2. Mental health disorders – A pressing global challenge
People living with either a mood or
an anxiety disorder every year
Canada: 4 million
Sources: Canadian Alliance on Mental Illness and Mental Health (2016)
Mental Health Commission of Canada (2013)
World Health Organization (2016)
Existing means and resources do not suffice
2 | November 2016
Over 600 million worldwide
3. Our mission
• To help individuals suffering from anxiety, depressive, and bipolar
disorders, as well as their families
Our approach
• Ad hoc support: listening, by sharing information and references
• Self-management support (psycho-educational follow-up)
• Partnerships: public, community and scientific networks, and
private sector
300,000 interventions over 25 years
10,000 individuals supported yearly
3 | November 2016
5. Revivre Services
Services 2015-2016 Statistics
Support and information • 3,213 telephone interventions
• 1,936 email interventions
Revivre.org website • 139,428 visits (84,470 website visitors)
Social media • 4,774 Facebook followers
• 2,169 Twitter followers
Discussion forum • 5,483 messages
• 674 new topics and 729 new users
Documentation • 15 fact sheets, 5 books, and 5 audiovisual material
Support groups • 3,289 participants in 188 meetings
Self-management
workshops
• 5 types of workshops
• Offered in 23 cities (8 regions) by approximately 30
organizations
• 217 individuals participated in 17 workshops at Revivre
• Across Quebec: more than 2,000 participants since 2012
Training and support
(intervention workers,
professionals and
administrators)
• 280 professionals and intervention workers from more than 50
organizations trained since 2012
5 | November 2016
6. An operational solution to the current endemic lack of
mental health services: Self-management support
Self-management :
All actions people can take to regain
control of their health, including
adopting behaviours that
• reduce symptoms,
• prevent relapses and
• improve their well-being on a daily
basis
Complementary to
pharmacotherapy and
psychotherapy
Know
Assess
Choose
Act
6 | November 2016
7. What is self-management?
“Self-management refers to the individual’s ability
to manage the symptoms, treatment, physical and
psychosocial consequences and life style changes
inherent in living with a chronic condition.
Efficacious self-management encompasses ability
to monitor one’s condition and to effect the
cognitive, behavioral and emotional responses
necessary to maintain a satisfactory quality of life.”
Barlow J, Wright C, Janice S, Turner A, Hainsworth J. (2002).
Self-management approaches for people with chronic conditions:
a review. Patient Education and Counseling, 48: 177-187.
7 | November 2016
8. Four pillars of self-management
Know
• Learn to know itself, its strengths and weaknesses, and to recognize “red flags” as well as
warning signs of relapse
• Get information about the illness, available resources and self-management strategies
Assess
• Evaluate your health condition, monitor your well-being, mood, and stress level variations
Choose
• On a daily basis, choose behaviours promoting health and well-being
• When faced with a deterioration of its health condition, choose appropriate actions to prevent a
relapse
Act
• Become proactive and adopt chosen behaviours
8 | November 2016
10. Structure of our 5 types of workshops
• Group of 10 to 15 participants
• 10 weeks, 2.5 hours/week
(Bipolar Disorder Self-Management
Workshop: 12 weeks)
• Material:
– Facilitator’s Guide
– Weekly leaflets for the participants
• Registration fees
– Revivre offices in Montreal: $390
(Bipolar Disorder Self-Management
Workshop : $460)
Limited number of subsidized
registrations available (through
donations from the private sector)
– Other organizations elsewhere in
Quebec: between $0 et $100
• Complementary to individual
psychotherapy and pharmacotherapy
• Educational approaches
– Psycho-education (readings & oral
communications)
– Skill development (individual or group
exercises, and between sessions)
– Social and peer support (learning by
observing others’ experience)
• Other components:
– Preliminary discussion with participants
– Operating rules for the group
– Co-facilitation (two trained mental health
care workers)
– Outcome measurement (feedback from
participants)
10 | November 2016
Currently available in French with translation planned in English,
German and Italian
11. J’avance! in a nutshell
Rigorous program
Quality content scientifically
validated by experts,
researchers, and participants.
Peer support
Support to revive hope and draw
ideas and strength from the
experiences of others
Regaining control
Proactive approach leading to
better mental health: making
lifestyle choices and
prioritizing actions to take.
11 | November 2016
12. • Fills a void
– Complementary to psychotherapy and pharmacotherapy
– Complementary to individual approach and bibliotherapy
– Strengths of the group approach (clinical and financial)
– Democratization of mental health workers and
professionals
• Unanimous opinion of professionals/administrators/
experts as to the relevance and the quality of the
program
• Distinctive advantages
– Efficacy measured by a university study (study on
depression, Houle & al. 2016)
– Credibility & rigour (conception and validation process)
– Ready to use and easy to replicate model
– Plan for common outcome measurement and
re-edition
A rallying project
J’avance!
