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New implementation toolkit offers practical resources for mental health and substance use care
Understanding recovery starts with acknowledging that every person is entitled to a satisfying, hopeful, and contributing life, even if they experience mental health problems or illnesses and/or substance use concerns. With that basic right comes a powerful shift to a path toward wellness that is rooted in hope, dignity, self-determination, and responsibility. In concrete terms, recovery-oriented practice encompasses a range of services and supports designed to meet each person’s goals and needs.
Practitioners, service providers, and policy makers in Canada (and around the world) increasingly recognize the principle of recovery as essential for improving mental health systems and outcomes. More importantly, it is embraced by persons with lived and living experience and their families, whose values and insights are crucially important for successful outcomes.
The time is ripe
To further advance the use of the recovery approach in mental health and substance use care, the Mental Health Commission of Canada (MHCC) has just released Recovery-Oriented Practice: An Implementation Toolkit. The new toolkit builds on the MHCC’s Guidelines for Recovery-Oriented Practice (Guidelines) and offers wide-ranging resources to show everyone across the health services system how to apply recovery-oriented approaches — no matter what their role, profession, discipline, seniority, or level of contact with service users.
The toolkit also outlines in detail how implementation of a recovery-oriented approach could work across different settings, from a large mental health hospital to a mid-size not-for-profit community mental health service to a small community support network. Included are ideas for using the Guidelines, examples of the progression through four action phases, and several tools, resources, and templates to support these efforts.
Persons with lived and living experience as equal partners
The importance of such values and insights is illustrated in the section on How to Take Action. Using the principles of implementation science, a method for turning best practices into actions, the toolkit emphasizes the significance of “co-production”: the process of engaging persons with lived and living experience as equal partners in identifying opportunities and creating solutions to improve services. Co-production is closely aligned with recovery-oriented principles through its use of a strengths-based approach and by valuing everyone’s participation.
Real-world examples
Eight real-world examples bring these ideas into more concrete terms through stories that shed light on the many ways recovery principles can be adopted and applied. One of these organizations has a long history of putting co-production at the heart of what they do.
CHANNAL (Consumer’s Health Awareness Network Newfoundland and Labrador) has been operated by and for persons with lived and living experience since its inception in 1989. As a non-profit network providing support, education, and policy advice, its main goal is to encourage recovery and self-determination by providing a safe space where people can support and learn from one another.
According to the organization’s public education supervisor Monica Fletcher, “the toolkit’s real-world section brings the large and somewhat idealistic concept of recovery into the realm of the possible, yet also makes it understandable and doable.”
While she is impressed by the way the toolkit maps out all the steps involved, she is realistic about what that means. “Make no mistake,” she explained, “implementation will take time to set up, assess, and complete — and commitment from the top down — although in the end, it will improve the lives of everyone involved. And that makes the effort worth it.”
Fletcher speaks from first-hand knowledge about such perseverance. In citing the process of instilling the skills and resources for recovery-oriented practice in CHANNAL’s workforce, she emphasized that “training and support is embedded into everything we do. All decisions the leadership team makes include feedback from our front-line peer supporters. We look to them for direction. If something doesn’t work, either for the people we support or our staff, we make changes. We allow all staff to take personal responsibility for their wellness. Even though this may look different for each person, it works. It’s a constant ebb and flow.”
For Troy, a CHANNAL service user who lives with schizophrenia, everything they do is about his recovery, not his illness. “I’ve seen counsellors, occupational therapists, family doctors,” he said. “It’s only at CHANNAL where I don’t feel like a victim.”
The growth of recovery
In CHANNAL’s case, the commitment to people with lived and living experience and to recovery has been central to changes across Newfoundland and Labrador. In 2017, the minister of Health and Community Services launched a new Provincial Recovery Council for Mental Health and Addictions, placing CHANNAL’s executive director in a leading role. Now, the organization not only advises the minister directly, its services have also grown exponentially (up 1,000 per cent between 2015 and 2020).
“It’s taken CHANNAL 10 years of concerted effort to get to where we are today,” said Fletcher. “When I started working here six years ago, there were only three front-line peer supporters. Now we have 33 staff members across Newfoundland and Labrador that we train and support. Many of our peer supporters work hand in hand with clinical teams while offering their training and experiential knowledge to support individuals in a professional and recovery-oriented manner.”
Organizations wishing to begin or further their implementation process can download the new toolkit from the MHCC’s Recovery page.
