Section Six

Legislation, Ethics and Advocacy in Mental Health and Addiction Nursing Practice

Legislation, Ethics and Advocacy in Mental Health and Addiction Nursing Practice
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Section Six

Upholding the rights and autonomy of persons with mental health condition and/or addiction is a critical nursing responsibility. This responsibility is integrally tied with ethical nursing practice and advocacy. For this reason, Section six addresses three correlating themes in the CASN/CFMHN (2015) Entry-to-Practice Mental Health and Addiction Competencies.

This section is divided into:

  1. 6.1 Legislation and Professional Accountability
  2. 6.2 Ethical Practice
  3. 6.3 Service to the Public

Legislation and Professional Accountability Teaching activities and resources

Legislation and Professional Accountability Teaching activities and resources

Outcomes

Purpose

This section supports educators and nurses with the key concepts of mental health and addiction legislation in Canada and how they relate to professional accountability of nurses caring for persons with mental health and addiction across the continuum of care.

Outcomes

At the end of this section, the educator will:

  • Understand the importance of mental health and addiction legislation at the provincial/territorial, federal and international level.
  • Understand how legislation assists in the assessment, treatment, rehabilitation and recovery of mental illness and addiction in the jurisdiction in which they practice.
  • Understand that progressive legislation can be an effective tool to promote access to mental health care.
  • Understand the role of advocacy in the care of persons with mental health and addiction.
  • Have increased knowledge of the criteria for voluntary and involuntary admission as outlined in their provincial or territorial mental health act.
  • Understand stigmatizing and discriminating attitudes regarding mental health conditions and addiction among individuals and health-care professionals and the impact they have.
  • Understand the influence of socioeconomic factors (poverty, geographic) on the mental health of Canadians.

CASN/CFMHN Competencies

1.1, 1.3, 1.5, 1.6

Legislation and Professional Accountability

Mental health and illness in Canada is greatly influenced by legal factors, among other factors including cultural, environmental, historical, physiological, psychological, spiritual and socioeconomic factors (Kent-Wilkinson, 2015). The impact of the law on individuals can be complex. For example, legislation can have effects related to access to health-care services and treatment for those experiencing mental health and/or addiction issues. Therefore it is imperative that nursing students and nurses understand legislation and their professional accountability when working with clients with mental health, illness and addiction issues.

The fundamental aim of mental health legislation is to protect, promote and improve the lives and mental well-being of citizens (World Health Organization, 2005). In other words, mental health legislation is a human right, and it plays an important role in:

  • Codifying and consolidating mental health human rights;
  • Protecting the rights of people with mental health conditions; and
  • Providing a mechanism to ensure adequate and appropriate care.

Canada, in comparison to many other countries, has comprehensive mental health policy, programs and legislation (Austin & Boyd, 2015). In regards to policy, in 2009, the Mental Health Commission of Canada developed an initial framework for a national mental health strategy, Toward Recovery and Wellbeing (MHCC, 2009). It contends that while appropriate legislation must be in place to protect anyone at risk from people living with mental health problems and illnesses, such legislation also represents power imbalances by providing the ability for care providers to impose safety measures on them, which is the “ultimate in loss of control” (MHCC, 2009, p 30). Therefore, it states a principle of recovery-oriented mental health policy and legislation must be employed.

Across Canada, each province and territory has its own Mental Health Act (see Resources) which greatly impacts the provision of care including treatment decisions and involuntary hospitalizations for individual experiencing mental illness and/or addiction (Gray & O’Reilly, 2001). Mental Health Acts rule over decisions made regarding competence—and the evaluation of competence—and what actions can be taken in cases where a person is ruled not competent. There are differing basic criteria for involuntary admission between provinces. As well, legislation impacts access to care through mechanisms such as consent from substitute decision makers, mandatory outpatient treatment (MOT), court-ordered outpatient treatment for clients who are unlikely to be compliant without a court order, and community treatment orders (CTO), an order issued by a physician and agreed to by the client that allows them to receive care and treatment in their community (Kent-Wilkinison, 2015).

