Exploring the impact, resources, and strategies for suicide prevention
September is Suicide Awareness Month. It serves as a poignant reminder of the importance of mental health, offering an opportunity to educate, empathize, and advocate for those affected by suicide.
The scale of the issue
Suicide remains a significant public health concern in Canada, affecting individuals of all ages, genders, and backgrounds. According to Statistics Canada, about 4,500 people in our country die by suicide every year, which is around 12 people each day. And for every person lost to suicide, many more experience suicidal ideation or attempts. COVID-19 has also had a negative impact on mental health, including a significant increase in reports of suicidal ideation. Among young people (15-24), suicide is often reported to be in the top three leading causes of death, an incidence rate further magnified by its effects on families, individuals, and communities across the country (and worldwide).
The reasons for suicide are complex: they include biological, psychological, social, cultural, spiritual, economic, and other factors. According to a leading researcher in the field, the people who think about and attempt suicide are seeking to end deep and intense psychological pain. And yet, despite the complexities, there is reason for hope.
A combination of mental health and public health approaches can reduce Canada’s suicide rate and its impact. In this context, Suicide Awareness Month takes on a vital role in increasing public awareness of the issue and encouraging dialogue.
Addressing the issue
Several resources the MHCC supports or has helped create emphasize the importance of open and non-judgmental communication when discussing suicide. While initiating a conversation about suicide can be challenging, it’s a vital step in helping those who need support and assistance to seek it out.
Talking to Children About a Suicide is a conversation tool to help caregivers, parents, and guardians understand how to speak with children when a suicide happens in the community or if someone they know has died by suicide. Research has shown that talking about suicide does not increase a child’s risk of suicide; in fact, it can be a helpful experience.
Suicide: Facing the Difficult Topic Together is an online module designed to assist medical professionals in preparing for such conversations. Health-care providers play a pivotal role in preventing suicides in Canada. They’re often in the best position to identify those at risk of suicide and to provide or link them with the care they need.
These days, many of our interactions happen online. Recognizing this behaviour, the Australian organization Orygen developed #chatsafe guidelines for online conversations among young people, though the tools can also be helpful for all ages.
The Mindset: Reporting on Mental Health media guide is aimed at journalists, but it is useful to anyone writing about suicide or other sensitive issues. Central to its encouragement of safe and responsible reporting are the following recommendations:
- respect for the privacy and grief of loved ones
- including local helplines that readers can reach out to for support
- representing suicide as preventable
The guide also discourages the romanticizing of suicide, characterizing it as a solution to an individual’s problems, detailing methods used, and publishing suicide notes.
Safe and responsible media reporting has long been a key element in national suicide prevention strategies. It figures prominently in the UN’s prevention of suicide guidelines, the Canadian Association for Suicide Prevention’s blueprint, and WHO’s preventing suicide report. Still, we often find problematic depictions in films and television shows, making these tools an important conversation starter to shift narratives.
Addressing stigma and misconceptions
A key component of Suicide Awareness Month is challenging the stigma and misconceptions around mental health and suicide. One of the issues the MHCC has highlighted for many years is the harmful impact of such stigma on individuals struggling with their mental health. Stigma can be a significant deterrent to individuals seeking help. It can also exacerbate their struggles and potentially lead to tragic outcomes.
By instead promoting understanding and empathy, we can create an environment where people feel safe and comfortable discussing their mental health challenges. This includes recognizing that seeking help is a sign of strength — not weakness — and that mental health is just as important as physical health.
Moira Farr wrote After Daniel: A Suicide Survivor’s Tale about the death of her partner. She is a journalist and instructor who researches and writes on a variety of topics for international and national publications, including The Catalyst. She noticed a change in the conversation since the publication of her book in 1999.
“I would say there has definitely been a shift in people’s willingness to openly discuss mental health issues, including suicide, in the past 20 years,” she says. “The campaigns to raise awareness about how and where to get help and to get people talking more honestly about their own mental health struggles seem to me to have been a positive force,” she says.
“Whether this has led to a decrease in the overall suicide rate in Canada, I imagine, is tricky to pinpoint. It can still be difficult to find the mental health resources you need – with greater awareness and willingness to seek help, the demands for mental health care have increased, with not necessarily enough to go around.”
While having mental health supports in place is important to suicide intervention, the Canadian Institute for Health Information pegs the national average wait time for community mental health counselling at 22 days.
Yet, provincial strategies to reduce wait times are offering promise. Prince Edward Island is emphasizing the need to increase access points for care, both inside and outside hospital settings. Reflecting on the province’s long waits for mental health services, it began looking to Newfoundland and Labrador, which recently reduced wait times by 67 per cent. P.E.I. is now following suit by also implementing Stepped Care 2.0, the model is used to provide more timely and holistic services through a range of methods such as telehealth, web-based services, and walk-in clinics.
Stepped Care 2.0 is organized around nine steps, including informational support, self-directed care, acute care, systems navigation, case management, and advocacy. To implement the model, service organizations select strategies in conjunction with client needs and preferences (e.g., e-mental health interventions, self-guided support, peer support, group programming, and in-person therapy) that align with the structure and number of steps available in each community.
Another major support — the 988 suicide prevention and mental health crisis hotline — will be implemented in November. People in need of immediate mental support will be able to call or text for help and be directed to a mental health crisis or suicide prevention service free of charge.
That idea has been under serious study in Canada for several years, with enthusiastic support among suicide prevention experts, mental health professionals, and political representatives at every level of government. Over the past few years, other countries like the Netherlands and the United States have also implemented a three-digit suicide prevention number.
In other developments, the Senate standing committee on social affairs, science and technology released a report in June titled Doing What Works: Rethinking the Federal Framework for Suicide Prevention and made a number of recommendations. These include:
- recognizing the impact of substance use on suicide prevention in Canada and funding research into interventions
- creating a nationwide database to better collect national data related to suicides, attempts, and effective prevention measures
- replacing the concepts of “hope and resilience” in the framework with “meaning and connectedness”
This shift in language echoes other perspectives. For example, in many Indigenous communities, terms like life promotion or wellness are often used when discussing suicide prevention. The First Nations Mental Wellness Continuum Framework — developed by the Thunderbird Partnership Foundation with Indigenous and non-Indigenous partners (including Health Canada) — identifies hope, meaning, belonging, and purpose as underpinning many Indigenous ways of knowing. As the framework explains, aligning these four aspects in a person’s everyday life brings that person a feeling of wholeness that protects them and acts as a buffer against mental health risks and potential suicidal behaviours.
