Yvonne I. Larrier
Indiana University South Bend
Monica D. Allen
San Jose State University
Irwin M. Larrier
Yvonne I. Larrier, Counseling & Human Services Department, Indiana University South Bend; Monica D. Allen, Department of Health Science and Recreation, San Jose State University; Irwin M. Larrier, Harold Abel School of Psychology, Capella University. Correspondence concerning this article should be addressed to Yvonne Larrier, Counseling & Human Services Department, Indiana University South Bend, South Bend, IN 46615. E-mail: email@example.com
Global mental health research is continuing to unearth the multiple systemic barriers that over 80% of the world’s population experiences in their search for cultural, contextual, and efficient mental health treatment and services. The widespread gaps and shortages in treatment, research, interventions, financial resources, and mental health care specialists are enduring and expansive thus leaving behind many communities and societies in low and middle income countries and high income countries. Whereas there are numerous approaches to these gaps, this article proposes a re-conceptualized approach to the promotion, practice, and intervention of mental health services locally and globally, with the Cultivating SEEDS System (CSS™) framework. This framework addresses two of the most prevalent barriers – the stigma associated with accessing mental health care resources, and the lack of mental health care professionals.
Keywords: Mental health treatment gaps, Mental health care professionals, Social-emotional competence, Mental illness stigma, Task sharing, Non-specialist health workers The Cultivating Seeds System™ (CSS™): A Potential Framework To Increase Mental Health Resources
The State of Global Mental Health – The Problem
Mental health is in crisis worldwide. Nearly 30% of people globally experience a mood, anxiety, or substance use disorder in their lifetime (Steel et al, 2014). According to data from the Global Burden of Disease (GBD) Study of 2010, reported in 2013, 7.4% of the GBD is attributed to mental health and substance use disorders (Whiteford et al., 2013). Although 80% of the world’s population live in low and middle income countries (LAMICs) (Saxena, Thornicroft, Knapp, & Whiteford, 2007), more than 90% of mental health resources are located in high income countries (WHO, 2005). It is estimated that in LAMICs between 76% and 85% of people with mental disorders receive no treatment for their mental health conditions (World Health Organization, 2004).
This situation has been referred to as the “treatment gap” (TG), which is the difference between the number of people with mental health disorders and the number of those people who are able to access appropriate services (Kohn, Saxena, Levav, & Saraceno, 2004). The TG has managed to help bring attention to problems or barriers that individuals encounter when trying to access mental health resources. Many help-seekers experience challenges that often exacerbate the actual disorder that they have (Corrigan, 2007; Martinez, Piff, Denton-Mendoza, & Hinshaw, 2011).
The many barriers to treatment include stigma and discrimination; insufficient financial resources; shortage of mental health care professionals; treatment gaps; collaboration among stakeholders; and culturally responsive multisystemic interventions (Collins & Saxena, 2016)
Diverse strategies are being developed to deal with the TG. Examples include the “Friendship Bench therapy” in Zimbabwe (Chibanda et al., 2015) and Sociotherapy in Rwanda (Richters, Dekker, & Scholte, 2008)
The Cultivating SEEDS System (CSS™) – An Overview
We propose a re-conceptualization approach to the promotion, practice and intervention of mental health services locally and globally through the Cultivating SEEDS System (CSS™) framework. With CSS™, we address, in particular, two of the most widespread barriers to access to and utilization of mental health services: stigma and the lack of mental health care professionals.
As an organizing framework, the CSS™ gives context, order, and meaning to client background information gathered. It also provides the practitioner, a layperson, or the Community Health Worker (CHW) using the CSS™ framework with the ability to make conceptual connections, find themes and linkages in the development of goals, conduct interventions, and implement strategies (Parsons, 2009). CSS™ uses social-emotional competencies and the social determinants of a person’s life course to explain human behavior. It also identifies culturally responsive approaches to influencing and transforming lives and communities.
The organizing structure within CSS™ is SEEDS – Social-Emotional Education in Diverse Settings. SEEDS is an agricultural metaphor that corresponds to the five core social-emotional competencies. As an example, in the plant world, the soil and the essential growth elements are the metaphorical equivalents to the social determinants of human development. The following table provides the working definitions that the CSS™ framework uses and the agricultural definitions from which they were adapted.