Without an understanding of provincial legislation that governs treatment decisions and involuntary hospitalization, nurses will be unable to adequately care for, or advocate on behalf, of clients with mental illness and addiction. The CFMHN’s Canadian Standards for Psychiatric-Mental Health Nursing, 4th edition, (March 2014), establishes the maintenance of quality care and provides direction for safe, competent, ethical professional practice, which includes standards that nurses have knowledge about relevant legislation and strive towards client and system level advocacy, to improve quality of care and mental health services. These standards also call for the reduction of stigma, and to promote social inclusion and community integration for clients.

For more information, see Resources in this section.

Teaching and Learning Activities

The following are teaching and learning activities that can be employed in the classroom to further support nurses in the integration of theory, principles and best practices related to legislation and professional accountability.

Topics for review in curriculum:

  • The purpose of mental health legislation in Canada.
  • International Agreements and Canadian Legislation related to addiction and mental disorders.
  • The principles for the protection of persons with mental illness and the improvement of mental health care in accordance to legislation.
  • The provincial/territorial Mental Health Acts/Mental Health Service Acts in Canada.
  • The sections of the Criminal Code of Canada that apply for mental health assessment.
  • The Principles of Protections of Persons with a Mental Illness (adopted by the United Nations in 1991).
  • The Convention on the Rights of Persons with Disabilities (CRPD).
  • The criteria for involuntary care in applicable jurisdiction.

Define and distinguish between the concepts of:

  • Examples of stigmatizing, discrimination, and stereotyping attitudes, behaviour and actions.
  • Competence evaluation.
  • Fitness to stand trial (FST).
  • Not criminally responsible due to a mental disorder (NCRMD).
  • Mandatory Outpatient Treatment (MOT).
  • Community Treatment Orders (CTO).

Discussion topics:

  • The right to refuse treatment.
  • Human rights, patient/client rights, offender rights, in relation to mental disorders.
  • The process of commitment for voluntary and involuntary admission in respective jurisdiction.
  • The role of the nurse with respect to advocacy, rights and professional responsibility.
  • Nursing orders for the provision of care regarding Nursing Close, Nursing Constant for mental disorders (i.e., Q5, Q15 for suicide or eating disorders).

Learner Engagement Questions

The following are thought-provoking and engaging learner questions that can be used to further discussions with nursing students regarding legislation and professional accountability. These questions can be used either to stimulate discussion, engage students in critical thinking or be tied to class assignments and/or reflection exercises.

  • How is being unable to access treatment and care an infringement of a person’s rights?
  • Do all Canadians have access to the same levels of health care (i.e., rural areas, northern communities, isolated communities)?
  • When does a person have the right to refuse treatment?
  • When can a person be held against his/her will?
  • When can the nurse legally hold a patient for mental health assessment?
  • How can stigma be a barrier to all aspects of life? Can you think of any stigmatizing behaviours that create barriers to care?
  • How would you respond to a patient with an opioid use disorder requesting pain medication post-surgery?

Evaluation and Self-reflection

The following evaluation methods can be used to evaluate students in their understanding and application of legislation and professional accountability.

  • Multiple choice exam questions
  • Clinical evaluation
  • Self-assessment through reflective writing
  • Guided discussion

SELF-REFLECTION

Self-reflection questions: What are your personal attitudes about mental illness and addiction? Have you stereotyped a person in your care? How would you know this and how could you change your behaviour in the future?

