GFP - FRAMEWORK FOR CULTURE HOUSES
GFP is designed as a new approach to mental healthcare that, by enabling those with moderate to severe mental health challenges to focus on skill-sharing and co-creation in the arts to build self-confidence, resilience, and community sever the often-debilitating link between diagnosis, illness, and identity. I worked as a musical therapist in the mental health field 15 years ago when I first realized how focusing first on clients' strengths – singing in a choir, for example, enabled them to temporarily shed the 'patient' label and the sense of powerlessness it too often suggests.
This realization inspired me to ideate the Guided Functional Peer Support model (GFP) over the next few years. An innovative combination of proven theories from occupational therapy, human development, and special education, GFP focuses first on hope and recovery by creating spaces called 'Culture Houses' in which clients, who are mainly transitioning from institutionalized to outpatient care, tutor and learn from each other based on personal strengths and interests. They create together, too, to strengthen a sense of agency and collaboration in a safe space. Trained mental healthcare professionals are present as facilitators and enablers – not therapists. Clients drive decisions such as music is created or plays are written and performed.
We first piloted GFP at the ELVIS Project's Culture House in Helsinki from 2009 to 2012. Its success has led to 16 more Culture Houses across Finland, even though our mental health sector is still relatively slow to innovate. A Culture House has also been established in western Sweden, Halmstad. Dramalogen targets marginalized groups such as recent migrants and are not limited only to clients facing severe mental health challenges. All of them use music, drama, poetry, and other arts as the means through which clients engage, shift self-perception and build self-esteem.
Mental illness affects roughly one in every five Finnish people who could
benefit from this approach. A steady stream of referrals from mental healthcare professionals ensures that GFP helps more than 2,000 clients across the country each year. Participants range in age from the young (the model's target demographic initially) to the middle-aged. Many of the latter are on sick leave from work and live alone. The unique power of the model's functional groups is in members' interactions, including the giving and receiving of feedback with peers facing similar challenges. Clients have opportunities to establish goals and be meaningful to others, all of which reignites a sense of purpose and hope. They continue to have symptoms of their mental health challenges, but as Culture Houses themselves are diagnoses-free, the focus is not placed on them. GFP thereby helps clients learn how to live with their symptoms rather than allow those symptoms to define them.
Nearly 60% of Culture House clients enroll in a vocational school or return to work. According to the Finlands State Audit Office, each marginalized young person pays about 1.2 million euros to society during their lifetime. This figure reflects that this year in Finland, around 60,000 young people (aged 15-29) are excluded from work and education.
Finland's mental health sector embraces traditional approaches to care based on the assumption that the trained professional is necessarily best suited to diagnose and treat. Ongoing tensions amongst university faculties and at training facilities around whether psychosocial or biomedical approaches work better reinforce professional reliance on deficit-based models of care. Moreover, a mental health professional's assessment of someone's ability to function too often focuses on what the evaluator considers essential, based on their own training and preferred approach, rather than on the client's capabilities for self-assessment.
The power dynamic embedded in this leaves those dealing with serious mental health challenges with little sense of agency to get better and reintegrate into communities and workplaces. It also reinforces the connection too often made between diagnosis and identity. This disregards a client's sense of autonomy, which is crucial for making decisions and actions to improve one's own mental health.
The traditional emphasis on clinical care also means that far too many patients need to queue for long periods before meeting with a mental health professional. In fact, WHO's most recent Mental Health Atlas states that there are only 251 mental healthcare workers for every 100,000 Finns. Peer support groups have been around for quite some time as a response to both trends, but they focus mainly on disease-informed dialogues in the tradition of Alcoholics Anonymous. These deficit-based models can cloud clients' sense of agency and hope. Finding new approaches is significant in Finland's case, given that according to OECD findings, more Finns are impacted by depression, anxiety, and other mental health challenges than any other national group in the EU.
