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From stop gap to solution
Twenty-something years ago, after Y2K did not result in the collapse of the modern world, my university campus general practitioner proposed something radical: while I was waiting for an appointment with specialized mental health services, I could access a newly-developed service that would offer Cognitive Behavioural Therapy (CBT) to me online and from the safety and comfort of my dorm room. More personalized and responsive than simply following along in a book, this interactive website taught me about common cognitive distortions and guided me through exercises to help identify my own patterns as well as combat their negative effects.
It was a decent stop gap, giving me something to keep me going while I waited to speak to a human, but in the days of flip phones, and long before touch screens, mobile data and video chat, the technology was fairly limited.
Fast-forward to February 2020 and I could access nearly the whole world from the palm of my hand, but still conventional wisdom had it that the plush and calming offices of our psychiatrists and therapists were the only places that we could truly get well. There is nothing like face-to-face communication, right?
Then, March 2020. Not a lot of things improved due to the COVID-19 pandemic – and general mental health most certainly did not improve (it suffered, overall) – but one big improvement has been changing the mindset that virtual mental healthcare (e-mental health) is second-rate care. E-mental health services existed before the pandemic, but their availability and use skyrocketed by as much as 3500% as the mental health impacts of the increased isolation hit, and the in-clinic world shut down.
Back then, anxiety-fuelled changes left us resisting the switch and looking only at the negatives, but I see the provision of e-mental health as a definite positive. Do I lament that I cannot look my care team in the eye? That they can’t see me in person and interpret my body language as effectively? That it is hard, in my three-bedroom apartment, to find a safe and private space to have my sessions? Maybe a little. But those drawbacks are far outweighed by three main advantages: cost, access, and stigma reduction.
Three big advantages of e-mental health
1. Cost
E-mental health doesn’t require a brick-and-mortar office for the clinician and increases the number of clients any one provider can connect with, reducing their overhead costs. This often (though, buyer beware, not always!) translates to reduced costs to their clients. E-mental health support is often much cheaper than in-person, making it accessible to more people.
2. Access
Traditional in-person therapy also imposes constraints based on location and time. You have to physically go to a therapist’s office, fight through traffic and find parking (or deal with public transit), wait your turn, and then repeat the process to return to life (work, school, family life) usually within regular business hours. There are many folks who do not have the time for this procedure (including me! And I am privileged to work in a job where I get sick and vacation leave and actually have a car) With e-mental health, you can access your session from literally wherever you are and often even have the option of texting or e-mailing your therapist between sessions, should you need to.
3. Stigma
The final, and I think most important, way that e-mental health improves upon face-to-face therapy, is in reducing stigma. When I received that first referral to mental health services from my campus doctor, I was MORTIFIED at the idea that someone would see me entering the building and immediately know that I had mental illness. That fear – that stigma – is what prevented me from getting the help I desperately needed for so long. And then the thought of having to ask my boss for time off to go to therapy was OUT OF THE QUESTION. E-mental health is totally private and confidential, being accessed from any phone or device, and can be accessed during your lunch break, before or after class or work (due to the beauty of flexible therapists and time zone trickery!) which strikes down the barriers to receiving care that stigma tries to throw up.
It still takes a great deal of courage to access mental health support of any kind due to stigma but seeing consistent advertising and influencers on social media promoting these services serves to further normalize the use of e-mental health because it is more cost-efficient and accessible than in-person services (see points 1&2 above) to more people than ever before.
An effective solution
Now, e-mental health has not been researched as much as in-person healthcare (obviously, since it much newer) and certainly e-mental health is not suitable for everyone. For someone struggling with severe mental illness – like me in the throes of suicidal depression or acute mania – e-mental health may not be appropriate because it cannot provide proximal urgent care (however, more and more services are emerging that provide life-saving crisis care).
For those who are less tech-savvy or less comfortable in the virtual environment, you may find that you are more comfortable with in-person care. And if you are in a more remote region where technological access is an issue, e-mental health may not be as convenient as it is in larger urban centers. But for those who can connect and want to take control of their mental illness – or those who need help bolstering their mental health – e-mental healthcare might be just the ticket. All you can do is try to see if it is for you and remember: any mental health care is better than none.
Studies show that e-mental health can be as effective as face-to-face treatment, particularly since it is so much more accessible by the people needing the help. In the traditional face-to-face mental health system, it can be difficult to locate appropriate treatment, get urgent care (waiting lists – if you know, you know!), and find a service you can afford. Let’s not forget about stigma. As mentioned above, e-mental health interventions reduce these obstacles, allowing anyone to access less expensive, quickly accessible, and confidential services. Still not sure what service to access? The MHCC has you covered with a two-pager on how to make an informed decision here!
Having my psychiatry and therapy appointments shifted to the virtual context has been a huge positive that has come out of the pandemic for me, and I sincerely hope that we never go back to the in-person default that we had before. I have so much less stress now that I can get help virtually more accessibly, efficiently, and with less stigma than ever before. I am much more able now to take care of my mental health and treat my mental illness. The online CBT courses that were cutting edge back when the Spice Girls were “it” were limited, but it was initiatives like that one which put e-mental healthcare into the hands of ordinary people and led to the more comprehensive care that we have now. I’m excited to see where we are 20 years from now…virtual reality perhaps? We’ll see…
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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Is there a right way to grieve—and for how long? Bereavement in the age of COVID is getting a re-think.