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Roots of Hope suicide prevention and life promotion program set to flourish in eleven more communities
The challenges wrought by the pandemic are splashed across the news. They inundate our social media feeds and dominate our conversations (still masked and at a distance) if we run into neighbours at the convenience store or gas station.
But COVID-19 isn’t the only public health crisis our communities are contending with. Every year in Canada, suicide claims the lives of 4,000 people. The ripple of effect from each of those tragedies is felt by another 100 family members, friends, or colleagues. Suicide brings with it a special brand of devastation. Survivors of suicide loss claim their place in a club no one would wish to join.
Just as we are all at risk of catching COVID-19, under the wrong circumstances anyone can find themselves experiencing suicidal thoughts. Recent Leger polling commissioned by the Mental Health Commission of Canada (MHCC) and the Canadian Centre on Substance Use and Addiction revealed that while seven per cent of those surveyed experienced thoughts of suicide during the pandemic, that number jumped to 16 per cent among those with pre-existing mental health problems, and 25 per cent for those with a lifetime history of substance use disorders.
For MHCC president and CEO Michel Rodrigue, the reverberations of a close friend’s suicide are never far below the surface. “I am deeply invested in the success of our suicide prevention efforts because we know that if a region binds together and levels its resources, creativity, and determination, we can weave prevention into the fabric of our communities,” he said. “Now, more than ever, we have a collective responsibility to look out for one another.”
Rooted in the best evidence
The efforts Rodrigue refers to involve the five pillars of the MHCC’s home-grown suicide prevention and life promotion model, Roots of Hope. Apart from designing the model, the MHCC convenes participating communities to share knowledge and ideas and evaluates the evidence they provide to see what works best. When it was launched in Ottawa in September 2018, seven communities sourced the funding to join in.
Now, after applications streamed in from across the country, eleven more have been named as Roots of Hope participants in a second cohort. Known as Early Adopters, the group includes communities in various regions, from the mining city of Flin Flon, perched on the Manitoba-Saskatchewan border, to the municipality of Halton in southern Ontario.
“We saw an overwhelming interest in becoming a Roots of Hope Early Adopter,” said Ed Mantler, the MHCC’s vice-president of Programs and Priorities. “That communities were able to find the means to make this happen tells us that there is not only a great need but also a real willingness to invest the time, money, and emotional energy that will spark change.”
For Angela Fetch Muzyka, community development officer for the Town of Stony Plain, Alberta, the appeal is two-fold. “Working on Roots of hope is an important opportunity to advance efforts in our own community. But it’s also exciting to know that our successes and failures will guide future communities in their approach to suicide prevention.”
Just as the pandemic has shown us that, through a concerted effort, we can band together and protect one another from harm — even if that sometimes means staying apart — it reminds us that preventing suicide isn’t all that different.
Roots of Hope gives communities access to pools of knowledge and approaches based on the best evidence, but it’s not a one-size-fits-all prescription. Each chooses to focus on the populations most at risk in their areas.
For example, Pontiac, Quebec, will target its efforts toward the whole population, with a specific focus on men. The populations of interest in New Brunswick, the first Early Adopter to apply Roots of Hope across an entire province, will include youth, older adults, veterans, Indigenous peoples, and those with incomes below the poverty line. The Yukon, as the first territory to join the program, is zeroing in on those living in rural and remote communities and students attending Yukon University.
“You can quickly see the benefit of gathering the information gleaned from the various communities,” said Nitika Rewari, acting director of Prevention and Promotion Initiatives. “Suddenly, we’ve got access to approaches that work for people of diverse ages, backgrounds, and circumstances.”
Growing education
Central to Roots of Hope is homing in on the specific strengths and unique features of individual regions.
“Our board chair Chuck Bruce has likened it to building model planes,” said Rodrigue. “They come plain and colourless in a box and are brought to life by the hands that build them.”
Given the complex factors at play, Roots of Hope doesn’t purport to solve a problem as complex as suicide overnight. Still, it is possible to leverage what we do understand to better serve people who may be experiencing suicidal thoughts.
For example, many people who die by suicide visit their family doctor in the six months before they take their own lives. “Training doctors, health-care professionals, and other community leaders about how to spot the signs and how to have that difficult conversation is an important part of knitting tighter safety nets,” said Mantler. “So too is reaching out to young people who have lost a friend or a loved one to suicide.”
“Some of our communities told us that there was a hesitancy around how to broach the topic of suicide with children,” explained Julie McKercher, a program manager with the MHCC’s Prevention and Promotion team. “So we set out to create a resource to support those crucial conversations. As the big-picture convener with ready access to expertise, the MHCC can be responsive to those needs.”
