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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.
Suzanne Westover
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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.”
Suzanne Westover
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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
Amber St. Louis
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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.”
Suzanne Westover
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Firefighter Steve Jones on the merits of The Working Mind First Responders course
When firefighter Steve Jones first completed his course to become a trainer for The Working Mind First Responders (TWMFR), he was encouraged to share some of what he’d learned with his crew.
“What I thought would be a 15-minute conversation turned into three hours,” said Jones, an acting platoon chief with the Burlington Fire Department. “Guys opened up about serious mental health problems in their families and in themselves, things that I had no idea were going on. That was the moment it hit me — we all know someone who’s struggling.”
TWMFR, which has recently been updated and adapted to a virtual format (until in-person learning can safely return), is designed to build awareness, reduce stigma, strengthen resilience, and encourage mental health conversations among first responders.
Participants are introduced to tools like the colour-coded mental health continuum to increase self-awareness, as well as to coping strategies and resources to better support themselves and each other.
Jones notes that while the material is deceptively simple, its impact extends far beyond the classroom. “Trajectory is one of the most important concepts. One short conversation about mental health, or the moment of courage it takes to say “I need help,” can alter someone’s trajectory forever. That’s what makes this course so powerful.”
A series of double standards
Part of that trajectory shift comes from the course’s emphasis on reducing stigma, which as Jones points out, often manifests as double standards around mental illness.
“When someone returns to work after a back injury, we don’t question whether it’s going to hold up on the job. We trust the process to clear them for duty and move on. But when someone returns after a psychological injury, that implicit trust isn’t there.”
Even more pervasive, he says, is the self-stigma that often comes from admitting one’s own struggles or having sought support — a point he tries to emphasize as a facilitator.
“I’ll ask my group to raise their hands if they think their crew would come to them if they needed to talk, and most hands go up. Then I turn the table, and ask if anyone would reach out to a teammate to share their own challenges, and the response is much different. First responders want to help people, but asking for help is a whole different beast.”
Steve Jones
Saving lives begins at the station
Recognizing stigma as a barrier to support his own department is partly what led Jones to become a trainer for TWMFR. Since then, the course has been rolled out across Burlington Fire, leading to a palpable culture shift (and an increase in employee and family assistance program use) that has resulted in other departments reaching out for guidance.
While Jones’s enthusiasm for TWMFR is largely driven by the positive impact it’s had in his own department, it’s the transformation he sees in his participants that continues to feed his passion. “There’s nothing more rewarding than having someone come up to me at the end who says, ‘I really needed this,’ he explained.
“I truly believe I’ve saved more lives in my five years as a trainer for TWMFR than in my 20 years as a firefighter.”
That sentiment was echoed early on in Burlington Fire’s rollout of the course by a surprise guest speaker — a retired fire captain who had asked to speak to the group at the beginning of a session.
“He reminded us that, as firefighters, we invest hours into training that will keep us safe in the field. There are drills for all types of situations so that when the floor gives out beneath you, all you have to do is call ‘mayday’ and you’ll be rescued. . . . But when you’re struggling with a mental health problem, and it feels like the floor is giving out, there is no ‘mayday.’ By training to protect our mental health, we’re training to save lives.”
As Jones recalls, the message struck a chord with everyone in the room. The retired captain was not only a well-respected mentor, he was someone who had seen the consequences of neglecting mental illness across his career, including losing a teammate to suicide.
“After that day, he came back and spoke to every training group before the start of the course. No matter how many times I heard it, his words hit home and my trajectory shifted a little bit more.”
To learn more about the benefits of TWMFR Virtual for your organization, contact solutions@openingminds.org
Amber St. Louis
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An impossible juggling act
Because the effects of the pandemic are not felt equally, the Mental Health Commission of Canada (MHCC) is turning its attention to populations that are disproportionately affected — including women.
“Women make up the majority of our organization,” said Karla Thorpe, the MHCC’s vice-president of Public Affairs and Organizational Performance. “Every day over the last year, we’ve been hearing from female staff in particular about having to juggle an impossible number of tasks, and we need to recognize that these realities have mental health ramifications.”
Thorpe herself is all-too-familiar with the mental toll arising from the COVID era’s push and pull.
“Personally, this past year was among the most challenging I’ve weathered. I had to move my elderly parents into a care home at the height of the pandemic. With long days of Zoom meetings, followed by caregiving visits in full PPE, there were times when normalcy felt so far out of reach,” she recalled. “Yet, I recognize my own good fortune. The challenge for those who have had to take longer-term leaves or don’t have the luxury of paid time off is even more complex. This is especially true for people without the resources to seek the support they need.”