Resources

ADVOCACY GROUPS

  • Advocacy Groups for Mental Health in Canada—Appendix G

WEBSITES

MENTAL HEALTH ACTS

 

PROVINCIAL COMMUNITY TREATMENT ORDERS

CANADIAN TEXTBOOKS

  • Kent-Wilkinson, A. (2015). The context of mental health care: Cultural, socioeconomic, and legal. In W. Austin & M. A. Boyd (Eds.), Psychiatric & mental health nursing for Canadian practice (3rd ed., Chapter 3, pp. 25–41). Philadelphia, PA: Wolters Kluwer.
  • Pollard, C. L. (2014). Ethical responsibilities and legal obligations for psychiatric mental health nursing practice. In M. J. Halter, Varcarolis’s Canadian psychiatric mental health nursing: A clinical approach. C. L. Pollard, S. L. Ray, & M. Haase (Eds.), (First Canadian ed., chapter 8, pp. 114–130). Toronto, ON: Elsevier Canada.

REFERENCE MATERIALS

  • Canadian Mental Health Association. (2012). Community committal. Retrieved from http://www. cmha.ca/public_policy/community-committal/
  • Canadian Mental Health Association. (2016). Community treatment orders (CTO’s). Retrieved from http://durham.cmha.ca/programs_services/community-treatment-orders/#.VwynTHErLcs
  • Kent-Wilkinson, A. (2015). The context of mental health care: Cultural, socioeconomic, and legal. In W. Austin & M. A. Boyd (Eds.), Psychiatric & mental health nursing for Canadian practice (3rd ed., Chapter 3, pp. 25–41). Philadelphia, PA: Wolters Kluwer.
  • Mordoch, E. (2014). Cultural implications for psychiatric mental health nursing. With contributions from R Zoucha & K. Gregg. In M. J. Halter, Varcarolis’s Canadian psychiatric mental health nursing: A clinical approach. C. L. Pollard, S. L. Ray, & M. Haase (Eds.), (First Canadian ed., chapter 7, pp. 99–113). Toronto, ON: Elsevier Canada.
  • Pollard, C. L. (2014). Ethical responsibilities and legal obligations for psychiatric mental health nursing practice. In M. J. Halter, Varcarolis’s Canadian psychiatric mental health nursing: A clinical approach. C. L. Pollard, S. L. Ray, & M. Haase (Eds.), (First Canadian ed., chapter 8, pp. 114–130). Toronto, ON: Elsevier Canada.
  • Rynor, B. (2010). Value of community treatment orders remains at issue. Canadian Medical Association Journal, 182(8), E337–E338.
  • Stanyon, W. (2014). Forensic psychiatric nursing. In M. J. Halter, Varcarolis’s Canadian psychiatric mental health nursing: A clinical approach. C. L. Pollard, S. L. Ray, & M. Haase (Eds.), (First Canadian ed., chapter 34, pp. 676–685). Toronto, ON: Elsevier Canada.
  • Srivastava, R. (Ed.) (2007). The healthcare professional’s guide to clinical cultural competence. Toronto, ON: Mosby Elsevier.
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Ethical Practice Teaching activities and resources

Ethical Practice Teaching activities and resources

Outcomes

Purpose

This section provides educators with knowledge and skills required to support nurses to assist persons with a mental health illness and addiction in making informed decisions about their care and symptom management in an ethical and culturally competent manner.

Outcomes

At the end of this section, the educator will enable the students to achieve the following:

  • Have increased knowledge of nursing ethics, including the CNA (2008) Code of Ethics for Registered Nurses.
  • Have increased knowledge of cultural competency and cultural safety, and relate the concepts to the role of the nurse.
  • Recognize that nurses have a professional ethical responsibility to advocate for persons with mental health and addiction disorders.
  • In a clinical setting for students—establish a safe and respectful environment for voluntary and involuntary patients seeking or receiving treatment for a mental illness and addiction; and demonstrate cultural competency and cultural safety.

CASN/CFMHN Competencies

4.1, 4.2, 4.3

Ethical Practice

Every nurse is responsible for upholding ethical practice standards. In Canada, the Canadian Nursing Association’s (2008) Code of Ethics for Registered Nurses provides guidance regarding ethical values for nurses and their client’s health-care needs. This resource is intended for all context and domains of nursing practice, and is also an excellent resource for nurses working with clients who have mental health or illness conditions and addiction.