The importance of community and support
During Suicide Awareness Month, communities across Canada come together to offer support and resources to those affected by suicide. These efforts include awareness campaigns, educational events, and initiatives aimed at reducing stigma and fostering mental health support networks.
The MHCC’s resources emphasize the importance of building a strong and supportive community to help prevent suicide. By working together and fostering connections, we can create an environment where individuals in crisis feel valued and understood. Suicide Awareness Month in Canada serves as a reminder that we can all play a role in suicide prevention.
Wellness Together Canada crisis support: If you’re in distress, you can text WELLNESS to 741741 to connect with a mental health professional at any time. If it’s an emergency, call 911 or go to your local emergency department.
Assistance: People in Canada experiencing mental health distress can get assistance through Talk Suicide Canada by dialing toll-free 1-833-456-4566.
Course: Mental Health First Aid teaches you how to provide help to someone developing a mental health problem or experiencing a mental health crisis or worsening mental health.
Resources: Suicide Prevention (Mental Health Commission of Canada)
Further reading: Three Easy Digits We’ll All Soon Know
Author Dr. Jennifer Mullan’s new book takes a critical look at care.
There are too many roadblocks to care, resulting in “an outdated system of wellness that is void of wellness.” So says Dr. Jennifer Mullan, a New Jersey-based clinical psychologist and author of the forthcoming book, Decolonizing Therapy: Oppression, Historical Trauma, and Politicizing Your Practice.
According to Mullan, many of those seeking care run into obstacle after obstacle, an experience that reflects what she calls the mental health industrial complex. In response, she has become part of a “growing movement of practitioners who are unlearning colonial methods of psychology,” which seeks nothing less than completely overhauling and restructuring the system.
The book’s 10 chapters are full of scathing observations and critical insight, with titles like “From Lobotomies to Liberations,” “Diagnostic Enslavement,” and “Emotional-Decolonial Work.” Throughout its 400-plus pages, Mullan explores a wide range of problems impairing the mental health system in the United States and elsewhere.
These systems operate like revolving doors, processing many clients but hardly ever dealing with an individual’s pain at the root level. She is convinced that this shortcoming helps explain the spasms of violence erupting with increasing frequency across the U.S., such as school shootings, rising depression levels, and increases in mental health concerns.
Mullan has spent much of her career conducting therapy sessions with children and adults who have experienced domestic violence, unhealthy substance use, child abuse, poverty, and gender identity issues. Over the years, these encounters have chipped away at her optimism and fuelled her frustration.
Ignoring the past
While Mullan’s book examines many different roadblocks to effective treatment, her most blistering criticisms are reserved for the system’s failure to acknowledge intergenerational trauma — which she insists is the root cause of many mental health problems.
She therefore sees her book as “a CALL to ACTION to mental health practitioners, space holders, and wellness workers everywhere. If we are to ‘treat,’ heal, and educate the individual, the group, and/or the organization,” she asks, “is it not essential to also include history, life experiences, and cultural traumas?”
Intergenerational trauma is not a new concept. It gained credence when researchers started studying the impact of the Holocaust perpetrated by Nazi Germany. Nowadays, a growing body of Canadian-led research links the abuse suffered at residential schools with this same kind of trauma. A Historica Canada video describes the experience this way: “For many, the trauma of the mental, physical, and sexual abuse [residential school survivors] suffered hasn’t faded. The children and grandchildren of survivors have inherited those wounds; they have persisted, manifesting as depression, anxiety, family violence, suicidal thoughts, and substance use.” A definition from the American Psychological Association describes how such trauma can make its way across generations. It is “a phenomenon in which the descendants of a person who has experienced a terrifying event show adverse emotional and behavioral reactions to the event that are similar to those of the person himself or herself. These reactions vary by generation.”
Mullan draws heavily on these themes in Decolonizing Therapy, pointing to the history of slavery, internment camps, dictatorships, and residential schools, while arguing that the failure to look at these events dooms future generations to ongoing cycles of pain. Her prescription for therapy means not only exploring family history but probing culture, traditions, rituals, religious beliefs, and practices. Once the buried trauma is revealed, the patient can then receive more focused treatment.
Unfortunately, most therapists are taught almost nothing about revealing intergenerational trauma and are often cautioned against bringing up the past.
“The way many therapists and social workers have been educated,” she says, “is to consistently keep a blank slate, don’t have opinions, don’t have anything in your office that is too forward-facing or political. We’re not going to talk about Black history. We are not going to talk about enslavement. We are not going to talk about racism.”
Waiting and wanting
What is discussed in counselling sessions usually amounts to a short conversation with little time to delve deeper into an issue. Mullan underscores the point by recounting a colleague’s workload at a community clinic that involved more than 90 clients over two weeks. In Mullan’s previous work as a university staff psychologist, she said that nearly 100 students were on a counselling wait-list for six months straight. “Resources have been poorly and criminally allocated,” she says. So, in many settings “money needs to be reallocated.”
A related issue is the crushing workload, which is causing mental and physical health problems for therapists themselves. The book details dismal conditions some therapists are experiencing, such as working other jobs to meet basic needs, paying student loans, dealing with intense vicarious trauma due to the material they are helping to hold, being overworked with up to 80 or more cases a month, moving from job to job, experiencing burnout, and receiving constant microaggressions, bias, and acts of discrimination.
One therapist quoted in the book describes the aftermath of a heart attack she’d had in her office. “It’s not their fault. I thought it was my fault. I changed my diet and worked out more. I went back to work and had panic attacks in between clients. My supervisor told me, ‘You need to get more rest. Are you sleeping? Seeing a therapist of your own?’ No self-care is gonna fix my heart and my anxiety and my nervous system.”
A few years ago, Mullan decided to stop accepting patients and concentrate on reforming the system through public speaking and writing her book, which also lists ideas for deeper reform.