A disproportionate toll
Women are no stranger to the role of primary caregivers, which is why up to one-third of working mothers have considered quitting their jobs since the onset of COVID. And the weight of leaving the workforce can be a heavy burden.
That’s why the MHCC created a mini-guide specifically designed to support the mental wellness of women who have been sidelined from the workforce, whether by pandemic business closures, caregiving, or other responsibilities.
Liz Horvath, manager of the MHCC’s Workplace Mental Health team, was game to support this resource from the word go. “I’ve walked a mile in those shoes,” she said, referring to a dark time when she was waitressing to support her child as a single mother. “I was studying, working, parenting, and all the time made to feel that my contributions weren’t valued, weren’t worthy. I was considered “just” — as in just a waitress. I was on a treadmill that was grinding me down.
But when I left that work in search of some greater meaning, I was faced with significant barriers despite the valuable knowledge and skills I had gained as a single mother, a waitress, and a student,” she explained. “The constant struggle wore down my resilience and left me in a state of crushing depression, at a time when stigma was very high and access to support services was really limited.”
Recalibrating for mental wellness
Yet there are ways, Horvath acknowledged, to walk a path of unemployment without losing confidence and connection. Equally, there are ways to create some space for self-care, even when the scales are tipped heavily toward workaday realities.
“Staying connected sounds trite, but it’s so important,” she said. “Whatever your area of work, from front-line service to the corner office, there are online groups or forums, volunteer opportunities, career counselling, and online aptitude tests. Embracing these types of connections, when I could, was very helpful.”
Thorpe concurred, adding that, “for women, confidence can be a stumbling block, especially during times of unemployment. That’s one reason we designed this resource to help women reframe their thinking. A gap in a CV is an opportunity to demonstrate experience that was gained outside the workplace. A set of skills we’ve learned in one area can be applied to another — because it’s our capacity to learn and grow that’s important.”
The mini-guide is an easy-to-use reference guide, with practical tips and resources on everything from mental health supports to financial literacy.
“In the winter, the MHCC had created a tip sheet to help employers support and welcome women returning to work after an absence,” said Horvath. “But we realized there was still an important gap to fill. What about the wellness of women during that time away? How can we make sure they feel supported?”
Supporting each other
For Thorpe, being a woman in a leadership position comes with an added responsibility. “As a female leader, I want to help break down the systemic barriers women continue to face in the workplace. Too often women take themselves out of the running for a job without even applying. Or we don’t ask for mentorship or we fail to negotiate a raise. As leaders, male and female, some of the onus for changing our systems, processes, and cultures at work to accommodate the realities of women’s lives — so we get the best possible talent — is on us.”
Horvath agrees, and is hopeful that resources like the new mini-guide will help women see their futures in a brighter light. “Taking an absence from the workforce comes with all kinds of challenges, but it also brings fresh opportunities. With the right support, the ending of one chapter can lead to a better one. I know it did for me.”
Suzanne Westover
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MHCC welcomes new president and CEO Michel Rodrigue
Michel Rodrigue
Change is never easy, conceded Louise Bradley, C.M., outgoing president and CEO of the Mental Health Commission of Canada (MHCC).
“But that doesn’t mean it isn’t necessary,” she said from her home office in Newfoundland, where she’s been working throughout the pandemic.
“I spent a lot of time reflecting as I went on early morning hikes. Moving on from the MHCC wasn’t a decision that was taken lightly . . . but once it was made, it did feel like a weight had lifted.”
Bradley has been championing the advancement of mental health for her entire career, beginning with her earliest days as a nurse on a psychiatric unit. “People expressed sympathy, implying that I wasn’t up to snuff for a real nursing job,” she said, laughing. “I can see the humour in it now, but at the time it was cutting.”
For over a decade, Bradley has brought her expertise on direct health care provision and administration to the MHCC leadership table, and that effort has borne fruit.
“I look at where we are today, and my heart really does swell with pride at our collective achievements. Truth be told, that’s when I knew it was time to step aside. I never wanted to leave a job undone, and with a new strategic plan in hand, deeply committed leaders and staff, and exemplary partnerships, it’s time to pass the baton to someone who is ready to tackle the next ten years.”
Passing the baton
MHCC board chair Chuck Bruce conceded that Bradley’s decision took him by surprise . . . at first. “But then I reflected on what it means to be a CEO for a full decade. And Louise went above and beyond running the place. She took it upon herself to speak to countless audiences in Canada, and around the world, to change minds, to open hearts, to open doors. And that level of commitment is what you see reflected in the strategic plan the board envisioned.”
