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How to start the conversation
When celebrated children’s author Robert Munsch began to struggle with his mental health, the first step toward wellness was the simplest. It was also the toughest.
“The stigma attached to mental illness kept me from going for help for 20 years,” he said. In a 2013 conversation with the Mental Health Commission of Canada (MHCC), Munsch spoke about his long struggle with the stigma around mental illness, prior to his diagnosis of bipolar disorder, and his related dependence on alcohol.
That first step of “going to talk to someone” was a “no-brainer,” he explained, but it required an enormous amount of courage because of the negative stereotypes toward mental illness. “It doesn’t matter who you are. It doesn’t matter how good you are. You can have a problem. Being open and having a support group is vital to beating it.”
For people who live with mental and substance use disorders, being open about mental health can definitely help. But building understanding and reducing stigma more generally is also crucial for helping them get the care they need without hesitation.
Stigma is a pervasive problem
A 2022 poll conducted by Leger found stigma to be a pervasive problem for people living with mental or substance use disorders in Canada: 95 per cent reported experiencing stigma in the past five years, while 72 per cent reported experiencing “self-stigma” (internalizing negative prejudices). Perhaps more tellingly, the survey found that people in Canada “expect individuals with mental health or substance use disorders to be devalued and discriminated against in their day-to-day lives.”
Survey respondents also cited stigma reduction as one of three main priorities for improving recovery and access to care (alongside greater access to care and more preventive mental health services). Clearly, reducing stigma and all of its negative effects is a crucial step in giving those who experience mental health and substance use problems the care they deserve.
Why it matters
The MHCC’s Opening Minds training division was developed for just that reason: to reduce discrimination resulting from negative attitudes around mental illness and substance use. It’s now the largest systemic effort dedicated to reducing stigma in the country. Since it began in 2009, almost a million people in Canada have been trained in at least one of the Opening Minds courses or programs. That number continues to grow as workplaces, classrooms, and companies (large and small) recognize the importance of fostering a psychologically healthy and safe environment.
As an organization, the MHCC has deep expertise with the National Standard of Canada for Psychological Health and Safety in the Workplace (the Standard), which was developed and launched in 2013 to provide guidelines on how to promote mental health and recognize and support those experiencing mental health concerns or illnesses. While more and more organizations are recognizing the benefits of psychological health and safety, many don’t know where to start. In such cases, one of the best foundations for building such a culture is Opening Minds training.
Opening Minds training also includes Mental Health First Aid (MHFA), The Working Mind (TWM), and The Inquiring Mind (TIM) programs. With so many people, organizations, and communities across the country taking part, you may already be one of their graduates (and even have the certification on your LinkedIn profile).
People who have participated in Opening Minds programs feel more confident and empowered when talking with someone experiencing a mental health problem or crisis. Firefighter Steve Jones said he felt that he’d saved more lives as a trainer with The Working Mind — First Responders program than in his 20 years of experience in the job.
Mental Health First Aid
MHFA is similar to regular first aid: It trains people on how to provide immediate help for someone experiencing a mental health problem or crisis until appropriate treatment can be found.
While it can prevent a current difficulty from becoming more serious, it also has wider benefits. Evidence shows that MHFA reduces stigma, increases understanding of mental crises signs and symptoms, and gives participants the confidence to approach a person who is experiencing such a problem.
MHFA participants have said the program changed them for the better by making them more empathetic and understanding toward people experiencing mental health problems.
The Working Mind and The Inquiring Mind
TWM’s evidence-based courses are designed to reduce stigma in the workplace. Along with the standard TWM course, versions tailored for people working in the first responder, health care, legal, and sports sectors are also available.
The course has been adopted by corporate, non-profit, and government organizations across the country, with more than 260,000 people trained so far.
Participants and trainers have also found that TWM has increased their empathy and understanding and has also had an immediate positive effect on their workplaces.
TIM is an adaptation of TWM to suit university or college settings.
Simple communication
Now, the Opening Minds website has re-launched, with a new, simplified design and a web portal that make it easier to browse courses or conduct searches based on specific criteria. Users will also be able to view detailed course outlines and facilitator profiles while keeping track of their own learning history.
These enhancements will enable the MHCC to continue working toward ensuring that everyone can expect a workplace or learning environment that values and supports their psychological safety. The more streamlined and efficient format will also help Opening Minds continue its leadership in delivering evidence-based programs to reduce stigma.
Getting past stigma, his own and others, has made all the difference for Munsch.
“People have to realize that mental illness is something wrong with the way our brains work, and there are various things now that you can treat it with.”