While her views were shaped in the U.S., her calls for change will likely get a thumbs up in many countries. Here in Canada, initiatives like Stepped Care 2.0 are already in place in Newfoundland and Labrador, the Northwest Territories, Nova Scotia, and elsewhere that have radically reduced wait times for mental health services. More organizations are also recognizing Indigenous ways of healing to provide informed and culturally aware forms of therapy. As well, a recent program by the Mental Health Commission of Canada and the Centre for Addiction and Mental Health culturally adapted cognitive behavioural therapy for South Asian communities.
Like many publications covering mental health, Decolonizing Therapy includes exercises, review questions, and detailed references. What makes it stand out is its feisty, passionate, and challenging voice — and Mullan’s personality, which is always present. “I’m holding the Mental Health Industrial Complex accountable and, along with you dear reader, I’m demanding change,” she writes.
Her views are perceived as controversial in certain circles, and some in the profession do not support her activism: a former professor she respects advised her against mixing psychology and politics. Yet Mullan sees it otherwise. In fact, by putting tough topics front and centre, the book is intentionally designed to change that narrative.
Further reading: CBT For You and For Me: A suite of culturally adapted cognitive behavioural therapy tools is designed to break through barriers.
When one size does not fit all. A look at Waypoint’s approach to structured psychotherapy.
There’s a specialty mental health hospital on the shores of Georgian Bay in Penetanguishene doing especially innovative work these days. In addition to its 301 beds, the Waypoint Centre for Mental Health Care is home to Ontario’s only high-secure forensic mental health program for patients served by the mental health and justice systems. The range of services covers acute as well as longer-term psychiatric inpatient and outpatient services for the region. Of late, their delivery of the Ontario Structured Psychotherapy (OSP) Program is receiving recognition for its ability to have a major impact.
I was honoured to present the group, which includes Jessica Ariss, Waypoint’s program manager, and Jeannie Borg, director, of system innovation at the Waypoint Centre, with the 2023 Award of Excellence in Mental Health and Addictions Quality Improvement from the Canadian College of Health Leaders in June. I asked the team about their approach to improving mental health outcomes.
The OSP offers publicly funded treatment for individuals experiencing depression, anxiety, and anxiety-related conditions by providing access to short-term, evidence-based cognitive behavioural therapy (or CBT), a form of care that helps people examine how they make sense of what’s happening around them and how these perceptions affect the way they feel.
Waypoint delivers CBT via partnerships with more than 20 organizations, meaning that people can access care in their communities rather than having to travel to a central hub. Through this model, the therapy is offered at no cost to clients. While it’s a highly effective treatment that improves symptoms and reduces the likelihood of mental health concerns becoming critical, Waypoint is far from the only organization offering CBT.
So what makes its program different and award winning?
Mind the gap
Waypoint won the award for its tenacity in addressing gaps in care. They did so by working to enhance access to CBT for priority populations, including Indigenous, francophone, and 2SLGBTQI+ individuals, which increased referrals to its programs. In one instance, Waypoint used its communications channels to promote the services to priority communities online and track the path from clicks to referrals. This part of the project took a wrap-around approach that covered training, communication strategies, and service modifications. Those modifications were informed by advisory circles that included patients and others with lived and living experience from various communities.
For Indigenous populations, the Waypoint team worked with the Indigenous Health Circle, B’Saanibamaadsiwin, and the Barrie Area Native Advisory Circle to develop clinical protocols and integrated care pathways for CBT services. These were based on client feedback, research evidence, and a training course (offered by Wilfrid Laurier University) called Sacred Circle CBT — Mikwendaagwad, an Anishinaabemowin/Ojibwe word for “It is remembered, it comes to mind.” The Indigenous service pathway — called Minookmii or “sacred tracks upon the earth” — uses an adapted intake assessment process conducted by an Indigenous clinician and services that include spiritual healers. These Indigenous health promotion practices ensure that the perspectives and needs of priority populations are central to Waypoint’s service development and evaluation processes.
Data and demeanour
The organization tracks those processes using a dashboard system that takes quantitative and qualitative measures into account. Qualitative feedback is incorporated into clinical reviews as part of a continuous improvement loop. But Waypoint never lets its commitment to dashboards and data inhibit the personal touch. It has mastered the balance between analytics and empathy, making sure that the human elements and the patterns add up to meaningful care.
For example, a clinician will meet with a client to determine the service that best fits their needs. Whether it’s a sweat, a smudge, connecting with an Elder, or another Indigenous approach to care — or something else like clinician-assisted bibliotherapy — it’s about meaningful, involved, and engaged care. As one participant put it: “Within the first few minutes of our meeting, the therapist I was paired with created a space that felt safe for sharing. Her kindness, knowledge, and warm demeanour encouraged me to speak more honestly and openly about my anxiety than I ever had before. She shared information, statistics, studies, anecdotal evidence, and examples that helped me to see my health anxiety from a different perspective — and also to make me feel less alone in my struggles.”
It’s these differences that make the program stand out, something that Heather Bullock, Waypoint’s vice-president of partnerships and chief strategy officer, sees as notable.
“The program runs close to its vision,” she points out. In other words, these elements are not nice-to-haves; rather, they are embedded processes. “There’s no gap between the vision and reality,” she says, citing their work with colleges, clinics, and different cultural environments. “We’ve managed to come together as communities and as different types of providers under a shared goal. We’re building something the way we want it to be built — and that’s something that aligns not with what we need in the future but with what we need today.”
Resource: Webinar – E-Mental Health and Indigenous Partnerships in Suicide Prevention. How Kids Help Phone uses e-mental health services to break down access barriers to inform its suicide prevention work.
Further reading: The Catalyst: Conversations on Mental Health article. CBT For You and For Me.
Getting started on a new plan for meaningful change
“I used to believe I was a bad person trying to be good,” says Steven Deveau, executive director of the 7th Step Society of Nova Scotia, a peer-run organization offering support to individuals who’ve been incarcerated. “My mindset changed when I realized I was a sick person trying to get well.”
As a person with lived experience of criminal justice involvement, Deveau’s sentiments could be widely shared among those who interact with the criminal justice system. Among federally incarcerated individuals, 73 per cent of men and 79 per cent of women meet the criteria for one or more current mental health disorders. Such statistics point to a need for increased access to quality mental health services, both within corrections and the community, as well as other prevention and early intervention supports like housing and education. As with all mental health concerns, it’s critical to ensure that people get help when they need it. Yet tangible progress toward these goals has so far been wanting.