And while education is a critical pillar in the Roots of Hope approach, so too is “means restriction.” “We need to look at how people take their lives and see if we can create barriers or restrict access,” said Rewari. “Many suicide attempts take place during a short-term crisis. Fewer completed suicides could result from barricades at train stations, limiting access to tall bridges, or encouraging people to safely dispose of unused prescription drugs.”
Hope in the time of COVID
“Just as we approached our management of COVID-19 with a concerted public awareness campaign centred on social distancing, mask wearing, testing, and staying home when sick,” said Rodrigue, “we can apply these same principles to creating public awareness about suicide prevention.”
While the pandemic has brought countless challenges, it has also illuminated how quickly we can marshal community responses to keep our residents safe. While that knowledge is fresh in our minds, we have an opportunity to apply it with equal determination and focus to promote life-saving measures like those identified by Roots of Hope.
In the words of Breanne Mellen, suicide program coordinator for the Early Adopter community in Medicine Hat, Alberta, “When we work together and honour the knowledge, experience, and abilities hidden within each of us, great things can and will happen.”
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Mental Health Commission of Canada’s HEADSTRONG summits go virtual
When much of the world shut down in March 2020, HEADSTRONG program manager Fiona Haynes was heartsick.
HEADSTRONG summits are interactive gatherings that give young people the chance to learn about mental health and gain the tools they need to become anti-stigma champions and ambassadors in their schools and communities.
According to Haynes, “those of us involved in the program were able to see first-hand the positive impact we were having and also how great the need was — how much young people benefited from a safe space to listen, learn, and ask questions. But we were also encouraged by how incredibly empowered they felt when asked to put forward solutions.” Ever since she joined the program in 2016, Haynes has seen it grow through word of mouth from a single national summit to a program that has reached hundreds of thousands of students.
Finding a Plan B
“After the pandemic struck, I was in my living room, worried sick about how we were going to reach these kids, how we were going to make sure they knew they hadn’t been forgotten, how we were going to put out that lifeline and say, ‘We’re still here for you,’” she recalled. “But I soon discovered that I wasn’t the only one having those concerns. The whole team was thinking, We needed a Plan B.”
As it turns out, Plan B came together so quickly that Haynes now proudly calls it a “second Plan A.” She always knew that reaching fly-in and other remote communities would mean a re-think of conventional get-togethers. What she didn’t expect was that the new virtual summits, inspired by the existing HEADSTRONG concept but with distancing measures, would exceed her wildest expectations.
“We found the secret sauce,” said Haynes, who pointed to evaluation reports from the early pilot projects showing an equal effect across the range of positive behaviours that the in-person summits sought to promote — everything from help seeking to stigma reduction.
Traditional HEADSTRONG summits worked by gathering students together from various high schools over the course of a full day. After hearing inspiring stories of recovery, they participate in thought-provoking activities and become aware of the positive influence they can have to change attitudes and behaviours around mental health. Students then take their new-found knowledge back to their own school to help make it mentally safer, with support from a sponsor (teacher or school counsellor).
While the virtual edition follows a similar path, students remain in their classrooms while joining up with as many as five other groups. Led by MCs who have specific training in virtual communication, the events are split into 75-minute modules (being mindful of Zoom fatigue) that align with the summit’s three-part motto: (1) “Be Brave,” on mental health, mental wellness, and appropriate help seeking, (2) “Reach Out,” on understanding and challenging stigma, and (3) “Speak Up,” on how to take meaningful action.
Learning through connection
The way the summits are presented directly affects what participants take away from their experience. As one student put it, “I learned how neglected mental health is, the importance of reaching out, being mindful and aware, and realizing how strong and capable people with mental illnesses really are.”
This kind of heartfelt observation, said Haynes, is likely the result of “contact-based education,” which occurs when a HEADSTRONG speaker (often a young adult) shares their experience of managing or recovering from mental illness.
“Suddenly, it’s not so other,” Haynes explained. “We see students having their fears, insecurities, and vulnerabilities mirrored by a successful young person who is a good communicator and a positive role model — and then, it’s like a light switch: ‘I can have anxiety, I can feel depressed, I can feel alone,’ and I can also be a worthwhile person who can reach out for the support I deserve.’”
Such insight, in combination with knowledge of available resources, also gives students the confidence to offer appropriate support and encourage peers to seek help. Young people have an important role in this, given that friends are often the first line of defense when a problem crops up.