Table 1 – Elements of the CSS™ Framework
|Element||CSS™ Framework Definition||Agricultural Definition|
|Soil||The environments in which an individual is born, grows, lives, works, learns, and plays. They are made up of influences on every aspect of a person’s life.||The environments in which the plant grows. It is made up of nutrients that feed the plant and support life.|
|Seeds||These are the five Social- Emotional Competencies (SECs): self-awareness, social awareness, self-management, responsible decision-making, and relationship management. They are the foundation for healthy growth and development.||Anything that can be sown and has the capability to develop and grow. They are the foundation for life.|
|Essential Growth Elements||Positive influences such as self, peers, government, home, school, work, community, media, and culture are needed to foster and promote growth. Optimal balance of these (influences or) elements results in healthy growth and development. Unfavorable balance of these elements leads to inadequate growth and production.||Conditions needed to foster and promote growth, such as soil minerals, water, air, temperature, and the sunshine. Optimal balance of these elements results in healthy growth and development. Unfavorable balance of these elements leads to inadequate growth and production.|
|Pollen||Words that are added to an individual’s vocabulary to promote healthy social and emotional growth and development.||The fertilizing element of flowering plants. Fertilizing occurs when suitable substances are added to make the soil more productive.|
|Seedlings||Individuals from birth to 18 years of age.||Very young plants produced from seed.|
|Saplings||Young persons between the ages of 19-24.||Young trees.|
|Sower||An individual who influences and inspires seedlings and saplings who implant the SECs. Sowers have the capability to change their environments and those of the seedlings and saplings.||An individual who introduces, implants, promulgates, and disseminates seeds, seedlings, and saplings.|
Additionally, the CSS™ is practical in that it describes a culturally responsive intervention called the RUMERTIME Process™. The RUMERTIME Process™ is a five-step psychosocial problem-solving strategy that helps individuals move from a position of inter- and intrapersonal imbalance to inter- and intrapersonal balance.
The Goals of the Cultivating SEEDS System
The goals of CSS™ are:
1. to increase access to the knowledge, skills, mindsets, and behaviors associated with healthy social-emotional development for individuals in diverse settings globally; and
2. to assist people in the utilization of social-emotional competencies in transforming lives and creating safer communities.
The CSS™ framework is built on five well-established principles: Ecological Systems Theory, Erikson’s eight-stage Psychosocial Development, Strengths-Based Approach, Social Learning Theory, and Cognitive-Behavior Therapy (CBT) approaches. The first four of these theories share some conceptual similarities that transcend theoretical bounds, and they explain and conceptualize human behavior as occurring within and across social contexts (Bronfenbrenner, 1979; Cook, 2012; Coyne & Cook, 2004; Feldman, 2014). These theories also look beyond the individual as the only influencing factor in human development. Furthermore, these principles include several external factors and systems (e.g., family, organization, and communities) in the explanation of behavior as well as in the intervention, planning, and implementation stages (Bandura, 2007; Bandura, 1977; Vimont, 2012; Watamura, Phillips, Morrissey, McCartney, & Bub, 2011). The fifth theory, CBT is one of the most widely used evidence-based practices for some issues in a person’s life such as relationship problems, self-esteem issues, drug and alcohol abuse, anxiety, depression, and CMHDs. CBT focuses on the development of personal coping strategies that target solving current problems and changing unhelpful patterns in cognitions (thoughts, mindsets, and attitudes), behaviors, and emotions (Beck, 2011, p. 19-20; Hollon & Beck, 2013, p. 393-394; Mennuti, Christner, & Freeman, 2012).
The Components of CSS
The CSS™ is made up of six components:
- five theories;
- an agricultural metaphor;
- social-emotional competencies;
- social determinants;
- levels of engagement;
- RUMERTIME Process™ (the intervention).
Each component works synergistically to create what we propose as a re-conceptualized approach to GMH promotion and intervention.
CSS™ and its Role in Reducing Systemic Barriers to Mental Health Care
CSS™ addresses two systemic barriers in particular.
With nearly 30% of people around the world experiencing a mood, anxiety, or substance use disorder at some point in their lifetime, it is unfortunate that they also encounter barriers to treatment and support due to mental illness stigma. Stigma according to the Mehta and Thornicroft (2014) refers to a cluster of negative beliefs, attitudes, and behaviors that motivate societies to fear, reject, avoid, and discriminate against a particular trait, individual, or group of people.
