Self-management support available for everyone:

Helping thousands of people to regain control over their

mental health

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

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

Revivre

Peer support

Hope Self-management

Recovery

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

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

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

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

J’avance! workshops

A real social innovation conceived by

Revivre

9 | November 2016

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

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

• 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

• 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

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

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

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

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

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

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

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

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.”

Revivre rhymes with hope: www.revivre.org

1 866 REVIVRE

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

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

Appendix – Clinical Arguments

25 | November 2016

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

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

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

Appendix – Key thematic areas of the five

workshops

29 | November 2016

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

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

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

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

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

Appendix – Varia

35 | November 2016

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

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.

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

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 |