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A national suicide prevention number – to launch in November 2023 – will bring 24-7 support to everyone
You’re a single mother in downtown Ottawa, off work due to COVID and distressed that you can’t cover the costs of rent and feeding your family. You’re an Indigenous teenager in northern Alberta trying to escape an abusive relationship. You’re a middle-aged man in New Brunswick who hasn’t told anyone how deep your depression is, and you feel like you can’t fight your suicidal urges anymore. You’re a refugee in small-town Ontario whose first language is not English, and you are experiencing frightening flashbacks to traumatic experiences of war. You’re a nurse in Vancouver, demoralized by the anti-vaccine protestors shouting at you as you go to work, where staffing shortages have brought you and your mental health to the breaking point.
Who do you call?
If you’re lucky, you’ll find the compassionate ear of a well-trained helpline counsellor in your community, who’ll listen as you tell your story, determine your level of suicide risk, de-escalate your stress, and connect you with the resources you need to get through this challenging moment in your life and set you on the way to long-term solutions and better times.
Still, in your state of mind you may not know where to turn. You might feel ashamed or embarrassed to admit you need help; or worse, you could be having suicidal thoughts. You might not feel up to searching for a 1-800 number — maybe you don’t have easy access to the internet and don’t know what supports are out there.
But what if we had a national three-digit suicide emergency helpline that everyone knew as well as they know 911?
That idea has been under serious study and development in Canada for several years, with enthusiastic support among suicide prevention experts, mental health professionals, and politicians at every level of government. Countries like the Netherlands and the United States have implemented a three-digit number, and in Canada a suicide hotline – 9-8-8 – will be accessible in all parts of Canada by the end of 2023.
According to Statistics Canada, about 11 people a day — 4,000 a year — take their own lives in this country. While the causes and circumstances vary, each loss is a tragedy that, for a host of unique and complex reasons, wasn’t prevented.
As the pandemic has unfolded, distress centres throughout Canada have been reporting higher numbers of people calling for help, particularly around addiction, job loss, the effects of inflation on the cost of living, and food insecurity. For those in the prevention field, a national suicide emergency number makes more sense than ever.
“The concept is widely accepted,” said Sean Krausert, executive director of the Canadian Association for Suicide Prevention (CASP). Based in Canmore, Alberta, Krausert was among many in the suicide prevention field in Canada (and internationally) consulted by the authors of Considerations for Implementing a Three-Digit Suicide Prevention Number in Canada, a 2021 MHCC policy brief that reviewed relevant literature and information.
“It’s more the logistical issues of putting this in place that will take time,” he said. “There needs to be a great degree of awareness in the public and strong funding to create a national service.”
Given Canada’s vastness and diversity, launching and maintaining a three-digit suicide prevention number is a complex task. Not only must such a service be built on the principles of equity and cultural inclusion, but it must also have a consistent technological infrastructure.
For example, for 9-8-8 to function from coast to coast to coast, 10-digit dialing needs to be in place where 7-digit dialing is still the norm, such as in Newfoundland, Labrador, northern Ontario, and Yellowknife. The Canadian Radio-Television and Telecommunications Commission (CRTC) says it may take until November 2023 to make the transition to 10-digit dialing in those locations. When the 9-8-8 system is up and running, all calls and texts to 9-8-8 will be directed to a mental health crisis or suicide prevention service, free of charge.
Additionally, access to well-trained counsellors must be made available 24-7 in every region of the country to serve diverse needs and to ensure that the help people require can be provided — whether they live in an urban centre or remote area, are young or old, speak English, French, or another language, or suffer from addiction, abuse, or mental illness. That means having one number for anyone in a suicidal crisis to connect to, no matter their walk of life, or their circumstances.
“Like a lot of guys, I always thought that whatever I had to deal with in my life, I would deal with it alone,” said Érick Légaré, in a 2019 video for the Association québécoise de prévention du suicide. Légaré, now 50, attempted suicide at age 45 and is grateful for the help he found when he was struggling. Today he has an urgent message for those who are feeling suicidal: “If you need help, know that it’s out there. You just need to let go and accept it. Talk to someone.”