Because “the expression of mental illness is heavily determined by culture” (Kent-Wilkinson, 2010, p. 31), it is imperative that nursing students understand and demonstrate cultural competency and cultural safety when caring for individuals with mental illness and addiction. Cultural competency is “the application of knowledge, skills, attitudes and personal attributes required by nurses to provide appropriate care and services in relation to the cultural characteristics of their client” (CNA, 2010, p. 1). Nurses first develop an awareness of one’s self and understand that cultural differences exist. It is also important to be aware that one’s own culture is not superior to that of others. Nurses caring for people with mental illness with a whole-person and recovery-oriented view must also be willing to learn about other people’s cultures, and respect the differences in culture and be willing to incorporate that knowledge into practice and educational curricula (Kent-Wilkinson, 2015).

Due to the complex nature of mental illness, nurses may face ethical dilemmas when working with this population, such as issues relating to client autonomy and restraint. Nursing students need to be well-prepared for a variety of ethical dilemmas, including voluntary and involuntary care, that will arise when working with people with mental illness and addiction. They should be taught the skills and knowledge to proactively and reactively manage the unpredictable.

For more information, see Resources in this section.

Teaching and Learning Activities

The following are teaching and learning activities that can be employed in the classroom to further support nurses in the integration of theory, principles and best practices related to ethical practice.

  • Review the CNA Code of Ethics (2017) and local College of Nurses documents pertaining to ethics
  • Define culture competency and cultural safety
  • Facilitate group discussion using questions such as:
    • What does the nurse do and at what point does the nurse have an obligation to do regarding (insert particular situation)?
    • Bathing/hygiene: what is the importance of bathing and the patients’ rights to make choice and decision regarding bathing?
    • Eating: what’s the importance of eating disorders and refusing right to eat?
  • Guest lecturer—person with lived experience (Appendix H), and Rights Advisors
  • Case studies—Section 9.3
  • Practice application
  • Review Safewards by Len Bowers

Learner Engagement Questions

The following are thought-provoking and engaging learner questions that can be used to further discussions with nursing students regarding ethical practice. These questions can be used either to stimulate discussion, engage students in critical thinking or be tied to class assignments and/or reflection exercises.

  • How can nurses become more culturally competent?
  • How would you balance off rights and laws/legal obligation?
  • Does addiction cause mental illness?
  • What is the relationship between mental health and addiction?
  • When is the use of coercion ever okay (e.g., medication, hunger strikes passes, bathing, eating, etc.)?
  • What does the nurse do when patients refuse to bath, eat, or take their medication?
  • How can the nurse engage clients therapeutically?
  • How does this link back to assessments (i.e., risk and strengths and health head to toe)?

 

Evaluation and Self-reflection

The following tools can be used to evaluate students in their understanding and application of therapeutic relationships.

  • Clinical evaluation
  • Guided discussion
  • Presentation

SELF-REFLECTION

Self-reflection questions include:

  • What are your thoughts regarding self-disclosure of addiction or mental illness in clinical practice? In school?
  • When is it appropriate to self-disclose? When is it inappropriate?
  • What are your personal beliefs about addiction, substance use and how it affects mental wellness or mental illness?
  • How do you apply the Code of Ethics in your practice?
  • Do you think you are culturally aware?
  • How much of your cultural awareness is based on stereotyping, influence from media or personal experience?

Resources

WEBSITES

FILM

The following films demonstrate ethical dilemmas that can be used to educate nursing students regarding ethics. Consider using the self-reflection questions to highlight themes that can be found in the films listed below.