Ms. B, age 65, has been feeling intense grief after her husband died of a heart attack. Not only is she tearful when remembering how wonderful he was, she avoids specific reminders of him (pictures, places they visited) to prevent even deeper bouts of misery. She is also angry that he died and has recurring thoughts about mistakes she believes his doctor made. In addition, she feels that the church she belongs to can no longer help, since no one can bring her husband back, and often forgets to take her hypertension medication, even though she knows that doing so is dangerous.
Would you consider what Ms. B is going through normal or something to be treated by psychotherapy or medication? Would your answer depend on how long it’s been since she lost her husband?
Since March 2022, as the pandemic’s third wave was setting in, those questions started to hit home with clinicians for the first time. Why? Because it was then that the American Psychiatric Association (APA) officially placed death-related grief into the realm of pathology with its latest revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR).
Let’s think about what that means. The DSM is the authority for diagnoses and research on mental disorders in Canada, the U.S., and Australia. Ever since it published the DSM-III in 1980, it has adopted a biomedical-brain disease model, directing psychiatrists and clinical psychologists to see mental disorders in terms of symptoms and illnesses, much like a physician diagnoses physical ailments. Despite the fact that scientists have yet to find “a biological cause of . . . any mental disorder,” it would be difficult to overstate the sway of the DSM’s classifications and diagnostic categories on the way clinicians treat people who come to them for help.
12 million people
Before looking at the APA’s reasons for including death-related grief in the DSM-5-TR — under the name prolonged grief disorder (PGD) — let’s first consider its possible effects in light of COVID-19. The international toll of COVID-19 deaths in September 2022, according to data from Johns Hopkins University, was nearly 6.5 million. With each loss affecting about nine others, (the reverberating effect is known as “bereavement multipliers”), we can expect almost 60 million people to have experienced death-related grief as a result of the virus.
That 6.5 million number is staggering enough in normal times. But restrictions in care facilities, hospitals, and indoor gatherings have made both the usual physical closeness during a loved one’s imminent demise as well as bereavement rituals difficult or impossible. Such isolation has surely added an even greater burden for those left behind in terms of dealing with their loss. The APA itself has said as much, estimating that the usual rate (5-10%) of the more intense and longer grief found in PGD may double in the pandemic context at 20 per cent.
With some fast math, we could estimate PGD afflictions at 12 million people worldwide.
No matter what the final number turns out to be, the pandemic has become doubly relevant to the normalcy or pathology of grief. Given that short-term psychotherapy is currently “the treatment of choice,” the decision to enshrine PGD into the DSM-5 as a psychiatric disorder has and will put unprecedented demands on already overburdened mental health professionals.
Cultural complications
The APA considers PGD a type of trauma- and stressor-related disorder characterized by “intense yearning or longing for the deceased (often with intense sorrow and emotional pain), and preoccupation with thoughts or memories of the deceased.” Because in “normal” grief these experiences generally lose their force over time (6 to 12 months), it says that PGD can be deemed to occur when “the duration of the person’s bereavement “exceeds expected social, cultural or religious norms.” In other words, clinicians should only consider grief symptoms as pathological (that is, subject to diagnosis and treatment) after this period of “expected norms” has run its course.
But will they? Putting such weight on a clinician’s judgment about social, cultural, and religious norms has certainly raised questions. One concern relates to applying a universal secular standard to norms which themselves contain values about healthy and unhealthy grief. Kaori Wada, a registered psychologist and the director of training at the University of Calgary’s counselling psychology program, points to a study involving Canadian undergraduates, which found that religious women participants with experience of bereavement were more likely to see the same grief responses the DSM now deems pathological as healthy.
A second issue is the APA’s adoption of a “normal grief period” in relation to social, cultural, and religious norms. This is something Harvard psychiatrist and medical anthropologist Arthur Kleinman questioned in the Lancet as the DSM-5 was being prepared. As he pointed out, “there is no conclusive scientific evidence to show what a normal length of bereavement is. Across the world, societies differ in what they regard as normal grief.”
Wada likewise stresses the newness of the DSM-5-TR’s “too much for too long” criterion, which is at odds with many cultures and expectations; for instance, those that see honour and moral depth in deliberate, enduring grief and emotional pain. She therefore thinks we should recognize the important shift that happens when we begin to fit what was once “understood outside medical language into a treatable disorder, [using a] ‘diagnose and treat’ logic.” By doing so, she argues, the DSM-5-TR “officializes [the idea] that if you’re grieving too long or too intensely, then you have a mental disorder.”
Wada’s concerns extend to the social, cultural, and religious norms designed to restrain the assessment and treatment of PGD. For her, not only are these norms diverse and complex, they are often far-removed from a psychiatrist’s or therapist’s expertise. In her view, the APA’s instruction to apply them puts a “tremendous amount of weight on the clinician’s shoulders.” And since most people in Canada rely on (short visits to) primary care physicians to address their mental health needs, she doubts whether such assessments are likely to be used very much in practice.
What can we expect when clinicians fail in this task of assessment or else ignore it because they feel ill-prepared? The most likely result would be the erasure of any grace period before recommending therapeutic interventions or dispensing medications.
Take this pill and . . .
While no pharmaceutical treatments for grief have been approved, the research traffic light is blinking bright green. That’s because, when the DSM-5-TR established PGD, the APA also changed complicated grief — a previous diagnostic category left out of the DSM-IV due to insufficient evidence and concerns about overdiagnosis — into persistent complex bereavement disorder (PCBD). While doing so, it also defined PCBD as a condition for further study (rather than a disorder in its own right). Thanks to that change, opportunities for new research were endorsed, including studies to establish medications for PGD.
