The Prof. Tilli’s theory is a interdisciplinary and intersectoral model of alternative and innovative solutions to the huge problem of discrimination and social stigma towards mental illness and to provide therapeutic supports to people with mental health disorders, with special emphasis on young migrants and refugees who suffer multiple vulnerabilities due to structural, linguistic and cultural barriers, increased during critical/sensitive periods of development (adolescence, transition to young adulthood). More than this, the model wants to study and research new ways to promote mental health and well being in a multicultural context.
The intervention study seeks to promote their social inclusion and strengthen their engagement in civil society by supporting their resilience to adversity, their ability to empowerment (in accordance with the Convention on the Rights of Persons with Disabilities adopted by the United Nations in December 2006, which establishes the right to social participation for people with disabilities). The creation of this model, given adequate support, will allow the research team to prepare an application to conduct a needs analysis, develop culturally specific interventions using the approach of “ICTs for mental health” to address this issue. This model, seeks to address an innovative and original issue through methods that are current, innovative, and state of the art.
Art therapy is a widespread practice since the 1940s in the U.S. and the 1960s in France. The U.S. is considered the referent on the practice and research of art therapy. The use of radio for mental health was first used in Argentina with Radio La Colifata, founded more than 20 years ago and has been adapted internationally in at least sixteen countries, including six in the EU (Spain, France, Italy, Poland, Portugal, and Sweden). The proposed model will contribute to the field of art therapy by conducting quantitative and qualitative research on the process by which these approaches impact participants as well as society at large, with special attention to the role of social and web-based media. The impact of this specific and innovative kind of intervention (radio and ICTs) could also be compared with therapeutic mediations more usually applied in art therapy. Although various authors from different disciplines have conducted research on art therapy, mediation, communication media, mental health and health communication, this project is the first on the scientific stage to address these issues through an innovative interdisciplinary approach: the use of social networks and NICTs from both a critical and quantitative approach. This model is ambitious and innovative as it intends to conduct research never done to date, and give birth to new knowledge opening the door to a new theoretical field of research and action. The interdisciplinary and intersectoral approach is justified by the lack of specific research and literature on mediated communication for mental health, and by the complexity of the subject matter.
The model will use mediated communication for therapeutic purposes among young immigrants and refugees, building on the extensive literature on the individual benefits of art therapy for individuals with mental health diagnoses expanding the effect to the larger population through mass media. Based on the therapeutic principles behind art therapy, the project will use information and communication technologies (ICTs) to help participants improve social integration and quality of life, to restore their ability to cope thanks to an active participation in the deconstruction process of stigma that may keep them from fully benefitting from social opportunities. This model aims to re-enforce an autonomous way of life for people who want to find their place in a new social environment. It is located at the crossroads of democracy and health care policies. This is also an opportunity to make visible and audible the invisible people (double title, as people considered as disabled and migrants). This model is at the intersection of a critical theoretical research and action research.
ICT-based interventions in this model refers to programs that engage young people with mental heath diagnoses in the creation, production and dissemination of messages using mass media including radio, and web based platforms. The study will be conducted through observation and analysis of various existing ICT interventions for people currently or previously receiving mental health services. The study will test a new approach using ICTs to empower people as “citizen users” of mass media as well as mental health services. By “citizen user” we refer to users, of both media and health services, who are engaged and have an active voice and representation within the systems that generate media and health.
Prof Tilli will conduct extensive field research through ethnographic observation and interviews to understand : (a) the therapeutic processes of interventions that use ICTs for healing and empowerment; (b) the multiple levels of engagement of the participants with the media process (information seekers, sharers or creators) and the mental health delivery process; and (c) how the expectation of having their voice heard impacts the therapeutic mediation process ; and (d) how listening to these voices may change the social representations of mental illness and migration among regular audience.
An important and innovative aspect of this study is the cross-country comparison : special challenge to engage young immigrants and refugees in mental health services due to psychological fragility related to this sensitive period of development, to language and cultural barriers, discrimination and exclusion due to immigrant status, lack of access to services, and cultural stigma related to mental illness.
The identification of socio-cultural differences seems essential both to develop a more comprehensive knowledge of the problems faced by young immigrants and refugees throughout the world, and to define the most appropriate kind of intervention due to these particularities (country of origin/culture of immigrants and refugees, causes and forms of migration, kinds of mental disorders, public policies regarding immigration, mental health and care of miners,…).
A main objective of this study is so to expand on the application of ICTs for mental health among hyper vulnerable populations and to identify socio-cultural differences. Prof Tilli proposes to analyze the different mediation processes during the practical application of a mass media approach to improve the wellbeing of young people with mental health challenges. A key construct in this research is the process of therapeutic mediation, which derives from art therapy. Therapeutic mediation is a process by which individuals should be able to mediate internal beliefs and external situations. With this model, the research team wishes to propose a new idea: mediated communication for therapeutic purposes.