Resource: The new Opening Minds website
Wes Smiderle
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- How do I tell my work I need time off for mental health?
- How do you tell your boss you’re struggling mentally?
- Can you call in sick because of mental health?
Would you feel comfortable answering these questions?
Work is such a big part of our lives. And stress is a part of life. But when workplace stress reaches beyond normal levels and becomes unhealthy, we need to do something about it. Actually, rather than just reacting to the crisis du jour, we need to think about actively protecting our mental health at work every day before crises develop.
Did you know:
- 70% of employees are concerned about workplace stress and psychological safety at work
- Only 23% of workers in Canada would feel comfortable talking to their employer about a psychological health issue
I remember when, many years ago, I was in a work situation where almost everything was stacked against me: a crushing workload, an unsupportive boss, a competitive and toxic environment, and almost impossible chances of delivering on the objectives. At the time, the answer seemed to work harder and log more hours to perform in the role successfully. Big mistake. I was focused on achieving success. I couldn’t see that how I chose to deal with the situation would lead me into serious difficulties.
One burnout later, I have learned that as noble as it is to work hard, sometimes you need to make changes or cut your losses and leave. At the time, it would never have occurred to me to talk about workplace stress with my boss. This is quite common. People hesitate to admit that there is an issue for all sorts of reasons, often because we don’t want to be deemed unfit for the job. The power of stigma can keep people stuck.
People will often ignore the psychological discomfort they’re in, believing that things will improve if they push on. And if there isn’t a corporate culture that supports managing and acknowledging mental health issues, workers are less likely to seek appropriate help when they need it.
Let’s talk about the work environment for a moment. Are you facing any of these challenges?
- Recurring struggle to maintain a work-life balance
- Heavy workload
- Abrasive relationship with manager
- Discrimination and inequality
- Low degree of control over work
- Job insecurity
Signs of workplace stress
Physical
- Headaches
- Muscle tension
- Rapid heart rate
- Digestion problems
- Restless sleep
Psychological
- Difficulty concentrating
- Low productivity
- Irritability
- Forgetfulness
- Mood swings
Is it stress or burnout?
Burnout can develop when you get into a state of emotional, physical, and mental exhaustion caused by excessive and prolonged stress. Burnout at work can cause you to feel emotionally drained and have difficulty functioning in your job as well as in your personal life.
Signs of burnout
Physical
- Major fatigue
- Sleep disruption
- Loss of appetite
- Backaches or headaches
Psychological
- Major decline in motivation and productivity
- Increase in errors
- Feelings of helplessness and/or hopelessness
- Self-doubt
Prioritizing mental health for workers and employers
Workers deserve safe and healthy working environments. Creating those environments starts with the employer, who has an essential role to play in supporting employees with awareness and information about mental health, as well as fostering an environment that encourages open dialogue. This means creating a culture where mental health is valued, and workers feel safe in seeking help. Promoting awareness can help create an accessible and positive workplace and improve staff retention, work performance and productivity.
What workers can do to protect their mental health
- Inform yourself and learn new skills with mental health training
- Recognize the signs and symptoms of overwhelming stress
- Step away from stress and take a mental health day
- Address stress with meditation, mindfulness, or yoga
- Nourish yourself – balanced nutrition can be a mood booster
- Take a walk – set aside time to get outside. Even 15 minutes can help
- Get enough sleep – lack of sleep can have a big impact on productivity at work and on your physical health
- Relationships – build positive relationships with your colleagues and your supervisor. Healthy relationships will facilitate communication and understanding
- Take action on work performance concerns – request a meeting with your manager if you aren’t getting enough feedback or if you’re only hearing negative feedback
- Seek professional help for stress-related symptoms like high blood pressure, migraines, or insomnia
What employers can do to support a mentally healthy workplace
Protecting and promoting mental health at work is about strengthening capacities to recognize and act on mental health conditions at work, especially for people responsible for the supervision of others.
To protect mental health, the WHO recommends:
- Manager training for mental health, which helps managers recognize and respond to emotional distress; builds interpersonal skills like open communication and active listening; and fosters a better understanding of how job stressors affect mental health and can be managed.
- Training for workers in mental health literacy and awareness to improve knowledge of mental health and reduce stigma against mental health conditions at work.
- Interventions for individuals to build skills to manage stress and reduce mental health symptoms.
