If you are in distress, you can call or text 988 at any time. If it is an emergency, call 9-1-1 or go to your local emergency department.

Are you having a lightbulb moment?

The SPARK Knowledge Translation Program charts a path for those with an idea to improve research and practice around mental health, substance use, or addiction. A look at the Grand Council Treaty #3 project, which serves as a mental health life-raft for 28 communities.

In the early days of COVID-19, Darlene Curci was taking note of the challenges in Kenora, Fort Frances, and Dryden. She is the Indigenous systems coordinator for Grand Council Treaty #3, which comprises 28 First Nation communities across 142,000+ square kilometres in northwest Ontario and southeast Manitoba.

“A lot of things were happening on the ground while we were going through lockdown,” she recalled. “Our health team was being deployed to help our communities through COVID by providing resources.”

As she worked, Curci was able to observe the evolving needs and challenges of coping with the pandemic. “Some of the communities are isolated and have few resources, which must then be shared across a large geographical area,” she said. “We don’t have specialized resources to address mental health or addiction issues. Psychiatrists have to fly in from Toronto, or else people must go to Winnipeg for specialized services.”

While those services may be rooted in a clinical practice, Treaty #3 communities have land-based, traditional, or combined approaches that include Western models of health and wellness. As Curci was looking for a way to bridge these approaches for Treaty #3 communities, she saw a social media posting about the Mental Health Commission of Canada’s SPARK program. After seeing how SPARK works to ensure success, she applied to the program — which includes 16 hours of workshop time and a one-year followup mentorship — to turn that idea into action.

Connecting the dots
SPARK’s Knowledge Translation Program seeks to provide the tools and resources needed to close the gap between what we know and what we do in the mental health and substance use fields. It gives people who have the germ of an idea — the spark — the means to foster positive change in their communities. As studies show, that process normally takes several years. But the SPARK Innovation to Implementation (I2I) framework can dramatically reduce that time.

Recent graduates (or SPARKies) include the Writers Collective of Canada, a charity that creates workshops for those under-represented in society. They partnered with Veterans’ organizations to offer expressive writing workshops as a non-clinical health intervention. Another charitable organization called Body Brave also worked with SPARK to help address service gaps for people seeking support for disordered eating.

The SPARK program asks applicants to focus on a problem they’d like to address and provides coaching and mentorship to participants across the seven I2I steps:

  1. State the purpose
  2. Select an innovation
  3. Specify actors and actions
  4. Identify agents of change
  5. Design the knowledge translation plan
  6. Implement
  7. Evaluate

For Curci, “the exercise provides a rigour that focuses the mind while also balancing the need to be agile and adaptable in working with different communities, specialties, levels of expertise, and ways of communicating. When I was going through the application process, I had to write out my intention, and that helped me focus on where I wanted to go with my idea.”

Over the course of the program, she developed the key output — The Grand Council Treaty #3 Mental Health Survival Guide Toolkit — which now serves as a “mental health life-raft” for all of its First Nation communities.

“It was a challenge to bring great value to the community by analyzing a large volume of information and conveying it in such a way that it would be useful to them,” she said. “But in the end, that process helped me reconnect with people in a less intrusive and more engaging way.”

Spark session

A SPARK planning session from February 2020.

The 50-page booklet includes practical advice on how to respond while in crisis, guidelines for engaging with Elders, practical hang-on-the-fridge lists with key phone numbers, colouring pages, worksheets to assist with stressful times, and tips for interacting with people based on where they’re at. For example, a section for teens and youth discusses boundaries, pointers on creative expression as a form of wellness, and red-light/green-light examples of healthy relationships.

The booklet is based on Ga-nan-da-wis (good health), a therapeutic concept rooted in traditional and cultural healing approaches to achieve emotional and mental balance, culturally and spiritually. Also included are mental health tips for parents, activity suggestions for Elders — like taking a walk or having a sweat with people in your bubble — and those contending with the cumulative and collective effects of historical (or intergenerational) trauma. Substance use, addiction, family violence, and suicide prevention are all addressed, along with isolation, loneliness, and finding balance when using technology.

Curci’s project is rooted in the Minobimaadziwin strategy (cited below) developed by Treaty #3 organizations, Elders, and community members, and was launched as a guiding framework in December 2019. Its 13 values are a throughline connecting Indigenous knowledge, wellness, and current realities related to COVID-19.

Grand Council Treaty #3 Minobimaadziwin Strategy

  1. Unified approach
  2. Engage Elders
  3. Promote cultural way of life
  4. Support Anishinaabemowin as healing mechanism
  5. Partnership and network development
  6. Address root causes of mental health
  7. Build community capacity
  8. Education and prevention centered
  9. Treaty #3-specific tools and training — Promote education and awareness on COVID-19 prevention practices
  10. Culturally safe services
  11. Healing rooted in traditional knowledge and practice-land based approach
  12. Respect treaty rights and relationships
  13. Every door is the right door

These guiding principles are informed by Treaty #3 traditions. “We are very strong and focused in our traditional ways,” Curci said. “We have developed our own child-care law, health law, and natural resource law — Manito Aki Inakonigaawin — it is the framework for how we do business.”

Her survival guide toolkit was launched during Mental Health Week in May 2021. After all 28 communities received an initial box of booklets, an increasing demand led to a subsequent reprint of 2,000 more copies. People see great value in what it offers, often using different resources for their specific needs. They tear out pages to post near their desks or take photos of the contents that help them most in challenging times.

“In a moment of distress, when things seem impossible, it’s a way to check in on yourself,” Curci said. In addition to being the creator of the booklet — she uses the tools herself. “I find it relaxing,” she said, referring to the colouring pages, along with activities like 10 Minutes to Reflect on Your Day (to build self-esteem) and the My Moods exercise.

Social workers also appreciate the quick tips to help guide people through thoughts of suicide by discussing risk and protective factors and providing counselling helplines, in addition to traditional guidance on grief and loss. The booklet’s foreword from the Grand Chief notes that “everyone’s mental health needs are different.” Rather than put forward well-intentioned platitudes or oversimplifications, his message focuses on the importance of asking for help when it is needed, “because there is always hope for new and better day.”


Learn more about Grand Council Treaty #3.

