Speaking notes for
President and CEO
Mental Health Commission of Canada
For delivery at the
Canadian Psychological Association National Convention
June 9, 2017
I would like to begin by acknowledging that the land on which we gather is the traditional territory of the Haudenosaunee the Metis, and most recently, the territory of the Mississaugas of the New Credit First Nation.
I would like to pay respect to their Elders, both past and present, and recognize the strength, resilience and capacity of Indigenous peoples in this land.
It’s an extraordinary honor to be accepting the Canadian Psychological Association’s 2017 Humanitarian Award.
This means so much to me because of the deep respect I hold for the profession of psychology.
That respect is two-fold: it arose over the many years I worked in mental health as a nurse. And it’s born from a profoundly personal experience, which I will share with you a little later.
Now, don’t get me wrong. This respect for psychologists overall, and my friendships with some of you here today, don’t make this address any easier to deliver. Quite the opposite in fact. Truth be told, as I look out over this impressive crowd, I feel both deeply humbled and tremendously lucky. But – since you are psychologists – so I will rely on your understanding and empathy when I confess that being on this stage, in this company, is nothing short of intimidating.
So, I’ll take a deep breath and begin. I hope you’ll stay with me over the next 30 minutes or so, as I examine some of the progress we’ve achieved together in advancing mental health. Even more importantly, I want to touch on the challenges still facing those of us working to provide care to people in need, within a system that is fundamentally broken.
Beyond that, I want to acknowledge the importance of maintaining good mental health as care providers, in the face of these many challenges.
But let’s start on a positive note. The MHCC is celebrating its tenth birthday this year. I’ve had the wonderful privilege of being involved for all those ten years.
The first two years, I sat on the Service System Advisory Committee chaired by Steve Lurie. Then they saw the light and hired me as the COO, which evolved into CEO 18 months later. Many of you will recall that was back when Canada was the only G-8 country without a national mental health strategy.
Changing Directions Changing Lives, now the definitive mental health strategy for Canada, is a document in which we should all take great pride.
It was written over four very long years – but it was imperative to listen and incorporate the voices of thousands of Canadians. Many of you here contributed to it
In retrospect, given the sheer size of our country, and the disparate needs of people living in it, four years of consultations seems about right.
When it was released in 2012, it was acclaimed nationally and even internationally as a comprehensive road map towards vast improvements to mental health care delivery in Canada.
And yet, five years later, Canada still spends the least on mental health in the developed world. And while we lag behind our peers, as we demonstrated with the Strategy, I think we are more than capable of catching up.
That is why I am so heartened by the current Federal government’s decision to link specific mental health spending to the Health Accord.
This funding presents a historic opportunity to bridge the gaping chasm of access to services. We’ve finally got what I called the three Ps in a Hill Times editorial: public interest, political will and policy push.
It is only when these three forces coalesce that we can hope to make the leap from enthusiasm to implementation.
But I think we can all agree, as professionals who have dedicated your lives to the promotion of mental health and the treatment of mental illness, your contribution cannot, and should not, be limited by an archaic system of care.
Because I know so intimately the power of this kind of help, I am brought up short every time I hear about people who are unable to access treatment for their mental health problems or illnesses.
I recently read an article in The Overcast, Newfoundland’s alternative paper, by reporter Chad Pelly. I encourage you to seek it out because it is one of the most pointed, clear-eyed assessments of the challenges our system currently faces.
He writes, “Our mental health system is such that we must get to the point of being beyond help, to get help.” He goes on to explain, “That is the exact opposite approach to physical medicine, where we go see our doctor as soon as we’ve cut a finger, instead of waiting for it to fester with infection.”
At the Commission, we have a close working relationship with the provinces and territories, and while the high-level strategies are in place, there are still problems on the ground. Much talking; lots of strategies but little action to change.
The challenges that we hear from our provincial and territorial advisory group aren’t likely to surprise you. Inadequate services for youth, lack of collaborative care, inattention to social determinants, focus on acute versus preventative care. And the list goes on.
There is no lack of evidence about the effectiveness of psychological services, and yet according to new data collected by Children’s Mental Health in Ontario, young people in urgent need of mental healthcare are waiting up to a year and a half for treatment in some parts of the province.