  • Blue Jasmine (2013). Cate Blanchett plays Jasmine, a rich socialite who’s life falls apart when her husband Hal dies and she is left destitute.
  • King (1991) Robin Williams plays Parry, a teacher who becomes mentally ill after he witnesses his wife being killed in a restaurant massacre. Unable to recuperate from the tragic incident, Perry becomes a deluded homeless man. He believes that he is a knight sent by God on a sacred quest.
  • 28 Days (2000) Sandra Bullock plays Gwen Cummings, a newspaper columnist obliged to enter rehabilitation for alcoholism.

CANADIAN TEXTBOOKS

  • Austin & Boyd (Eds) (2015) Psychiatric & Mental Health Nursing for Canadian Practice (Third Canadian Edition).
    • Chapter 3: Kent-Wilkinson (2015) The Context of Mental Health Care: Cultural, Socio-economical and Legal.
    • Chapter 7: Austin (2015). Ethical Psychiatric and Mental Health Nursing Practice.
  • Halter (2014) Varcaroli’s Canadian Psychiatric Mental Health Nursing: A Clinical Approach (First Canadian Edition).
    • Chapter 7: Mordoch. (2014)Cultural implications for psychiatric mental health nursing.
    • Chapter 8: Pollard (2014)Ethical Responsibilities and Legal Obligations for psychiatric mental Health Nursing Practice.

REFERENCE MATERIALS

  • Baba, L. (2013). Cultural safety in First Nations, Inuit and Métis public health: Environmental scan of cultural competency and safety in education, training and health services. Prince George, BC: National Collaborating Centre for Aboriginal Health.
  • Browne, A. J., Varcoe, C., Smye, V., Reimer-Kirkham, S., Lynam, M. J., & Wong, S. (2009). Cultural safety and the challenges of translating critically oriented knowledge in practice. Nursing Philosophy, 10(3), 167–179.
  • Canadian Nurses Association. (2008). Code of ethics for registered nurses. Ottawa, ON: Author.
  • Canadian Nurses Association. (2009). Cultural competence and cultural safety in nursing education: A framework for First nations, Métis and Inuit Nursing. Aboriginal Nurses Association [ANA], Canadian Association of Schools of Nursing [CASN], and Canadian Nurses Association [CNA]. Retrieved from https://cna-aiic.ca/~/media/cna/page-content/pdf-en/first_nations_ framework_e.pdf
  • Canadian Nurses Association. (2009). Global health and equity (Position statement). Retrieved from http://www.cna-aiic.ca/en/advocacy/policy-support-tools/cna-position-statements/
  • Canadian Nurses Association. (2010). Position Statement - Promoting cultural competence in nursing. https://www.cna-aiic.ca/~/media/cna/page-content/pdf-en/ps114_cultural_ competence_2010_e.pdf?la=en
  • College of Nurses of Ontario. (2009). Practice Standard: Ethics. Retrieved from: http://www.cno. org/en/learn-about-standards-guidelines/educational-tools/learning-modules/ethics/
  • Engel, J., & Prentice, D. (2013). The ethics of interprofessional collaboration. Nursing Ethics, 20(4), 426–435. http://dx.doi.org/10.1177/0969733012468466
  • Ewashen, C., McInnis-Perry, G., & Murphy, N. (2013). Interprofessional collaboration in-practice: The contested place of ethics. Nursing Ethics, 20(3), 325–335.
  • Hart-Wasekeesikaw, F., & Gregory, D. (2009). Cultural competence and cultural safety in First Nations, Inuit and Métis nursing education: An integrated review of the literature. Institutional Repository, University of Lethbridge, Lethbridge, AB.
  • Halter, M. J. (2014). Psychiatric mental health nursing standards of practice, code of ethics, beliefs and values. In M. J. Halter, Varcarolis’s Canadian psychiatric mental health nursing: A clinical approach. C. L. Pollard, S. L. Ray, & M. Haase (Eds.), (First Canadian ed., appendix A, pp.735–736). Toronto, ON: Elsevier Canada.
  • Kent-Wilkinson, A. (2015). The context of mental health care: Cultural, socioeconomic, and legal. In W. Austin & M. A. Boyd (Eds.), Psychiatric & mental health nursing for Canadian practice (3rd ed., Chapter 3, pp. 25–41). Philadelphia, PA: Wolters Kluwer.
  • Kersey-Matusiak, G. (2012). Culturally competent care: Are we there yet? Nursing Management (Springhouse), 43(4), 34-39.
  • Kirmayer, L. J. (2012). Cultural competence and evidence-based practice in mental health: Epistemic communities and the politics of pluralism. Social Sciences & Medicine, 75(2), 249-256.
  • Pollard, C. L. (2014). Ethical responsibilities and legal obligations for psychiatric mental health nursing practice. In M. J. Halter, Varcarolis’s Canadian psychiatric mental health nursing: A clinical approach. C. L.
  • Pollard, S. L. Ray, & M. Haase (Eds.), (First Canadian ed., chapter 8, pp. 114–130). Toronto, ON: Elsevier C Canada.
  • Registered Nurses’ Association of Ontario. (2007). Embracing cultural diversity in health care: Developing cultural competence. Toronto, ON: Registered Nurses’ Association of Ontario.
  • Richardson, D. (2008). Cultural safety: An introduction. Paediatric Nursing, 20(2), 39–43.
  • Srivastava, R. (Ed.) (2007). The healthcare professional’s guide o clinical cultural competence. Toronto, ON: Mosby Elsevier.