Author:

Fateema Sayani

Fateema Sayani  has worked in social purpose organizations and newsrooms for twenty-plus years, managing teams, strategy, research, fundraising, communications, and policy. Her work has been published in magazines and newspapers across Canada, focusing on social issues, policy, pop culture, and the Canadian music scene. She was a longtime columnist at the Ottawa Citizen and a senior editor and writer at Ottawa Magazine. She has been a juror for the Polaris Music Prize and the East Coast Music Awards and volunteers with global music presenting organization Axé WorldFest and the Canadian Advocacy Network. She holds a bachelor’s degree in journalism, a master’s degree in philanthropy and nonprofit leadership, and certificates in French-language writing from McGill and public policy development from the Max Bell Foundation Public Policy Training Institute. She researches nonprofit news models to support the development of this work in Canada and to shift narratives about underrepresented communities. Her work in publishing earned her numerous accolades for social justice reporting, including multiple Canadian Online Publishing Awards and the Joan Gullen Award for Media Excellence.

With stigmatizing language, things can get pretty cloudy

This article is part of the Catalyst series called Language Matters.

“I hate this weather, it’s so bipolar. One minute it’s sunny and the next it’s raining. I never know how to dress in the morning.” I roll my eyes at my friend, and she apologizes. “I’m sorry. I forgot.” She’s not the first to use my diagnosis to describe something negative, and she won’t be the last, but it stings every time.

Adopting clinical terminology to emphasize our experiences happens all the time. How often have you heard someone say they’re OCD when they really mean they’re organized or respond to a new story with “That’s so crazy! That’s insane!”? We’ve all heard such things (or even said them ourselves). But just because something is familiar doesn’t make it OK. Using that kind of hyperbole reduces mental illness while doing a disservice to the people who live with those concerns. It also affects how we think about mental health conditions.

It’s called associative activation, and it happens when we unconsciously attach an emotion to an idea. Usually, the process is so quick that we’re not even aware we’re making a link. Yet our brains are hard at work producing a response to the words we use and hear. When my friend is talking about the weather, she’s also associating a negative emotion with bipolar disorder. It sounds innocent enough, but it has a lasting effect. And it’s one of the ways stigmatizing language is able to flourish.

So what’s the big deal? No need to be such a stickler. They’re just words.

Actually, those words do have a big impact on people. Think of a time when someone said something hurtful to you. How did it made you feel? For those living with mental health concerns, it can be disappointing to learn that someone you thought of as an ally has unconsciously held negative feelings about your condition. It can also be frustrating to hear your diagnosis being reduced for the sake of a quip or to exaggerate a point. Of course, anyone within earshot of that conversation about the weather is likewise forming their own negative views about bipolar disorder. What might their reaction be if they or someone they love is diagnosed a mental health condition?

Talking illustration

Language is constantly evolving as we understand more about mental health and strive to do better. While it can be difficult to keep track of shifting ideas around acceptable language, it’s certainly possible. A good place to start is to learn about stigmatizing language and some of the available alternatives.

Another thing to remember is to try not to get defensive if someone asks you to adjust your language. It probably just means they care enough to want to keep you from making the same mistake again. Many of us instinctively resist the idea of removing language from our vocabulary, but it does get easier with practice. And since choosing other words is one of the simplest ways that we can all help reduce mental health stigma, it’s worth the effort.

My friend and I put our umbrellas away. The sun was now peeking out from behind the clouds and warming our faces. “What I meant to say is that the weather is unpredictable these days. I should have worded it differently. I spoke without thinking. I’ll do better next time.” And for a long time now, that’s a promise she has kept.

Find other articles in the series: Person-first language.

Belgian singer Stromae — whose European hits meld weighty themes with clubby beats — touches on the complexities of mental health on his recent album, Multitude. Ahead of his North American tour, Florence K — CBC Music host, singer, author of three books on mental health, and PhD candidate in neuropsychology — looks at its lyrics and layers.

We read it everywhere. We see it everywhere. We say it everywhere. There’s no place for shame or guilt when mental suffering knocks on our door and no valid reason to maintain stigma around mental health. It took a lot of speeches, awareness campaigns, expert testimonials, and hashtags to spread that message until it became loud and clear and to make inroads into social norms still enclosed by taboos.

This work has taken decades.

Yet in one song — in just a few sentences — Stromae challenges an entire generation, and he needn’t say more. A loose translation of the lyrics from “L’Enfer” (Hell) is at once hard-hitting and spare:

I’m not alone…To say that many others have already thought about it, but still, I feel alone…As a result, I sometimes have suicidal thoughts and I’m not very proud of it…These thoughts that make my life hell.

While words are his craft, Stromae is a man of very few. His raps are slow, and he never crams syllables into the same verse. The effect is like an underline — his words stand out and paint precise images that linger and stick in your mind — you can’t unsee them.

Pretty pictures aside, there’s also plenty of straight talk throughout the album. On the same track, Stromae steps out from behind the metaphors to discuss his mental health challenges and the sense of shame that would wash over him, despite his best efforts to be vocal and challenge stigmas.

The echo of this refrain has resonated in millions of hearts, validating the suffering many of us feel. In this chorus, listeners have a chance to step away from solitude and feel, for a moment, less alone. How many have asked themselves, “If Stromae suffers from depression, maybe I’m not the only one? Maybe I shouldn’t feel so bad?”

Florence Khoriaty

Florence Khoriaty

It’s an important message because, even after decades of work, depression is still too often seen as a sign of laziness or weakness. Yet nothing could be further from the truth (Stromae’s prolific career is shorthand for that). Research shows that depression is a mental health disorder whose causes involve biopsychosocial interactions with complex mechanisms — neurophysiological, genetic, psychological, and environmental — that factor into each individual’s unique situation.

In opening up about his experiences, Stromae is declaring that a mental health disorder is not a choice and not something that discriminates by socio-economic class, by education level, by the contents of one’s wallet, or by one’s success. There’s a side effect to these words, set to endlessly catchy music; namely, that it reaches people differently than a public service campaign. That’s the magic of the album. And he advances the cause in leaps and bounds without a commercial tinge. The songs and lyrics have nuances and textures as real as the vicissitudes of life in all its rich complexities.