To address the challenge of access to health care
12 | November 2016
13. • 42 experts participated in the
validation process
• Major investment in development and
validation: $600,000 (donations from
the private sector) and more than
14,000 hours of work
• 280 professionals and mental health
workers trained by Revivre to
facilitate the workshops
• A total of more than 199 workshops
held since 2012, with 76 by Revivre
• 25 workshops per year at Revivre
• More than 2 000 participants since
2012 (1,034 at Revivre) with more
than 600 last year (322 at Revivre)
• Now offered in 8 regions (23 cities)
across Quebec by approximately 30
partner organizations
• Now offered in Switzerland
(7 workshops offered in 2016)
• 100% of participants recommend our
workshops
• 91%: participant satisfaction rate
The wonderful story of J’avance! in numbers
13 | November 2016
14. Saguenay-Lac-Saint-Jean Bas-Saint-Laurent
Abitibi-
Témiscamingue
Montérégie
Montréal
Gaspésie
East of Montreal
(5 locations)
Longueuil
Sorel-Tracy
Ville de Ville-Marie
Alma Dolbeau-Mistassini
Chicoutimi
Jonquière La Baie
Roberval
La Pocatière Rimouski
Rivière-du-Loup
Amqui Témiscouata-
sur-le-Lac
Ville de
Mont-Joli
Trois-Pistoles
Ville de Sainte-
Anne-Des-Monts
Ville de Pointe-
à-la-Croix
Ville de Gaspé
J’avance! Workshops
now offered in more than
25 locations in Quebec
by 30 partner
organizations
Matane
14 | Octobre 2016
Switzerland
15. 3 implementation models
Public or private network Partnership
Public and community networks
Community organization
(self-financing: 100% financed by
users and donations from the
private sector)
In a CISSS / CIUSSS location
OR
Family Medecine Group
(GMF)
Workshop offered by an NPO financed
and referred by the CISSS / CIUSSS
Revivre
Private psychotherapy centre Co-financing and co-facilitation
(1 NPO facilitator and 1 facilitator from
the CISSS / CIUSS)
Revivre in partnership with another
community organization
Testimonials from the CISSS Bas-Saint-Laurent Mental Health and Dependence Director:
“J’avance! workshops of Revivre are an effective and complementary response to the
needs of the population in Bas-Saint-Laurent. They also offer an excellent
opportunity to work in real partnership with mental health community organizations
across our region.Joint organization of these workshops allows for sharing practices,
building links between organizations, and informing participants that we are working
within a network. The workshops are easy to set up with the training program for
facilitators and material for participants supplied by Revivre.”
15 | November 2016
16. How we help organizations to implement
workshops
• Training of professionals and mental
health workers on self-management
support and workshop facilitation
• Sale of the material (facilitators’ guides
and participants’ booklets)
• Support provided to administrators and
facilitators to ensure workshop
implementation and success
• And more (ex. promotion and visibility of
workshops, training of regional facilitators)
16 | November 2016
17. Advantages of establishing a partnership with Revivre
• Efficient and fast response to the needs of the
population
– Group model
– Ready to use (conception & validation are finalized)
• Reliability of J’avance! and Revivre
– Efficacy measured by a study (on depression) and
evidenced-based data on self-management
– Rigorous conception and validation processes
developed by Revivre with the help of qualified
collaborators
– 30 other organizations use J’avance!
– Backed up by numerous testimonials and statistics
– Access to the cooperation of experts
• Project sustainability – Future of J’avance!
– Structured plan for expansion, translation, and
renewal
– Researchers’ interest
– Interest of other funders
– Opportunity to participate in the outcome
measurement and the renewal of J’avance!
•
Answers to the 2015-2020 Action Plan of the
Quebec Ministry of Health
– Primacy of the person (measure 1)
– Self-management (measure 1)
– Access to specific mental health services (measure 31)
– Consultation between public and community health
networks (measure 19)
– Integration and job retention (Workplace workshop)
(measure 7)
– Can be included in organizational performance
indicators
• Project agility
– Flexible involvement based on the interest of each partner
– Number and type of workshops offered in each area
based on needs
• Revivre’s openness to use J’avance! for specific
clienteles
– Pilot project and/or adaptation
– Ex., youths seniors, autochthones, newcomers,
comorbidities, etc.