Clearly, a national suicide helpline is a valuable addition to the supports already in place at the local and regional levels in Canada. “Whatever service it is, it is essential to provide immediate mental health supports 24 hours a day to the people in distress who call in,” said Andrea Poncia from Ottawa’s Community Suicide Prevention Network, who also pointed out that, for a national phone line to be effective, “funding has to be scaled up and maintained long term.”
Leslie Scott, manager of media and communications with the Distress Centres of Ottawa and Region, agrees that a national three-digit suicide emergency phone service is a good idea, and, once implemented, could take pressure off local non-profit distress centres.
“COVID has been intense,” said Scott, with more calls to the service than ever before. To succeed, a national service will need a “huge marketing campaign” to make sure people know it exists and understand what it provides. Like Poncia, Scott believes funding is essential for training those answering the phones, so they’re competent in best practices for helping a person in a suicidal crisis. Phone counsellors at distress centres in Canada now receive Applied Suicide Intervention Skills Training (ASIST), which enables them to offer “suicide first aid” to anyone who needs such support. National phone line counsellors will also need that, along with solid knowledge of what services are available to whoever calls, wherever they may be. That will enable them to triage and direct people to the appropriate help, both short and long term. An Indigenous teenager in Alberta will need something different than a middle-aged man in New Brunswick, an elderly farmer in rural Ontario, or a recent refugee of war with PTSD whose first language is not English.
“You need people who know how to actively listen,” said Scott. You have to be able to gauge a person’s mood, get into the nitty gritty with them. You need to be able to get to the heart of their story.”
The creation of a national three-digit suicide emergency hotline also serves another critical function: reducing the sense of stigma people may feel about asking for help or admitting they have a mental health concern. Scott notes that those taking the first step toward getting support may internalize stigmatizing language and perspectives.
“Unfortunately, some people still think that if they call for help, they’ll be taken away to the ‘loony bin.’ But of course, that is not the case,” said Scott. Knowing that there’s a phone number that anyone in Canada can use, any time, should contribute to the awareness that every human being goes through struggles, help is available, and you are not alone.
Karen Letofsky, one of Canada’s leading experts on suicide prevention — she became an Order of Canada member in 2007 in recognition of her years of service in this field — said the idea of a national suicide prevention number is something leaders in the distress centre community have championed for many years, getting started on partnerships to push the idea into reality in 2015. “We knew we needed a reasonable plan, and some pilot money. Once we had that we could start organizing. It’s been an ambitious goal to build capacity. If you increase access to a service like this, it means you need adequate resources and proper staffing to ensure success.”
It’s “a massive undertaking to provide universal access to a national suicide number,” she added, “but it’s definitely a worthy goal that will normalize asking for help.” While the many details surrounding funding, technological infrastructure, linking services, and training across the country are being worked out, Letofsky is optimistic that the partner organizations will continue to develop the best model for Canada.
Organizations that have been working with the MHCC and CASP include the Canadian Mental Health Association, the Centre for Addiction and Mental Health (CAMH), the Public Health Agency of Canada, Veterans Affairs Canada, and Kids Help Phone. Together, they’ve also consulted with organizations such as 113 Suicide Prevention in the Netherlands and the Substance Abuse and Mental Health Services Administration in the U.S., which also has a hybrid model that lets people choose to either text or phone the three-digit number.
More than anything, said Letofsky, the key to providing a quality service will be to ensure that those who answer the phones are “responders who are well trained in listening.”
It’s that one-on-one connection made between a caring human being and another in distress that’s critical. “Let’s not get caught up in numbers, statistics, and algorithms. Every person is unique. We don’t want to lose the personal story.”
The MHCC offers webinars, toolkits, learning modules, and a range of other resources on its Suicide Prevention page.
Moira Farr
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This blog post discusses trauma.