The full range
As with “L’Enfer,” the album’s other tracks are forthright accounts of the state of our society. It brings to mind the words of the rap group N.W.A., who said, “Our raps are documentary. We don’t take sides.” In that sense, Stromae’s album also avoids simple polarities with an honest portrait that isn’t couched in toxic positivity or end-of-the-world pessimism. Nor does he seek to be a standard-bearer for a particular disease or social cause or claim to be The Defender of All Those Who Suffer. Still, his lyrics have teeth.

In “Déclaration,” he denounces the hypocrisy of those who pride themselves on being fashionable feminists, while true progress continues to elude society. Stromae’s sarcasm belies a benevolence that serves as a through-line on the album. You hear the compassion clearly on the track “Santé” (Health), a celebratory toast to the disregarded: pilots, nurses, long-haul truck drivers, flight attendants, fishers, and bakers — along with professional insomniacs and “those who do not have the heart for celebrations.”

Let’s celebrate those who don’t celebrate themselves. A toast to the heroes of the worst times.

In “La Solassitude” (which combines loneliness and lassitude), he explores the ups and downs of romantic relationships and the with-or-without-you challenge of maintaining a quality couplehood. He also looks at real solitude — that inner emptiness that follows you like a shadow and is seemingly inescapable no matter the surroundings.

In expressing the maudlin dark sides next to life’s more luminous moments, Stromae avoids easy divisions of “good” and “bad.” Yet he offers a winking reference to black-and-white thinking in two songs artfully sequenced toward the album’s end: “Mauvaise journée” (Bad Day) and “Bonne journée” (Good Day). Back to back, they express wry and poignant lyrics where listeners will likely recognize themselves in one way or another. They do so because we all have our ups and downs, just like we all experience a multitude of states of mind and see our lives from different angles as our perspectives evolve and shift. As Stromae reminds us of this, his album has a uniting effect. It reaches out to those who may need to hear that they’re not the only ones suffering in this giant universe, where we’re all just trying to get by.

The North American leg of Stromae’s tour starts October 21 in Vancouver.

Author: is a singer, songwriter, pianist, and weekly host of C’est formidable! on CBC Radio One and CBC Music. She is completing her doctorate at UQÀM.
Photo: Matthew Eisman/Getty Images

Is there a right way to grieve—and for how long? Bereavement in the age of COVID is getting a re-think.

Ms. B, age 65, has been feeling intense grief after her husband died of a heart attack. Not only is she tearful when remembering how wonderful he was, she avoids specific reminders of him (pictures, places they visited) to prevent even deeper bouts of misery. She is also angry that he died and has recurring thoughts about mistakes she believes his doctor made. In addition, she feels that the church she belongs to can no longer help, since no one can bring her husband back, and often forgets to take her hypertension medication, even though she knows that doing so is dangerous.

Would you consider what Ms. B is going through normal or something to be treated by psychotherapy or medication? Would your answer depend on how long it’s been since she lost her husband?

Since March 2022, as the pandemic’s third wave was setting in, those questions started to hit home with clinicians for the first time. Why? Because it was then that the American Psychiatric Association (APA) officially placed death-related grief into the realm of pathology with its latest revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR).

Let’s think about what that means. The DSM is the authority for diagnoses and research on mental disorders in Canada, the U.S., and Australia. Ever since it published the DSM-III in 1980, it has adopted a biomedical-brain disease model, directing psychiatrists and clinical psychologists to see mental disorders in terms of symptoms and illnesses, much like a physician diagnoses physical ailments. Despite the fact that scientists have yet to find “a biological cause of . . . any mental disorder,” it would be difficult to overstate the sway of the DSM’s classifications and diagnostic categories on the way clinicians treat people who come to them for help.

12 million people
Before looking at the APA’s reasons for including death-related grief in the DSM-5-TR — under the name prolonged grief disorder (PGD) — let’s first consider its possible effects in light of COVID-19. The international toll of COVID-19 deaths in September 2022, according to data from Johns Hopkins University, was nearly 6.5 million. With each loss affecting about nine others, (the reverberating effect is known as “bereavement multipliers”), we can expect almost 60 million people to have experienced death-related grief as a result of the virus.

That 6.5 million number is staggering enough in normal times. But restrictions in care facilities, hospitals, and indoor gatherings have made both the usual physical closeness during a loved one’s imminent demise as well as bereavement rituals difficult or impossible. Such isolation has surely added an even greater burden for those left behind in terms of dealing with their loss. The APA itself has said as much, estimating that the usual rate (5-10%) of the more intense and longer grief found in PGD may double in the pandemic context at 20 per cent.

With some fast math, we could estimate PGD afflictions at 12 million people worldwide.

No matter what the final number turns out to be, the pandemic has become doubly relevant to the normalcy or pathology of grief. Given that short-term psychotherapy is currently “the treatment of choice,” the decision to enshrine PGD into the DSM-5 as a psychiatric disorder has and will put unprecedented demands on already overburdened mental health professionals.

Cultural complications
The APA considers PGD a type of trauma- and stressor-related disorder characterized by “intense yearning or longing for the deceased (often with intense sorrow and emotional pain), and preoccupation with thoughts or memories of the deceased.” Because in “normal” grief these experiences generally lose their force over time (6 to 12 months), it says that PGD can be deemed to occur when “the duration of the person’s bereavement “exceeds expected social, cultural or religious norms.” In other words, clinicians should only consider grief symptoms as pathological (that is, subject to diagnosis and treatment) after this period of “expected norms” has run its course.

But will they? Putting such weight on a clinician’s judgment about social, cultural, and religious norms has certainly raised questions. One concern relates to applying a universal secular standard to norms which themselves contain values about healthy and unhealthy grief. Kaori Wada, a registered psychologist and the director of training at the University of Calgary’s counselling psychology program, points to a study involving Canadian undergraduates, which found that religious women participants with experience of bereavement were more likely to see the same grief responses the DSM now deems pathological as healthy.

A second issue is the APA’s adoption of a “normal grief period” in relation to social, cultural, and religious norms. This is something Harvard psychiatrist and medical anthropologist Arthur Kleinman questioned in the Lancet as the DSM-5 was being prepared. As he pointed out, “there is no conclusive scientific evidence to show what a normal length of bereavement is. Across the world, societies differ in what they regard as normal grief.”