What mental health at work looks like
- Employee satisfaction
- High levels of engagement and collaboration
- Productivity
- Trust
- Agility
- Resiliency
- Higher staff retention rates
Remember, while it may seem like creating a mentally healthy workplace is lots of work, the efforts and investments made by both workers and employers have been shown to be well worth it. Mental health at work is good for business.
You may also like
https://mentalhealthcommission.ca/catalyst/is-it-time-to-decolonize-therapy/
https://mentalhealthcommission.ca/catalyst/how-to-break-up-with-your-therapist/
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.
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Navigating stigma, grief, and loss and finding healing, hope, and community support after a death by suicide. A personal story.
Each November, people around the world take part in special events to mark International Day for People Impacted by Suicide. Those directly affected by suicide loss often use this day to remember loved ones and share their stories and experiences. Here is just one. Names have been changed for privacy reasons.
Rachel died by suicide on June 15, 2022, six weeks after her 30th birthday. I had known her for just over a year. We had been neighbours, then close friends, then briefly lovers. My relationship with her, though affectionate, was fraught with conflict and I have felt immense guilt for my self-perceived role in her death, for not being the partner she needed me to be, for not loving her the way she needed to be loved.
I’m sharing my story because suicide continues to carry an immense stigma, and loved ones who remain can feel isolated in their grief.
As with any tragedy, suicide reaches far beyond the act itself; its ripples are extensive. I think about the many people who have been, and will likely continue to be, affected by Rachel’s death: her best friend, who discovered her in her home two days after she died; her colleagues, who valued her for far more than her productivity and perfectionism; members of her biological and chosen families, who reached out to me on Facebook, searching for answers in the weeks following her death; her transgender teen cousin, who looked up to Rachel as a queer role model and confidante; and her ex-partner, Nigel, with whom she had had a nine-year relationship and who bore the unenviable responsibility of selling the home they co-owned and sorting through all her personal belongings.
Joy and Jessica Ruano.
Honest conversations
When I heard about Rachel’s death, my first thought went to my daughter Joy, who was not quite two and a half years old at the time. Joy had known Rachel for half of her short life, and their beautiful bond included visits to the Canada Agricultural Museum farm and sitting on her lap to play piano together. As a solo parent raising a young child during a worldwide pandemic, I was grateful to have Rachel as one of the few people I trusted to care for Joy.
I believe in being transparent and truthful with children. So I told Joy as soon as she asked that we wouldn’t be seeing Rachel anymore because she had died, that it was very sad, and that we were going to miss her and it was okay to talk about it.
The following week, we visited with several of our former neighbours, many of whom came out to sit with me and Joy in sadness and solidarity. I answered their questions, as many of them were still very much in the dark regarding the circumstances of Rachel’s death. Yet a new awkwardness and a weighty cheerlessness hung over our little cul-de-sac. The previous year, I had hosted Junkyard Symphony, an environmentally conscious percussion group, in the middle of the street. It was one of many events that spoke to the atmosphere and culture: a place where the kids would always come out and play together, where the neighbours didn’t mind if Joy picked and ate the tomatoes right from their front yard, and where we knew all the names of the dogs and the cats (even the tortoise, Miguel) who lived there. Rachel adored this community, which she lovingly referred to as Sesame Street, and her little house she had wanted to live in forever.
After two weeks off, I tried to go back to work. For brief periods, I was able to focus on the tasks at hand; other times, I found myself staring into space. Often, I felt raw, on the brink of crying, or having a panic attack — my emotions volatile. I did what I could, then requested more time off with the support of my family doctor. But knowing where to direct my energy and how to find healing was hard. The people who had been showing up for me in the first few days and weeks were quickly dispersing, moving on with their lives as people do. Then, some of my close friends stopped talking to me. Most made excuses about being busy, even though before Rachel’s death we regularly got together, and one actually sent me an email citing Rachel’s suicide as one of the main reasons she needed to take a “break” from our friendship. This was a hard blow, as my relationship to my immediate family was strained, so I yearned for the support of my chosen family during this time.
Finding support
In mid-August, feeling lost and very much alone in my grief, I reached out to Bereaved Families of Ontario and started attending their Thursday afternoon support group over Zoom. I also attended an LGBTQ2S+ Death Café hosted by the Home Hospice Association on Tuesday evenings, which focused on political questions around death, dying, and illness as they pertain to the queer community; for example, relying on chosen family rather than non-supportive biological family. I started listening to Paula Fontenelle’s Understand Suicide podcast, which recently reached 100 episodes.