Intervention engages participants in a process of creation user-generated content based on their own skills and strengths, identified through a participatory approach whereby participants explore their identities and share their creative outputs with a larger audience achieving a two-fold objective: (1) experience a self-therapeutic process and (2) become agents of social change within their communities. The model does not aim to simply target young immigrants and refugees suffering with mental health challenges, but also to tailor stigma reduction messages developed by their peers. Our research approach involves young people themselves - and other stakeholders – thus who directly contribute to the design of the intervention.
The underlying theoretical framework builds on the principles of art therapy, which posits that through rebuilding participants’ own perspective on their quality of life, and not in pursuit of a specific clinical outcome, they will become empowered to share their process with others without shame. It is also based on the principles of interactional psychology and systemic approach that develop an active and comprehensive approach to person - with no psychological or sociological reductionism - considering the plurality and diversity of living environments in the analysis of individual and social changes. Intercultural psychology principles allow more specifically to grasp the psychological and social problems of migrants, analyze and / or accompany them in the development of identity strategies that enable them to cope with the effects of a strong cultural disparity (between belonging culture and host culture), potentially alienating for the person. These approaches complement medical approaches to treating mental disorders by enabling participants to engage differently with society and supporting their recovery by strengthening their identity and their image, improving their confidence, reconstructing their past, restoring social engagement, and recovering their voice which may have been silenced by multiple levels of stigma (e.g., mental health immigration status, economic barriers). This use of media allows people’s voices and images to circulate in society, breaking the separation between the symbolic and the physical, and between those with mental health diagnoses and those without. We expect that this exposure slowly changes the societal response to this vulnerable population.
A practical benefit of using mass media is that it includes a mass audience as part of the process, providing a louder voice and facilitating the re-integration of the person in the social structure by breaking physical and symbolic isolation and allowing participants to recognize themselves as discourse makers/citizen users, as actors of social ties. With this approach, Prof Tilli seeks to encourage the emergence of new contexts through the use of ICTs for mental health through a process where the planned communication event, the unexpected reaction, the audience’s participation, and the encounter between the symbolic and the concrete, occur at three levels: (1) Intra-individual: for each participant (intra-psychologic level), (2) Intra-community: among participants and (3) Inter-community: between participants, systems (media and health), and society at large. The purpose is not to deny what society thinks of mental disorders and people living with them, but rather to deconstruct the stigma about mental illness.
The importance of a mass media intervention is the ability to dismantle the participants beliefs about the “undetermined other”  who in turn may begin to question his/her own perceptions from his/her social position and think differently about mental health issues. The dynamics of the co-construction of social meaning of mental disorders elucidates the problem without denying it, acknowledging a different point of contact from which social empathy may emerge. The media are used to create shared spaces and encounters, providing opportunities for exchange, debate and reflection, essential acts of social ties and citizenship. The interactive nature of ICTs allows participants with mental health disorders to hear the voices of their peers and society in general around the topic of mental health. Through listening to each other and receiving feedback from the “undetermined other,” participants redesign their relationship with their social environment in what the research team describes as a "therapeutic event."
Similarly, the process of therapeutic mediation also occurs two levels: the individual and societal level. At the individual level, the process of mediation that takes place in the creation of media content that represents their lived experience, serves a therapeutic function the leads to empowerment, self-efficacy, and improved perceived quality of life. At the societal level, the dissemination of media content serves to change social norms and perceptions about people living with mental disorders and also leads to increased empowerment, decreased feelings of isolation, and great social integrations.
This model is a scientifically-based, transdisciplinary, and international effort to examine the use of ICTs for mental health and social inclusion. It will develop process and impact indicators of the intervention approach, and increase understanding of cultural and identity issues of different immigrant and refugee young populations. The relevance of Prof Tilli’s model is reflected by the recognition of mental health a priority by WHO, PAHO, and the Council and the European Parliament. By the way, adolescence and young adulthood are recognized as crucial periods of psychological development. When mental disorders appears, early intervention can lead to lasting positive effects on mental health, capacity of resilience and empowerment, and on a range of educational, social and economic outcomes for young people.
The program is significant in that it is the first to conduct a cross-country analysis of the use of ICTs to promote mental health among young immigrants and refugees using both qualitative and quantitative research methods. American, European, and international health authorities are seeking alternatives to better integrate and support young people with mental illness into society through different types of interventions. The European Parliament has stated that there are still shortcomings in this area and there is a need to encourage and support research on the subject . This model fits into the objectives set by these institutions, which are interested in improving mental health and require states to implement additional and innovative measures to achieve this.
This model and tasks carried respond to three major objectives. The firs is the foundational objective which is to help improve the quality of life of young immigrants, migrants and refugees with mental health challenges by creating mechanisms of social inclusion. The second objective is mire global and reflects the group’s commitment to prevent mental health disorders in young migrants and refugees, and discrimination against people with mental illness. The third objective is to apply an innovative pluridisciplinary approach that created opportunities for therapeutic mediation through information and communication technologies (ICTs) as a mechanism of empowerment. These broad objectives cannot be achieved through any single narrow discipline, and requires bringing together a groups of diverse academics and professionals with common interests and complementary competences that will develop an holistic approach able to response of this major societal challenge.
Photo : Adrien Marquez-Velasco