Wada likewise stresses the newness of the DSM-5-TR’s “too much for too long” criterion, which is at odds with many cultures and expectations; for instance, those that see honour and moral depth in deliberate, enduring grief and emotional pain. She therefore thinks we should recognize the important shift that happens when we begin to fit what was once “understood outside medical language into a treatable disorder, [using a] ‘diagnose and treat’ logic.” By doing so, she argues, the DSM-5-TR “officializes [the idea] that if you’re grieving too long or too intensely, then you have a mental disorder.”

Wada’s concerns extend to the social, cultural, and religious norms designed to restrain the assessment and treatment of PGD. For her, not only are these norms diverse and complex, they are often far-removed from a psychiatrist’s or therapist’s expertise. In her view, the APA’s instruction to apply them puts a “tremendous amount of weight on the clinician’s shoulders.” And since most people in Canada rely on (short visits to) primary care physicians to address their mental health needs, she doubts whether such assessments are likely to be used very much in practice.

What can we expect when clinicians fail in this task of assessment or else ignore it because they feel ill-prepared? The most likely result would be the erasure of any grace period before recommending therapeutic interventions or dispensing medications.

Take this pill and . . .
While no pharmaceutical treatments for grief have been approved, the research traffic light is blinking bright green. That’s because, when the DSM-5-TR established PGD, the APA also changed complicated grief — a previous diagnostic category left out of the DSM-IV due to insufficient evidence and concerns about overdiagnosis — into persistent complex bereavement disorder (PCBD). While doing so, it also defined PCBD as a condition for further study (rather than a disorder in its own right). Thanks to that change, opportunities for new research were endorsed, including studies to establish medications for PGD.

woman sits on medication

So far, the leading candidate is naltrexone, currently being used to treat opioid and alcohol use disorders. A number of experts have found this opioid antagonist choice surprising. Indeed, the basis for considering it is the theory that PGD is an addictive condition — in this case, addiction to grief itself. So, as with opioids and alcohol, the purpose of naltrexone is to reduce the grieving person’s connection to the deceased. But since this medication does not discriminate which social connections are affected, psychologists have argued that it’s a mistake to reduce those ties at a time when relations to others are so important. They also emphasize that the pharmacological approach itself neglects the context involved in grief; for instance, the grieving person’s relationship to the deceased, the qualities of that relationship, and the kind of death involved (e.g., natural or unexpected).

Donna Schuurman, who is an expert with years of experience dealing with grief in children, youth, and families in connection with unnatural deaths, offers a less reserved critique, seeing efforts to develop a “grief pill” as entirely removed from the human context: “If you yearn or pine too long for your dead child, partner, spouse, or friend, you may be addicted to grief, according to the new revision of the DSM.” As it turns out, the road that has led to the possibility of a grief pill — while paved with good intentions — includes a rather dramatic shift. But to see it requires a bit of context.

A key element to support the DSM-5-TR’s new position on grief is the role played by major depressive disorder (MDD). MDD was initially distinguished from grief in the 1990s through the work of Holly Prigerson, then a professor at the Harvard department of psychiatry. After noticing the difficulty certain people had in resolving their death-related grief, she and others began arguing that this situation called for a new disorder. The point is that the initial justification for what was to become PGD was the discovery of grief symptoms thought to be distinct from those of MDD.

Remember Ms. B from our opening description? Her case was included in a 2010 paper by Prigerson’s colleagues as a way to offer insight into this distinction, since Ms. B’s mood symptoms failed to meet the criteria for MDD (as did her behaviours for post-traumatic stress disorder [PTSD]).

Yet Wada believes that an argument against overmedication — which Prigerson and her colleagues originally put forward to justify the separation of grief from MDD — has now fallen away. One of their key rationales for this distinction was to “spare [people] from being wrongfully medicated.” But today, with PCBD becoming a condition for further study, some of those same MDD medications that were ineffective for grief are being considered as potential solutions for PGD. While Prigerson herself agrees that antidepressants have not been effective for grief, she thinks it’s important to continue learning more about grief in psychiatric terms to help people in such pain.

The way ahead
Supporters of using medications (perhaps alongside therapy) for those diagnosed with PGD insist that “no one wants to medicalize a normal, adaptive process.” Still, a clinician’s assessment of social, cultural, and religious norms as the sole constraint does not inspire confidence that such an aspiration can be achieved. Nor does the DSM-5’s contentious removal of the “bereavement exclusion” from the DSM-IV — which at least provided a two-month grace period before clinicians were supposed to consider symptoms during death-related grief as major depression. Although these shifts occurred in the name of relieving suffering and concerns over the risk of overlooking such depression, Wada points out that the act of “establishing a disorder category enables, even stimulates, further research into pharmacological interventions.”

While, at the policy level, the crux of the debate may rest on values related to the overuse of medication, the path the DSM-5-TR has cleared for the development of a grief pill is hard to deny. No matter where the APA’s new conception of grief takes us, in light of the millions of vulnerable people experiencing longer and more intense grief due to COVID (or the next mass trauma), this new diagnostic landscape will no doubt itself receive longer and more intense scrutiny.

Author:

William Wahl

Activating an entire school community (parents, peers, education workers) can reduce the nefarious long-term impacts of bullying — a look at promising models to create kinder environments for kids

Bullying, including cyberbullying, is a growing and worrisome epidemic. Not only have one in three children been bullied at some point in their lives, the long-term impact on young people and adults can be life changing. An increasing body of evidence points to its detrimental effects on people’s mental and physical health. Studies also show that there can be lasting impacts in terms of future social and financial outcomes.

“It’s part of life”
Contrary to lingering social attitudes, we now know that bullying is not just an inevitable part of growing up or a harmless rite of passage. Bullied children and adolescents have a much higher risk of developing psychosomatic symptoms than those who escape it. Commonly reported problems linked to bullying include poor health, loss of appetite, sleep disturbances, headaches, abdominal pain, breathing difficulties, and fatigue.

For Eric, it started in elementary school, where the bullies targeting him kept up a relentless campaign of abuse. Its effects, he recalled, included anxiety, headaches, nausea, weight loss, and the absolute erosion of his self-worth. But those weren’t Eric’s only worries. After two years, with no hope in sight, he had reached his breaking point: “I didn’t care whether I lived or died,” he said. His family, desperate to find help, turned to a psychiatrist, who took Eric out of school and put him into intensive treatment. Thankfully, after some time, things turned around for him. In fact, he ended up becoming a kind of champion of the underdog among his peers. Today, Eric describes himself as “lucky.”

