Available online at www.sciencedirect.com

Procedia - Social and Behavioral Sciences 47 (2012) 1413 – 1416

CY-ICER 2012

An on-line course in critical mental health promotion: teaching and
learning at multiple spheres of influence
Jakubec, S.L. a *, Mascaro, P.a, Nordstrom, P. a , Judd, L. a, Weimand, B. b
a

Mount Royal University, Calgary, Alberta, Canada
b
Hedmark University College, Elverum, Norway

Abstract
Background: Supportive environments contribute to the mental health of individuals, local and global communities. Ways of
thinking “critically” about what we know and ways of accomplishing mental health promotion work have a more contested
history however. A critical perspective demands subjective awareness, and an openness to view the world from multiple
perspectives. As such, a collaborative, international, and fully on-line course was developed between post-secondary educational
institutions in Norway and Canada. This course intends to meet a need for critical awareness and understanding of the connect ion
of diverse perspectives and environments to mental health promotion practices in the field. Purpose: Our study, of the
development and implementation of an innovative critical mental health promotion course, was oriented around the following
key questions: How is capacity for critical mental health promotion awareness developed through an on-line international
learning environment? And how can supportive learning environments reshape mental health support across international
borders? Our goal was to explore the work of students and faculty with the tensions that dominate current mental health
promotion. This course began from the diverse locations, experiences and approaches of our students as important sites of
critical exploration. Through the virtual world of electronic learning activities, students entered this diversity of worlds, and
debated over the shape of health and mental health as notions themselves, as well as over the approaches that best produce
support. Most importantly, students debated over the distribution of power, justice, and social and economic advantage held
within mental health and various approaches to promoting mental health. Method: The overall approach was based on action
research using collaborative enquiry of the case study of our pilot course offering. The enquiry was conducted over 3 years of
course development and pilot course delivery. Results: Ultimately, through our reflection and study of the critical learning
approaches in action, we were able to explore what supportive environments for mental health are and what particular approaches
“do” locally and globally. Further we were able to reorient mental health promotion work through network building in ways that
may potentially change nursing practice. Conclusions: The results and lessons learned, from development to implementation of
an on-line collaborative international mental health promotion course, expanded the capacities of nursing programs, educational
institutions, faculty and students, and expanded what can be known about supportive environments for mental health.
© 2012
2012 Published
Published by
by Elsevier
Elsevier Ltd.
Ltd. Selection and/or peer review under responsibility of Prof. Dr. Hüseyin Uzunboylu
©
Open access under CC BY-NC-ND license.

Keywords: Mental Health Promotion, Multiple Spheres of Influence, On-line learning, Internationalisation

1. Introduction
This paper reflects research, as well as course design, development and implementation collaboratively undertaken
at our School of Nursing in Canada with our partners at Hedmark University in Norway. This is work that has, at its
core, a critical examination of mental health promotion approaches. In our view this has been a neglected population

* Sonya L. Jakubec (+) 403-440-5075 E-mail address: sjakubec@mtroyal.ca

1877-0428 © 2012 Published by Elsevier Ltd. Selection and/or peer review under responsibility of Prof. Dr. Hüseyin Uzunboylu
Open access under CC BY-NC-ND license. doi:10.1016/j.sbspro.2012.06.835

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which is often marginalized within our societies, as well as neglected in research and policy activity. Certainly most
discussions about the restructuring of the mental health system world-wide neglect to identify the multiple spheres
of influence, tensions, realities and limitations that individuals, families, communities, professional care-givers, and
policy and decision-makers often encounter when working to promote the health and well-being of this marginalized
and disenfranchised population.
,
knowledge and attitudes. Mental health promotion approaches are therefore ones of problem solving,
control/protection, and fostering selfchange approach was used in the course to expand student perceptions of the influences on mental health and
interventions for mental health promotion. Wallace and Hellmudt (2003) showed how learning environments,
where students participate in critical thinking and dialogue, foster internationalization and collaboration outside of
disciplinary knowledge.
Our central question/tension in this analysis is one that we believe preoccupies many of us at this time - how to
find opportunities for new and innovative thinking in increasingly globalized and networked world, and ultimately
strengthen networks of support for mental health in the context of everyday realities.
2. Analytic Approach to a Pilot Course Offering
This analysis is based on a case study approach (Hentz, 2011) and reflections from a pilot offering of a model of
on-line learning for mental health promotion. This course model is one that relies heavily upon the analysis of
supportive networks alongside network building. It evolved in response to trends towards internationalization of
curriculum. This collaborative approach to teaching and learning facilitated an on-line community network which
intended to foster critical mental health promotion with an emphasis on human rights oriented practice, as well as
approaches for social inclusion and empowerment.
In the words of one of the course developers:
-line network of the course models a supportive environment for mental health, students both get to
learn about supportive network building, as well as participate in such a network, although for the
The course was developed to incorporate multiple spheres of influence: interpersonal, community and
global/political. Contexts, issues, and processes of balance between problem solving and empowerment, integration
and inclusion and protection and liberation were central to the course blueprint, all in an effort to explore alternative
voices and make space for non-dominant experiences.
3. An Innovative Course On Critical Mental Health Promotion
This course began from the diverse locations and experiences of international course writers and educational
technology experts, and sought to incorporate the approaches and locations of our students as sites of critical
exploration of mental health promotion. Our goal was to inspire student learning through a fully on-line exploration
of three particular tensions that dominate current mental health promotion: problem solving and empowerment,
integration and inclusion, as well as protection and liberation. This course was not designed exclusively for
students in nursing or in developed Western and/or European educational programs. Indeed, the pilot experiences in
the course have demonstrated that a broader audience outside of the field of nursing and outward to middle and lowincome countries would be appropriate.