 

 

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Service to the Public Teaching activities and resources

Service to the Public Teaching activities and resources

Outcomes

Purpose

This section provides educators with the knowledge and skills about educating and supporting nurses to be able to work collaboratively with government, organizations, and other public community stakeholders to promote mental illness and addiction advocate for improvements in health services for persons experiencing a mental health condition and/or addiction.

Outcomes

At the end of this section, the educator will enable students to achieve the following:

  • Apply knowledge of the health-care system in order to contribute to the improvement of mental health and addiction services.
  • Recognize the impact of the organizational culture on the provision of mental health care to persons experiencing mental health conditions and addiction, and act to ensure appropriate services are delivered safely.
  • Define the terms: collaborative, inter- and intra-professional, and inter-sectoral practice.
  • Engage in collaborative, inter and intra-professional, and intersectoral practice when providing care for persons with mental health conditions and addiction.

CASN/CFMHN Competencies

5.1, 5.2, 5.3

Service to the public

According to the WHO, “Advocacy is an important means of raising awareness on mental health issues and ensuring that mental health is on the national agenda of governments. Advocacy can lead to improvements in policy, legislation and service development” (WHO, 2003, p. 1). Every nurse has the opportunity—and professional ethical responsibility—to advocate for improvements and advancements in health care for persons with mental health, illness and addiction.

Ensuring future nurses have knowledge of mental health legislation, and the health-care system, is vital to identifying improvements and strengthening mental health and addiction services. However, in order to advocate for change, it is also necessary to understand political and organizational culture, and its impact on the provisions of care. Establishing and maintaining collaborative processes within inter- and intra-professional practice teams, understanding person-centred care and leadership is important when caring for clients with complex mental health and addiction conditions (RNAO, 2006a). For more information, see Resources in this section.

Teaching and Learning Activities

The following are teaching and learning activities that can be employed in the classroom to further support nurses in the integration of theory, principles and best practices related to service to the public.