Stigma is further perpetuated through language and labels. Researchers suggest that one of those forms is the continued use of labels and language associated with mental illness. Language can become a spotlight that highlights certain attributes or qualities of objects or people, making selective aspects of the world more prominent than others (Granello & Gibbs, 2016; Wolff & Holmes, 2011). For instance, the movement toward person-first language emerged from concerns that the use of labels to refer to individuals had the potential to promote bias, devalue others, and express negative attitudes (Granello & Gibbs, 2016). This person-first movement is grounded in the philosophy of linguistic relativity which states that language shapes perceptions of the world and significantly influences cognitive processes (Wolff & Holmes, 2011). In other words, the labels and language we use to describe people with mental illnesses shape how they perceive and treat themselves as well as how others perceive and treat them (Corrigan, Watson, Bryne & Davis, 2005). These perceptions help to influence whether or not they pursue treatment and support (Corrigan, 2007).
A study conducted by Granello and Gibbs (2016) emphasized this principle that the terminology used to describe individuals in need of mental health support does matter. Three groups (undergraduate college students in general education courses, community adults, and professional counselors/counselors in training attending a counseling conference) completed the Community Attitudes Toward the Mentally Ill (CAMI) survey. Participants were randomly assigned a version of the survey: one version used the term “the mentally ill” and the other used the term “people with mental illnesses.” In each of the three groups, the participants who completed the survey with the term “the mentally ill” had significantly lower tolerance scores than those whose version used the term “people with mental illnesses.” This indicated that people with the lower tolerance scores perceived “the mentally ill” person as inferior and as a threat to society; these participants had less empathy for clients. The difference in tolerance based on words used was noticeable, meaningful, and real (Granello & Gibbs, 2016).
Social-emotional competencies and mental health
The terminology or the language of Social-Emotional Competencies (SECs) plays an important role in CSSTM. SEC is a person’s ability to recognize, understand, manage, express, and reflect upon the social and emotional aspects of his or her life in ways that enable the person to successfully relate to self and others while effectively navigating life tasks, milestones, challenges, and changes (Elias, 1997; Nagaoka, Farrington, Ehrlich, & Heath, 2015). Several researchers (McAneney et al., 2015) have identified emotional, psychological, and social well-being as the building blocks of optimal mental health. Optimal mental health is considered to exist on a continuum. As individuals move towards optimal mental health, the goal is for them to experience congruence and balance between their intrapersonal and interpersonal selves across the various settings in which they live, learn, work, and love (McAneney, et al., 2015; Nagle & Usry, 2016; Williams, Priest, & Anderson, 2016).
Being mindful of the labels and language research that supports de-stigmatization of individuals with CMHDs, we propose to use the terminology associated with SEC, such as self-awareness, social awareness, self-management, relationship management, and responsible decision-making. Using the SEC language instead of CMHD’s terminology could aid in the reduction and removal of the stigma associated with mental illness and open up a path to encourage individuals to seek mental health support.
Agricultural metaphor (revisited)
The proposed agricultural metaphor with CSS™ (Table 1) is predicated on a similar principle to that found within SEC which posits that words matter; how we label, and the language we use to describe individuals presenting problems, can be a barrier or facilitator for people seeking support for CMHDs (Corrigan, 2007; Granello & Gibbs, 2016). Therefore, we propose using terminology associated with the building blocks of mental health and well-being (social, emotional, psychological, and behavioral) as opposed to the categorical mental health terminology (e.g., conduct disorder) (Corrigan, 2007; Erreger & Foreman, 2016).
We chose to use an agricultural metaphor as part of the CSS™ organizing framework for several reasons:
– agriculture is found in every corner of the globe, making the connection between agriculture and the social-emotional well-being of individuals relatable;
– agriculture does not have any inherent biases; it is accessible to a wide range of people with respect to gender, age, physical ability, and so on;
– researchers have found positive mental and physical health effects of viewing and being in and around landscapes, including landscapes with characteristics often found in farming and ranching areas. The main health effects were related to “reduced stress, improved attention capacity, facilitating recovery from illness, ameliorating physical well-being in elderly people, and behavioral changes that improve mood and general well-being” (Ulrich, 1981; Velarde, Fry, & Tveit, 2007); and
– agriculture is a fitting metaphor when describing a range of issues related to at-risk individuals; it serves as a unifying structure for the various at-risk categories and intervention strategies (McWhirter, McWhirter, McWhirter, & McWhirter, 2013).
- Shortage of Mental Health Care Professionals
Mental health care is a profession that hasn’t switched to automation and technology. It relies mainly on human interactions and relationships to provide services. Therefore, a shortage of psychiatrists, psychiatric nurses, counselors, mental health therapists, social workers, and psychologists impedes treatment and care in LAMICs (Saxena et al., 2007). For example, in Liberia, with a population of 3.5 million, there is only one psychiatrist; Afghanistan, with a population of 25 million, has only two psychiatrists (Saxena et al., 2007).