Building momentum
So far, HEADSTRONG’s three virtual pilots and official launch summit have all met with positive results.
“We had a tried and tested formula for in-person summits, and to see that translate well to a modified virtual version is heartening,” said Laura Mullaly, interim manager of knowledge mobilization with the Mental Health Advancement team. “We have rigorous evaluations that tell us, ‘Yes, this is working the way it’s supposed to,’ and to see those replicated with virtual summits means we can continue this important work, regardless of COVID measures.”
One comment on the virtual summit from a grade ten student says it all: “I’m more educated. I know how to get help, and I know how to help others.”
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New policy brief underscores the plight of parenting in a pandemic
There is a “secret society” at the Mental Health Commission of Canada (MHCC), just like there is at every workplace across the country. Its members recognize each other through various signs and signals — some subtle, others less so.
Do you take calls in the blessed quiet of a car, in the bedroom closet, or in the relative peace of the furnace room? Are you the person at the meeting who switches off your camera so you can pour a bowl of goldfish crackers and offer feedback on an indiscernible drawing of a cat (or is it a crow)? Do you hear yourself saying, “I’ll help you find your shoe/bunny/imperceptibly tiny Lego accessory as soon as I finish writing this report/booking this meeting/drafting this article”?
If your answer to any of these questions is yes, chances are you’re part of the club.
Parents of young children have borne the brunt of COVID-19 stress — mothers especially. Consider new research from the MHCC (in partnership with the Canadian Paediatric Society), which found rates of depression during the pandemic among mothers of infants and children (age 18 months to eight years) rising to 42 per cent from nine per cent.
A growing need
Even before COVID-19, signs that we needed to rethink the services and supports available to families were already appearing, especially among those facing the additional stressors of financial insecurity, low social support, or racial discrimination. Pre-pandemic, less than 20 per cent of families had access to the greatest equalizer of disparities in the early years: affordable, licensed, early childhood education centres.
Since the pandemic began, families have been forced to deal with an additional range of unplanned complications, from social isolation and disruptions in child care and schooling to financial worries and loss of employment. Unsurprisingly, the result has been increased family conflict, including divorce.
Samantha Bennett, a parent who works in the MHCC’s Public Affairs department, is no stranger to this reality. “At the onset of the pandemic, I lost my mom, my husband lost his job, and my children lost their routine,” she explained. “There is no doubt in my mind that the adverse experiences parents are contending with have a trickle-down effect when it comes to children’s well-being.”
Bennett’s anecdotal findings are corroborated by the 40 per cent of Ontario parents who report behavioural and emotional changes in their children and the 61 per cent of parents across Canada who are concerned about managing their child’s behaviour, anxiety, emotions, and stress.
The search for new solutions
When looking at solving these real-world problems, our joint policy brief makes specific recommendations for decision makers to consider.
“We need targeted mental health supports for parents of young children,” said Brandon Hey, MHCC Policy and Research senior analyst. “And we need interventions that reduce parental stress and support caregiving needs.”
On that score, the Wellness Together Canada (2020-2024) portal is a great place for parents to start. Even before signing up for an account, basic information on managing anxiety for adults and children is readily available. With an account, you have access to an even broader array of resources, including evidence-based behavioural management courses, one-on-one (or group) counselling, and self-guided programs that allow you to track your state of mind.
Support starts with speaking up
Bennett, who lived with mental illness prior to the pandemic, has seen her anxiety spike. “The other day I got an alert on my activity tracker. It told me my heart rate was through the roof but had the ‘sense’ to recognize I wasn’t exercising. Sometimes a mental health problem is as obvious as a flashing alarm on your watch, yet with others it’s more insidious.”
That’s why, affirmed Hey, we need measures that address short-term challenges while also considering how to create policies that improve outcomes down the road, such as early education, child care, income supplements, and protections from discrimination.
“The pandemic has exacerbated pre-existing service gaps and inequities,” he added. “The wait times are too long, the number of qualified practitioners too few, and the accountability measures too weak.”
“The struggle parents face is very real,” said Bennett. “No one does their best parenting under duress, and we know that when stress builds we run the risk of modelling less than perfect behaviour or show less than ideal coping strategies, which can have serious implications for our kids. But there is no shame at all in saying, ‘Look, I need help, I’m not OK.’”
And when people do reach out, said Hey, we need to make sure that that the right person is there to answer the call.
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New virtual Mental Health First Aid course teaches adults to support the youth in their lives
Long before the pandemic, the need to support the mental health of young people was evident. With 50 per cent of all mental health problems established by age 14, the formative years of our youth are some of the most vulnerable. Now, by also having to face the impacts of COVID-19, that vulnerability in our youth has only grown.