  • Define the terms: collaborative, inter and intra-professional, and inter-sectoral practice
  • Identify local systems (child welfare, criminal justice system, mental health system, social service, housing programs, methadone clinics, community treatment providers, and addiction treatment centres, police services, mental health courts, diversion services etc.)
  • Reflect on organizational culture through guided discussion
  • Discuss the following:
    • Legal implication of persons with mental disorders charged under the Criminal Code of Canada;
    • The role and responsibility of the Substitute Decision Maker;
    • Collaboration and communication between the person with a mental health condition and addiction condition, their family, the health care system and the nurse; and
    • The role of Mental Health Advocate.
  • Schedule tours of psychiatric facilities, addiction treatment centres, community clinics and local street level centres such as shelters, correctional facilities
  • Mapping local systems such as services, facilities and treatment centres

Learner Engagement Questions

The following are thought-provoking and engaging learner questions that can be used to further discussions with nursing students regarding service to the public. These questions can be used either to stimulate discussion, engage students in critical thinking or be tied to class assignments and reflection exercises.

  • Where are the mental health and addiction services in your city/province?
  • Can you identify a local advocacy group for mental health/illness awareness?
  • How can nurses advocate for persons with mental illness outside of the psychiatric ward?

Evaluation and Self-reflection

The following tools can be used to evaluate students in their understanding and application of service to the public.

  • Guided discussion
  • Presentation (about an advocacy group)

Resources

CANADIAN TEXTBOOKS

  • Austin & Boyd (Eds) (2015) Psychiatric & Mental Health Nursing for Canadian Practice (Third Canadian Edition).
    • Chapter 3: Kent-Wilkinson (2015)The Context of Mental Health Care: Cultural, Socio-economical and Legal.
  • Halter (2014) Varcaroli’s Canadian Psychiatric Mental Health Nursing: A Clinical Approach (First Canadian Edition).
    • Chapter 8: Pollard (2014) Ethical Responsibilities and Legal Obligations for psychiatric mental Health Nursing Practice.

 

REFERENCE MATERIALS

  • Canadian Interprofessional Health Collaborative. (2010). A national interprofessional competency framework. 
  • Canadian Nurses Association. (2011). Interprofessional collaboration. 
  • Canadian Nurses Association. (2012). Position statement on mental health services. Ottawa, ON: Author.
  • Ewashen, C., McInnis-Perry, G., & Murphy, N. (2013). Interprofessional collaboration-in-practice: The contested place of ethics. Nursing Ethics, 20(3), 325–335.
  • Faulkner-Gibson, L., & Wong, K. (2015). Mental health promotion with children and adolescents. In W. Austin & M. Boyd (Eds.), Psychiatric & mental health nursing for Canadian practice (3rd ed., Chapter 29, pp. 668–690). Philadelphia, PA: Wolters Kluwer.
  • Moore, S. (2015). Mental health promotion with older persons. In W. Austin & M. A. Boyd (Eds.), Psychiatric & mental health nursing for Canadian practice (3rd ed., Chapter 32, pp. 752–764). Philadelphia, PA: Wolters Kluwer.
  • Roberts, G., & Grimes, K. (2011). Return on investment: Mental health promotion and mental illness prevention. Ottawa, ON: Canadian Institute for Health Information.
  • Kent-Wilkinson, A., & Sanders, S. L., Mela, M., Peternelj-Taylor, C., Adelugba, O, Luther, G., Woods, P., Olver, M., & Wormith, J. S. (2012). Needs assessment of forensic mental health services and programs for offenders in Saskatchewan. Executive summary. Study conducted by Forensic Interdisciplinary Research: Saskatchewan Team (FIRST Centre for Forensic Behavioural Sciences and Justice Studies, Saskatoon, SK: University of Saskatchewan.
  • Moore, S. (2015). Mental health promotion with older persons. In W. Austin & M. A. Boyd (Eds.), Psychiatric & mental health nursing for Canadian practice (3rd ed., Chapter 32, pp. 752–764). Philadelphia, PA: Wolters Kluwer.
  • Schizophrenia Society of Canada. (2016). Advocacy. 
  • World Health Organization. (2003). Advocacy for mental health. Geneva: Author.
  • World Health Organization. (2010). Framework for action on inter professional education and collaborative practice. 
  • World Health Communication Associates (2010). Promoting health: Advocacy guide for health professionals. 
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