The RUMERTIME Process™ (RP) is a five-step psychosocial problem-solving strategy that helps individuals achieve a position of intra- and interpersonal balance from a state of intra- and interpersonal balance. RUMERTIME is an acronym. Participants in the process RUMERIZE when a triggering event occurs in their life that activates negative thinking, acting, and feeling patterns. To interrupt this pattern of negativity, they Recognize, Understand, Manage, Express, and Reflect on their Thoughts, Interactions, Mindsets, and Emotions (RUMERTIME) related to the triggering event.
One of the goals of the CSS framework, specifically intervention using the RP, is to add to the body of knowledge, promotion, and practice. The feasibility, adaptability, and cultural responsiveness qualities of the RP creates an opportunity for task-sharing to occur. Task-sharing, defined as the involvement of non-specialist health workers in delivering mental health services, is an essential component to reducing the 1.2 million health worker shortage in LAMICs (Nyatsanza, Schneidner, Davies, & Lund, 2016).
Non-specialist health workers play an important role in improving mental health in LAMICs. Researchers (Van Ginneken et al., 2013) examined 38 studies from 22 developing countries, and found that non-specialist health workers or laypeople were able to alleviate some depression and anxiety in mental health patients and also able to improve caretakers’ coping skills. These researchers believe that laypeople and non-specialists who are well trained can play a key role in addressing the human resource shortages in mental health care in LAMICs. The RP is being taught to persons of all ages, from as young as eight-years old, so that they can use the five-step strategy on their own as a part of their daily living activities. The adaptability of the RP lends itself to being taught to laypersons or non-specialist health workers so they can work with clients.
The CSS™ Framework Applied
We will illustrate how the components of the CSS™ interact synergistically by working through a case study.
Murall is a 21-year-old single mother of a 4-year-old boy and a 1-year-old girl living in an underserved, under-resourced community. She is a member of a racial and ethnic group that is marginalized and disenfranchised. She did not complete high school and does not have a steady job. Her children are from two different men. These men are both older than she by a wide margin. The office personnel at the community center that she visits to get assistance with food, rent and clothes reported that Murall disclosed to them that she sometimes feel as if she is drowning. Many days, she does not have basic utilities because she does not have money. She gets furious with her children, and screams and beats them. Then she feels guilty, ashamed, and depressed, and those are some of the times when she especially feels as if she is drowning. She feels as if she is losing her mind but is too ashamed to go for help. Even as she talks with the office personnel about what she is feeling, the office staff tell her about the one community-counseling agency on the outskirts of her community and devalue Murall’s feelings in the process of sharing information. She does not have her own transportation, and her community has no public transit services; therefore, she cannot get there. Even so, she has not heard positive things about “that place.”
As we discussed earlier, the goals of the CSS™ are to increase people’s access to knowledge and skills for healthy social-emotional development and to help them use these skills to transform their lives.
The community center office personnel will attempt to generate opportunities for Murall to access information about obtaining necessary utilities, learning skills of appropriate parenting, and managing her emotions, thoughts, and interactions, especially as they relate to herself, her children, and her life circumstances. Hopefully, the office personnel will be able to encourage Murall to seek help in becoming more self-aware, managing herself and her relationships, and making responsible decisions.
- Five Theories
To recap, the five principles that form the theoretical basis of CSS™ are: Ecological Systems Theory (EST), Erikson’s eight-stage Psycho-social Development (EPD), Strengths-Based Approach (SBA), Social Learning Theory (SLT), and Cognitive-Behavior Therapy (CBT).
Murall needs help in understanding her embeddedness in her community and that she is an active participant in her own development as well as her children’s development. She needs help to understand that several systems have influenced her life up to this point and that she influences those systems (EST). Murall will hopefully seek out help and in so doing the Sowers will help her to identify or recognize her strengths, even in the midst of what may appear to be a very dismal life course (SBA). The hope is if Murall seeks help to handle her thoughts, interactions, mindsets, and emotions effectively, the Sowers (CSS™ practitioner/CHW/trained layperson) will empower her through social emotional education and skill building on how to create a better life and model better coping skills for her children (SLT).
Developmentally, Murall first became a mom when she was 15 years old and in stage five of Erikson’s psychosocial development model. Stage five is “identity vs. role confusion.”(EPD). The primary goal of the Sowers in Murall’s case should be to teach Murall the RUMERTIME ProcessTM, which is a five-step psycho-social, problem-solving strategy to help move her from negative thinking, behaving, and feeling to productive and positive thinking, acting and feeling.