These were the voices I needed to hear: people who were willing to push through their discomfort with death and suicide to talk about their feelings openly, whether the loss was last month or several years ago. I found myself thinking outside my own grief to empathize with the man who lost his wife of fifty years to cancer, with the young woman who lost her father in a politically charged murder, with the people who had suffered multiple losses over the years and felt utterly destabilized by the repeated blows. I knew I was not alone in my experience, though it often felt that way, and connecting with other people, even strangers I might never meet outside the virtual world, helped me remember that.
Through all this, I wanted to make sure I was being a consistent parent for Joy. A friend of mine asked me recently how I managed to keep it together over the past year, and my best answer was simply Joy — you don’t have the option to fall apart when your child needs you. At least, I didn’t. I couldn’t.
But it wasn’t easy. Joy frequently brought up Rachel — the places they went together, games they would play, and items in our home — like kitchen utensils or pieces of clothing — that reminded her of Rachel. I always tried to respond positively, even though it sometimes pained me to hear about her. One night, Joy woke up screaming and later expressed between sobs: “I’m sad . . . because Rachel went away.” For many months, she had been sleeping comfortably in her own bed, but after Rachel’s death, she became increasingly resistant to spending nights apart from me. I questioned her about it, and she eventually explained that she was afraid to let me sleep alone without her — because I might die like Rachel did. And the questions continued:
“Why did Rachel die?”
She was sick, my love.
“Was she old?”
No, baby, she was young. Younger than me.
“I don’t want her to be dead.”
Me neither.
“I miss her.”
Me too.
While I couldn’t bring Rachel back or promise that we wouldn’t lose other people in the future, I did my best to reassure her that “Mama and Joy are forever” in case there was any doubt in her mind.
“And Ba, too?” she asked, about her stuffed beluga.
And Ba, too.
More than one year later, I continue to feel the effects of Rachel’s death, including symptoms of post-traumatic stress disorder. The difficulties I’ve been having with concentration and managing anxiety, especially when in front of a computer, mean that I’m unable to work like I used to. So, I recently made the shift from salaried employment to freelance work to allow for more flexibility in my schedule. With regular therapy, I’ve been working through my feelings of guilt and on being the best possible parent for Joy. I’ve been building back my community of support, finding comfort in the people who showed up for me at the most challenging times. I exercise and meditate to maintain a healthy body and tranquil mind. And I write as much as I can.
Earlier this year, perhaps in a reactionary move, I booked flights for us to London, England, where I lived for four years just over a decade ago. For four weeks this past July, we travelled across Europe by train with only a carry-on suitcase and a backpack. It was good to step out of our routine and leave behind all the reminders of last summer. Apart from the usual challenges of travelling with a young child, such as meltdowns stemming from ever-changing environments, it was a wonderful bonding experience for us.
I am so grateful for my life and for wanting every day to be alive and to stay alive, even on the hardest days. I have a fierce desire not only to survive but to thrive in this life. So, with Joy by my side, that is exactly what I will continue to do.
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. Dial toll-free: 1-833-456-4566.
Resources:
- Suicide Prevention (Mental Health Commission of Canada)
- Talking to Children About a Suicide
Jessica Ruano
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When I left my job at the height of the pandemic, it wasn’t after months of quiet quitting. Nor did I do a happy dance. I didn’t see myself reflected in the media narratives about quitting one’s job.
I wasn’t like the flight attendant who went viral by dramatically announcing his departure over a loudspeaker before throwing himself down the emergency slide in an inglorious exit. And neither was I someone who’d phoned it in with the bare minimum, recusing myself from any extra duties in a form of silent protest.
I was resigning, in the truest sense of the word. I was conceding defeat without being checkmated. I had come to accept that something undesirable could no longer be avoided.
After nearly ten years, I had slowly come to the realization that a job I’d loved and been devoted to hadn’t given back to me as assiduously as I’d given to it.
Like a frog in a pot, I was brought to a slow simmer over time. And while apparently that myth has been debunked, and frogs do, in fact, have the good sense to leap out when they start to cook, I opted to braise in my own juices.
It wasn’t a choice I made consciously.
Like so many women of my age, working in professional careers while balancing a personal life, I was torn between wanting to make a difference in my work while needing to be present for my family. But my generation was sold a bait-and-switch.
We could have it all, society told us. Be powerful working moms: bosses in the board room who baked cookies on the weekend. (No one told us we’d likely get burned.)
Many of us, myself included, tried to cash in on that promise, only to discover the coupon was time-limited. At first, it’s easy to climb the ladder. But it gets harder if you find yourself stepping off and back on, as the needs of your kids, spouse or older parents ebb and flow.