A young person being bullied can feel isolated, have trouble trusting people, and lack quality friendships. Should they end up believing that they can’t do anything to change their situation, they may stop trying. This feeling of defeat can also lead to hopelessness and a conviction that there’s no way out, often because they think telling someone won’t change anything. They might also prefer to suffer silently rather than risk escalation or imagine that the bullying will eventually end if they just keep quiet.

As bullied young people become adults, they may continue to struggle with relationships and avoid social interactions. Difficulties with self-esteem and trusting others can undermine significant personal relationships as well as their social and work lives. Victims of bullying also have a greater risk of emotional disorders in adulthood, including depressive and anxiety disorders, panic disorder, generalized anxiety, and suicide.

“There is clear evidence that a wide range of childhood adversity has long-term negative effects on both mental and physical health,” said Dr. Keith Dobson, a professor of clinical psychology at the University of Calgary. “Further, the emerging literature demonstrates a strong linkage between bullying and later depression and other health problems.”

Role modelling
Why does bullying still happen? Many experts point to the lack of a systematic approach to tackling the problem in schools. For a long time, it was left to teachers to address bullying behaviours — and for that to happen they would have had to witness it. Beyond that, the responsibility for reporting the problem was often left to the student, which meant that much of it was never reported.

Teacher talking to student

Enter proactive bullying prevention.

The research on anti-bullying interventions is extensive, with numerous school-based programs having been evaluated scientifically. Some, like the KiVa program in Finland, focus on mobilizing the bystanders who witness bullying. These work through the power of peer responses to inhibit or fuel such behaviour.

Other programs seek instead to actively create a kinder school environment. The most prominent of these, the Olweus Bullying Prevention Program, is also one of the most widely tested. Developed by the late Swedish-Norwegian psychologist, Dan Olweus, it’s rooted in the idea that bullying is often the product of a wider culture’s tolerance toward victimization. On that basis, it tackles bullying from the perspective of a school’s entire ecosystem.

Olweus therefore works by changing the social climate around bullying: raising awareness among students, adopting anti-bullying norms, and having teachers clearly communicate their anti-bullying attitudes. But it also goes beyond the student-teacher dynamic. Every adult in the school gets basic training about bullying — not just educators and administrators — but cafeteria staff members, bus drivers, custodians, and others.

The program is effective when all these adults function as positive role models, reinforce good behaviours, and refuse to allow victimization. As part of this process, clear expectations are set for acceptable behaviour, as are the consequences of failing to abide by them. In ending their support for the culture of secrecy around bullying, each person helps to create an environment where reporting it is appropriate and expected. When saying no to bullying becomes everyone’s responsibility, it is soon ingrained in a school’s culture.

The research strongly supports the success of whole-school programs to decrease bullying behaviours. In fact, a recent study of 69 randomized clinical trials concluded that such interventions not only reduce the incidence of bullying and victimization but also improve the mental health of students.

A kinder community
When parents commit to the prevention of bullying, especially if they actively participate, a school program will be more successful. Parents can set a good example by getting involved, raising awareness, and supporting anti-bullying measures.

But since bullying is not confined to school corridors and the playground, and not all children who are bullied ask for help, parents and caregivers should also be on the lookout for warning signs. These include unexplainable injuries; lost or destroyed clothing, books, electronics, or jewelry; frequent headaches or stomach aches; feeling sick or faking illness; or changes in eating habits (like suddenly skipping meals or binge eating). In this last scenario, kids may be coming home from school hungry because they didn’t eat lunch. They may also have difficulty sleeping or frequent nightmares, declining grades, loss of interest in schoolwork (or not wanting to go to school), sudden loss of friends or avoidance of social situations, feelings of helplessness or decreased self-esteem, or self-destructive behaviours such as running away from home or harming themselves.

As well, parents can empower their children to stand up to bullies. Start by talking about what bullying is and what healthy friendships are and are not. Children themselves can also learn how to report bullying when they see it. Here, it’s important that parents help them understand why they don’t want to be a bystander and offer them practical knowledge on how to handle the situation. Taking such steps can make a big difference in the outcome. 

Programs such as HEADSTRONG, offered by the Mental Health Commission of Canada, can also play an important role in supporting healthy school environments by providing students and youth the tools, confidence, and inspiration to become leaders for mental health and wellness in their schools and communities.

While bullying can have long-term negative effects, it doesn’t have to, according to Dobson. What is important is to act and intervene for the sake of others and yourself. If you know of a child who is being bullied, try to understand what’s going on and intervene if doing so is indicated. If you’ve been bullied and are living with the ongoing consequences, resources are available to help you improve your well-being.

Author:

Nicole Chevrier

An avid writer and photographer. A first-time author, she recently published her first children’s book to help children who are experiencing bullying. When she isn’t at her desk, Nicole loves to spend her time doing yoga and meditation, ballroom dancing, hiking, and celebrating nature with photography. She is a collector of sunset moments.

First Nations First Aiders support individuals and strengthen communities

Those who teach Mental Health First Aid in First Nations communities have lived experience with trauma. Roger Chum’s experience is a stark example.

“I have a personal story,” said Chum, a member of the Omushkego Moose Cree First Nation near James Bay, and a residential school survivor. “I tried to take my life, too, as a young man because of all the trauma I was walking with.”

He was saved with the support of others, and now, years later, he’s a counsellor in the First People’s Centre at Canadore College in North Bay. He also travels to communities across Canada to co-facilitate sessions in the Mental Health Commission of Canada’s (MHCC’s) Mental Health First Aid (MHFA) First Nations program, where he sees reflections of his own pain in others.

“The common themes in all the training I’ve done — in communities from B.C. to Nova Scotia to Prince Edward Island to Ontario — seem to be suicide, racism, and discrimination that people face when they’re trying to walk in two worlds, trying to live in general Canadian society but keeping their cultural and Indigenous identity at the same time, trying to balance that,” Chum said.

mhfa first nations logo

He estimates that he’s trained about 2,700 people to be Mental Health First Aiders since the mid-2010s, when he completed training to be a MHFA First Nations co-facilitator. In turn, those First Aiders have gone on to support thousands of people in their communities. When those who receive support to help survive their own psychological turmoil go on to help others, it creates a cycle of support that strengthens entire communities.