- Agricultural Metaphor
The Agricultural Metaphors are shown and defined in Table 1.
Murall has multiple role designations. Her emotional age is that of a seedling, mainly because of the age at which she became pregnant with her first child. Chronologically, she is a sapling because of the age group she is presently in (19-24). Finally, she is a sower because of her role as a mother. However, given her circumstances, she isn’t able to change the environment for her children or herself, hence the reason for her feelings of overwhelming depression, shame, guilt, and anger.
Her environment/soil is described as underserved and under-resourced. She is raising her children in a similar environment to that in which she grew up, one that has limited or less than optimal essential growth elements.
- Social-Emotional Competencies (SECs)
The five Social-Emotional Competencies (SECs) involve individuals becoming self-aware, socially aware, and skilled at managing self, others, situations, and decisions (Bandura, 1986, 1997; Elias, 2008). Ultimately, our goal, like that of the WHO, is for all individuals to realize their full potential, as they live balanced and productive lives, while contributing to improving self, others, and societies. This state of well-being experienced by individuals is a reflection of balance and social-emotional competence.
Murall seems to demonstrate some self-awareness about her emotions, strengths, weaknesses, and resources. Her inability to manage her own emotions and interactions evokes shame and depression, adversely affects her standard of living, and negatively impacts her relationship with her children and adults. This further isolates her from connecting with desperately needed mental health support. These SECs can be taught to Murall, even at her age and in her role as a mother. Teaching Murall self- and relationship management skills using the RUMERTIME™ Process is a very practical and contextually relevant solution to her life circumstances.
- Social Determinants of Mental Health
The social determinants of mental health are defined as the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies, development agendas, social norms, social policies, and political systems (Lund et al., 2014; Lundy, 2008; WHO, 2014). Risk factors for many CMHDs are heavily linked to social inequities (Allen, Balfour, Bell, & Marmot, 2014). As stated earlier, 85% of the world’s population bears more than 20% of the global burden of disease, namely mental illness. These LAMICs, where most of the 85% of the population resides, are beleaguered with severely stressful events, dangerous living conditions, exploitation, and a shortage of primary care services for overall health and mental health. These conditions increase the inequities and risk factors for people in these locations, making the course of illness more severe and debilitating (Allen, Balfour, Bell, & Marmot, 2014).
Murall’s home and community are plagued by several economic, social, political, educational, and public health inequities that increase her and her children’s risk factors. Murall’s case clearly states that she lives, works, and raises her family in an underserved and under-resourced community, and that the racial-ethnic group she belongs too is marginalized and disenfranchised.
- Levels of Engagement (LOE)
The CSS™ facilitator, CHW, or trained layperson operationalizes the CSS™ goals as he or she engages with the individual as the client, the family as the client, the school as the client, and the community as the client. Various activities take place at each level of engagement with different clients to fulfill the CSS™ goals. In addition, each LOE contains Units of Activity and a Growth and Development Plan.
The case of Murall is examined from an individual and a family perspective. At the individual LOE, Murall was a Seedling (adolescent) in the developmental stage of identity vs. role confusion when she became pregnant. Presently, she is a Sapling (young adult) in the developmental stage of intimacy vs. isolation (Feldman, 2014). From an ecological systems perspective, Murall is struggling with elements from all five systems. However, the struggle is most directly being experienced from the micro-, meso- and exo-systems specifically (Bronfenbrenner, 1979). From a family LOE perspective, we look at her children’s development, both of whom are seedlings. However, the one-year-old is in the trust vs. mistrust stage of life; and the four-year-old is in the autonomy vs. shame and doubt developmental life stage (Feldman, 2014). Her children are also being influenced by Murall’s struggles with elements from the micro-, meso- and exo-systems specifically (Bronfenbrenner, 1979).
Units of activity (UOA)
Each Level of Engagement has Units of Activity (UOA) that promote the core principles of the theories associated with the CSS™ framework. Units of Activities are defined as the individual strategies, techniques, and tools employed to implement the goals of the CSS™ framework.
The CSS™ practitioner will conduct a comprehensive Social-Ecological Strengths-Based intake assessment with Murall. This intake assessment will be completed with Murall’s full participation so that the interventions developed will be culturally and contextually relevant to Murall’s life circumstances as well as increasing the likelihood of Murall incorporating the strategies because she was an integral part of developing the strategies. An example of questions from the intake would be, “What is the most creative thing you’ve ever done?”; “What is most important to you in life?”; “Who are your heroes or role models?”