17 | November 2016
18. An ambitious goal, although probably too modest:
Multiply access by 10
Maintaining: Accessibility, recurrence, quality
Maintain a participant recommendation rate of 100%
Remain the top reference in support to self-management
Include self-management in the continuum of services in Canada
500 participants
per year
5,000 participants
per year
“A systemic change”
18 | November 2016
19. Workshop deployment kick-off in Quebec, in Canada, and
and beyond our borders
19 | Septembre 2016
Increased number of partnerships
Improved measurement
Deployment of workshops for francophone
minorities in Canada and French-speaking
countries
Calls / emails from
everywhere
Faces of mental health
2016
Ottawa Parliament
Translation and adaptation
for specific clienteles
20. 40% already funded and completed
Search for major partnerships to raise $1 million over 4 years for J’avance!
(in addition to the operating mission of Revivre)*
* Each phase includes independent components with their respective visibility elements
** Respectively: Depression (J. Houle)
Anxiety (P. Roberge/J. Houle)
Four-year plan including deployment, translation, and
renewal of J’avance! (excluding virtual version of workshops)
(in thousands of dollars) To date 2016-
2017
2017-
2018
2018-
2019
2019-
2020
Total
Phase 1 – Conception and validation 610 610
Phase 2 – Expansion (including improvement of
evaluation methods, communities of practice, continuing
education, etc.)
85 170 45 300
Phase 3 – Translation and adaptation for specific
clienteles
175 90 85 350
Phase 4 – Content updating (renewal) 125 125 250
Individual grants for participants 5 30 30 35 40 140
Total 700 200 250 250 250 1 650
Self-financing J'avance! (workshop registrations,
sale of material, training)
120
(2015-2016)
135 280 380 495 1 290
Grants for scientific research** 104 670 774
20 | November 2016
21. Testimonials from participants:
“I was finally able to share with others and realize I wasn’t the only
one in a similar situation.”
“The workshops allowed me to better accept depression, to see it
more as an illness. The concept of self-management brings hope that
many things can change, that we can still have some level of self-
control.”
“What stuck in my mind throughout the workshops is the self-
management concept, the determining role that every person has in
recovering from their illness. And this, without any guilt feelings.”
“I am 100% satisfied with the workshop; you enabled me to open up
and rediscover my joie de vivre.”
“I feel like I’m in less of a void. I understand better, I’m proactive and I
put strategies into action. Thank you! It changed my life.”
23. Webinar (French only) – Self-management
support and J’avance! (April 15, 2016, available on YouTube)
http://www.qualaxia.org/sante-mentale-
information/conferences/2016/avril.php?lg=fr
23 | Octobre 2016
24. Our team and partners
• 10 employees, 20 contractuals et 50
active volunteers
– Jean-Rémy Provost, general manager
– Bruno Collard, clinical coordinator
– Stéphanie Fontaine, J’avance!
manager
• Board members:
– Martin Énault, president
– Guy Gervais, treasurer
– Hélène Brouillet, psychologist
– Serge Beaulieu, psychiatrist
– Brian Bexton, psychiatrist
– Etc.
• Expert committees
• Network of 30 partner organizations
24 | Septembre 2016
26. Why self-management?
• 600,000 people affected each year in Quebec:
– Anxiety, depressive, and bipolar disorders: the most
common mental disorders
• Comorbidity: chronicity or high recurrence
• Efficiency of treatments (psychotherapy, pharmacotherapy)
– Real but limited effectiveness
• Support groups:
– Useful, but requires additional involvement by participants
• Chronic-care management model
• Self-management: regaining control over your health
26 | November 2016
27. Clinical arguments for self-management and/or
J’avance! (page 1 of 2)
• Acceptability study and potential efficacy of Revivre’s Self-Management of
Depression workshop
• Significant improvement of symptoms
• Ministerial orientations, April 2011, pages 6 and 35
• 2015-2020 Action Plan of the Quebec Ministry of Health
– Primacy of the person (measure 1)
– Self-management (measure 1)
– Accessibility to specific mental health services (measure 31)
– Consultation between public and community health networks (measure 19)
– Integration and job retention (Workplace workshop) (measure 7)
– Measures for youths: clientele targeted by specific workshops
• Qualified as “a quality product” by the
National Centre of Excellence in Mental Health
English: Houle, J. et al. (2016). UQAM
http://www.cjcmh.com.www.nrcresearchpress.com/doi/abs/10.7870/cjcmh-2016-033
French: Houle, J. et al. (2014). UQAM
http://vitalite.uqam.ca/revivre-presentation.html
27 | November 2016
28. Clinical arguments for self-management and/or
J’avance! (evidence) (page 2 of 2)
• Inspired by Wagner’s Chronic Care Model
• Proven efficacy in chronic physical illness management, such as diabetes,
heart diseases, asthma, etc.