We are missing a crucial opportunity to intervene early, which we know is a predictor of better outcomes. In Canada, roughly 1.2 million children and youth have a mental health problem or illness, but less than 20 per cent get the help they need.
This statistic is unconscionable – and because of a deeply personal experience, I am viscerally affected every time I hear it.
For all that I tout my Newfoundland roots, my childhood bore no resemblance to those wonderful tourism ads where small children play by the water and run through meadows. The sun is always shining I might add – you’d think it never rains in Newfoundland.
Well, it does rain. And even in glorious Newfoundland, not every childhood is idyllic.
We were poor, and I was bounced around a woefully inadequate foster system. It was only much later in life that I realized these adverse childhood experiences bred trauma… a word, and a concept, I didn’t know growing up.
By the time I was 12, I was in pretty rough shape. I found myself hospitalized under the care of a wonderful psychiatrist.
At the time, I was convinced he was some kind of magician. How else could he divine the need to get me out of the home where I’d been placed? I told him it was wonderful…yet he saw right through me. So, I was lucky. John Williams was a kind and gifted child psychiatrist who helped me a great deal.
Would that when I was discharged, I’d had some follow-up…by anyone! But there was no one. So as excellent as my care was, a brief treatment in isolation from broader services and supports can only go so far.
That’s why I am so heartened to see programs springing up in communities that look at a child’s wellbeing in the context of their circumstances: programs that provide support not only to children, but also to their parents.
For example, Ontario’s comprehensive early intervention program, Better Beginnings, Better Futures, saves the system nearly 25 per cent in publicly funded services per person. Because these savings come from fewer physician visits and lowered social welfare and education costs, we know they are improving more than economic drivers – they are putting kids on the path to success.
Then there is Strongest Families in Nova Scotia, an awrard-winning, evidence-based distance coaching program for children and families, which they can use in the comfort and privacy of their own homes.
So, there are bright spots.
But to go back to Pelly’s beautifully written piece in the Overcast, “We do very little to keep mentally healthy people mentally healthy. Our approach is to put more and more ambulances at the bottom of the cliff our people are falling off, instead of building a fence atop that cliff, with more and varied services.”
Until access to services and funding for mental health reaches parity with physical illness, we cannot flag.In An Imperative for Change, a report prepared for the CPA, the authors characterize the delivery of mental health services in Canada a silent crisis.
Thankfully, people are beginning to speak up.
Many of you will be familiar with the heartbreaking story of Lisa O’Connor. The British Columbia mom of two is advocating from a place of courage and outrage about the disparity between accessing physical medicine and mental health care.
Her 16-year-old daughter, Kiera, has a rare form of Hodgkin’s lymphoma. Her 14-year-old, Kylie, lives with clinical depression and obsessive-compulsive disorder.
Kiera was quickly treated for her cancer diagnosis. Kylie is still without help. The family has hit upon countless dead ends and yearlong wait-lists. They are now facing the possibility of separation to find Kylie care out of province.
In a recent interview, Ms. O’Connor said, “I will probably shock most people with what I’m going to say, but if I had a choice about what disease or ailment, if I had to choose for my child, I would pick cancer over mental illness.”
Parents should not have to contemplate this kind of Sophie’s choice.
Far too many young people are falling through the cracks. And for those who do manage to access appropriate services, the compulsory transition into the adult system is jarring at best, impossible at worst.
We need to create a seamless continuum of care for emerging adults – young people between the ages of 16-25 – and design services based on development needs – not chronological age.
Sadly, young people are just one of the many underserved populations within an already overburdened system. What of those who are marginalized, new to Canada, unfamiliar with our language?
As insurmountable as these challenges may seem, we are working hard at the Commission to bridge these gaps. I am tremendously proud of our efforts to shine a light on vulnerable populations, like immigrants, refugees, ethno-cultural and racialized people, who have challenge layered upon challenge when it comes to getting mental health care.
The fact is, we can no longer pretend that “colour and culture” blind approaches to care are acceptable when research tells us they lead to poorer outcomes.