For adults, it can be difficult to know how to relate to the young people in their lives, let alone how approach them about their mental well-being. To help open up those important conversations, the Mental Health Commission of Canada’s (MHCC’s) updated its MHFA Supporting Youth training and adapted it to a virtual format — and, as adults may be surprised to learn, “relating” isn’t part of the curriculum.
“When you’re talking to a young person about their experiences, it’s not about you,” explained Denise Waligora, a training and delivery specialist at the MHCC. “By the time you’re an adult, you’ve overcome hardship, and learned coping strategies along the way. The same isn’t necessarily true of youth. You have to be able to listen without minimizing their experiences or comparing them to your own.”
That kind of non-judgmental listening is just one of the strategies participants can expect to pick up from the new Mental Health First Aid virtual training. During the highly interactive 10-hour course, they will also learn how to recognize the signs of declining mental well-being and engage in conversations about those observations, assist in mental health or substance use crises, seek outside supports, and care for themselves as a “first aider.”
Focusing on the individual
Rather than offering a step-by-step approach to supporting all youth, course facilitators emphasize the role individuality plays. “Everyone has a baseline set of behaviours, moods, and attitudes,” said Waligora; for example, while one young person’s declining mental health could manifest in low grades or conflicts with friends, those things could be the norm for someone else.
The most important factor to be aware of, she said, is change. “As soon as we recognize a shift in any of these areas, we need to ask, How big of a deviation is this from that person’s baseline and how long has it been going on?”
In a similar way, effective conversational strategies and types of support may also vary depending on the individual. While some youth might be eager to share their feelings if given the opportunity, others may feel embarrassed and need more time. To help create a comfortable atmosphere, course participants are taught to approach youth more casually while engaging in an activity, as opposed to confronting them head-on.
“Whether it takes one try or five, you’re showing that young person someone cares about them.”
An updated approach
While the updates to MHFA Supporting Youth were based on the original in-person course, the content has undergone more than a virtual makeover.
One key addition, says Waligora, is a section dedicated to marginalized groups, including racialized, Indigenous, and 2SLGBTQ+ youth. “A young person from the 2SLGBTQ+ community may have a very different high school experience than their peers, for example. We have to learn about and acknowledge those differences to provide the most effective support.”
Another aspect of effective support (and further addition to the course content) is self-care for first aiders themselves. While participants are largely trained to support the youth around them, they are also taught to acknowledge the toll caring for others can take on one’s own well-being.
Finally, the updated course has shifted to include a more holistic approach to wellness. Rather than focusing on labels, the training follows a recovery-oriented model, emphasizing resilience and overall well-being in all areas of life.
Our collective responsibility
While the course was built for adults who interact with youth, as Waligora points out, that group extends far beyond parents.
“Almost all of us have young people in our lives, whether it’s relatives, neighbours, students, or employees. If you’re close enough to notice a change in a person, you’re close enough to offer your support.”
Late last year, the government of Saskatchewan echoed that sentiment by committing $400,000 to provide MHFA training in K-12 schools across the province.
“Our goal is to have at least one staff member in each school receive Mental Health First Aid training by December 2021,” said Saskatchewan Education Minister Dustin Duncan. “We are excited to support schools in ensuring students have access to mental health resources, and I encourage all provincial school divisions to take part to help remove the stigma around mental health.”
For Waligora, the bottom line is simple: “We have a responsibility to protect our youth. Every young person deserves a safe place to turn. As adults, we can be that place.”
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MHCC marks the retirement of Phil Upshall
Soon after Louise Bradley was named president and CEO of the Mental Health Commission of Canada (MHCC) more than 10 years ago, she began to surround herself with a leadership team that could guide the organization with the wisdom of lived experience.
According to Bradley, a big part of that plan took the form of an “irrepressible, intelligent, highly opinionated, gold-hearted, self-deprecating, one-of-a-kind adviser” by the name of Phil Upshall, who, she added, was “someone who would make sure the voice of lived experience was front and centre.”
When they first met, Upshall was part of a circle of influential mental health thought leaders “who were well ahead of their time,” she said. “They had their finger on the pulse of the economic and human cost of mental illness long before awareness campaigns were in fashion.”
Phil Upshall
But while Upshall had great tenacity and wide-ranging connections, what intrigued Bradley most was his own lived experience, which was accompanied by a willingness to freely share his story in the service of improving the lot of others.