Not just another report
“People ask me for my opinion. They ask, ‘What can we do to make things better?’” says Mo Korchinski, executive director of Unlocking the Gates Services Society. “And then it sits on a desk, and it stays in a report. I just want to see action.”
Inspired by this and other calls to produce meaningful change, the Mental Health Commission of Canada (MHCC) is developing an action plan for Canada to support the mental health and well-being of people who interact with the justice system. It draws on the expertise of those with lived and living experience, along with other experts who have highlighted these issues for years. The action plan also relies on relevant work from the past two decades — including the MHCC’s 2012 Mental Health Strategy for Canada, which lists criminal justice as a priority — and what is currently being done to focus on actions capable of implementation. The scope of this national project will be broad and comprehensive, including a focus on upstream prevention and early intervention, structure, law reform, and system transformation, and an assessment of mental health supports for all types of criminal justice involvement, from first contact with police to community reintegration and every stage in between.
Inside the system
“I articled in a criminal court duty counsel office, and in that role I immediately recognized the intersectionality of mental health and the justice system,” says A.J. Grant-Nicholson, principal lawyer with Grant-Nicholson Law and project adviser for the action plan.
“All too often, I saw accused persons with cognitive challenges, trauma, psychiatric illness, and/or substance use and mental health concerns that related to their criminal charges. Quickly, I deduced that the justice system was the system of last resort — and sometimes the default system — for persons with mental health-related issues,” he says.
Grant-Nicholson’s career has long been focused on the topic. Following his articling program, he worked as a mental health staff lawyer at Legal Aid Ontario, the first position of its kind in the province. There, he represented clients who came before the Consent and Capacity Board and acted as duty counsel at a forensic psychiatric hospital as well as in mental health court.
“I observed that the justice system was not an ideal place to remedy mental health conditions,” he says. “Defence lawyers, prosecutors, justices of the peace, and judges are not clinicians. Criminal law is a blunt instrument that is limited in its ability to provide therapeutic support for accused persons with mental health-related needs.”
Grant-Nicholson acknowledges that there is “increasingly more mental health support in criminal courts, such as having a designated mental health court where accused persons can be connected to mental health workers and mental health-related programming.” However, he finds that “the availability and overall level of support is not consistent across all jurisdictions — and sometimes, accused persons are not aware of the mental health supports available to them.”
As a legal representative for detainees, Grant-Nicholson has seen a significant portion of incarcerated people with serious mental health and/or addiction issues, and he finds the intersection between mental health and the justice system readily apparent in detention facilities.
“It has been my experience that correctional institutions are suboptimal for mental health recovery and that incarceration itself exacerbates mental illness,” he says. “I have also seen the frequent pattern of clients with mental health conditions backsliding once they are released from detention and, subsequently, their almost inevitable re-entry into the justice system. This is often due to barriers in accessing health and social services in the community and/or finding suitable housing when they are discharged or released.”
Seeing these gaps, Grant-Nicholson is seeking to make meaningful change. “My hope is that the action plan will provide stakeholders with insights so the justice system will be better equipped to support mental health, and over time, fewer people with mental health conditions will be incarcerated and the recidivism rate will decrease for this population.”
Grant-Nicholson says that is why an action plan for Canada on mental health and criminal justice is so vital. Deveau of the 7th Step Society of Nova Scotia also sees hope with the project and the people who are part of the committee. It has the power to change lives and change communities, he says.
“I have this saying that I woke up today sober and not in prison — the physical or the mental one — so it’s a good day,” he says. “Some of the smallest things can be the greatest motivators.”
Learn more about the action plan and how you can contribute to its success.
Further reading: A Name and a Face: A filmmaker illustrates how easy it is for someone living with mental illness to end up on the street or get caught up in the criminal justice system.
It’s time to reframe masculinity — one step at a time
Beyoncé and Kendrick were crooning about America’s problems as our truck wound its way toward the trail. My husband, in the driver’s seat, was his usual jovial self as he chatted about music aligning with historical movements. It was 6:30 a.m. My husband is disgustingly and unabashedly a morning person, and we were on our way to an eight km hike along the Gatineau escarpment in Quebec.
Our son — who is in no way a morning person, or a hiker — was in the back seat. He was in charge of the music, and he was there to win a bet.
Despite my more taciturn demeanour, I was happy to be heading out that morning for the anticipated hike. It was the dynamic brewing between father and son that had me feeling cautious. Men can be weird and competitive, even when they’re trying to be chill.
Macho, Macho Man
The machismo started in the parking lot when my son stepped out of the truck wearing a sweater and holding his coffee.
“Leave your sweater and coffee here,” my husband said, which prompted my son to slip on his mutinous face and grip both his coffee cup and his sweater with determination.
Before the world’s dumbest argument over knitwear and a travel mug could unfurl, I said to my husband, “You’re not carrying it or wearing it, so stop trying to control it.” To my son, I added, “It’s going to be hot, and there will be bugs — are you sure you want to bring those?”
I started the hike in the lead spot to avoid the inevitable male jockeying for the alpha position. This is one of the reasons I think men are weird. Why does it matter who goes first? It’s not a race. There are no prizes. Societal norms do men no favours when they inspire them to be dominant.
My son has no idea which direction we are taking, and yet he edges forward to take the lead. My husband, who regularly encourages me to go first when it’s just the two of us, suddenly wants to set the pace. The scene makes me think it’s no small wonder that men’s mental health is in the state it is. How can you seek help when you are convinced you should have all the answers?
Yes, I know, not all men are the same. But the statistics weigh heavily and are unignorable.
In Canada, 12 people die by suicide every day — with Statistics Canada reporting up to 4,500 annually — and men’s suicide rates are three times as high as women’s.
According to research by the Mental Health Commission of Canada, compared to men in the general population, Indigenous men exhibit higher rates of suicidal behaviour, including suicidal ideation, attempt(s), and death. Suicide attempts are 10 times as high among male Inuit youth, compared to non-Indigenous male youth, and compared to heterosexual men, sexual minority men (such as those who identify as gay, bisexual, or queer) are up to six times as likely to experience suicidal ideation.