So far, the leading candidate is naltrexone, currently being used to treat opioid and alcohol use disorders. A number of experts have found this opioid antagonist choice surprising. Indeed, the basis for considering it is the theory that PGD is an addictive condition — in this case, addiction to grief itself. So, as with opioids and alcohol, the purpose of naltrexone is to reduce the grieving person’s connection to the deceased. But since this medication does not discriminate which social connections are affected, psychologists have argued that it’s a mistake to reduce those ties at a time when relations to others are so important. They also emphasize that the pharmacological approach itself neglects the context involved in grief; for instance, the grieving person’s relationship to the deceased, the qualities of that relationship, and the kind of death involved (e.g., natural or unexpected).
Donna Schuurman, who is an expert with years of experience dealing with grief in children, youth, and families in connection with unnatural deaths, offers a less reserved critique, seeing efforts to develop a “grief pill” as entirely removed from the human context: “If you yearn or pine too long for your dead child, partner, spouse, or friend, you may be addicted to grief, according to the new revision of the DSM.” As it turns out, the road that has led to the possibility of a grief pill — while paved with good intentions — includes a rather dramatic shift. But to see it requires a bit of context.
A key element to support the DSM-5-TR’s new position on grief is the role played by major depressive disorder (MDD). MDD was initially distinguished from grief in the 1990s through the work of Holly Prigerson, then a professor at the Harvard department of psychiatry. After noticing the difficulty certain people had in resolving their death-related grief, she and others began arguing that this situation called for a new disorder. The point is that the initial justification for what was to become PGD was the discovery of grief symptoms thought to be distinct from those of MDD.
Remember Ms. B from our opening description? Her case was included in a 2010 paper by Prigerson’s colleagues as a way to offer insight into this distinction, since Ms. B’s mood symptoms failed to meet the criteria for MDD (as did her behaviours for post-traumatic stress disorder [PTSD]).
Yet Wada believes that an argument against overmedication — which Prigerson and her colleagues originally put forward to justify the separation of grief from MDD — has now fallen away. One of their key rationales for this distinction was to “spare [people] from being wrongfully medicated.” But today, with PCBD becoming a condition for further study, some of those same MDD medications that were ineffective for grief are being considered as potential solutions for PGD. While Prigerson herself agrees that antidepressants have not been effective for grief, she thinks it’s important to continue learning more about grief in psychiatric terms to help people in such pain.
The way ahead
Supporters of using medications (perhaps alongside therapy) for those diagnosed with PGD insist that “no one wants to medicalize a normal, adaptive process.” Still, a clinician’s assessment of social, cultural, and religious norms as the sole constraint does not inspire confidence that such an aspiration can be achieved. Nor does the DSM-5’s contentious removal of the “bereavement exclusion” from the DSM-IV — which at least provided a two-month grace period before clinicians were supposed to consider symptoms during death-related grief as major depression. Although these shifts occurred in the name of relieving suffering and concerns over the risk of overlooking such depression, Wada points out that the act of “establishing a disorder category enables, even stimulates, further research into pharmacological interventions.”
While, at the policy level, the crux of the debate may rest on values related to the overuse of medication, the path the DSM-5-TR has cleared for the development of a grief pill is hard to deny. No matter where the APA’s new conception of grief takes us, in light of the millions of vulnerable people experiencing longer and more intense grief due to COVID (or the next mass trauma), this new diagnostic landscape will no doubt itself receive longer and more intense scrutiny.
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This blog post discusses trauma
Until recently, I had spent much of the 55 years of my life being chased by my past, staying one step ahead of it. It’s a past I wanted to run from, needed to run from.
In the 1970s, bipolar 2 was called manic depression. It was treated with lithium and sometimes shock therapy. I know this because my father was diagnosed with manic depression in the early 70s. Actually, for me, it was like having three fathers. There was the angry, reckless, violent one, and the sullen, withdrawn one that lies in bed for days, won’t make eye contact and talks about dying. But there was also the well-meaning, hard-working one, the poet who has vision, who loves his kids and is proud of them, and is going to give them a great life.
Learning at a young age to live life walking on eggshells leads to much confusion, doubt, and fear.
When I was twelve I was removed from my father’s custody and moved far away, but I was always nervous, looking over my shoulder – I knew he would come back one day. He did return when I was eighteen. I wasn’t home at the time, but if I had been there, what would have happened? I’ll never know. I do know that, even though I was now bigger and stronger than him, I was still petrified.
He died young, when I was in my mid-twenties – lithium had taken a large toll on his brain. While a certain fear was now behind me, the years ahead would actually be worse for me. His death marked the beginning of three decades of flashbacks, panic attacks, bouts with alcohol, and even the occasional suicidal thought.
How well I hid all of this – most of the time anyway. I dabbled in some therapy, which was helpful, and while I tried hard at various times I really should have stayed with it more. I immersed myself in my career, academics, and athletics – a busy, distracted mind is one that can stay a step ahead of the past.
Until a pandemic comes, that is. In short order, my days went from 95% full to just 5% full. And I was alone – the border was closed so my uncle couldn’t return to Canada. When the initial shock of the pandemic was over, and I couldn’t distract myself by looking outward, I was forced to do what I needed to do – look inward. I’m fairly introspective so once I got started on this path, I gained momentum quickly.
In 2021 I realized the time was perfect to take courses I’ve always wanted to take, but never had the time or energy. I took a writing course, which rejuvenated my passion for writing. And the course I found most transformational was a compassionate listening course – very inspiring. I learned much about spirit and values, and the gift of listening –most importantly, I learned how much more I need to learn!