Globally in 2019, it was estimated that one in seven adolescents experience mental disorders. This amounts to an estimated 166 million adolescents (89 million boys and 77 million girls), boys and girls globally. Untreated mental health problems account for 13% of the total global burden of disease. It is projected that, by 2030, mental health problems (particularly depression) will be the leading cause of mortality and morbidity globally. Only in the UK, the 2013 Chief Medical Officer's report estimated that the broader costs of mental health problems to the UK economy are £70–100 billion per year – 4.5% of gross domestic product (GDP). Mental health and substance use disorders affect 13% of the world's population. That number could increase as people worldwide shelter in place and adjust to a new normal amid the coronavirus pandemic. 970 million people worldwide have a mental health or
substance abuse disorder. (Our World in Data, 2018)
GFP is designed as a viable alternative to deficit-based mental healthcare by prioritizing clients' passions and strengths in diagnosis-free spaces, shifting how hospitals and therapists talk about their patients and care, and building partnerships with and between organizations that work with wellbeing and the arts. Central to the GFP model is a commitment to creating diagnoses-free spaces where clients prioritize their passions, strengths, and connectedness to peers. At each of these Culture Houses, trained professionals welcome clients and facilitate conversations to surface what they are keen to create and the relevant skills they can share. Although many clients are severely depressed, Culture House staff do not ask clients about their diagnoses or medication. The co-creative process then begins, with the facilitator (professional) identifying opportunities for clients to collaborate and teach/learn from each other.
We, the people working in culture houses are committed to open-sourcing the GFP model since its first articulation, each Culture House is run independently and chooses which of the arts it will prioritize. The Culture House in Jyväskylä, for example, prioritizes drama productions while also engaging clients in activities to build concentration and eye contact. The Culture House in Halmstad, Sweden, involves a broader range of arts activities but focuses primarily on sparking connections between clients so that they feel like they belong to a community. The online Culture House Roso uses photography, music, writing, and the visual arts on dedicated Discord channels to create peer teaching and learning opportunities for 250 young clients.
Across all Culture Houses, the clients' bonds develop as they collaborate, take decisions, give and take feedback, and co-create. Strengths drive the work, not diagnoses and the deficits they highlight. 50-60 staff from the various Culture Houses convene online and in-person each year to share best practices.
My own road led to building connections with and between potential partners to scale GFP and finally founding of Kukunori, which I co-founded in 2012. The organization now convenes and supports 43 Finnish non-profit member organizations that work with wellbeing, arts, and Culture. Some run Culture Houses; others explore how to transfer the GFP model to other sectors.
I have also led the development of Kukunori's Pokka impact evaluation tool, available to all Finnish NGOs. Customizable by sector, Pokka is the ecosystem's first standardized method for measuring the impact of social entrepreneurial projects. It also enables any association to compare the impact of its project with other NGOs doing similar work.
GFP has scaled nationally through partnerships with eight of Finland's leading health and social care foundations and associations. One of my long-term goals is to formally embed Culture Houses on hospitals' psychiatric wards or especially outpatient care units.
In Kukunori, we are also scaling GFP beyond mental healthcare. We are also exploring new partnerships to scale the GFP model to support victims of gender-based violence as they re-establish economic independence and leave shelters. We are starting to work with schools, as well, to help them apply GFP to their work with school bullies and mental health issues.
We have begun to collaborate with mental health professionals in Glasgow and northern California to facilitate the adoption of GFP in their work with the homeless and others facing mental health challenges. Kukunori has also started applying the model to young adults'
game jamming communities and training substance abuse clients as walking football coaches.
GFP's impact internationally is my primary focus moving forward. I hope to create a social impact bond to fund the model's growth beyond Finland and facilitate its replication to other sectors in Finland.
PEDRO MONTELLANO GOOD PRACTICE AWARD
Kukunori was a winner of the Pedro Montellano Good Practice Award for culture houses using Guided functional peer support-model 2019 by Global Alliance of Mental Illness Advocacy Networks-Europe (GAMIAN-Europe).