Boys don’t cry
My husband is brilliant in many ways — including being low-key when big things are happening to him — but I’m starting to wonder if this stoicism by him and our male friends is a mask for bottling emotions, something men are socialized to do. Health issues? It’ll go away on its own. Business problems? No big deal. Family woes? Don’t go there.
When you give it any thought at all, the statistics should come as no surprise. Men living in environments where they are expected to uphold norms such as strength, toughness, and self-reliance can feed into negative beliefs about mental health. Men who adhere strongly to these norms may find it more difficult to recognize signs of mental illness in themselves and others and be less likely to access mental health support.
Reframing “masculinity” to allow greater expression and recognition of emotion and help seeking is a good first step.
A new generation is getting this lesson at Eskasoni First Nation on Cape Breton Island. GuysWork, a Nova Scotia program that started in 2012, bills itself as “a safe space to address masculine toxicity.” It does so by having male facilitators talk with groups of adolescent boys about different issues — things like health care, mental health resources, intimate partner violence, and keys to healthy relationships. Elsewhere, NextGenMen’s Cards of Masculinity box set presents 50 bold questions on topics like objectification and hook-up culture to facilitate meaningful discussions about boys’ beliefs and behaviours.
These organizations are working to change the narrative of outdated masculinity that leaves men feeling isolated, unable to express their emotions, and reluctant to seek help when they need it.
Such collective efforts help de-stigmatize mental illness among men, enhance the quality of health-care provider relationships, and open new pathways for building better personal relationships.
Programs that allow for “shoulder-to-shoulder” action-oriented tasks (think camping, sports, art, auto mechanics), rather than face-to-face talk-focused therapy may help get the conversation going.
Back on the trail, my husband points to the preferred path up a rocky incline. My son, of course, takes an alternate and more complex route. Nope, no obvious symbolism there.
We dragged him out of bed to hit the trail because we were getting worried — he needs to do more to get his physical and mental well-being in order. So, my husband bet him he couldn’t get up early enough to join us.
My husband used to run to keep in shape, but after a series of health issues took running off the table, I started to worry about him. I suspect he did so as well. Then we discovered that, while he could no longer run, he could hike — and the world shifted. Running in the neighbourhood was good, but hiking in the forest was transformational.
Even better, hiking is something my husband and I could do together. Some of our best and most rewarding conversations have happened on the trail. We’ve tackled work problems while admiring wild trilliums and resolved deeply personal issues while glimpsing white-tailed deer. Talking things through is good for us; it makes us reflect more.
As we approach the trail’s end two hours later, my son is in the lead. His sweater is around his waist, his coffee mug is full, and we’re all smiling.
If it’s just not working, then don’t ghost. Name your needs.
In a famous episode of the popular TV series Curb Your Enthusiasm, Larry David, the curmudgeonly main “character” (said to be an exaggerated version of himself), decides he must end therapy after seeing his middle-aged psychiatrist at the beach in a thong. When he announces his intention to leave, the psychiatrist seems surprised by the decision and keeps pressing Larry to tell him why it’s over. Larry keeps hedging, then ungracefully bolts.
In reality, the question of why and how to end therapy — to “break up” with your therapist — is for most more complicated than this scenario suggests. Ideally, the decision to move on is mutual, anticipated, and planned. If your therapist is a good fit, and you’ve developed a trusting relationship, you’ll both probably know when it makes sense to do so. It’s also likely that you’ll be able to discuss it openly: you’re feeling better; you’ve worked together toward gaining insights on the challenges that brought you into therapy, you’ve grappled with grieving, worked to improve or let go of toxic relationships, begun to heal from trauma, etc. Now, you both sense that you have the tools and understanding to deal with situations that trigger anxiety or other issues. You’ve grown, your therapist has genuinely helped you, and with respect and goodwill on both sides, the time to part has come.
But what if you and your therapist are not such a good fit? They’re just not “getting” you, and it seems unlikely that you’ll feel better any time soon. While the most frequent advice is to “shop around,” in practice it can be hard to tell your story — in all its intimate, painful details — multiple times to different strangers. That kind of reluctance can tempt you to stick with the therapist you’ve been working with, despite your reservations.
At this point, it’s all too easy to rationalize your way back into familiar territory. Maybe you’re relying on community or employee services, where choices are more affordable. Maybe you have trouble asserting yourself. Maybe you don’t want to say something that might hurt your therapist’s feelings or invite some kind of judgment. While each of these reasons might be valid, continuing on when you’re not fully invested will be an unfortunate waste of time for you both.
Take “Jean,” for instance, a woman in her 60s who sought therapy when she found herself stuck getting over the death of a pet. Her online therapist, a woman in her 30s, seemed to pigeonhole Jean as a lonely empty nester who needed to get out more. “Yet I’m not lonely,” says Jean, a creative spirit who is happily married, sees her grown children often, and enjoys a wide circle of friends. “She was very nice, but she was off about who I am.” Jean felt stereotyped, but being conflict-avoidant, didn’t know how to convey it. She ended up leaving after completing several sessions and didn’t seek out another therapist. Eventually, she moved past her grief on her own, without the external help and insight she had been looking for. Jean still wonders if, with the right therapist, the process might not have taken so long or been so painful.
So, though it may not be easy, if you’re dissatisfied for any reason, you owe it to yourself and your therapist to communicate your feelings and end the therapeutic relationship.
Of course, incompatibility can be avoided by finding a good fit from the beginning. Many therapists detail their specialties and training in online biographies, which makes it easier to narrow the field and choose someone with expertise in what you’re experiencing — someone who has a good chance of understanding and appreciating who you are and what you need.
According to Lindsey Thomson, a registered psychotherapist based in Kanata, Ontario, and public affairs director for the Canadian Counselling and Psychotherapy Association, with 13,000 members across the country, as you go through this process “it’s important to be truthful about your preferences. Let’s say you’re a woman who wants to work on your experience of a past trauma that makes you uncomfortable talking with a man. Or maybe you’re part of a marginalized community and feel more comfortable with someone who shares the same cultural background. If you have preferences like that,” she says, “you need to find someone who meets them.” Many therapists, including Thomson, offer a 30-minute complimentary session to help potential clients test the waters and see if the fit is good for both people.