So many of us wind up mid-way, too far down to be the masters of our fate, but just high enough to feel the weight of responsibility. My solution was to double down. To make the maximum input possible while stranded mid-rung.
So, I launched myself into learning everything I could about mental health, the purview of my organization’s mandate. I had a stack of books on my nightstand. I read Simon Sinek and Adam Grant, who put organizational psychology in simple terms.
I poured over countless personal accounts of lived experience.
I delved into the imprint left by intergenerational trauma, and the indelible scars of racism on the psyche.
I composed op-eds in the shower. I practiced interviews while doing the dishes. I scribbled tip sheets on damp paper while watching my daughter’s swimming lessons. I was constantly scanning the news landscape to see how our organization could be more relevant. I listened to podcasts, watched documentaries and read articles late at night. Instead of winding down on the commute, I did some of my best writing on the bus.
Yes, I truly wanted to understand better. But my motivation wasn’t entirely altruistic. I also wanted to be the best. To affirm my place as a trusted source of information and underscore my value. I derived a sense of meaning from this work, but I should have seen the danger signs when it began to define me.
I wasn’t reading the mysteries I’d always loved. I was rarely writing for the sheer joy of it. I’d let my physical wellness take a back seat. The irony of working to advance mental health and wellness, while risking mine to burn out, didn’t dawn till later.
My work slowly became not just something I did, but a central fact of who I was. If you work hard enough in a (fruitless) effort to become irreplaceable, your stock in a workplace can only climb so high before the law of diminishing returns kicks in.
You work more diligently. You put in longer hours. You never turn down a colleague in need. You constantly put up your hand. “I have an idea,” was my watchword in a meeting. Inevitably, the work I suggested would fall to me. And I relished it. Because it conformed to the myth I was making about my own invincibility. I could do it all, I told myself. I was the person that could always be relied upon. I wouldn’t ever let anyone down.
And the cycle ticks along just fine…Until slowly you become tired. Then you start to make little mistakes. Finally, your judgement clouds and your temper shortens. Soon, I was disappointing myself. My very efforts were working against me. I was my work, but I no longer liked who I was.
And that, for me, was the point of no return. I wasn’t a healthcare worker, or a first responder. I wasn’t someone whose job puts them in harms way. There is heroism and sacrifice in that kind of selflessness.
I, on the other hand, was making a choice, which meant I could also un-choose it.
But giving up a job that’s come to mean too much to you isn’t done easily or without cost.
I still remember powering down my laptop for the last time. Switching off my phone. Carefully folding up my power cords. Placing the whole lot in a cardboard box and sealing it up like a time capsule. And in a way, that’s exactly what it was. I was packing in the formative years of my professional career, not entirely certain what my next chapter would hold.
And while I would miss my colleagues terribly, and, much later, mourn the loss many aspects of my work that brought me joy, I knew that I had something important to do. Quitting a job doesn’t have to be a celebration. Nor does it need to be done quietly. Sometimes it’s too complicated to be boiled down to a single emotion.
Maybe that’s when it’s time to hand in your notice to go in search of yourself.
An Ottawa writer and former speechwriter, and Manager of Communications at the Mental Health Commission of Canada. A homebody who always has her nose in a book, she bakes a mean lemon loaf (some would call her a one-dish wonder) and enjoys watching movies with her husband and 13-year-old daughter. Suzanne’s time with the MHCC cemented her interest in mental health, and she remains a life-long learner on the subject.
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Writing your end-of-life story has therapeutic effects. The art of getting to the end.
The obituary — a written announcement of a person’s death, including biographical details — has been with us for centuries.
The sombre, even forbidding word, from the medieval Latin obituarius, was first used in 1703, according to the Merriam-Webster dictionary. Over the years since, it has become common practice for a family member or friend to write such a notice for a loved one who has died. While never a happy task or one to be taken lightly, it has become so customary that the best obituaries are collected in books. Besides that the funeral industry now provides how-to advice and templates, news organizations pre-write them for the famous, ghostwriters will write one for you — and increasing numbers of people are writing their own.
Some irreverent, self-written obituaries, after being appreciated by complete strangers for their refreshing candour about personal failings, family conflict, and mental illness, have gone viral. One of them, from Angus Macdonald of Glace Bay, Nova Scotia, is also now listed for its poignancy and humour under “Funny Obituaries” on Legacy.com. “I think I was a pretty nice guy, despite being a former punk and despite what some people would say about me,” he recounted in the obituary he wrote before his death at age 67 in 2016. “What did they know about me anyway? I loved my family and cared for them through good times and bad; I did my best.”