I also started listening to podcasts. One of my favourites is Oprah Winfrey‘s Super Soul Sunday. I found some of her guests so intriguing I began listening to their podcasts, like Michael Singer for example. There’s no question, 2021 was a year of minor awakenings for me.
Fast forward to January 2022, when I was listening to a Michael Singer podcast about being able to detach from traumatic life events. The message I was getting is how to lean away, to relax when anxiety-inducing thoughts creep in. I could feel it working, I could feel I was gaining more control over my negative thoughts.
I tested it with a few ‘small-t’ trauma events, and it worked – in my mind’s eye, I pictured myself leaning back and away from the thoughts – I could detach from them while I experienced them. The real test, I thought, is the one ‘big-T’ trauma event in my life: the one where my father had to scuttle me out of town for a week.
It worked! I could “watch” the traumatic event “from a balcony in the corner”, instead of from the up-close perspective of a helpless child. Suddenly and all at once, the years of on-and-off therapy, the helpful podcasts, the yoga, my own stubbornness – they all came together in an epiphany. Just like that, I could re-visit traumatic events, instead of feeling constantly forced to re-live them in flashbacks. What a truly liberating feeling.
By February I had forgiven everyone previously on my “unforgivable” list. And I understand now how forgiving someone isn’t a win for them, it’s a win for the forgiver – and that has it’s own special kind of liberation. I realize now that there are no villains in my narrative, just a few villainous acts.
While I still have more psychological tidying up to do, I feel like I have had a real breakthrough, a major step toward peace and fulfillment. To keep that moving forward, my regime includes the following:
- Getting back into yoga. I became addicted to hot yoga about 10 years ago – it feels like a moving meditation, with immense health benefits to both body and mind. The pandemic halted that, plus I moved, so I’m now slowly getting back into it. I’m currently practising regular yoga using YouTube videos (many great ones!) and look forward to getting in into a studio of any temperature soon.
- Learning more and engaging in topics around compassionate listening, kindness, gratitude, spirit, and values. The compassionate listening course I took was transformational for me. Admittedly I’m a novice at these, and I know that the more I learn, and the more I apply my learnings, the more I can evolve and try to help dial down the temperature in our increasingly polarized world.
- Writing about and sharing my story. Until the epiphany, there were many things I couldn’t talk about. And even now, there are a few things I can’t bring myself to talk about. But I can write about them. And I am. Like this blog. I’m also writing a memoir, which I hope to get published next year. I find if I write about it, I stop ruminating about it.
- Focusing more on community and service. Giving back is win-win – it helps someone in need, and it makes the giver feels great. I intend to do this much more frequently. Now that I can talk about my story, I plan to be as helpful as I can to others who are struggling with the same issues I’ve dealt with.
- Seeking therapy as needed. I have admittedly been very haphazard when it comes to seeking therapy; if my anxiety hits certain threshold levels, I seek help. I naïvely thought I was out of the woods when I had my epiphany but writing the memoir has required walking down certain dark and scary corners of my memory banks – this has made clear to me that, while my anxiety levels are much improved, they still exist. So, I plan to be more proactive in managing this.
I realize that, while I may have made great strides and had great awakenings in a short time, it has been a long-term process. All my efforts, everything I did to try to help myself, were all steps to getting me where I need to be. It took me a long time to get here but I never gave up. It takes hard work and dogged persistence to conquer trauma, but I got there, and you can too.
Author: Cam Scholey
An MBA and Fellow CPA, whose career focus has been primarily on strategy and people. In the twilight of a rewarding career in business consulting, teaching university, and writing about strategy, Cam’s future plans include writing, speaking, and teaching more about dealing with trauma, and matters related to fulfillment in life. He is currently writing a memoir.
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Activating an entire school community (parents, peers, education workers) can reduce the nefarious long-term impacts of bullying — a look at promising models to create kinder environments for kids
Bullying, including cyberbullying, is a growing and worrisome epidemic. Not only have one in three children been bullied at some point in their lives, the long-term impact on young people and adults can be life changing. An increasing body of evidence points to its detrimental effects on people’s mental and physical health. Studies also show that there can be lasting impacts in terms of future social and financial outcomes.
“It’s part of life”
Contrary to lingering social attitudes, we now know that bullying is not just an inevitable part of growing up or a harmless rite of passage. Bullied children and adolescents have a much higher risk of developing psychosomatic symptoms than those who escape it. Commonly reported problems linked to bullying include poor health, loss of appetite, sleep disturbances, headaches, abdominal pain, breathing difficulties, and fatigue.
For Eric, it started in elementary school, where the bullies targeting him kept up a relentless campaign of abuse. Its effects, he recalled, included anxiety, headaches, nausea, weight loss, and the absolute erosion of his self-worth. But those weren’t Eric’s only worries. After two years, with no hope in sight, he had reached his breaking point: “I didn’t care whether I lived or died,” he said. His family, desperate to find help, turned to a psychiatrist, who took Eric out of school and put him into intensive treatment. Thankfully, after some time, things turned around for him. In fact, he ended up becoming a kind of champion of the underdog among his peers. Today, Eric describes himself as “lucky.”
A young person being bullied can feel isolated, have trouble trusting people, and lack quality friendships. Should they end up believing that they can’t do anything to change their situation, they may stop trying. This feeling of defeat can also lead to hopelessness and a conviction that there’s no way out, often because they think telling someone won’t change anything. They might also prefer to suffer silently rather than risk escalation or imagine that the bullying will eventually end if they just keep quiet.