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The challenges facing those with mental illness and the issues of supporting mental health promotion are
experienced internationally and include widespread social exclusion and denial of basic human rights (Lewis, 2009).
The challenges that drive people with mental illness into vicious circles of poverty and relapsing illness, and support
stigma and marginalization are reinforced in the mental health system a system that is moving away from the
progressive empowerment models introduced in the 80s an
-medical causes of mental illness over contributing social and structural
factors (Nelson, Lord, & Ochocka, 2001; Wilton, 2004). Therefore, critical examination and student engagement in
the challenges of fostering supportive environments for mental health is timely.
4. Findings and Evaluation of Pilot Course Experiences
Through the virtual world of electronic learning, students engaged with international classmates around global
mental health promotion practice. They debated over the shape of health and mental health as notions themselves,
as well as over the approaches in the balance of problem solving and empowerment, integration and inclusion, and
protection and liberation that best produce support in different circumstances. In one key learning activity they were
asked to loo
geographic locations for instance mental health legislation and policies in different nations, the influencing factors
and potential outcomes. This activity, and others including on-line film and case-studies, asked the students to think
about things like the distribution of power, justice and equity.
how they felt they were able to ask challenging questions of mental health promotion to learn what was shaping
mental health practice and in doing so, shifted some of their own assumptions about how best to approach their
practice. Stated Elisa (pseudonyms used):
I plan on sustaining the learning I have accomplished within the micro sphere by educating those around
me about the information I have learned so that I am able to transfer my knowledge on to others and
increase mental health awareness. I hope in my future learning and professional work that I will be able to
build upon the spheres of influence and approaches I have learned through this course and gain more
knowledge on how to better support individuals with mental illnesses and better educate our society about
Unanticipated ideas that surfaced in the students debates were the depth of their reflection on comparing and
-line mental health atlas. For students engaged in a
networked and global world, activities encouraging more in-depth reflection on the health promotion impacts of
a whole other level of learning
health atlas mapping activity reveals the eye-opening experience of reflecting upon differing budgets to finance
mental health world-wide:
budget for mental health is often very small, relative to other health and social policies and certainly
compared to other spending for instance military spending, when in fact mental health is such an
Given an opportunity to reflect and have a voice about what they could seek and find about the promotion of
mental health, students rose to the challenge. Similarly, when asked about whether integrating people with mental
health challenges into existing policy and practices or including the voices and needs of these patients and families
students were able to reflect on circumstances and examples at the community and international domains.

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5. Discussion and Concluding Questions
In their learning activities, students were able to find examples of social exclusion resulting from structural
problems (class, status and power) and identify solutions as enforcing rights of citizenship, inclusion (through
universal access to programs), and empowerment approaches. Through these activities faculty realized that
supportive environments could be re-imagined if students explored real time supportive networks, learned more
about mental health promotion and advocacy happening at interpersonal, local and international levels, and shared
their learning on-line. Re-imagining the supportive environment in our case study included student blogs, public
service announcements, posters and their pursuits of numerous networks in operation world-wide.
This network building strategy for teaching and learning about mental health promotion is, in our view, an
effective model in shaping critical mental health promoting environments. Building an on-line network and
searching and reflecting upon on-line mental health promotion examples, points the way to more developments in
teaching and research for mental health promotion internationally. Further evaluation, with respect to how students
uniquely experience and fare as a result of their participation in this model of learning; the impact of student
networking and connections for their later nursing practice and development of innovations will be beneficial. In
particular, the strategy of finding spaces in the neoliberal agenda and discourse for critical examination of
approaches to mental health promotion will be valuable to move mental health practice forward. Next steps in
course development and research may include expanded evaluation of the outcomes for clinical practice based on
the study of critica
mental health promotion at interpersonal, community and global levels could be examined in future research. This
is not to say that this should replace other work that is trying to influence mental health policy, however this case
example demonstrates one opportunity for shaping critical mental health promotion practitioners.
We want to conclude with the following questions for reflection and future exploration:
How might the mental health and educational systems better support the development of collaborative
networks that foster critique and the development of a highly reflective mental health promotion practice?
What is the best way to foster critique and the development of highly reflective mental health promotion
practice?
What kind of practitioner in mental health do we need and what is the best way to prepare them?
What are strategies that connect nurses/students/practitioners in supportive environments for mental health?
And what are the challenges to building these networks?
References
Hentz, P. (2011).Case study method. In P. Munhall (Eds.), Nursing research: A qualitative Perspective (5 Ed.). Sudbury, MA: Jones and
Bartlett Press.
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mental health services? Social Policy and Society, 8 (2): 257-274.
Nelson, G., Lord, J., & Ochocka, J. (2001). Shifting the Paradigm in Community Mental Health. Toronto: University of Toronto Press.
Wallace, M. & Hellmundt, S. (2003). Strategies for collaboration and internationalisation in the classroom. Nurse Education in Practice, 3(2):
89- 94.
Wilton, R. (2004). Poverty and people with serious mental illness: Putting policy into practice? Social Science and Medicine, 58: 25-39.
World Health Organization (WHO). (2011). Mental Health Atlas 2011. WHO, Geneva.
http://www.who.int/mental_health/publications/mental_health_atlas_2011/en/index.html