Putting lived experience at the heart of decision making
Michel Rodrigue, who took over the MHCC helm from Bradley in March, agreed. “We can credit Phil not just for embedding an appreciation of lived experience into our leadership group, but for making the essential importance of being a conduit for lived experience central to its DNA.”
“Phil will grouse that I only took a third of his advice,” laughed Bradley. “But the fact is, Phil’s presence around the executive leadership table did more than hold us to account. He challenged our thinking, and when our approach diverged from his, he asked that we look him in the eye to provide a well-reasoned argument.”
For Ed Mantler, the MHCC’s vice-president of Programs and Priorities, Upshall provided sober second thought. “His lived experience reminded me that every piece of our work has real-world implications. Phil inspired me to be a greater champion for our work on recovery, and he opened my eyes to the importance of shining a light on peer support.”
Larger than life
“Phil made no apologies for this forthright manner,” reflected Bradley, whose recollections of Upshall were infused with deepest affection and respect.
“It gave me comfort,” said Mantler, “to know that our decisions were endorsed by someone whose agenda was in alignment with ours but whose opinions were squarely his own. Phil is a political animal, yet he is that rare breed who is able to make himself heard above the din of party politics.”
“In the mental health space generally, Phil was larger than life,” concurred Rodrigue. “He was instrumental in so many key advancements, from the creation of the Canadian Alliance on Mental Illness and Mental Health to championing the creation of the MHCC. But what I am left with, because of my personal interactions with Phil, is an openness to hearing hard truths — an appreciation of the strength it takes to be vulnerable.”
Rodrigue does not plan to stray far from those learnings. “Our Hallway Group, our Youth Council, our many staff members who embody grace and recovery, they all have stories that ground us, experiences that humble us, and wisdom that guides us. Phil has taught us to listen to those North Stars, and that will never change.”
A quiet legacy
While Upshall’s part in the MHCC’s success has been largely behind the scenes, that’s exactly why Bradley felt it has had the greatest impact.
“Phil never asked for credit, nor did he care about his contributions being heralded from the rooftops,” said Bradley. “All he ever wanted was for us to get it right. Phil’s tenure as a formal adviser to the MHCC may be winding down, but his friendship will never waver.”
As Upshall’s MHCC retirement begins, the organization is proud to celebrate his quiet legacy, which is just one small part of the indelible stamp he is leaving on Canada’s broader mental health landscape.
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New polling looks at realities of mental health and substance use workforce
For Dr. Mary Bartram, policy director at the Mental Health Commission of Canada (MHCC), gaining a better understanding of the realities of those who work in the field of mental health and substance use (MHSU) is key to unlocking improved mental health outcomes.
“For far too long, data about these essential care providers hasn’t been collected,” explained Bartram. “As we are bracing for an echo mental health pandemic, we have to understand the hidden workforce called upon to address it.”
Bartram noted that, while detailed data is regularly gathered about doctors and nurses, we only have a cursory understanding about psychologists and social workers and know almost nothing about all the other kinds of MHSU workers — from psychotherapists to addiction counsellors.
“Responding to the increased MHSU issues we are seeing as a result of the pandemic means knowing exactly what tools we have at our disposal,” said Bartram. “Yet we don’t know where this workforce works, how many hours of service its workers provide, which populations they serve, or what areas of expertise they have.” This lack of knowledge is concerning, given these workers’ unique position in responding to these emerging needs during the pandemic.
Mary Bartram
Shining a light into care gaps
Fortunately, this lack of understanding is beginning to change, with a recent survey conducted by the MHCC and the Canadian Health Workforce Network, which specifically set out to take a snapshot of this undiscovered landscape.
For Bartram, the numbers revealed in the Mental Health and Substance Use Workforce Capacity to Respond to COVID-19 Survey set off warning bells on several fronts.
“This survey lays bare the two-tiered nature of our system of care. Much as we like to tout universal health care, the reality is that 31 per cent of the providers we surveyed get no public funding for the services they provide. Instead, their clients pay out of pocket or through the private insurance provided by employers.”
Bartram says it is no surprise that the MHSU impacts of the pandemic have been worse among lower income populations. These are people who didn’t have access to private insurance before the pandemic and may have felt they had no means to mitigate their mental health challenges throughout its course.
As Bartram noted in a recent Hill Times op-ed, while two-thirds of the population have access to extended health benefits, “the remainder of the population pays out of pocket, faces long waits for limited publicly funded services, ventures into the brave new world of virtual services if broadband allows, or goes without.”