When I was sixteen, I ran away because it wasn’t safe at home. I couch surfed, stayed with friends, lied about my age to stay in a shelter, and rented squalid rooms in boarding houses. Eventually, I found a place to stay with some people in a derelict house. My rent was $35 per month. I slept on the floor and kept my clothes in garbage bags. I couldn’t afford cardboard boxes.
I fell in with a bad crowd, the kind of people who gravitate toward and use vulnerable young people. Because I had nowhere to go, I became enmeshed in that situation, a place far too adult for an immature person who was lost. It was a dark and insular world, filled with shadows, secrets, half-truths, and shame.
I managed to keep going to school, and for a while, I kept up the pretence of normal. But after some time of going to school on a few hours of sleep, sometimes hung over with substance use, things started to slip. And even though I looked sleep-deprived and usually went without lunch, what caught the attention of the school guidance counsellor was my free-falling marks. What interested him most was my academic plunge, but he did not think to ask me about my situation. Or maybe he thought of asking and decided not to. “Pull yourself up by your bootstraps” was his advice to me.
For all sorts of reasons, I was falling through the cracks of the system. I craved the help and guidance of adults and could find no way to ask for it. The shame kept me silent. Only one of my teachers, a nun, noticed that something was wrong or chose to notice, and reached out. What if she hadn’t?
It’s been a long journey from there to here. From balancing on an abyss to a solid footing.
It might seem like stating the obvious, but living this way is not good for your mental health. I want to share what I wish I had known then and the lessons I learned the hard way.
- Just being here is a miracle in itself. The odds of coming into this world are mind-boggling and almost impossible. Always remember this, no matter how hard things get.
- You are the expert on what you feel and what you need.
- Being a people-pleaser will drain you of your energy and vitality faster than anything else.
- No-one will understand you and that’s not really important. What is important is that you understand you.
- Being judgemental is based in fear. A day spent judging yourself and others is an exhausting day.
- Don’t count the days. Make the days count. Stop saying you don’t have time.
- Get clear on what is important to you and ruthlessly direct your time, attention, and energy to that. Don’t get co-opted by someone else’s agenda unless you choose to.
- Perfectionism is the fastest and surest road to unhappiness. Constantly seeking approval and being a slave to perfectionism is based in fear.
- Don’t be afraid of your uniqueness. Show the world who you are.
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Navigating the transition from full house to empty nest
One of the main ironies of parenting is that your job is to make yourself irrelevant. Babies are born, children are nurtured and grow up, and then one day — eventually — most are independent enough to move out of the family home.
At least that was a typical trajectory in Canada. These days, the transition isn’t always so linear. Economic challenges such as the high cost of housing and precarious employment, as well as socio-demographic shifts like the need for more post-secondary education, mean so-called “boomerang” kids leave and then return, sometimes repeatedly.
For the parents who are left behind, whether temporarily or forever, this passage into the next phase of life can be difficult to navigate. Yet, as a parent, it also represents an opportunity to renew relationships with yourself, your partner, your friends, and your family, including the child or children who are making the leap into their adult lives.
My wife and I are on the cusp of this change: Our twin daughters will be starting university this fall. To help prepare for this double departure, Lisa and I are spending a lot of time talking to friends, neighbours, and colleagues whose children have already left or are about to leave home.
One friend told us that her kids moving out changed her life more profoundly than when they were born. Another, whose father-in-law moved in after his daughters went to university, talked about the sense of flux in his household, with caring for aging parents also affecting the configuration of his nest. My own mother cautioned me that our house might feel like a train station for a while: you won’t know who’s coming or going, or how long they’ll stay.
Next station
Although the range of reactions and circumstances varies greatly, as a whole what people told us reflects research findings and advice from mental health professionals. For Simon Fraser University gerontology and sociology professor Barbara Mitchell, the “stereotype of the empty nest syndrome has largely been debunked as a cultural myth.” She takes a matter-of-fact view of this and other major changes in life. That is, to approach the empty nest phase as one of many junctions in a fluid existence while staying mindful and ready for whatever might follow.