As bullied young people become adults, they may continue to struggle with relationships and avoid social interactions. Difficulties with self-esteem and trusting others can undermine significant personal relationships as well as their social and work lives. Victims of bullying also have a greater risk of emotional disorders in adulthood, including depressive and anxiety disorders, panic disorder, generalized anxiety, and suicide.
“There is clear evidence that a wide range of childhood adversity has long-term negative effects on both mental and physical health,” said Dr. Keith Dobson, a professor of clinical psychology at the University of Calgary. “Further, the emerging literature demonstrates a strong linkage between bullying and later depression and other health problems.”
Role modelling
Why does bullying still happen? Many experts point to the lack of a systematic approach to tackling the problem in schools. For a long time, it was left to teachers to address bullying behaviours — and for that to happen they would have had to witness it. Beyond that, the responsibility for reporting the problem was often left to the student, which meant that much of it was never reported.
Enter proactive bullying prevention.
The research on anti-bullying interventions is extensive, with numerous school-based programs having been evaluated scientifically. Some, like the KiVa program in Finland, focus on mobilizing the bystanders who witness bullying. These work through the power of peer responses to inhibit or fuel such behaviour.
Other programs seek instead to actively create a kinder school environment. The most prominent of these, the Olweus Bullying Prevention Program, is also one of the most widely tested. Developed by the late Swedish-Norwegian psychologist, Dan Olweus, it’s rooted in the idea that bullying is often the product of a wider culture’s tolerance toward victimization. On that basis, it tackles bullying from the perspective of a school’s entire ecosystem.
Olweus therefore works by changing the social climate around bullying: raising awareness among students, adopting anti-bullying norms, and having teachers clearly communicate their anti-bullying attitudes. But it also goes beyond the student-teacher dynamic. Every adult in the school gets basic training about bullying — not just educators and administrators — but cafeteria staff members, bus drivers, custodians, and others.
The program is effective when all these adults function as positive role models, reinforce good behaviours, and refuse to allow victimization. As part of this process, clear expectations are set for acceptable behaviour, as are the consequences of failing to abide by them. In ending their support for the culture of secrecy around bullying, each person helps to create an environment where reporting it is appropriate and expected. When saying no to bullying becomes everyone’s responsibility, it is soon ingrained in a school’s culture.
The research strongly supports the success of whole-school programs to decrease bullying behaviours. In fact, a recent study of 69 randomized clinical trials concluded that such interventions not only reduce the incidence of bullying and victimization but also improve the mental health of students.
A kinder community
When parents commit to the prevention of bullying, especially if they actively participate, a school program will be more successful. Parents can set a good example by getting involved, raising awareness, and supporting anti-bullying measures.
But since bullying is not confined to school corridors and the playground, and not all children who are bullied ask for help, parents and caregivers should also be on the lookout for warning signs. These include unexplainable injuries; lost or destroyed clothing, books, electronics, or jewelry; frequent headaches or stomach aches; feeling sick or faking illness; or changes in eating habits (like suddenly skipping meals or binge eating). In this last scenario, kids may be coming home from school hungry because they didn’t eat lunch. They may also have difficulty sleeping or frequent nightmares, declining grades, loss of interest in schoolwork (or not wanting to go to school), sudden loss of friends or avoidance of social situations, feelings of helplessness or decreased self-esteem, or self-destructive behaviours such as running away from home or harming themselves.
As well, parents can empower their children to stand up to bullies. Start by talking about what bullying is and what healthy friendships are and are not. Children themselves can also learn how to report bullying when they see it. Here, it’s important that parents help them understand why they don’t want to be a bystander and offer them practical knowledge on how to handle the situation. Taking such steps can make a big difference in the outcome.
Programs such as HEADSTRONG, offered by the Mental Health Commission of Canada, can also play an important role in supporting healthy school environments by providing students and youth the tools, confidence, and inspiration to become leaders for mental health and wellness in their schools and communities.
While bullying can have long-term negative effects, it doesn’t have to, according to Dobson. What is important is to act and intervene for the sake of others and yourself. If you know of a child who is being bullied, try to understand what’s going on and intervene if doing so is indicated. If you’ve been bullied and are living with the ongoing consequences, resources are available to help you improve your well-being.
Nicole Chevrier
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First Nations First Aiders support individuals and strengthen communities
Those who teach Mental Health First Aid in First Nations communities have lived experience with trauma. Roger Chum’s experience is a stark example.
“I have a personal story,” said Chum, a member of the Omushkego Moose Cree First Nation near James Bay, and a residential school survivor. “I tried to take my life, too, as a young man because of all the trauma I was walking with.”
He was saved with the support of others, and now, years later, he’s a counsellor in the First People’s Centre at Canadore College in North Bay. He also travels to communities across Canada to co-facilitate sessions in the Mental Health Commission of Canada’s (MHCC’s) Mental Health First Aid (MHFA) First Nations program, where he sees reflections of his own pain in others.
“The common themes in all the training I’ve done — in communities from B.C. to Nova Scotia to Prince Edward Island to Ontario — seem to be suicide, racism, and discrimination that people face when they’re trying to walk in two worlds, trying to live in general Canadian society but keeping their cultural and Indigenous identity at the same time, trying to balance that,” Chum said.
He estimates that he’s trained about 2,700 people to be Mental Health First Aiders since the mid-2010s, when he completed training to be a MHFA First Nations co-facilitator. In turn, those First Aiders have gone on to support thousands of people in their communities. When those who receive support to help survive their own psychological turmoil go on to help others, it creates a cycle of support that strengthens entire communities.