It is appropriate, then, that the architect of the new plan — Answering the Call — would be the person stepping into the role of president and CEO on March 24. As vice-president of Public Affairs and Organizational Performance, Michel Rodrigue has been walking in lockstep with Bradley for the last five years. In that time, he has helped to create a culture of forward-thinking innovation that has led to key breakthroughs like championing the Stepped Care 2.0 e-mental health initiative and knitting together communities in the name of suicide prevention with the national Roots of Hope program.
An eye to the future
“When we were building this new plan, I didn’t know how the future would unfold, but I did know that the board had a bold, ambitious vision that built on the foundational pillars Louise embedded in our organizational culture,” said Rodrigue. “And now, as we embark on the next decade, we can take the knowledge we gain, year over year, and compound our progress.”
Rodrigue, a CPA by trade, with wide-ranging executive leadership experience, believes his greatest asset is curiosity. “I am someone who loves learning, loves challenging myself, and loves being challenged. I went back to school later in life to complete an executive MBA and become a chartered professional accountant, and I found that experience energizing. Too often we become entrenched in our identities, but I think we have to constantly revise our thinking.”
In good hands
Bradley believes Rodrigue’s open-mindedness will serve him well. “The mental health landscape is constantly changing. Best practices are always emerging. You can’t afford to be static in your thinking, and Michel is someone who is willing to listen to the experts and is unafraid to change course.”
Bruce agrees. “We had an exemplary list of candidates, as you might expect for an organization as well respected as the MHCC. But Michel rose to the occasion time and again in the process. He not only understands the organizational culture and helped set us on a course for the next decade, he also has the kind of questioning mind-set that goes hand-in-glove with quiet confidence. You cannot run this organization without a willingness to bring a learner’s mind to work every day.”
As the MHCC begins a new work plan with a new president and CEO at the helm, Bradley for her part, has one last question.
“I wonder what great things the organization will do next?”
Suzanne Westover
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Stephanie Knaak
In conversation with structural stigma researcher Dr. Stephanie Knaak
Stephanie Knaak has been studying structural stigma for the better part of a decade. She’s an expert in the foundational policies, laws, and practices in our health-care system that put people who live with mental illness at a disadvantage.
“But that doesn’t mean I have all the answers,” said Knaak from her home office in Golden, B.C., where she’s been working since the onset of the pandemic. “Sometimes I get overwhelmed. It’s a beast of a challenge to tackle because some people can’t see structural stigma, and others are suffocating under its weight. It all depends on where you’re sitting.”
When asked how something so invisible to some and dead obvious to others can be addressed, she paused. “In health-care settings, if you aren’t measuring it, it just doesn’t matter. We’ve got to show providers and administrators the true cost of these blind spots by giving them tools that can bring them to light. Then, we’ve got to use the evidence of those gaps to make a case to close them.”
New frontiers
Knaak and her colleagues at the Mental Health Commission of Canada (MHCC) are charting new territory. For example, they are mapping out the topography that people living with mental illness must face when seeking basic physical health care.
“A person’s mental health may have nothing to do with the reason for their visit, but it becomes a huge barrier to getting timely and proper diagnosis and treatment — because physical complaints are often dismissed or seen only through the lens of their mental health diagnosis. The system doesn’t have the right checks and balances to make sure these kinds of blind spots get caught,” she explained. “This is the equivalent of a mountain, and we’ve got to identify it on a map so we can point to it and say, ‘How are we going to scale this?’”
Unlike the early explorers who were blind to their own limitations, Knaak approaches this new body of research with the humility born of experience.
“We’re finding out new things every day. This area of study is massive. It’s almost intimidating to put a stake in the ground, because its constantly shifting beneath you. But someone has to be first. Someone has to say, “OK, we have to get better because people are bearing the consequences of system inertia. We’ve got to get the wheels in motion. Even if we have to backtrack and start again, we’ve got to get moving.”
If you build it . . . they will come (around)
Knaak believes that by forcing policy change in health-care settings a different attitude will follow. “Take handwashing, for example. Because it has standards for when, where, and how to do it, hospitals measure it so they don’t fall outside the protocols. If we want things to change for people living with mental illness, we need to write protocols that explicitly name and address the behaviours that are manifested by structural stigma.”
“In a way, it’s easier to change the mind of one individual,” said Knaak, who has worked to develop many of the MHCC’s Opening Minds anti-stigma training programs. “But what excites me is the ripple effect when you’re doing work to change the entire culture of care. It has the capacity to improve the experience of every person who walks through the door.”
Putting a stake in the ground
Up next for Knaak and the structural stigma team is creating the tools to help organizations plot a course toward improved care. This could include structural stigma report cards, client satisfaction surveys, and other measurement tools.