To suggest that everyone’s mental health needs are the same, regardless of culture, background or language is to provide equally ineffective care to everyone.
My experience as a white, Canadian-born educated woman is not going to be the same as a woman newly arrived in Canada, who is living below the poverty line while looking for work, caring for family here and worried about loved ones back home.
If I need to access mental health care, I might get a referral from my family doctor, take paid time off work, drive myself to my appointment and use my benefits coverage to help finance my psychologist visit.
Because I have the financial means, I’ll pay out of pocket for whatever isn’t covered under my benefits plan and I’ll deem the investment well worth it.
Let’s examine for a moment the struggles of my fictional counterpart. We’ll call her Amena. There are likely many barriers preventing her from even finding mental health services. Amena may not have a family doctor to give her a referral, she may not have access to childcare or affordable transportation and she may even face stigma in her own family and community.
But let’s say she finds somewhere to go...since she doesn’t have insurance she’ll likely wait anywhere from three to 18 months for an appointment.
And even if Amena finds childcare and transportation and makes it through the door, there is no guarantee that interpretation services will be available, or that she will have access to a care provider who is trained to provide culturally competent care.
Collectively, we must work harder to provide services that address the social determinants of health.
If the mental health system does not take into account social inequality and poverty, then time and resources will be wasted and results will be diminished.
Canada has a global reputation as a safe haven and cultural mosaic. A place where people can work hard, make a good life, and give their children better prospects than their own.
Sadly, that’s more fairytale than reality.
We know that poverty in Canada is disproportionately concentrated in racialized communities. For example, in Toronto, between 1980 and 2000, the number of racialized families living in poverty increased by more than 350 per cent.
Since the creation of the Mental Health Commission in 2007, our country has welcomed roughly three million newcomers. Some are immigrants, some are refugees, but virtually all come here holding tight to the belief that they have come to a place of hope, opportunity and safety.
If we want our country to thrive, then we must consider the needs immigrant, refugee, ethno-cultural, and racialized populations in the context of their culture, background, language, religion and experiences.
We can’t just treat illnesses, we must support people.
We have to take a long, hard look in the mirror, and acknowledge why our generally struggling mental health system is doing a spectacular job of failing certain populations.
This isn’t easy. Because it means we have to get close to some uncomfortable truths. Like it or not, we operate in a multi-tiered mental health system. One such as myself could argue that there isn’t a single mental health system in Canada.
This makes it difficult to collect data, measure effectiveness and reinforce accountability – in short, to know that the right services are being delivered to the right people in the right places.
We need a holistic perspective that considers the determinants of mental wellness –not just the incidence of mental illness – and involves diverse communities in co-creating services and solutions.
Nowhere is this more obvious than among Indigenous communities in this country.
And I have to say, as this year’s award recipient, my sense of humility is deepened because of my tremendous respect for last year’s honoree, Senator Murray Sinclair. Through the bridges of reconciliation he is building, Senator Sinclair is helping to heal our country of so many traumas.
For our part, at the Commission, we partnered with Reconciliation Canada to hold dialogues for all MHCC staff, as well as Board members and the executive team. One of the most compelling facts I recall from this moving experience was around Canada’s ranking on the United Nations’ human development scale.
If we were judged solely on the economic and social well-being of Indigenous people, our position would drop dramatically. We would be displaced from our usual top ten spot to 48th out of 174 countries. Furthermore, of the bottom 100 communities on the Community Well-Being Index, 96 are First Nations.
Consider that as of January 31, 2017, in 77 First Nations communities, there were 96 long-term drinking water advisories. This means the advisory has been in place for more than a year.
Imagine the hue and cry if residents of the City of Toronto were unable to safely drink their water for 12 months? We cannot accept these substandard living conditions among Indigenous peoples as par for the course.
Poverty, infant mortality, sexual abuse, incarceration and suicide are all much higher among Indigenous people than in any other sector of Canadian society.
In short, how can there be mental wellness in the absence of food security, safe drinking water, decent housing and education?
The answer isn’t imposing one worldview upon another.
Rather, it means meeting one another where we are – physically, culturally and linguistically.