What sets MHFA First Nations apart
Today, about 70 First Nations co-facilitators provide MFHA training across Canada, primarily in First Nations communities but also elsewhere. Chum, for example, continues to conduct sessions for members of the Greater Sudbury Police Services, most of whom are non-Indigenous.
MHFA is a series of actions that people can take to support those who may be experiencing a crisis or decline in their mental health. While the commission offers various MHFA programs, none are quite like MHFA First Nations.
The MHCC conducts regular reviews of the course. A recent update adapted its broader objectives beyond regular MHFA training, which is very much about the skills participants might use and the actions they might take to support someone whose mental health is declining.
Some areas of the MHFA First Nations coursenow have a lot to do with building community through activities that engage the group as a whole and addressing systemic issues that have impacted First Nations people more directly — things like social determinants of health, systemic racism, and colonization.
Learning to train Mental Health First Aiders
The program’s ongoing success relies on two First Nations master trainers, Amanda Petit and Mary Wabano-McKay. These trainers teach the course First Nations people take to become MHFA co-facilitators, who in turn teach community members to be Mental Health First Aiders.
“I couldn’t imagine taking a course such as MHFA First Nations and having it delivered by a non-Indigenous person,” said Wabano-McKay, a Mushkegowuk (Cree from Attawapiskat First Nation), who lives in Sault Ste. Marie and works for Algoma University as vice-president of Nyaagaaniid — student success and Anishinaabe initiatives. “How could they relate to the lived experience and life experiences of First Nations people without having that lived experience?”
She added that Indigenous master trainers “serve as positive role models in communities among our peers and colleagues to show that not only did we inherit a lot of loss, grief, and trauma, we’ve also inherited resiliency, strength, and determination. Those things are imbued in the co-facilitators that deliver the MHFA First Nations course across the country.”
To become a co-facilitator, candidates go through 20 hours of group instruction, then spend two days working one-on-one with master trainers to go deeper into the material and demonstrate that they can deliver the MHFA First Nations course. To be accredited as a co-facilitator, they must complete further requirements within one year.
Impacts, obstacles, ways forward
The course content to become a co-facilitator can be disturbing, Wabano-McKay pointed out. In addition to going through the colonial legacy of TB hospitals, residential schools, the 60s Scoop, and other intergenerational traumas, it covers “how all of these are continuing to have serious impacts on First Nations people, on overall wellness, on mental health — from anxiety and depression to substance use and psychotic disorders.
“Such material can often be triggering for those who take the course,” she said, which is why co-facilitators are on site when an MHFA First Nations workshop is held. Community Elders are also invited to provide further support to participants, as needed.
Another potential obstacle for co-facilitator training is for candidates to get past their own stigmas about mental health and understand that everyone has it.
For co-facilitator Laurie Belcourt, a Treaty 8 Nations of Alberta employee from Bigstone Cree Nation, the course was a revelation.
“It changed who I was,” she said. “The way I think about people, the way I interact with people, it’s different. I’m a lot more understanding, I’m a lot more empathetic. It’s helped me understand that people have mental health problems. They’re not just looking for attention; they just don’t know how to deal with what’s going on.”
Through the MHFA First Nations course, Belcourt passes on that empathy and understanding to help First Aiders learn how to recognize mental health struggles in their communities, perhaps in their own families or circles of friends. “You’re that bridge between where they’re at, and where they need to go,” she said.
Co-facilitators are not there to provide professional care. Rather, their task is to listen and provide support in the moment, much like physical first aid. The next step, said Wabano-McKay, is to “connect the person to appropriate professional help and explore other supports people may have within their community. We let them know that their role as Mental Health First Aiders is to be that go-between, to give somebody that opening to be able to say, ‘I’m not okay, and I need some help.’”
Because every First Nations community has its own history, all of these interactions are carried out while respecting each tradition and culture. As Chum puts it, we’re always finding that “their food is different, their ways of knowing are different, their culture is different. We’re a very diverse people right across this place we call Turtle Island.”
Mental Health First Aid is provided to a person developing a mental health problem, experiencing a mental crisis, or a worsening of their mental health. More than 500,000 Canadians have been trained since 2007 and you can as well. Find a MHFA course online or in person.
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I was diagnosed with bipolar II disorder, exacerbated by postpartum depression shortly after my son was born. When I first heard my psychiatrist say I was diagnosed with bipolar I did not want to believe it. I had preconceived notions that people living with bipolar are scary, unstable, hyperactive, have split personalities and are not able to function in society. How could I be diagnosed with something like this? It did not make sense to me that a partner, mother, and teacher like myself would be diagnosed with bipolar disorder. My own stigmas surrounding mental illness and bipolar disorder stopped me from accepting the diagnosis. I was ashamed of this disorder and wanted to hide it from others that way I had been hiding it for all these years.
Accepting my diagnosis
It took a while for me to truly understand and accept my diagnosis. Months of therapy with a counselor and my psychiatrist plus the proper medication, helped me realize that I had actually been living with undiagnosed bipolar for a long time. I had been functioning with this disorder by putting a mask on for my audience. I finally decided to take off the mask when my son was around 5 months old. I was tired of hiding who I was and wanted to share my story with friends and family. My wish was that by sharing my story it would help other people living with mental illness know they are not alone. For months, I kept dragging my feet about sharing my story. I worried about what would people think of me and if they would accept me after they found out I have bipolar disorder. And this is what stigma is all about. Worrying about what others would think of me and keeping my story hidden was contributing to the stigma surrounding mental health.