“It’s all in the service of identifying the barriers and pitfalls that can create such dispiriting and damaging experiences for people when they are vulnerable and at their place of greatest need,” said Knaak. “Essentially, we’re asking people who are working hard within a flawed system to unlearn what they’ve been conditioned to believe and to be open to doing things differently — not only as professionals, but as people.”
Knaak is referring to the way stigma is so imprinted on the DNA of organizations — as well as our own. “It’s like stigma at the cellular level, literally. It’s thrumming below the surface all the time, and it can erupt at any moment with disastrous results.”
When the professional becomes personal
Knaak is familiar with what that looks like. She has watched a loved one try to get help from a system that is not designed to effectively address the needs of a person living with mental illness.
“It’s ironic that my work came home to roost. All the things I was documenting as a researcher were laid bare. I had data points and key informant interviews and hundred-page reports. They all said the system was broken. But when you experience it up close, how it sometimes impedes the healing process more than it helps it along. . . . For me, this work has now become more personal, and more imperative, than ever before.”
When asked what success looks like, Knaak’s answer is surprisingly simple. “I often hear my family members who’ve experienced cancer laud the system for the timely, effective, compassionate care they received. All I want is the same thing when someone experiences mental illness.”
“Surely,” she said, “that’s not too much to ask?”
This is the third in a three-part series on structural stigma. Previously we talked to a care provider and a service user.
Suzanne Westover
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MHCC launches virtual course — delivered by first responders, for first responders
Pauline Meunier
For Pauline Meunier, a paramedic of 26 years, it took a trip to the allergist to give her anxiety a name.
“What I thought were allergic reactions turned out to be panic attacks,” she said. “Before I was asked about anxiety, it never occurred to me that my mental health could be the problem.”
That difficulty in recognizing one’s own mental injury or illness, she explained, is common among first responders, as is the undertone of stigma or self-stigma that may prevent someone from seeking help.
Now, as a training and delivery specialist with the Mental Health Commission of Canada’s (MHCC’s) Working Mind team, and a facilitator for the new The Working Mind – First Responders (TWMFR) Virtual course, Meunier is helping to break the cycle.
“First responders know that taking care of their physical health is critical to performing at their best,” she said. “Through this training, we want them to understand that caring for their mental health is equally important.”
The freshly revamped course is now being delivered virtually (until it becomes safe again to do so in person). Using an evidence-based approach, it gives first responders the knowledge they need to self-assess and also to talk about mental health — including strategies to help them cope with challenges and resources to seek out when they need support. To maximize the material’s resonance, its scenarios and terminology are tailored to each relevant group (e.g., paramedics, firefighters, police), and the course’s facilitators all come from first responder backgrounds.
A mental health pulse check
For those who work in the helping professions, especially in the extreme situations faced by first responders, it can be easier to recognize distress in someone else than in oneself. But the course’s mental health continuum model offers a way to help them do so. It matches a range of thoughts, attitudes, and behaviours to a colour-coded mental health spectrum: green (healthy), yellow (reacting), orange (injured), and red (ill).
For Meunier, that continuum — in the form of a wallet card — led to her own personal breakthrough.
“While attending a presentation, I was staring at the miniature mental health continuum on my table when it struck me — I was deep into the orange and I needed help,” she said. “As paramedics, we aren’t good at putting ourselves first. But as I learned first-hand, the continuum can be an effective tool for all first responders to check in with themselves and recognize when they need extra support.”
Leveraging language
One new component in the updated course is an emphasis on language. Based in part on the MHCC’s Language Matters guide, participants learn the value of using person-first language (where appropriate) as a powerful way to reduce stigma around mental illness and substance use.
Based on research showing that labels like “crazy” or “addict” can perpetuate stigma and discourage help seeking, participants are encouraged to use language that paints a more accurate picture by putting the human first and the condition second; for example, “this person is living with a mental illness or an addiction.”
“In the field, it’s easy to rely on labels as a sort of shorthand for easier communication,” Meunier explained. “But if we make an effort to use respectful language, we can help overcome stigma rather than contribute to it.”
The way forward
While there is still a long way to go in reducing stigma and establishing parity between mental and physical health among first responders, Meunier is hopeful for the future.
“If there’s one group who cares about excelling at their jobs, it’s first responders,” she said, adding that with the help of courses like TWMFR Virtual, the idea that mental wellness is part of that success is gaining traction.
“The most rewarding thing about facilitating these courses is receiving messages from participants who say things like, “it all makes sense now” or “this explains so much.” Those moments of realization can be life changing — I know it was for me.”
To learn more about the benefits of TWMFR Virtual for your organization, contact solutions@openingminds.org