As they face death, some autobiographical scribes are motivated by a wish to set the record straight, settle scores, or comfort those left behind, with honesty, humour, and courage. They may also see it as an opportunity to reflect on the entirety of their lives — the triumphs and accomplishments, failings and regrets, lessons learned, and in the mind of the writer at least, a chance to leave behind words of wisdom worth preserving. Those who know they are close to the end may gain valuable perspective from writing authentically about their lives and, in the process, find a way to accept and be at peace with the inevitable.
An examined life
Now, therapists, counsellors, and writing coaches are seeing the mental health benefits of asking clients to write their own obituary, regardless of age or how much life they have left.
While some might find the idea morbid, it’s gaining popularity as a therapeutic exercise in self-examination and as a way to help clarify important issues that we all face as we go through life.
We may have a hard time facing our own mortality, but thinking about what we’d want in our obituary when we die, experts say, might lead to a better, happier, and more meaningful and productive life. It’s worth noting that obire, the Latin root word of “obituary,” means “go toward” or “go to meet.”
“Sometimes people will do this exercise and stop and look at their lives and say, ‘I’m actually living a life that is completely opposite to what I want to be remembered for,’” says Talia Akerman, a licensed mental health counsellor working with Humantold, a group practice based in New York City. Most of Akerman’s clients are in their early 20s, dealing with depression, anxiety, and trauma and searching for answers to life’s big questions as they try to heal from painful experiences and build their adult lives.
In the context of existential therapy, based largely on ideas developed by renowned psychiatrist Viktor Frankl in the early 20th century, writing an obituary for yourself is a means of exploring how to find genuine, self-determined meaning and purpose. “It forces you to hold up a mirror to your life, your actions, your values, the people around you,” says Akerman. “It gives you a very intense moment to say, ‘This is not what I want for myself. Let me change that.’ And then, I’ll ask, ‘What are the common themes in this obituary? If you need to make a change, how do you go about that?’” On the other hand, she says, a person might find they are more on track than they realized after writing down an account of their life.
For someone dealing with depression, it’s an opportunity to work with a therapist on boosting self-esteem, reconnecting with the good, and finding hope for the future. “It’s reminding them of the strengths they have, and it is very beneficial. Other times with depression, or whatever mental health issue you might be experiencing, it’s a little harder, and that person might not be at the point where they’re ready to see that,” says Akerman. “This is where I think a good therapist comes into play. You need to be the person instilling hope in somebody before they’re ready to metaphorically grab the hope from your hands and hold it for themselves.”
It may also help a person to go back to the obituary in later months or years to see how their lives have changed, for better or for worse, and reflect again on what path they really want to take. “I will have them keep it somewhere, and if they don’t want to keep it because it’s a little too jarring, I’ll keep it somewhere safe and private for them, and we can revisit that,” says Akerman. “They can ask themselves, ‘Have I made the changes I want, or am I in the same place? And if I’m in the same place, why am I here?’”
Changes in direction
During the pandemic, so many people were forced to “pivot” in their choices of employment or deal with all kinds of losses that in some cases led to mental health crises, Akerman says, which made obituary writing an even more relevant exercise for her clients.
“I think this tool was really helpful during COVID. People could say, ‘I can’t control everything on a social level, but I can look at what I want to do with my life, look at my values, and what I care about and figure out, do I need to change anything professionally or relationally?”
Whether young or old, close to or far from death, reflecting on the lives we’ve led, are now living, or will lead clearly has benefits — from finding peace to changing directions to simply appreciating who and where we are and what we’ve accomplished or would still like to before the end.
Resource: Sharing Your Story Safely
Related reading:
Moira Farr
Everything you always wanted to know about therapy but were afraid to ask
Choosing to go to therapy may feel scary and overwhelming. Some may even have the belief that a therapist tells you what to do to ‘solve’ your problem. Therapy over the years has been stigmatized, but as we become more aware of mental health, the stigma has lessened.
Imagine having a person give you their undivided attention with no interruptions, empathizing, and providing professional guidance on what you may be experiencing. Can you imagine how supportive and life-changing this can be? Going to therapy was a life changer for me, and to this day, I still enjoy its benefits.
In this post, I’ll share with you the various types of therapy, qualities to look for in a therapist and some ideas on where to find them.