For the most part, talking about mental health is not a part of our everyday lives. But what if this wasn’t the case? What if we could share that we have a mental illness without worrying? What if it was as easy as saying what you had for breakfast that morning? Mental illness is not something that people choose. After I wrote about my experience with being diagnosed, I decided that I would become an advocate for mental health whenever I got the chance. I no longer wanted to stay quiet about my diagnosis because I have been wearing a mask for too long. I started writing to different publishers and speaking up to friends and family whenever I got the chance.
Breaking the silence
Stigmas are still strong in our society but the more we bring up the subject of mental health, the more we can begin to break the stigmas. I remember sitting at a baby mommy group that I have attended for several months. The group facilitator always started off each baby class with a light ice breaker question, asking us about our favourite movie or where we would like to travel. The moms and I always shared lighthearted answers to these questions. One day the facilitator asked us to tell the group about one thing no one would ever guess about us. This was my chance to break the stigma and share about my bipolar. I went back and forth with this idea while other moms shared their very tame and predictable answers. Finally, it was my turn and I nervously said, “something that you would never guess from me is that I live with bipolar disorder”. As I looked around the room no one was saying anything or making eye contact with me, it was something that no one was expecting to hear. The facilitator thanked me for being brave enough to share this with the group, and she told me how more people needed to do this. By letting others know your journey we can start to break the stigma.
Mental health doesn’t have to be the elephant in the room. I am proud of the accomplishments I have had while dealing with a bipolar diagnosis. This diagnosis is no joke and for people to lead successful lives while dealing with an often-debilitating illness is amazing. Having spent some time on social media platforms, I have found that there are strong individuals sharing their stories. The stigma of mental health is diminishing because people are brave enough to talk about it and share. They are not sharing for attention; they are sharing for connection. When we connect with someone who shares our mental illness it gives us hope. Hope that we can survive and live with our mental illness every day. Our mental illness does not have to define us. So, if you are hesitating about sharing your story just do it; you’ll be glad that you did. Sharing your story with even one person who is going through what you are going through can make all the difference and is one step closer to helping break those stigmas.
Author: Jamie Rose
A longtime elementary school teacher and a mother to a beautiful one-year-old boy. When her son was born, she was hospitalized and later diagnosed with bipolar disorder, exacerbated by postpartum. Jamie vows to advocate for mental health awareness and to continue crushing the stigmas. In her spare time, Jamie can be found playing volleyball, walking her dog, and listening to 90s rock music.
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Using person-first language to make an important distinction
This article is part of the Catalyst series called Language Matters.
When talking about mental health, the language we use falls into two broad categories: person-first or identity-first. At the Mental Health Commission of Canada (MHCC), we typically use and recommend person-first language, but that choice may not apply in all situations.
What’s the difference?
Identity-first language leads with the illness or condition as opposed to the person experiencing it. For example: “schizophrenic person” uses schizophrenia as a descriptor before referencing the individual. Conversely, person-first language focuses on the individual while de-emphasizing the illness or condition. So, in this instance, if using person-first language, you could say, “an individual who lives with schizophrenia.”
The language used to talk about mental health or substance use can play an important role in reducing — or reinforcing — stigma. By focusing on the individual, person-first language underscores the fact that a diagnosis is only one component of someone’s overall being. It also shows respect for an individual as a person rather than as “abnormal,” “dysfunctional,” or “disabled.” For that reason, it is considered less stigmatizing and is often preferred in the mental health and substance use context.
That said, it’s important to bear in mind that this preference is not universal. As one friend explained, “I don’t live with bipolar disorder. It’s not my roommate.” For her, using identity-first language — “I’m bipolar” — better represents how deeply intertwined the condition is with every aspect of her life, while person-first language has a minimizing effect.
For others, identity-first language is rooted in the relationship between their personal and cultural identities and their condition. For example, deafness, which has a rich culture unique to those who share the experience, often emphasizes abilities over disabilities. In that case, “deaf person” might be preferred over “person who lives with deafness.”
How to choose?
In an American Psychological Association survey of 3,000 individuals living with a range of conditions, 70 per cent chose “person with a disability” when asked about the language that best describes them. “Disabled person” was chosen by just eight per cent.
When writing, the MHCC recommends person-first language as a first choice, unless you know that an individual or group describes themselves otherwise. When talking to a person with lived and living experience, listen for or ask them about the language they use. It’s not about getting it “right” on the first try. It’s about listening, learning, and championing the use of respectful, non-stigmatizing language — whichever form that takes.
Amber St. Louis
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Educators play many roles and are increasingly called on to support youth mental health. Organizations are responding by equipping teachers with Mental Health First Aid training and tools.
In Canada, mental illness affects more than 1.2 million children and youth. By the time they reach age 25, that number rises more than six-fold to 7.5 million. These figures show just how much the early years provide the foundation for mental health and resilience throughout a person’s life. Since the start of the pandemic, concern over the mental well-being of youth has increasingly been a topic of discussion, particularly with the disruption of their routines.
Yet, as young people navigated from online school and back to in-person classes, the enormous pressure teachers have felt to develop additional skills for handling this mental health crisis has also affected their well-being. According to a June 2021 University of British Columbia survey, about 80 per cent of teachers reported experiencing moderate (56.7%) or serious (22.9%) mental distress.
As a result, the Toronto District School Board (TDSB) and the government of Saskatchewan have been investing in mental health training to give teachers the necessary tools to maintain mental well-being — for themselves and their students.
