Burnette Teen Assistance Fund. The Fund was started by a group of five businessmen who were friends of one of the fathers who had lost his son. After this particular tragedy, they began to solicit funds in the community. In the beginning, they had no specific plan for what to do with the funds. Rather, they shared the thought that they wanted to make a difference. The first meeting between the Teen Assistance Fund and the Community Resource Centre is etched in the memories of all those who were present. The business philosophy was evident in the very first question, "How much to fix this?"  In the business world, if there is a problem, quite simply, you fix it. This first encounter enabled the "professionals" to give a crash course into the complexity of youth mental health issues. The end result was a keen awareness that the Teen Assistance Fund's creators had essentially the same vision to address youth mental health concerns in the community. 

"Developing community capacity means taking risks, improving things and sharing control" (HRDC, 1999). The Teen Assistance Fund became a catalyst in advancing the message about youth mental health issues. The assets that the Teen Assistance Fund trustees possessed were not merely financial. They brought key human resources to the partnership and had important connections in the community to broaden the scope of the message delivery concerning youth mental health. They provided resources such as printing materials, accounting, space for meetings and many other in-kind donations. In addition, they were able to identify existing networks and connections that were previously untapped. The Brady Burnette Teen Assistance Fund and the Community Resource Centre forged a unique partnership that has been sustained beyond the impetus for action. The fund provides financial support to the Community Resource Centre to enable it to offer both coordination and programming, such as school-based substance abuse counselling for the youth. 

A clear example of how professionals do not always have the answers came at the beginning of the partnerships. Of great concern was that the Fund was named in memory of a youth who had "suicided." Mental health professionals are acutely aware of the dangers of memorializing this type of death due to the contagion effect. These concerns were raised early on in the partnership formation. A decision was made to connect with those directly affected and, accordingly, these apprehensions were related to the youth. Consultation with the youth revealed that Brady Brunette's name was appropriate to use; they also indicated that the name should include the word "Assistance." The youth felt that it specified that this young person needed assistance and therefore did not glorify suicide, but reminded youth that they needed to get help. Outcomes of community capacity building include an expanded intuition in sensing what to do. The intuition of both the business representatives and the youth was to keep the name. It made sense to the community as it greatly reflected their collective loss. This became a significant paradigm shift in the defining who the "experts" in the community were. 

Community mobilization is the use of capacity to bring about change by joining together the strengths of the community into an action plan. Business community members need to see that within their groups are the capacities that go well beyond fund raising. They are also "experts" in their community and thus are viewed as having a powerful voice in guiding youth mental health promotion activities. In West Carleton, the Brady Burnette Teen Assistance Fund members evolved into an advisory committee for both the development and implementation of an action plan and for evaluation of this plan. Many teachable moments in capacity building and the subsequent mobilization would have been lost had this partnership been simply about money. 

The membership of the committee went beyond the original five businessmen to include the Community Resource Centre, community representatives, parents and youth. In other words, it mirrored the many partnerships that were forged as the community began to mobilize. Clear goals and objectives were set related to both fund raising activities and youth mental health promotion activities. The business group also now had key linkages with the school and the youth service agencies. The community capacity building and mobilization were now being synthesized into a definitive action plan. 

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