Knowing when to seek therapy
You may be experiencing a temporary problem that can be helped with supportive family/friends or your own ‘toolbox,’ but at times, you might need professional support for what you are experiencing. It may be time to see a therapist when something is causing you ongoing distress and interferes with your life in the following ways:
- the quality of your life has decreased significantly or is decreasing
- your daily activities, school, work, or relationships are being negatively impacted
- feeling controlled by symptoms
- there is a risk of harm to yourself or others
You may also be experiencing:
- feeling overwhelmed or fatigued
- disproportionate anger, rage, resentment
- feeling anxious, panic, intrusive thoughts
- apathy, hopelessness
- shame, social withdrawal
Like myself, you may also choose therapy for ongoing support once the problem/crisis has been managed.
Not all therapies are the same
Depending on what you are experiencing, there is a wide range of therapies available. Remember, therapy can involve all aspects of your humanness, mind, body, and spirit. Sometimes, I need support physically (for example, naturopath, massage, acupuncture, osteopath, etc.), which in turn ends up assisting my mental health too. I’m amazed at the connection between the mind and body. When something is manifesting physically, it can create a risk to one’s mental health, and when the mind is experiencing symptoms, it can directly impact you physically. For example, the symptoms of a panic attack are eerily like that of a heart attack.
Here are a few different approaches to therapy:
- psychoanalysis
- behavioural therapy
- cognitive therapy
- integrative or holistic therapy
Psychodynamic therapy is based on the principles of psychoanalysis and is an in-depth form of talk therapy. This form of therapy involves recognizing, acknowledging, and overcoming negative feelings and repressed emotions to improve the client’s relationship with themselves, with others and with the world around them. With Behavioral Therapy, the basis is that certain behaviours develop from things you’ve learned in your past and that behavioural therapy can help you change your responses to those behaviours.
Cognitive behavioural therapy (CBT) is another form of behavioural therapy often used to treat mental health conditions and substance use disorders. This form of therapy focuses on the connection between thoughts, feelings, and behaviours.
Integrative or holistic therapy considers the whole person, mind, body, and spirit. These modalities can also be a wonderful complement to conventional treatment. Within the above-mentioned categories, there are a variety of more specialized approaches that can be found here.
Choosing a therapist
While it’s natural to want to make a connection with a therapist, remember that they aren’t your friends. Also, keep in mind that while they might have personality traits that you don’t mesh with personally, that doesn’t mean you can’t still nurture a productive, professional relationship. Here are some qualities to look for in a therapist:
- meet professional qualifications and standards
- non-judgmental and empathetic
- diverse
- genuine
- compassionate
- flexible, but with healthy boundaries
- self-aware and connected to their humanness
Also, when a therapist is connected to a network of other professionals, they may be able to refer you to others who may support your journey further.
One size does not fit all
You are an important part of the therapeutic relationship. The therapist you are working with may not be the best-suited one for you, and that’s OK! I remember my very first experience with a therapist, and after a few sessions, there wasn’t much progress. The therapist was lovely and empathetic and provided a safe space for me. However, I needed someone who would challenge me, go deeper, and provide the opportunity for me to grow and heal. Working with my next therapist provided the opportunity for me to do just that. Letting my previous therapist know that I didn’t think we were a fit was challenging, but it did provide me the opportunity to speak my truth, and I grew stronger as a result. I believe that there are no “waste of time” therapeutic experiences. It’s true; therapists are all as individual and unique as you are.
Where to find a therapist
There is a wide range of therapeutic services available. Considering the resources available to you, checking in with a medical doctor is a great place to start. They will look to provide you with a referral. It’s important to note there may be waitlists. Getting your name on the waitlist as soon as possible may prove the wait was worth it. In the meantime, support from friends and family may be helpful. Depending on the type of therapy you are looking for, there may be costs involved. I suggest checking in with your work for any benefit plans they may have. Most companies have incorporated therapy into their benefit offerings. Some therapists provide a sliding scale; depending on your financial situation, they will customize a fee. There are also low or no financial costs provided through non-profit and government-funded programs. In most provinces, there are 211 websites that have great mental health service resources.
On a final note: therapy gave me the ability to heal, grow, and be of service to others while being in care of myself. It wasn’t always easy; however, it was worth it every step of the way! As Brene Brown says, “Truth and courage aren’t always comfortable, but they are never weakness.”
Author: Yvette Murray
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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 reports. 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.”
Wait times
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.
Three digits
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.
Ways forward
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
Fateema Sayani
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I’m going to go to a bit of a dark place, and I would invite you to follow me there because it is important. I have had (and the way bipolar disorder goes so cyclically, likely will have again) suicidal ideation, and I would like to tell you what it is like. I’ve never told anyone this before, but I would like to tell you this now because of suicide awareness day, which is commemorated each September 10 in honour of all those who have died by suicide and those living with suicide attempts or suicidal ideation and their loved ones.