Also essential is understanding what type of therapy the counsellor is offering and what their overall philosophy is. As Thomson points out, studies suggest that what matters most is the dynamic between client and therapist. “This is a working relationship we’re dealing with,” she says, “you know, human to human. If something comes up that you don’t agree with, or if you don’t like the way the therapist has framed something — or you were challenged, and you weren’t ready for it — bring that up. It’s really important. Yes, it can be uncomfortable. But just know that all therapists want to know what’s going on for you in that process.”
Definitely don’t “ghost”!
While therapeutic situations differ, says Thomson, clients will average between 12 and 20 sessions, particularly with goal-oriented models like cognitive behavioural therapy (CBT).
“Let’s say I’m a client in therapy with generalized anxiety, and I’ve had 10 sessions. I’ve noticed a decrease because I’ve been working on some behaviour changes to help reduce it. At that point, the therapist can do a progress check on my initial goals and see how I’ve been doing with practising those skills — whether it’s behaviour changes, regulating emotions, or challenging an automatic negative thought to let it go and move on. Do I feel confident that I can maintain that without the therapist’s support?” For the therapist in this situation, says Thomson, rather than a complete termination, “maybe we switch the frequency of sessions. I typically see clients every two weeks. So why don’t we try seeing each other once a month for what we call maintenance-type therapy? If the skill implementation isn’t going so well, then we can go back to where we left off.”
At every stage of the process, the key to success is being comfortable communicating your feelings. You’re there to gain insight and develop the skills to grow, heal, and cope. Your therapist should be in your corner all the way.
If they do or say something truly unprofessional, and the organization they are registered with has a code of ethics and disciplinary measures, you can make a complaint. Check the laws and regulations in your province or territory to determine how to proceed in this kind of situation.
Further reading: Weaving Through the Challenges: The ABCs of Finding an ACB Therapist
The Future Ready Initiative’s community-helping-community model supports people to strive and thrive.
Amina (not her real name), a young mother of four, faced serious challenges when she separated from her husband. Although she had lived in Canada for more than 10 years, she was isolated in her home, and the fear and stress of suddenly finding herself on her own were overwhelming. She urgently needed psychological counselling and help with learning English, doing her banking, buying groceries, and navigating the city’s public transport. “It is such a humbling and inspiring story,” says Ramzia Ashrafi, clinical practice team lead for Future Ready Initiative (FRI), which has supported hundreds newcomers across Canada since its inception two years ago.
The Future Ready team connected Amina with mentors, both professionals and volunteers (also called “family navigators”) who recognized her situation as an emergency and fast-tracked the help she needed. Within weeks, she had received counselling from a practitioner who specializes in helping immigrants and refugees. “After eight or nine months she was very comfortable expressing herself in English, and with no additional support, found a house and a job that allowed her to financially sustain herself and her children,” says Ashrafi.
Amina’s is one of many success stories to emerge from the initiative, which has multiple programs targeting youth, families, and seniors in need of support with mental health, education, settlement, and employment. “It’s the community helping the community build resiliency,” says Aleem Punja, national operations officer at Future Ready Initiative, whose stated core values are “individual agency, dignity, and equity.”
Not surprisingly, the number of people in need of their support has increased significantly since the pandemic hit three years ago.
“It has not been easy,” says Punja, “but we are doing our best.” FRI is a new national organization with 24 staff members and 500 community volunteers across Canada, yet it is able to provide the range of support services so many need.
The positive energy generated by all those involved in FRI is reflected in the virtual exhibition, Journey Upstream, a moving showcase of art, photography, music, spoken word poetry, graphics, and testimonials illustrating the experiences, hopes, and dreams of those new to Canada looking to connect with others. According to the exhibition’s description, it “aims to tell the story, via different and unique perspectives, of how the Future Ready Initiative fosters hope and builds resilience, and equips families and individuals with resources that enable them to confidently overcome challenges and thrive.” The priority given to mental health support is sharply illustrated in one of the photographs: a chain-link fence adorned with three simple black and white signs — YOU MATTER, YOU ARE NOT ALONE, DON’T GIVE UP.
The multidisciplinary Future Ready Initiative mental health case management team includes social workers, nurses, and psychotherapists specially trained in crucial areas such as suicide prevention, addiction, grief, and post-traumatic stress disorder. For those fleeing war and persecution, there is a particular need to offer care “in a trauma-informed way,” says Punja. That means building partnerships with numerous sister organizations, such as ABRAR Trauma and Mental Health, that can offer timely support, virtually or in person. Whether it’s the loss of loved ones to COVID-19, pandemic-related mental and physical health issues, or disruption to income and education due to the disease, war, settlement, or political upheaval — all have had a massive social impact on individuals and families.
For some, reaching out for help still carries a stigma, says Punja. Admitting you are having trouble finding a job, paying bills, or feeding your family is stressful enough, but dealt with in isolation such problems can seem impossible to overcome. Making it easier for people to ask for and receive help means connecting with them in a way that lets them see how everyone has challenges and everyone benefits from helping others. “Maybe a cousin helps you with English, or a neighbour does your taxes,” he says. Changing the language and the dynamics between the helped and the helpers also makes the process of helping someone get back on their feet less stigmatizing. “We don’t talk about ‘poverty’ but rather ‘vulnerability.’”
It also helps to focus on goals: an individual or family may be in a tough place now, but by helping them map out a path to better times, Future Ready emphasizes people’s agency and resilience as they find their own best strategies for success.
As well, helping others be “future-ready” means focusing on community connections as vital to mental health (in addition to direct interventions like counselling and coaching). Events that bring people together, such as musical performances, art exhibitions, sports, and those tailored especially for youth, families, or seniors have been successful in integrating newcomers and helping them stay positive and optimistic despite challenges and obstacles.
FRI’s Impact Report 2022 notes a number of positive milestones for the organization. “Since its inception in 2021, FRI delivered holistic and tailored support in the areas of family mentorship, future of work, mental health, settlement excellence, and youth mentorship to over 727 individuals.” It provided 560 hours of service to people with mental health risks. This included helping individuals on long waiting lists find care from a mental health or primary care doctor and supporting family members who were worried about the mental health of a loved one. Future Ready Initiative also assisted more than 100 family navigators and mentors “to competently manage sensitive situations while avoiding burnout.”