Growth & development plan (GDP)
Each LOE has a Growth and Development plan (GDP) that is synonymous with a treatment plan. We have chosen to use the term growth and development plan instead of treatment plan because of the CSS™ focus on the strengths-based approach in engaging clients. In addition, the authors’ fundamental view of human nature is oriented toward a growth and development model and not a deficit and treatment model. The CSS™ GDP is a document that includes a comprehensive set of tools and strategies that are used to organize the client’s information obtained from the intake assessment and other data points.
The GDP looks at the client’s strengths, struggles, support systems, goals, and plans.
The CSS™ practitioner or CHW will engage Murall in a series of questions about herself, e.g., “What are you good at that nobody knows?”; a series of questions about her family of origin, e.g., “What did you hear about ancestors whom you never knew?”; Questions about her home, e.g., “Are all your basic needs met?”; and questions about her community, e.g., “Do you feel safe in your neighborhood?” Murall’s responses to these and other questions will help the CSS™ practitioner, CHW, or trained layperson to obtain a comprehensive picture of Murall and all the systems in which she is embedded.
- The RUMERTIME Process™
In the RUMERTIME ProcessTM, recognizing and understanding the triggering event helps the individual to become self-aware. Managing and expressing their thoughts, interactions, mindsets, and emotions (TIME) regarding the triggering event helps people to find ways to productively handle them, thus facilitating growth and development in the areas of self- and relationship management skills. Reflecting upon the triggering event, individuals are able to make a clear-headed assessment of benefits and drawbacks to their involvement with the triggering event. It is in reflecting that responsible decision-making skills are actuated. Practicing these steps on a daily basis with any life situation, whether it has to do with self or relationships, can help individuals become socially and emotionally competent.
The CHW will begin to teach Murall how to handle her response to her children when she is feeling overwhelmed and as if she is drowning. For example, the CHW or trained layperson will ask Murall, “What are your thoughts about yourself, others, and your situation? What are your interactions (behaviors) toward yourself, others, and situations as it relates to feeling overwhelmed? What are your beliefs (mindsets) about yourself, others, and situations as they relate to feeling overwhelmed? What emotions are you experiencing as they relates to yourself, others, and your situation?” Helping Murall to utilize this five-step, psycho-social, problem-solving process will help her increase her self-awareness and also help her to be in a better position to manage herself well and make more informed decisions regarding her relationship with her children.
What CSS™ Means for Mental Health Care Practice and Practitioners
We have put forward a re-conceptualized approach to the promotion and practice of global mental health. We believe it is important to consider using dimensional descriptions of CMHD or the building block terminology (e.g., self- regulation) as opposed to categorical language (e.g., conduct disorder) when working with individuals who are seeking mental health support. It is our presupposition that labels and language matter, and that the verbiage used to describe CMHD can act as a barrier or facilitator for those in need of mental health support. Furthermore, we believe that by using dimensional descriptors instead of categorical descriptors the effects of stigma may also be reduced over time. Presently, we believe that, for the global burden of mental health to be shared among nations more equitably, researchers, practitioners, businesses, politicians, policy makers, and laypersons must all fully engage. In this way, individual, institutional, community, and societal wholeness may be attained.
The community center office personnel, if trained to use the CSS™ framework, can become a point of access for Murall to receive not only assistance with her utilities but also assistance with her social-emotional needs. Equipping laypersons to recognize and intervene in the lives of the Muralls of this world would create access for more individuals to receive the mental health support they so desperately need.
The Cultivating SEEDS System™ presented in this article provides a practical organizing framework for home, school, community professionals, and laypersons when well trained to use it in their work with local and global populations. It provides an agricultural metaphor as a universal way to understand and address some of the challenges facing children, youth, and adults. Its primary purpose is to improve social-emotional competence by de-stigmatizing mental illness through removing labels and changing language, thus making it more acceptable to seek and receive mental health services. The theory-based framework is operationalized through a process of individuals recognizing, understanding, managing, expressing, and reflecting upon their thoughts, interactions, mindsets, and emotions. As a result, homes, schools, workplaces, and communities will be the beneficiaries of highly socially-emotionally competent individuals who have acquired and are utilizing social-emotional competencies across diverse settings.
Allen, J., Balfour, R., Bell, R., & Marmot, M. (2014). Social determinants of mental health.International Review of Psychiatry, 26(4), 392-407. doi:10.3109/09540261.2014.928270
Bandura, A. (1977). Social learning theory. Englewood Cliffs, New Jersey: Prentice Hall, Inc.
Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, New Jersey: Prentice Hall, Inc.
Bandura, A. (2007). Health promotion from the perspective of social cognitive theory. Psychology and Health, 13(4), 623-649. doi:10.1080/08870449808407422
Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). New York, New York: The Guilford Press.
Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Massachusetts: Harvard University Press.
Chibanda, D., Bowers, T., Verhey, R., Rusakaniko, S., Abas, M., Weiss, H., & Araya, R. (2015). The Friendship Bench programme: A cluster randomised controlled trial of a brief psychological intervention for common mental disorders delivered by lay health workers in Zimbabwe. International Journal of Mental Health Systems, 9(21). doi:10.1186/s13033-015-0013-y
Collins, P. Y., & Saxena, S. (2016). Action on mental health needs global cooperation. Nature, 532, 25-27. doi:10.1038/532025a
Cook, E. P. (2012). Understanding people in context: The ecological perspective in counseling. Alexandria, Virginia: American Counseling Association.
Corrigan, P. W. (2007). How clinical diagnosis might exacerbate the stigma of mental illness. Social Work, 52(1), 31-39.
Corrigan, P. W., Watson, A. C., Byrne, P., & Davis, K. E. (2005). Mental illness stigma: Problem of public health or social justice? Social Work, 50(4), 363-368. doi:10.1093/sw/50.4.363
Coyne, R. K., & Cook, E. P. (2004). Ecological counseling: An innovative approach to conceptualizing person-environment interaction. Alexandria, Virginia: American Counseling Association.
Elias, M.J., Parker, S.J., Kash, V.M., Weissberg, R.P., & O,Brien, M.U. (2008). Social and emotional learning, moral education, and character education: A comparative analysis and a view toward convergence. In Nucci, L. P., Narvaez, D., Nucci, L., Narvaez, D., & Krettenauer, T. (Eds.). Handbook of moral and character education (pp. 248-266). doi:10.4324/9780203931431
Elias, M. J., Zins, J. E., Weissberg, R. P., Frey, K. S., Greenberg, M. T., Haynes, N. M., … Shriver, T. P. (1997). Promoting social and emotional learning: Guidelines for educators. Alexandria, VA: ASCD.
Erreger, S., & Foreman, A. (2016). That’s so borderline: #Language Matters when talking about Borderline Personality Disorder. Retrieved from http://www.socialworker.com/feature-articles/practice/that-s-so-borderline/
Feldman, R. S. (2014). Development across the life span (7th ed.). Upper Saddle River, New Jersey: Pearson Education.
Granello, D. H., & Gibbs, T. A. (2016). The power of language and labels: The mentally ill versus people with mental illnesses. Journal of Counseling & Development, 94(1), 31-40. doi:10.1002/jcad.12059
Hollon, S.D. & Beck, A.T. (2013). Chapter 11: Cognitive and Cognitive-Behavioral Therapies. In Hollon, S. D., & Beck, A. T. (Eds.). Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change (6th ed., pp. 393-394). Hoboken, New Jersey: John Wiley & Sons.
Kohn, R., Saxena, S. Levav, I, & Saraceno, B. (2004). The treatment gap in mental health care. Bulletin of the World Health Organization, 82(11), 858-866.
Lund, C., Schneider, M., Davies, T., Nyatsanza, M., Honikman, S., Bhana, A., Dewey, M. (2014). Task sharing of a psychological intervention for maternal depression in Khayelitsha, South Africa: Study protocol for a randomized controlled trial. Trials, 15(1), 457-468. doi:10.1186/1745-6215-15-457
Lundy, M. (2008). An integrative model for social work practice: A multi-systemic, multi-theoretical approach families in society. The Journal of Contemporary Social Services, 89(3), 394-406. doi:10.1606/1044-3894.3765
Martinez, A. G., Piff, P. K., Denton-Mendoza, R., & Hinshaw, S. P. (2011). The power of a label: Mental illness diagnoses, ascribed humanity, and social rejection. Journal of Social and Clinical Psychology, 30(1), 1-23.
McAneney, H., Tully, M. A., Hunter, R. F., Kouvonen, A., Veal, P., Stevenson, M., & Kee, F. (2015). Individual factors and perceived community characteristics in relation to mental health and mental well-being. BMC Public Health, 15(1), 1237. doi:10.1186/s12889-015-2590-8
McWhirter, J. J., McWhirter, B. T., McWhirter, E. H., & McWhirter, R. J. (2013). At risk youth: A comprehensive response for counselors, teachers, psychologists and human service professionals (5th ed.). California: Brooks/Cole Cengage Publishing.