“As education workers, we work to educate Canada’s future generations,” said Mara Boedo, an executive officer with Toronto Education Workers (TEW), whose 17,000 CUPE members (local 4400) include TDSB employees. “This means that every positive change we can help our members make will impact the students in their care — and this will stay with them for the rest of their lives.”
The TDSB, which serves nearly 250,000 students across the district, has been investing in The Working Mind (TWM) since 2018. The course’s stigma-reduction focus is designed to promote mental health in the workplace by giving participants tools designed to assess their own mental wellness, identify signs and symptoms, and develop healthy coping strategies.
Mara Boedo
Teaching the teachers
After taking TWM, one participant’s recovery from mental distress became noticeable to others, including her family doctor, who asked, ‘What are you doing differently?’ “I have a new vision for myself,” she said. Through the course, participants work on changing behaviours and attitudes around mental illness by discussing resiliency, investing in their mental wellness, and exploring stigmatizing attitudes.
The participant was sharing this story with her TWM facilitator Cherill Hiebert, which led her to remark on the importance of teaching others about the small steps anyone can take to improve their mental well-being — rather than waiting until it gets to the point where a person needs professional help.
“That was the most powerful thing I have heard,” Hiebert said. “Without the program, that person would have had no vision because she had no hope.”
For these organizations, TWM signifies a proactive approach to their members’ mental well-being. But what happens when it’s too late for proactive measures? How can teachers prepare for a mental health crisis developing right in front of them? These have been long-standing questions for the Saskatchewan government.
Cherill Hiebert
Preparing for crisis
In December 2020, Saskatchewan announced a $400,000 commitment to provide Mental Health First Aid (MHFA) training to at least one staff member in each school in the province. MHFA enables individuals to provide help for someone who is either developing or going through a worsening mental health problem or experiencing a mental health crisis. Just like a person might provide physical first aid until medical treatment is available, MHFA is given until appropriate support is found, or the crisis is resolved.
When this funding was announced, Education Minister Dustin Duncan encouraged all the provinces’ school divisions to help remove the stigma around mental health. Such strong ministry support paved the way for coordinating training in 733 schools for 926 staff members. Every division now has MHFA responders with specific knowledge to support youth when they need it.
A hopeful future
These efforts to provide a more inclusive and sustainable approach to mental health in educational environments do not stop there. The National Standard of Canada for Mental Health and Well-Being for Post-Secondary Students, created by the Mental Health Commission of Canada (MHCC), enables academic institutions to better support students and integrate mental health into their services and systems. A starter kit to help them align their policies with the Standard and reaffirm their commitment to student mental health has now been downloaded more than 2,000 times, in settings of all sizes across the country. The Standard has also helped institutions continue their emphasis on student voices and perspectives, as we’ll see in a video series this fall where students will discuss mental health in post-secondary institutions.
The range of resources the MHCC has developed for the education sector is at the forefront of mental health and well-being for students, teachers, and faculty alike. One other example available to individuals and institutions is The Inquiring Mind Post-Secondary, an evidence-based training program to promote mental health and reduce stigma around mental illness.
Putting the right tools in hands of the people who educate Canada’s youth allows this impact to spread. In reflecting on the training and feedback received from participants, Boedo notes, “We are not only changing people’s lives, but we are also learning to change the way we approach the situations that are outside of our control.”
MHCC training programs are designed to increase mental health literacy, reduce stigma, and provide skills and knowledge to manage potential or developing mental health problems. To find courses and learn more, visit the MHCC Mental Health Training page.
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The pandemic has been a stressful event for most of us. Being locked away at home, away from the hustle and bustle, triggered a few emotions for me. Adjusting to the “new normal” has not been easy, it has been a strenuous process. However, I decided what I would prefer to learn from the entire experience is that the pandemic prompted deeper conversations about mental health. It highlighted the importance of mental health issues and coping strategies. I believe it encouraged people to come forward, providing them with a safe space, and allowed them to address their unsettling experiences and feelings of despair.
Two years of isolation not only highlighted the importance of preserving one’s mental health but led to mental health care services becoming available to a wider population. Online therapy and counselling are now a cost-efficient method of delivering interventions remotely. Online psychotherapy is a relatively new realm with benefits and drawbacks. However, I think it is the first step towards a more affordable and accessible mental healthcare.
I have always been intimidated by the idea of getting into a therapeutic relationship. It is not my lack of faith in professional assistance, but rather a fear of dealing with emotions that follow, my incapacity to control my thoughts or even work through the process of healing. Despite being a student in this field, acknowledging my struggle with maintaining my mental health has not been easy.
At the end of last year, I decided to start with therapy. It occurred to me that the first step of healing is to accept that you are experiencing a range of emotions with which you are not entirely comfortable. Next is to know that help is available, and lastly, it is to encourage oneself to depend on mental healthcare as long as it is needed.
Being attentive to our mental health is just as important as ensuring our physical wellness. As someone new to therapy I would say, it is necessary to value and embrace the emotions brewing within us, whether they are perceived as good or bad. Relying on assistance is not a sign of weakness but of strength. It is important that we treat ourselves with the warmth we deserve.
Author: Riya Mitra
A recent clinical psychology postgraduate student. She loves to research the realms of mood disorders, learning disabilities, trauma and grief, and the socio-cognitive approach in psychology. She is passionate about mental health advancement and inspiring a change in how we perceive mental illness and psychological intervention. In her spare time, Riya can be found writing, reading the works of female poets, or watching cinema.