Suicidal ideation, or thoughts of suicide, are undoubtedly different for everyone, so I can only tell you about my experience. If my experience can make even one person feel seen or understood, it will be worth it.
Most often, my thoughts of suicide are passive, as in “I would be better off dead” or “It would be better if I didn’t wake up.” These are the thoughts I will be describing in this blog post. Certainly, when I am in more distress, these thoughts can become more active, culminating, for me, in plans to die by suicide, but these are more rare (and these, particularly when accompanied by plans, are where interventions need to be made by loved ones and mental health professionals).
For me, my thoughts of suicide are a study in opposites. They are equal parts horrifying, foreign thoughts, and soothing, familiar thoughts. Let me explain what I mean. Thoughts that I would be better off dead come unbidden into my mind and are not welcome there. I am deeply ashamed of them. I know they are “deviant” (at least, I choose to label them as such), and they seem to come at me from some outside force, and I don’t want them to. But at the same time, they are soothing and familiar – they offer a way out of a situation that I have thought through and thought through and for the life of me cannot find a way out of (my depression). They offer a seductively easy way out of my situation at that, almost like a mother soothing me with a “there, there” and a pat on the back, promising me that it will all be alright – there is a solution (and it is easy).
Suicidal ideation changes volume, too. Sometimes, it is a whisper in the back of my mind, barely there but just audible. Sometimes, it is insistent, like a child asking for screen time tugging at my sleeve. Sometimes, it feels like it is literally screaming to be heard, and nothing else can drown it out and I am just left to listen to it suggest, cajole, demand, insist and request that its ideas be heeded.
Does having these thoughts mean that I am planning to die by suicide? No. As dark and insistent as they are, these thoughts are just thoughts. Just like the thoughts in traffic that you would like to ram that car in front of you or any of the other fantasies that pass through your mind throughout your day, suicidal ideations are just that – fantasies. Fantasies that make life more livable. It is because they are so stigmatized that they are so frightening and so difficult to talk about. Now, we have to be careful to walk the line between reducing the stigma around suicide and making it a genuine option, but I believe that that line is thick enough that there is room to reduce the stigma and give relief to people like me, who struggle with guilt and shame over their suicidal thoughts to the point that they won’t seek help.
So, with that, what makes up the resistance, you might ask? What’s the good news story here? I am lucky. I have a partner I can talk to about these scary thoughts. She doesn’t buckle and collapse. She listens calmly, stroking my hand all the while. Then she asks if I have any plans. She asks what we should do – should we call my psychiatrist (whom I am also fortunate to be able to disclose suicidal ideation to without being summarily put in the hospital) or take me to the hospital, or are we safe just to wait and see, and then she lays with me while I cry. I am lucky. Not everyone has a partner or loved one like this because not everyone understands that just having these thoughts does not mean that I am imminently in danger or, worse, “crazy.” Most people, when they hear of suicidal thoughts, get quite scared themselves, and they lose themselves in that fear. Please, don’t. I assure you, your loved one who is telling you this is more afraid than you are. Keep your cool. Better yet, before you are ever in this situation, get some basic training that will help you cope, like Mental Health First Aid (MHFA) or even more specialized suicide assistance training. Courses like this will help you to be able to assess risk and figure out what to do next, whether that is simply being with your loved one or whether that is making a safety plan and getting help.
Suicide is not something that affects other people. In this country, 12 people die by suicide every day – and that is just the deaths that are verified as suicide. Due to stigma, many deaths are attributed to other causes rather than bringing shame to a family or community. It is the second leading cause of death among youth and young adults (15-34 years), and 12% of Canadians admit to having had thoughts of suicide in their lifetimes. We all love someone who is thinking about or will think about dying by suicide. I hope this little piece of vulnerability will help at least one of them.
BSc, PhD, aka the StigmaCrusher, is a mental health advocate and keynote speaker with a rare blend of academic expertise and lived experience. Equipped with a doctorate in experimental psychology and firsthand knowledge of bipolar disorder, she’s both heavily educated and, as she likes to say, heavily medicated. Crazy smart, she’s been crushing mental health stigma since 2010.
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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.”
Changing gears
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.
Resource: Fact Sheet: Common Mental Health Myths and Misconceptions
Further reading: CBT For You and For Me: A suite of culturally adapted cognitive behavioural therapy tools is designed to break through barriers.