Mountain biking in Charlevoix, Quebec: The author with Daisy, Lisa Gregoire, and Maggie. Transitioning from full house to empty nest is an opportunity to renew relationships with yourself, your partner, your friends, and your family, including the children who are making the leap into their adult lives
“Most parents actually find it to be a positive experience,” Mitchell says. “They’ve done their job and are now free from day-to-day responsibilities. They’ve established roots for their children — and wings — so they can become autonomous adults.”
Despite that general trend, if rooted in a traditional mom-as-homemaker role, some women feel a strong sense of loss when the kids leave, as of course do some men. While this sadness and disorientation (commonly called “empty nest syndrome”) are often short-term, she points out that about 20 per cent of parents struggle with it, and in extreme cases it can require intervention.
Mitchell, who has been researching family transitions since she was a graduate student in the mid-1980s and is perhaps the only academic in Canada with this expertise, notes that the empty nest is a relatively recent phenomenon in North America. Historically, at least one child regularly stayed with aging parents, especially in rural areas. But as our population became more urban, as life expectancies rose, and as the affluent middle class boomed after the Second World War, mothers and fathers increasingly found themselves alone in their later years.
Of course, parents from what she describes as “collectivist cultural groups” often have entirely different experiences, such as remaining within a multi-generational household or viewing the departure of a child for education or marriage as a sign of success. “The context of the family environment is important,” says Mitchell. “There are many potential complexities.”
Among these complexities are compounding stressors like health issues or retirement, which can exacerbate negative emotions.
Mental health and wellness in Canada is in fact influenced by numerous factors, including life experience, workplace, and family environments, and social and economic conditions that fundamentally impact our well-being.
Edmonton psychologist Loriann Quinlan, who specializes in treating adults with anxiety and has helped clients with empty nest syndrome and other life transitions, knows that every individual and family experiences this change differently. And since it can be accompanied by a range of emotions, from sadness and grief to excitement and joy, she advises clients to approach the process without judgment, to sit with any discomfort, and to engage in self-care.
Taking the time to become better acquainted with yourself, your partner, and others in your circle can be healthy, she says, because as parents we invest a tremendous amount of time and energy into relationships with our children. No wonder we’re knocked adrift and feel empty when such a critical part of our identity — for so many years — is no longer clearly defined.
As parents, we invest a tremendous amount of time and energy into relationships with our children. No wonder we’re knocked adrift and feel empty when such a critical part of our identity — for so many years — is no longer clearly defined. —
Making the shift
This transition also offers a chance to appreciate the perspectives of the young adults who are leaving and taking steps toward independence.
“It’s an amazing opportunity for parents and kids to see each other through a new lens,” Quinlan says, “and to shift the dynamic and hopefully connect on a deeper level.”
To get there, she recommends keeping the lines of communication open. Talking about thoughts and fears helps us understand where other people are coming from. Not shying away from conversations about well-being also helps us know when it’s time to reach out for support. That could simply be a chat with a friend or connecting with a more formal mental health resource.
While the internet is making that access a little easier, rapidly advancing communication technologies and other recent phenomena, such as the pandemic and the tight housing market, are also influencing how parents deal with the departure of their children, notes Mitchell, who wants to do more research on the impact of these “overlapping factors.”
On one hand, young adults are stepping into an increasingly uncertain world; on the other, you can make a video call with them no matter where they are. At least in theory.
My friend Eleanor Fast, who will be seeing her younger son off to university when my girls leave next fall, confesses to “stalking” her older son online while he’s been away at college in the U.S. for the past two years. He doesn’t always respond to her texts, and it can be difficult to schedule video calls, so she checks his Instagram feed — “for proof of life” — and looks to see if he’s posted any recent running routes on the exercise app Strava.
“The world may be more difficult than it was when I was 18 and left home,” says Fast, “but kids still need to get out there. They’ve been isolated for the past couple years because of the pandemic and have missed a lot of living.”