• Recommended by many clinical practice guides (NICE, APA) on the care of
people suffering from depression
• Intervention protocol « Faire face à la dépression au Québec », (2012, Centre
de recherche du CHUM, Sherbrooke University, and INSPQ) Support to self-
management interventions are part of collaborative care and best low-
intensity practices
• Supporting primary care and services improvement for anxiety and depressive
disorders Cible Qualité II project, Qualaxia network, 2012
Relapse and recurrence rate
Severity level of depression
Level of functioning
Adherence to pharmacological treatments
28 | November 2016
29. Appendix – Key thematic areas of the five
workshops
29 | November 2016
30. Depression Self-Management Workshop
1. Refine self-knowledge and self-observation, and
observation of depression and early warning signs
2. Increase knowledge of available resources in
order to use them more efficiently
3. Increase understanding, acceptation and control
of emotions
4. Benefit from the support of those around you
5. Identify its anchorage points
6. Review lifestyle choices
7. Examine filters of perceptions and their influence
on mood
8. Learn to reduce tension and better manage stress
9. Learn to fit within its work environment
30 | November 2016
More than 550 participants since 2012
31. Anxiety Self-Management Workshop
1. Improve self-observation and self-knowledge, and
observation of anxiety
2. Identify anxiety triggers and maintenance factors
3. Learn about techniques to reduce anxiety levels
4. Understand the role of avoidance and exposure
5. Embrace acceptance and be active again
6. Examine filters of perception and their influence on
anxiety
7. Examine the relationship between yourself,
anxiety, and others
8. Aim to regain control over your situation and your
anxiety
31 | November 2016
More than 550 participants since 2014
32. Bipolar Disorder Self-Management Workshop
1. Refine self-knowledge and self-observation, and
observation of bipolarity and early warning signs
2. Increase knowledge of available resources in order to
use them more efficiently
3. Understand stress better, its impact and its importance
in bipolar disorder in order to better react and manage it
4. Examine lifestyle choices and their influence on mood
5. Increase understanding of emotions and find ways to
better channel them
6. Show interest in relationships with those around you
7. Take advantage of social support and understand its
importance
8. Develop a self-management plan
32 | November 2016
More than 200 participants since 2014
33. Self-Management in the Workplace
1. Define what work represents and develop a
realistic view
2. Understand the different manifestations of
anxiety, depression or bipolarity in the workplace
3. Recognize the early warning signs in a
professional context
4. Identify your behavioural patterns
5. Recognize the influence of your perceptions in
order to modify them
6. Improve stress at work management
7. Address issues related to revealing difficulties
and how to reconcile them
8. Better understand and manage a sick leave, as
well as apprehensions to return to work
9. Facilitate return to work
33 | November 2016
More than 260 participants since 2013
34. Self-Esteem Self-Management Workshop
1. View self-esteem as multi-dimensional
2. Develop greater self-knowledge and self-
observation
3. Pay attention to perceptions and the
influence of self-esteem on them, as well as
their impact
4. Explore emotions, understand their role, and
manage them better
5. Take into consideration self-esteem in
interpersonal relationships
6. Aim for healthier self-affirmation
7. Choose actions according to life priorities
34 | November 2016
More than 380 participants since 2013
36. Benefits of mutual aid:
Peer Support
• Break the sense of solitude and isolation
• Be receptive and non-judgemental as for emotions and hardships
experienced
• Share the suffering as well as the tools used: learn about others’
strategies and use them as appropriate
• Counter preconceived ideas about itself, debunk or dispel the myths
• Identify with others in a similar situation
• Keep hope derived from others who progress and bounce back, little
by little
• Take pride in offering something unexpected to those who identify
with you
37. Characteristics of good self-management
Adequate understanding of the disorder
Ability to improve its quality of life
Motivation to self-manage its care
Engagement in a personalized care plan
Active participation in the decision process
Disorder symptoms control and management
Know-how to resolve its problems and/or seek help
Adoption of a lifestyle that promotes good health
Access to support services and utilisation of those services
Health Council of Canada. (2012). Support for self-management for Canadians suffering from chronic
illnesses: Focus on primary health care. Toronto: Health Council of Canada. As presented in Support
the improvement of primary care and services for anxiety and depressive disorders from the Cible
project Qualité II, Qualaxia network, 2012.
38. If you have any questions…
Stéphanie Fontaine
Special Projects Director – J’avance! program
514-529-3081, extension 232
514-817-2809 (mobile)
stephanie.fontaine@revivre.org
Bruno Collard
Clinical Coordinator
514-529-3081, extension 234
bruno.collard@revivre.org
39. Every $1 invested
generates a return of $4
(WHO, Lancet, 2016) but,
above all, it helps a
person to regain their
dignity and their full
potential
39 | 2015 |