Ali Masroor Bigzad, who emigrated with his family from Afghanistan in September 2021 and currently lives in Sherbrooke, called his submission to the Journey Upstream exhibition “Spark of Hope.” It was FRI that gave him that hope. “Upon our arrival, the FRI officer came to our place and welcomed us on behalf of the community leadership and asked if we needed anything. We were all so happy that these institutions were here, reigniting that hope in us for a better future. The staff supported our settlement in different ways. The FRI member gave me advice about the different education pathways I could take. Without him, it would have been difficult for me to seek out the right path to start my educational journey.”
FRI staff, family navigators, and mentors have every intention of carrying on with the initiative to provide hope and real service to help every member of the community thrive on their journeys.
Aging without support is becoming more prevalent for older people in Canada. How can we stem the tide? A look at inclusive aging during Loneliness Awareness Week
“Why was it, she wondered, so difficult to believe that the old had been young, with the strength and the animal beauty of youth, had loved, been loved, laughed and had been full of youth’s unmeditated optimism?” — PD James —
This past winter, my neighbours found one of our older residents wandering around downstairs in the laundry room hallway of our apartment building. She appeared to be lost and confused.
We ended up calling an ambulance once it became clear that she was unwell. She had been living across from me, but I never really knew her. That day, after a brief phone assessment, the dispatcher told us it would be a four-hour wait. Since there wasn’t any food in her fridge, some of us brought snacks and made her a few cups of tea while waiting for the ambulance at her kitchen table. After learning she was 91 and living alone, we asked her about people we might call. But it took a few hours of chatting before she told us that she had no children or siblings. The one exception was a nephew who lived hundreds of kilometers away, who was surprised when we called him, saying they had not spoken in years.
The events that January day were a turning point for her, and for me. She hasn’t been back since being taken to the hospital. I don’t know what ended up happening, and I will never find out because I am not part of her family. Still, later that evening I couldn’t help wondering whether this was what the future might look like for me.
Aging and loss
Aging can bring an accumulation of losses: loved ones, social networks, physical well-being, financial security, purpose, a sense of being part of the wider world, and even a sense of personal identity. These are the kinds of significant losses that “deeply challenge people’s sense of connection to the world around them,” according to Dr. Sam Carr, principal investigator for The Loneliness Project — which qualitatively explored older people’s experiences of loneliness in depth. Many of them spoke to the researchers about how aging presents unique challenges related to loneliness and isolation. The research — now published in Ageing and Society — generated over 130 hours of conversations. One participant’s experience with losing a spouse shows the extent these losses often have: “When he was gone, I didn’t know where I fitted anymore. I didn’t know who I was anymore because I wasn’t [upset]. You just existed. Went shopping, when you needed food. I didn’t want to see people. I didn’t go anywhere.”
In an interview study of older persons’ loss of meaningful connection, researchers at Malmö University in Sweden concluded that profound loneliness in later life can be understood as if the individual “is in a process of letting go of life.” Such an experience also “involves the body, in that the older person is increasingly limited in his/her physical abilities. The older person’s long-term relationships are gradually lost, and finally the process entails the older person’s increasingly withdrawing into him- or herself and turning off the outside world.”
Getting older without kin
In Canada, aging without support is also on the rise. Sometimes called “solo agers,” an increasing number of older adults are kinless, meaning they are without a spouse or living children (or the children live far away). Others who may not be technically kinless may still be isolated. Even though most of them want to age in place, kinlessness can lead older people into long-term care. As a country that already has one of the highest kinless rates in the world, how will Canada support and care for the increasing number of people in this group?
In the U.K., the issue is connected to a larger theme: loneliness as a growing health threat. In 2018, Prime Minister Theresa May called it “one of the greatest public health challenges of our time” when she established “the world’s first ministerial lead” to tackle loneliness. Japan’s Prime Minister Yoshihide Suga followed suit in early 2021, adding a new minister of loneliness to his cabinet. Its initial appointee, Tetsushi Sakamoto, was tasked with preventing and reducing widespread loneliness, social isolation, and the increased suicide rates accelerated by COVID-19 restrictions.
Such measures are grounded in evidence about the health and mental health risks of loneliness. Research has consistently shown that low social support or increased social isolation is one of the major risk factors for depression at all ages,” according to Dr. Keith Dobson, a professor of clinical psychology at the University of Calgary. The U.S. National Institute on Aging ties loneliness and isolation with “poor aging outcomes,” including higher rates of mortality, depression and cognitive decline.
Loneliness in significant numbers also comes with an economic impact. In the U.S., a decades-long increase in loneliness has reached the point where “more than two out of three working adults consider themselves lonely” — something that costs employers about $154 billion each year due to related health problems, productivity losses, and staff turnover. In England, 45 per cent of adults experience some degree of loneliness, which, according to a 2017 New Economics Foundation report, costs U.K. employers £2.5 billion (C$4.2 billion) each year. The data paints a dire picture, especially when you consider that much of it stems from pre-pandemic research.
It’s not the same for everyone
As we might expect, the effects of loneliness and isolation don’t impact everyone equally. Charitable organizations that support older persons witness first-hand how some people bear the brunt of overlapping life challenges. According to Gregor Sneddon, executive director of Ottawa-based HelpAge Canada, we know that “as people age and experience physical and cognitive impairments, their exposure to the world shrinks, as does their exposure to other people and they ‘bear the fruit of isolation.’ Add in a global pandemic that locks people in their homes, takes away their means of participating in the community and belonging, and disconnects them from family and friends, and the result is critical health effects.” But it is definitely “worse for those with little money. . . . Those who don’t have options are the most susceptible to loneliness, which we know, can be fatal.”
Does Canada need a minister of loneliness?
CARP interim chief policy officer Bill VanGorder understands that “loneliness and isolation doesn’t only affect people who may be considered a senior.” But he’s all for having a minister of loneliness in Canada “if that’s what it takes to address the impact of isolation and loneliness on Canadians. A minister would make sure that programs are in place to ease these issues, other parts of the government would be accountable to them, and maybe, finally, we could change the way we care for older Canadians.” In societies like ours that favour independence and individualism, we tend to let people sort out and manage their own challenges. But if you are unwell, isolated, and lacking support, that’s much harder to do.