What sets MHFA First Nations apart
Today, about 70 First Nations co-facilitators provide MFHA training across Canada, primarily in First Nations communities but also elsewhere. Chum, for example, continues to conduct sessions for members of the Greater Sudbury Police Services, most of whom are non-Indigenous.

MHFA is a series of actions that people can take to support those who may be experiencing a crisis or decline in their mental health. While the commission offers various MHFA programs, none are quite like MHFA First Nations.

The MHCC conducts regular reviews of the course. A recent update adapted its broader objectives beyond regular MHFA training, which is very much about the skills participants might use and the actions they might take to support someone whose mental health is declining.

Some areas of the MHFA First Nations coursenow have a lot to do with building community through activities that engage the group as a whole and addressing systemic issues that have impacted First Nations people more directly — things like social determinants of health, systemic racism, and colonization.

Learning to train Mental Health First Aiders
The program’s ongoing success relies on two First Nations master trainers, Amanda Petit and Mary Wabano-McKay. These trainers teach the course First Nations people take to become MHFA co-facilitators, who in turn teach community members to be Mental Health First Aiders.

“I couldn’t imagine taking a course such as MHFA First Nations and having it delivered by a non-Indigenous person,” said Wabano-McKay, a Mushkegowuk (Cree from Attawapiskat First Nation), who lives in Sault Ste. Marie and works for Algoma University as vice-president of Nyaagaaniid — student success and Anishinaabe initiatives. “How could they relate to the lived experience and life experiences of First Nations people without having that lived experience?”

She added that Indigenous master trainers “serve as positive role models in communities among our peers and colleagues to show that not only did we inherit a lot of loss, grief, and trauma, we’ve also inherited resiliency, strength, and determination. Those things are imbued in the co-facilitators that deliver the MHFA First Nations course across the country.”

To become a co-facilitator, candidates go through 20 hours of group instruction, then spend two days working one-on-one with master trainers to go deeper into the material and demonstrate that they can deliver the MHFA First Nations course. To be accredited as a co-facilitator, they must complete further requirements within one year.

Impacts, obstacles, ways forward
The course content to become a co-facilitator can be disturbing, Wabano-McKay pointed out. In addition to going through the colonial legacy of TB hospitals, residential schools, the 60s Scoop, and other intergenerational traumas, it covers “how all of these are continuing to have serious impacts on First Nations people, on overall wellness, on mental health — from anxiety and depression to substance use and psychotic disorders.

“Such material can often be triggering for those who take the course,” she said, which is why co-facilitators are on site when an MHFA First Nations workshop is held. Community Elders are also invited to provide further support to participants, as needed.

Another potential obstacle for co-facilitator training is for candidates to get past their own stigmas about mental health and understand that everyone has it.

For co-facilitator Laurie Belcourt, a Treaty 8 Nations of Alberta employee from Bigstone Cree Nation, the course was a revelation.

“It changed who I was,” she said. “The way I think about people, the way I interact with people, it’s different. I’m a lot more understanding, I’m a lot more empathetic. It’s helped me understand that people have mental health problems. They’re not just looking for attention; they just don’t know how to deal with what’s going on.”

Through the MHFA First Nations course, Belcourt passes on that empathy and understanding to help First Aiders learn how to recognize mental health struggles in their communities, perhaps in their own families or circles of friends. “You’re that bridge between where they’re at, and where they need to go,” she said.

Co-facilitators are not there to provide professional care. Rather, their task is to listen and provide support in the moment, much like physical first aid. The next step, said Wabano-McKay, is to “connect the person to appropriate professional help and explore other supports people may have within their community. We let them know that their role as Mental Health First Aiders is to be that go-between, to give somebody that opening to be able to say, ‘I’m not okay, and I need some help.’”

Because every First Nations community has its own history, all of these interactions are carried out while respecting each tradition and culture. As Chum puts it, we’re always finding that “their food is different, their ways of knowing are different, their culture is different. We’re a very diverse people right across this place we call Turtle Island.”

Mental Health First Aid is provided to a person developing a mental health problem, experiencing a mental crisis, or a worsening of their mental health. More than 500,000 Canadians have been trained since 2007 and you can as well. Find a MHFA course online or in person.

Using person-first language to make an important distinction

This article is part of the Catalyst series called Language Matters.

When talking about mental health, the language we use falls into two broad categories: person-first or identity-first. At the Mental Health Commission of Canada (MHCC), we typically use and recommend person-first language, but that choice may not apply in all situations.

What’s the difference?
Identity-first language leads with the illness or condition as opposed to the person experiencing it. For example: “schizophrenic person” uses schizophrenia as a descriptor before referencing the individual. Conversely, person-first language focuses on the individual while de-emphasizing the illness or condition. So, in this instance, if using person-first language, you could say, “an individual who lives with schizophrenia.”

two people talking

The language used to talk about mental health or substance use can play an important role in reducing — or reinforcing — stigma. By focusing on the individual, person-first language underscores the fact that a diagnosis is only one component of someone’s overall being. It also shows respect for an individual as a person rather than as “abnormal,” “dysfunctional,” or “disabled.” For that reason, it is considered less stigmatizing and is often preferred in the mental health and substance use context.

That said, it’s important to bear in mind that this preference is not universal. As one friend explained, “I don’t live with bipolar disorder. It’s not my roommate.” For her, using identity-first language — “I’m bipolar” — better represents how deeply intertwined the condition is with every aspect of her life, while person-first language has a minimizing effect.

For others, identity-first language is rooted in the relationship between their personal and cultural identities and their condition. For example, deafness, which has a rich culture unique to those who share the experience, often emphasizes abilities over disabilities. In that case, “deaf person” might be preferred over “person who lives with deafness.”

How to choose?
In an American Psychological Association survey of 3,000 individuals living with a range of conditions, 70 per cent chose “person with a disability” when asked about the language that best describes them. “Disabled person” was chosen by just eight per cent.

When writing, the MHCC recommends person-first language as a first choice, unless you know that an individual or group describes themselves otherwise. When talking to a person with lived and living experience, listen for or ask them about the language they use. It’s not about getting it “right” on the first try. It’s about listening, learning, and championing the use of respectful, non-stigmatizing language — whichever form that takes.

Author:

Amber St. Louis

Educators play many roles and are increasingly called on to support youth mental health. Organizations are responding by equipping teachers with Mental Health First Aid training and tools.