Now, I think my nerves have abated enough to recount that personal experience with psychology I mentioned earlier.
I want to point out that I’m not alone when it comes to care providers being reticent about coming forward with their own lived experience.
The work we are doing at the MHCC around anti-stigma and health care providers actually tells us that disclosure is the single biggest barrier for care providers seeking treatment for mental health concerns.
When I was in Boston studying for my Masters in Nursing, my best friend of many years, Mar-Cha, died by suicide.
I was devastated. I couldn’t afford a plane ticket, so I drove from Boston to New Brunswick and back again.
At each rest stop, I was overcome by crying jags. Pull yourself together, I told myself. You can make it to the next Shell station. So that’s what I did. I drove, and cried, and drove and cried some more.
I was devastated and grief-stricken. But I was adamant I didn’t need any professional help.
After all, I worked in mental health. I knew the signs and symptoms of what mental illness looked like, and when I looked in the mirror, I would say to myself: “You can handle this. You’re tough. You help people, you don’t need help.”
I didn’t want to admit that I saw in some of my own patients what I was experiencing, because at that time, I still didn’t fully understand the complexity of recovery from mental illness.
Somewhere deep inside, I believed that people who were living with a mental illness were “other.”
Of course, I wanted to help them.
Of course I wanted to show them compassion.
But I can tell you right now…I didn’t want to be “one of them.”
When the Dean suggested that I see someone, I waved her off and told her I’d be fine. She told me it wasn’t a suggestion.
So, I agreed to go, and that experience re-oriented the trajectory of my life.
It wasn’t an easy journey. The profound grief and guilt triggered in me all the unresolved and pent up pain from childhood.
It was a long process and a painful one – but one that helped me become a better person, a better nurse, and ultimately, a wiser and more compassionate leader.
And one thing my leadership role at the MHCC has reinforced, time and again, is that changing the fabric of Canada’s mental health landscape is going to require all of us to do our part. We have to build bridges, fill gaps, advocate, amplify and support one another in this work.
We need a stepped approach to care. We have people in Canada who are getting pharmacological treatment when they would prefer psychological services, but they simply can’t access them.
Similarly, we must ensure that people can access peer-support, social services and counseling when the specialist care of a psychologist might be better expended elsewhere.
At the MHCC, we recently convened a roundtable to explore policy considerations to expand access to counseling, psychotherapy and psychological services.
It quickly became apparent there is no single “right way.” But we must act quickly. In 2001, approximately 80 percent of consultations with psychologists took place within the privately funded system. We know that higher income earners with stable employment are likely to have the best benefits. The irony then, is that low income Canadians – who are much more likely to report poor to fair mental health – have less access to services.
Even if all private plans followed the lead of progressive employers like Starbucks and Manulife, it would still leave a very large proportion of Canadians with limited to no access to counseling, psychotherapy and psychological services.
So, we have to dip into the pool of providers who practice outside the publically funded system. There is no choice. Models of how to do this vary. But international experience from the likes of the UK and Australia provide us with a strong indication that it should be possible to design an effective plan for Canada.
This won’t just benefit specific populations. An equitable, recovery-oriented system of care, with publically funded access to psychological services, means we can be more flexible and responsive, benefitting everyone living in Canada.
I, for one, owe a great deal to Judy Clementson, my psychologist in Boston.
I wish I’d had access to that kind of care and mentorship much earlier.
More than anything, my greatest wish is that everyone in this country had access to the right service, in the right place, at the right time.
We have a Mental Health Strategy, which we built together. We have funding, which we needed so desperately. Now is the time for action.
There is no limit to what we can achieve together. And the impact of our individual efforts will help make cumulative improvements.
Throughout my own life, as I surpassed my expectations for myself, time and time again, I owe credit and gratitude to all those people along the way…some fleeting, others fixtures…who took the time to nurture the small seed of courage and resilience that resides within all of us.
Psychological services helped me to understand that obstacles can be surmounted. That not only can you rise above them, but that you can be changed by them, and for the better.
It is because of the guiding lights in my life that I stand before you today.
They allowed me to believe that I deserved to have my voice heard, and that I had something valuable to say.
One could not ask for a greater gift.