Indeed, the survey findings indicate that, although 33 per cent of MHSU providers decreased their capacity because of social distancing measures, almost as many (28 per cent) said the decrease was because clients encountered issues with virtual care.
Inequity on multiple fronts
Bartram says that, while the explosion in virtual care options such as the Wellness Together Canada portal is a positive sign, we need to be prepared for the significant learning curve many people will have and also understand that this form of care will not serve the needs of everyone.
“Equity is a huge piece of the puzzle,” she said. “It isn’t just about whether you would be comfortable using virtual services. It’s also about questions like, ‘Do you have broadband?’ and ‘Are you safe in your home?’”
A gender divide in the survey responses also highlights the importance of understanding how care providers of different genders are faring.
Overall, there was more of a decrease in service delivery by female practitioners (who make up almost 80 per cent of the survey sample), with “additional personal responsibilities” among the top reasons.
By contrast, more male practitioners have been able to increase their service delivery by offering voluntary services and taking advantage of new funding.
Bartram says the numbers align with findings in a recent Leger survey commissioned by the MHCC and the Canadian Centre on Substance Use and Addiction, which highlights the pandemic’s disproportionate impact on women.
“Women took on more of the caregiving and household responsibilities before the pandemic,” she explained. “Covid has amplified that disparity and left many women, particularly those with younger children at home, with less spare time and poorer mental health than their male counterparts.”
The way forward
Even with some practitioners able to increase their services, demand continues to far exceed supply. Earlier results from recent joint MHCC-CCSA polling found that only 18 to 20 per cent of those experiencing MHSU concerns accessed services during the month of February.
Addressing that imbalance, Bartram emphasizes, will require us to continue looking at the providers who are delivering those services. The findings from this survey, funded through a Canadian Institutes of Health Research operating grant, will be discussed at a policy dialogue in June. Of note is that we need much more than one survey to have the kind of data necessary for population needs-based planning.
“The realities of the MHSU workforce have been overlooked for too long,” said Bartram. “Our hope is that bringing them to light will take us one step closer to meeting the needs of everyone in Canada — including the providers themselves — both now and long after the pandemic is behind us.”
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The Working Mind First Responders offers police a new kind of protection
Beth Milliard
Staff sergeant Beth Milliard is no stranger to the mental health impact of policework. Coming from a police family, she entered her career committed to making mental health a priority — for herself and her fellow officers.
It was that drive to create a more supportive environment that led her to The Working Mind First Responders (TWMFR) training. While at first she was simply looking to explore options for her service, York Regional Police (YRP), she would ultimately become a master trainer with the program.
“Police are very skeptical and very honest. Yet when we piloted this course for the service, almost 100 per cent of the feedback was overwhelmingly positive,” she said, adding with a laugh that the few negative comments had to do with things like trouble finding parking. “After the initial feedback, it became clear that we needed to make the course mandatory for everyone in the service.”
The interactive course, which was recently adapted to a virtual format (until it’s safe to return to in-person learning), aims to build mental health awareness, reduce stigma, and promote resiliency. Using an evidence-based approach, participants learn how to self-assess and talk about mental health, along with strategies to help them cope with challenges and resources to seek out when they need support.
Recognizing the importance of mental health
Although it took over two years to train everyone at YRP, Milliard is not alone in calling it a worthy investment. “People who had been around long before we rolled out the program started asking, ‘Where was this ten years ago?’”
The program has been so successful that YRP has now in fact made it mandatory. But in addition, it’s been integrated into the Ontario Police College curriculum — the training body responsible for all new officers across the province.
For Milliard, this prioritization of mental health among officers is encouraging. “When I went through police college, we had maybe an hour of mental health training focused on dealing with people in crisis. Not only did that add to the misconception that mental illness is black and white — you’re in crisis or you’re fine — we never learned how to recognize warning signs within ourselves, let alone what to do about it.”
Speaking a common language
One of the most important components of the course for Milliard is the Mental Health Continuum Model, which teaches users to assess their mental health at any time using a colour-coded mental health spectrum: green (healthy), yellow (reacting), orange (injured), and red (ill).
“The continuum allows everyone to talk about mental health using the same language,” she said, adding that YRP has taken it one step further by teaching the model to their on-staff psychologists, social workers, and other staff members, allowing for easier communication across the organization.
“Now when someone seeks professional help through work, all they have to say is, ‘I think I’m in the orange,’ and there is an immediate understanding of what that means.”