In Canada, mental illness affects more than 1.2 million children and youth. By the time they reach age 25, that number rises more than six-fold to 7.5 million. These figures show just how much the early years provide the foundation for mental health and resilience throughout a person’s life. Since the start of the pandemic, concern over the mental well-being of youth has increasingly been a topic of discussion, particularly with the disruption of their routines.

Yet, as young people navigated from online school and back to in-person classes, the enormous pressure teachers have felt to develop additional skills for handling this mental health crisis has also affected their well-being. According to a June 2021 University of British Columbia survey, about 80 per cent of teachers reported experiencing moderate (56.7%) or serious (22.9%) mental distress.

As a result, the Toronto District School Board (TDSB) and the government of Saskatchewan have been investing in mental health training to give teachers the necessary tools to maintain mental well-being — for themselves and their students.

“As education workers, we work to educate Canada’s future generations,” said Mara Boedo, an executive officer with Toronto Education Workers (TEW), whose 17,000 CUPE members (local 4400) include TDSB employees. “This means that every positive change we can help our members make will impact the students in their care — and this will stay with them for the rest of their lives.”

The TDSB, which serves nearly 250,000 students across the district, has been investing in The Working Mind (TWM) since 2018. The course’s stigma-reduction focus is designed to promote mental health in the workplace by giving participants tools designed to assess their own mental wellness, identify signs and symptoms, and develop healthy coping strategies.

Mara Boedo

Mara Boedo

Teaching the teachers
After taking TWM, one participant’s recovery from mental distress became noticeable to others, including her family doctor, who asked, ‘What are you doing differently?’ “I have a new vision for myself,” she said. Through the course, participants work on changing behaviours and attitudes around mental illness by discussing resiliency, investing in their mental wellness, and exploring stigmatizing attitudes.

The participant was sharing this story with her TWM facilitator Cherill Hiebert, which led her to remark on the importance of teaching others about the small steps anyone can take to improve their mental well-being — rather than waiting until it gets to the point where a person needs professional help.

“That was the most powerful thing I have heard,” Hiebert said. “Without the program, that person would have had no vision because she had no hope.”

For these organizations, TWM signifies a proactive approach to their members’ mental well-being. But what happens when it’s too late for proactive measures? How can teachers prepare for a mental health crisis developing right in front of them? These have been long-standing questions for the Saskatchewan government.

Cherill Hiebert

Cherill Hiebert

Preparing for crisis
In December 2020, Saskatchewan announced a $400,000 commitment to provide Mental Health First Aid (MHFA) training to at least one staff member in each school in the province. MHFA enables individuals to provide help for someone who is either developing or going through a worsening mental health problem or experiencing a mental health crisis. Just like a person might provide physical first aid until medical treatment is available, MHFA is given until appropriate support is found, or the crisis is resolved.

When this funding was announced, Education Minister Dustin Duncan encouraged all the provinces’ school divisions to help remove the stigma around mental health. Such strong ministry support paved the way for coordinating training in 733 schools for 926 staff members. Every division now has MHFA responders with specific knowledge to support youth when they need it.

A hopeful future
These efforts to provide a more inclusive and sustainable approach to mental health in educational environments do not stop there. The National Standard of Canada for Mental Health and Well-Being for Post-Secondary Students, created by the Mental Health Commission of Canada (MHCC), enables academic institutions to better support students and integrate mental health into their services and systems. A starter kit to help them align their policies with the Standard and reaffirm their commitment to student mental health has now been downloaded more than 2,000 times, in settings of all sizes across the country. The Standard has also helped institutions continue their emphasis on student voices and perspectives, as we’ll see in a video series this fall where students will discuss mental health in post-secondary institutions.

The range of resources the MHCC has developed for the education sector is at the forefront of mental health and well-being for students, teachers, and faculty alike. One other example available to individuals and institutions is The Inquiring Mind Post-Secondary, an evidence-based training program to promote mental health and reduce stigma around mental illness.

Putting the right tools in hands of the people who educate Canada’s youth allows this impact to spread. In reflecting on the training and feedback received from participants, Boedo notes, “We are not only changing people’s lives, but we are also learning to change the way we approach the situations that are outside of our control.” 

MHCC training programs are designed to increase mental health literacy, reduce stigma, and provide skills and knowledge to manage potential or developing mental health problems. To find courses and learn more, visit the MHCC Mental Health Training page.

A national suicide prevention number – to launch in November 2023 – will bring 24-7 support to everyone

You’re a single mother in downtown Ottawa, off work due to COVID and distressed that you can’t cover the costs of rent and feeding your family. You’re an Indigenous teenager in northern Alberta trying to escape an abusive relationship. You’re a middle-aged man in New Brunswick who hasn’t told anyone how deep your depression is, and you feel like you can’t fight your suicidal urges anymore. You’re a refugee in small-town Ontario whose first language is not English, and you are experiencing frightening flashbacks to traumatic experiences of war. You’re a nurse in Vancouver, demoralized by the anti-vaccine protestors shouting at you as you go to work, where staffing shortages have brought you and your mental health to the breaking point.

Who do you call?

If you’re lucky, you’ll find the compassionate ear of a well-trained helpline counsellor in your community, who’ll listen as you tell your story, determine your level of suicide risk, de-escalate your stress, and connect you with the resources you need to get through this challenging moment in your life and set you on the way to long-term solutions and better times.

Still, in your state of mind you may not know where to turn. You might feel ashamed or embarrassed to admit you need help; or worse, you could be having suicidal thoughts. You might not feel up to searching for a 1-800 number — maybe you don’t have easy access to the internet and don’t know what supports are out there.

But what if we had a national three-digit suicide emergency helpline that everyone knew as well as they know 911?

That idea has been under serious study and development in Canada for several years, with enthusiastic support among suicide prevention experts, mental health professionals, and politicians at every level of government. Countries like the Netherlands and the United States have implemented a three-digit number, and in Canada a suicide hotline – 9-8-8 – will be accessible in all parts of Canada by the end of 2023.

According to Statistics Canada, about 11 people a day — 4,000 a year — take their own lives in this country. While the causes and circumstances vary, each loss is a tragedy that, for a host of unique and complex reasons, wasn’t prevented.

As the pandemic has unfolded, distress centres throughout Canada have been reporting higher numbers of people calling for help, particularly around addiction, job loss, the effects of inflation on the cost of living, and food insecurity. For those in the prevention field, a national suicide emergency number makes more sense than ever.