Mehta, N., & Thornicroft, G. (2014). Stigma, discrimination and promoting human rights. In V. Patel, H. Minas, A. Cohen, & M. J. Prince (Eds.), Global mental health: Principles and practice, (pp. 401-424). New York, New York: Oxford University Press.
Mennuti, R. B., Christner, R. W., & Freeman, A. (2012). Cognitive-behavioral interventions in educational settings: A Handbook for practice (2nd ed.). New York, New York: Routledge.
Nagaoka, J., Farrington, C. A., Ehrlich, S. B., & Heath, R. D. (2015). Foundations for young adult success: A developmental framework. Concept Paper for Research and Practice. University of Chicago Consortium on Chicago School Research. Retrieved from http://www.wallacefoundation.org/knowledge-center/Documents/Foundations-for-Young-Adult-Success.pdf
Nagle, G. A., & Usry, L. R. (2016). Using public health strategies to shape early childhood policy. American Journal of Orthopsychiatry, 86(2), 171. doi:10.1037/ort0000088.
Nyatsanza, M., Schneidner, M., Davies, T., & Lund, C. (2016). Filling the treatment gap: developing a task sharing counselling intervention for perinatal depression in Khayelitsha, South Africa. BMC Psychiatry, 16, 164-176 doi:10.1186/s12888-016-0873-y
Parsons, R. D. (2009). Thinking and acting like an eclectic school counselor (ed.). Thousand Oaks, California: Corwin.
Richters, A., Dekker, C., Scholte, W. F. (2008) Community based sociotherapy in Byumba, Rwanda. Intervention: Journal of Mental Health and Psychosocial Support in Conflict Affected Areas. 6(2), 100–116.
Saxena, S., Thornicroft, G., Knapp, M., & Whitford, H. (2007). Resources for mental health: Scarcity, inequity, and inefficiency. Lancet 370, 878-889. doi:10.1016/S0140-6736(07)61239-2
Ulrich, R. S. (1981). Natural vs. urban scenes: Some psychophysiological effects. Environment & Behavior, 13(5), 523-556. Retrieved from https://www.forestry.gov.uk/forestry/hcou-4u4jns
Van Ginneken, N., Tharyan, P., Lewin, S., Rao, G.N., Meera, S.M., Pian, J.,…& Patel, V. (2013). Non-specialist health worker interventions for the care of mental, neurological and substance-abuse disorders in low- and middle-income countries. Cochrane Database System Review, 11. doi: 10.1002/14651858.CD009149.pub2
Velarde, M. D., Fry, G., & Tveit, M. (2007). Health effects of viewing landscapes–Landscape types in environmental psychology. Urban Forestry & Urban Greening, 6(4), 199-212. doi:10.1016/j.ufug.2007.07.001
Vimont, M. (2012). Developmental systems theory and youth assets: A primer for the social work researcher and practitioner. Child & Adolescent Social Work Journal, 29(6), 499-514. doi:10.1007/s10560-012-0271-3
Watamura, S. E., Phillips, D. A., Morrissey, T. W., McCartney, K., & Bub, K. (2011). Double jeopardy: Poorer social-emotional outcomes for children in the NICHD SECCYD experiencing home and child-care environments that confer risk. Child Development, 82(1), 48-65. doi:10.1111/j.1467-8624.2010.01540.x
Whiteford, H.A., Degenhardt, L., Rehm, J., Baxter, A.J., Ferrari, A.J., Erskine, H.E.,…Vos, T. (2013). Global burden of disease attributable to mental and substance use disorders: Findings from the Global Burden of Disease Study 2010. Lancet, 382. doi:10.1016/S0140-6736(13)61611-6
Williams, D. R., Priest, N., & Anderson, N. B. (2016). Understanding associations among race, socioeconomic status, and health: Patterns and prospects. Health Psychology, 35(4), 407-411. doi:10.1037/hea0000242.
Wolff, P., & Holmes, K. J. (2011). Linguistic relativity. Cognitive Science, 2(3), 258-265. doi:10.1002/wcs.104
World Health Organization. (2004). Prevention of mental disorders: Effective interventions and policy options: Summary report. Retrieved from http://www.who.int/iris/handle/10665/43027
World Health Organization & Calouste Gulbenkian Foundation. (2014). Social determinants of mental health. Geneva: World Health Organization.