A changing culture
When Milliard reflects on the culture shift around mental health that she’s witnessed throughout her career, she can’t help but think of her father, a retired officer of 30 years. “My dad spent the last 15 years of his career dealing with fatal car accidents,” she explained. “And in that whole 15 years, no one ever asked him how he was doing or whether he needed some time off. Not once.”
Fortunately, she says, the culture of silence and stigma has come a long way, and with courses like TWMFR, it’s getting better all the time.
“I like to use the body armour analogy,” she said. “Before 1980, bulletproof vests weren’t mandatory in the field. Now, any officer would say it’s unthinkable to go out without that protection. I think the same is true of this course. Now that we have it, it’s almost impossible to imagine doing the job without it. It’s an added layer of protection.”
To learn more about the benefits of TWMFR Virtual for your organization, contact solutions@openingminds.org
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It’s human nature to skirt difficult conversations, especially when they involve uncomfortable circumstances and topics. But sometimes we need to face these challenges head on.
That’s certainly true for several of the communities participating in the Mental Health Commission of Canada’s (MHCC’s) Roots of Hope suicide prevention initiative.
In one of these northern communities, “there was a tragic cluster of suicides,” said Nitika Rewari, the MHCC’s acting director of Prevention and Promotion initiatives. “For parents, grandparents, and caregivers, addressing something so painful can be paralyzing. So it wasn’t surprising when people started asking us to create a resource for such situations, one that could really speak to the need to support children in a caring, safe, age-appropriate way.”
That said, she added, it’s natural for any caregiver of a child affected by suicide to feel overwhelmed and unsure about what to do.
Where to begin
“So we developed Talking to Children About a Suicide, a resource designed to walk parents, teachers, and others through these discussions, step by step. Since it’s not an easy path, we wanted to let caregivers know how to mentally prepare, what to expect (or not expect), and how to respond with language that is helpful, not harmful,” Rewari explained.
For Michel Rodrigue, the MHCC’s new president and CEO, the new resource strikes a deeply personal chord.
“I lost a dear family friend to suicide, and this tragic loss occurred when his children were very young. Back then, we simply didn’t have guidance on the importance of talking openly. I can see now that the best path to healing is creating the space for grief, acknowledging those feelings, and giving children permission to ask difficult questions,” he said.
Program manager Julie McKercher, who has worked extensively in community-based crisis intervention, created the resource and had eight experts review and validate its approaches. As she points out, having accurate information is a key part of the process. “We aren’t born knowing how to support a child in grief, and we may be afraid that talking about suicide could plant ideas in a child’s head or create even more angst. Yet those are misnomers — they simply aren’t true.”
Striking the right chord
Talking to Children About a Suicide not only dispels common myths, it also walks caregivers through simple techniques to help alleviate some of the pressure they may feel during those hard talks.
“Things like sitting hip to hip make so much sense, but’s it’s not something you automatically know how to do,” said Rodrigue, referring to the ‘sideways conversation’ technique that removes the pressure of eye contact to let you talk more naturally, either as you’re walking or engaging in a quiet activity side by side. “It can open up space that allows the awkwardness to move its way through.”
The resource itself is deceptively simple. “The first thing you have to do is prepare yourself to be the support,” said McKercher. “And that requires you to deal with any personal feelings you may have, so you can set them aside and offer a non-judgmental, caring ear.”
Grief looks different for each child, she added, and as kids grow, so does their comprehension of death. But regardless of a child’s reaction, gently reaffirming that they aren’t to blame for the suicide is one of the most important things a caregiver can do.
A long conversation
Children not only pick up on moods, they overhear conversations and exchange ideas with their peers. “So we need to equip kids with the right information for their age and stage of development, and we need to be guided by their questions,” said Rewari. “Dealing with suicide isn’t a one and done conversation.”
A resource like this is important, said Rodrigue, because it highlights the shift in children’s understanding over time. A child who loses a loved one to suicide at a very young age, for example, may begin to act out as they grow older and have a greater understanding of the permanence of death.
“Whether it’s anger, frustration, guilt,” added Rewari, “not sleeping, having trouble concentrating — or no visible signs at all — grief doesn’t abide by a chart, and it can’t be plotted on a graph. Yet, while no one can anticipate what shape it might take, we can give caregivers a road map for conversing with a child as it may unfold.”
Rodrigue agrees. “A suicide isn’t something one gets over. It’s something one learns to live with. And if we can model empathy, non-judgment, and understanding, the children in our lives will learn, over time, to do the same. It’s a ripple effect that could spell transformational change around how we talk about and respond to suicides in our communities and families.”