The U.K. government is taking an integrated approach to this issue, recognizing that more needs to be done and everyone must play a role. Building an effective network of connection and supports requires government involvement as well as that of friends, family, employers, voluntary and community sectors, local authorities, and public health bodies. But that’s just the start. Its loneliness strategy is guided by a framework to improve and connect social services, reimagine community spaces, transportation, housing, and technology, holistic health approaches, and public health campaigns to raise awareness and reduce stigma around loneliness. One example is the government’s 2019 Let’s Talk Loneliness campaign, which challenges this stigma by emphasizing the importance of talking about it.
The program even uses social prescribing, where community connectors, health and well-being advisers, and community navigators support non-clinical needs (including those of people who feel lonely) by connecting people to community groups and services for practical and emotional support.
While the success of the U.K.’s integrated approach is still to be evaluated, regardless of future results, its common-sense principles seem more robust than the current fragmented and disconnected supports available in Canada. While some resources and programs exist, they can be difficult to find, especially if someone is isolated and has no internet access. And yet, the premise could not be simpler: communities benefit when we support the well-being of older people and their families. The same could be said for people who live with chronic illness or disability. A truly inclusive society benefits everyone.
What does the future of inclusive and healthy aging in our country look like? Is it a society that recognizes the value of older people, and the worth and dignity of all, putting aside ableism and prejudice? I hold out hope for a new vision of supportive and inclusive aging where we “create living environments in which these mechanisms of support are embedded and integrated into [our] communities.”
Resources for people in Canada:
Future directions for disability inclusion
Disability is often viewed as an issue that affects a small subset of the population. Yet the pandemic has broadened the scope of that definition — think long COVID symptoms — which could also include mental health conditions that affect most people at some point in their lives. In other words, disabilities — short-term and long-term — are likely to be a part of everyone’s life, whether personally or as a caregiver, and policy needs to catch up with that reality. While Canadian disability policy has made great strides in recent years, barriers to inclusion continue.
Making disability normal
As a person with disabilities, I need a variety of workplace accommodations to help reduce my pain and function well, including a flexible schedule, ergonomic workstation, dictation software, and the ability to work remotely.
I have hydrocephalus, cerebral palsy, and chronic pain as well as depression and anxiety, which further limit my ability to function. While chronic pain affects my mental health and I need psychotherapy, I can’t afford it because disability-related expenses like physiotherapy eat into my meagre income. I’ve managed to cut back on some expenses since the pandemic started, but my ability to do so is based on my need for isolation to avoid catching COVID, which would have devastating consequences for me (cerebral palsy affects breathing). On the other side, isolation itself comes with a cost: it leads to more depression, anxiety, and loneliness. Of course, that won’t be a surprise to people with disabilities and chronic conditions. Research shows that those of us who are living with such conditions have had the worst health and employment outcomes during the pandemic.
A wider spectrum to promote inclusion
I share my personal story to try and normalize the conversation around the accommodation process and advocate for a more streamlined approach. To close policy gaps and set a future course for disability inclusion, those with lived experience need to be at the table. As experts on their own lives, people who experience episodic or fluctuating conditions or invisible disabilities, for example, can make their daily challenges known to help inform policies around work, health care, and other systems. To ensure that policy reflects the needs of those it affects, scholars recommend that people with disabilities be included in research and be consulted as subject matter experts. Doing so would reduce barriers to social inclusion and bring policy questions around employment and financial security into the open.
An aging population also raises new questions; for instance, in connection with the decline in functional ability as people age. Shouldn’t disability policy account for the many who may find themselves coping with unexpected or new limitations in their daily lives?
In Canada’s most populous province, the Ontario Disability Support Program (ODSP) currently provides income and employment support along with drug benefits only to people with “substantial physical or mental impairment that is continuous or recurrent and expected to last a year or more.” That narrow definition focuses on permanent disabilities and chronic illnesses with no prospect of improvement — excluding episodic, temporary, or fluctuating disabilities like long COVID, which can include brain fog, shortness of breath, and other debilitating symptoms. While coverage has recently been included in the Ontario Health Insurance Plan, people with long COVID are having challenges navigating the benefits system, since it is considered “invisible and hard to diagnose.”
Closing the gaps
While social assistance programs are essential, functional limitations are central to receiving adequate benefits. In other words, the worse a person’s condition is, the more financial support they qualify for. At the same time, the program makes it hard for people with disabilities to break the cycle of poverty and income support. To get off social assistance, one must be able to work full time (or at least consistently enough to earn a living). But most people on ODSP can’t work, and those who can must often take low-paying jobs (with long hours in front of a computer) that don’t reflect their skill levels (like call centre jobs).
Unfortunately, these kinds of systemic barriers to employment are all too common. In 2019, I applied to the federal government inventory for students with disabilities, an employment initiative for students to work in the public service and gain valuable experience. However, my application was denied because of my part-time student status (the program was only available to full-time students). Although I explained that my disability made it necessary for me to study part time, that was not sufficient to be included in the pool.
Another example is from the Accessible Canada Act, passed in 2019, which aims to remove barriers related to employment, the built environment, communication, information, program delivery, and transportation. In many cases, work adjustments can be minor — a modified schedule, telework, or an ergonomic workstation — but cumbersome approval processes often lead to frustrating delays.
Similarly, the federal government has implemented a public service Accessibility Strategy that seeks to hire 5,000 people with disabilities by 2025. Applicants for these positions must provide medical documentation in each selection process to receive assessment accommodations. That sounds reasonable enough, yet having a centralized service for accommodation documentation would reduce the cost of doctor’s notes for people who often have limited incomes (and may not have access to a family doctor).
Bringing these barriers to light has been one part of disability advocacy. Other work has led to Bill C-22, the Canada Disability Benefit Act, a monthly amount that aims to reduce poverty for people with disabilities. Within a year after it passes (it is now before the Senate), the bill will provide them with much-needed funds and hope for a better future. Over that 12-month period, C-22 outlines plans to give “persons with disabilities from a range of backgrounds” the chance to collaborate on its regulations, application process, eligibility criteria, and the amount of the benefit. It is my hope that such consultations will lead to an expanded definition of disability and enable equitable access to adequate supports, so people with disabilities in Canada can participate fully in professional and civic life.