“The concept is widely accepted,” said Sean Krausert, executive director of the Canadian Association for Suicide Prevention (CASP). Based in Canmore, Alberta, Krausert was among many in the suicide prevention field in Canada (and internationally) consulted by the authors of Considerations for Implementing a Three-Digit Suicide Prevention Number in Canada, a 2021 MHCC policy brief that reviewed relevant literature and information.

“It’s more the logistical issues of putting this in place that will take time,” he said. “There needs to be a great degree of awareness in the public and strong funding to create a national service.”

Given Canada’s vastness and diversity, launching and maintaining a three-digit suicide prevention number is a complex task. Not only must such a service be built on the principles of equity and cultural inclusion, but it must also have a consistent technological infrastructure.

For example, for 9-8-8 to function from coast to coast to coast, 10-digit dialing needs to be in place where 7-digit dialing is still the norm, such as in Newfoundland, Labrador, northern Ontario, and Yellowknife. The Canadian Radio-Television and Telecommunications Commission (CRTC) says it may take until November 2023 to make the transition to 10-digit dialing in those locations. When the 9-8-8 system is up and running, all calls and texts to 9-8-8 will be directed to a mental health crisis or suicide prevention service, free of charge.

Additionally, access to well-trained counsellors must be made available 24-7 in every region of the country to serve diverse needs and to ensure that the help people require can be provided — whether they live in an urban centre or remote area, are young or old, speak English, French, or another language, or suffer from addiction, abuse, or mental illness. That means having one number for anyone in a suicidal crisis to connect to, no matter their walk of life, or their circumstances.

“Like a lot of guys, I always thought that whatever I had to deal with in my life, I would deal with it alone,” said Érick Légaré, in a 2019 video for the Association québécoise de prévention du suicide. Légaré, now 50, attempted suicide at age 45 and is grateful for the help he found when he was struggling. Today he has an urgent message for those who are feeling suicidal: “If you need help, know that it’s out there. You just need to let go and accept it. Talk to someone.”

Clearly, a national suicide helpline is a valuable addition to the supports already in place at the local and regional levels in Canada. “Whatever service it is, it is essential to provide immediate mental health supports 24 hours a day to the people in distress who call in,” said Andrea Poncia from Ottawa’s Community Suicide Prevention Network, who also pointed out that, for a national phone line to be effective, “funding has to be scaled up and maintained long term.”

Leslie Scott, manager of media and communications with the Distress Centres of Ottawa and Region, agrees that a national three-digit suicide emergency phone service is a good idea, and, once implemented, could take pressure off local non-profit distress centres.

“COVID has been intense,” said Scott, with more calls to the service than ever before. To succeed, a national service will need a “huge marketing campaign” to make sure people know it exists and understand what it provides. Like Poncia, Scott believes funding is essential for training those answering the phones, so they’re competent in best practices for helping a person in a suicidal crisis. Phone counsellors at distress centres in Canada now receive Applied Suicide Intervention Skills Training (ASIST), which enables them to offer “suicide first aid” to anyone who needs such support. National phone line counsellors will also need that, along with solid knowledge of what services are available to whoever calls, wherever they may be. That will enable them to triage and direct people to the appropriate help, both short and long term. An Indigenous teenager in Alberta will need something different than a middle-aged man in New Brunswick, an elderly farmer in rural Ontario, or a recent refugee of war with PTSD whose first language is not English.

“You need people who know how to actively listen,” said Scott. You have to be able to gauge a person’s mood, get into the nitty gritty with them. You need to be able to get to the heart of their story.”

The creation of a national three-digit suicide emergency hotline also serves another critical function: reducing the sense of stigma people may feel about asking for help or admitting they have a mental health concern. Scott notes that those taking the first step toward getting support may internalize stigmatizing language and perspectives.

“Unfortunately, some people still think that if they call for help, they’ll be taken away to the ‘loony bin.’ But of course, that is not the case,” said Scott. Knowing that there’s a phone number that anyone in Canada can use, any time, should contribute to the awareness that every human being goes through struggles, help is available, and you are not alone.

Karen Letofsky, one of Canada’s leading experts on suicide prevention — she became an Order of Canada member in 2007 in recognition of her years of service in this field — said the idea of a national suicide prevention number is something leaders in the distress centre community have championed for many years, getting started on partnerships to push the idea into reality in 2015. “We knew we needed a reasonable plan, and some pilot money. Once we had that we could start organizing. It’s been an ambitious goal to build capacity. If you increase access to a service like this, it means you need adequate resources and proper staffing to ensure success.”

It’s “a massive undertaking to provide universal access to a national suicide number,” she added, “but it’s definitely a worthy goal that will normalize asking for help.” While the many details surrounding funding, technological infrastructure, linking services, and training across the country are being worked out, Letofsky is optimistic that the partner organizations will continue to develop the best model for Canada.

Organizations that have been working with the MHCC and CASP include the Canadian Mental Health Association, the Centre for Addiction and Mental Health (CAMH), the Public Health Agency of Canada, Veterans Affairs Canada, and Kids Help Phone. Together, they’ve also consulted with organizations such as 113 Suicide Prevention in the Netherlands and the Substance Abuse and Mental Health Services Administration in the U.S., which also has a hybrid model that lets people choose to either text or phone the three-digit number.

More than anything, said Letofsky, the key to providing a quality service will be to ensure that those who answer the phones are “responders who are well trained in listening.”

It’s that one-on-one connection made between a caring human being and another in distress that’s critical. “Let’s not get caught up in numbers, statistics, and algorithms. Every person is unique. We don’t want to lose the personal story.”

The MHCC offers webinars, toolkits, learning modules, and a range of other resources on its Suicide Prevention page.

is the author of After Daniel: A Suicide Survivor’s Tale. She teaches in the journalism programs at Carleton University and Algonquin College in Ottawa.

Moira Farr

An award-winning journalist, author, and instructor, with degrees from Ryerson and the University of Toronto. Her writing has appeared in The Walrus, Canadian Geographic, Chatelaine, The Globe and Mail and more, covering topics like the environment, mental health, and gender issues. When she’s not teaching or editing, Moira freelances as a writer, having also served as a faculty editor in the Literary Journalism Program at The Banff Centre for the Arts.

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