COVID was Fast’s biggest concern when her son left home — she was worried he would be lonely doing online classes while confined to a dorm room — but turns out he was fine. And although she and her husband truly enjoyed having a full house, they found it really nice when there was just one kid to focus on. They’re already planning activities they can do as a couple, such as taking long-distance bicycle trips together.
“I love my kids and love being with them,” says Fast, “but I want them to have their own lives, and making plans for the future helps counteract the sadness of them leaving.”
That sums up the mindset Lisa and I have as we reflect on the past and prepare for our next chapter. One of our daughters will be moving several provinces away in a couple months, and even though the other will be going to university in the city where we live, and recently decided to stay at home instead of residence in first year, we’re conscious of the fact that this is simply a new rhythm to experience.
Our children are no longer children. They — and we — are both excited and nervous about the journey ahead. And like many times over the past 18 years, we can learn a lot from them.
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Addressing a void in mental health care systems
Fabiola Phillipe
Fabiola Phillipe — mother, sister, and friend — was kind, compassionate, generous, and humble. She also lived with mental health challenges that stemmed from experiences of loneliness and isolation during her youth. As she struggled with depression, she began using substances — as a comfort and a substitute for the support and understanding she needed.
Before her death in 2017, Fabiola’s struggle with addiction had lasted nearly two decades. While these years included periods of both contentedness and hopelessness, help always seemed beyond her reach.
As she sought out different institutions over several years, she either had difficulty accessing services or was turned away because her needs were considered beyond the scope of care. In response to such experiences, Fabiola began staunchly refusing treatment — despite the urging of family members — who felt unequipped and powerless to support her while trying themselves to navigate confusing health-care systems.
Based on the gaps they saw in the system, Fabiola’s sister, Marie Philippe-Remy, and daughter, Lydia Philippe, launched Fabiola’s Addiction and Mental Health Awareness and Support Foundation (FAMHAS) in 2018 to promote awareness and advocate for change in mental health care for African, Caribbean, and Black (ACB) communities.
Missing pieces
Fabiola’s sister, Marie Philippe-Remy
According to a Columbia University psychiatry department article, the adult Black community is less likely to seek support even though its members have a 20 per cent greater chance of living with serious mental health problems. Black emerging adults (ages 18-25) were also described as experiencing “higher rates of mental health problems and lower rates of mental health service use compared to White emerging adults and older Black adults.” While there are many reasons for such lower access rates in ACB communities, a 2020 Ottawa Public Health study emphasized three common themes: cost, wait times, and difficulty finding culturally competent providers with a shared identity and experience. By making care more difficult, these barriers exacerbate their mental health challenges.
As she provided support to Fabiola, Marie began learning more and more about mental health care systems. Yet, as her main champion, she often felt depleted when she could not find the care her sister needed. She was also regularly frustrated by her own inability to understand how Fabiola felt trapped by her depression and substance use. “How can you not want to get better?” she recalled asking herself at one point. Although caregivers who experience mental health challenges when supporting a loved one in crisis frequently express such sentiments, Marie’s question would help define FAMHAS’s focus: to address access barriers and stigma while offering complex, nuanced, community-focused care for ACB people experiencing mental health challenges.
Access and understanding
Fabiola Phillipe
Once FAMHAS was launched, it didn’t take long for Marie and Lydia to realize that ACB communities had little formal knowledge on mental health. Even after a dedicated search, there was no way to ignore this glaring gap. Where, they wondered, was the research, information, and organizations geared to mental health in these communities? With no answer in sight, they decided to use their own lived and living experience and reach out to their network.
“The best way to learn and reach the community was by actually talking to people,” Marie said. She explained that connecting with people who had been through similar situations was key to connecting, spreading awareness, and promoting understanding. Mental health has many faces and stories, but if you don’t see those people and hear their stories, how do you move past something like stigma?
The urgency of the foundation’s work became increasingly clear after key themes emerged from just a few conversations. For example, Marie and Lydia found that people wanted to break through what they saw as taboo. Simply having an open conversation about mental health and acknowledging it as a priority provided space for people in ACB communities to speak more freely. Without having to explain or defend themselves, meaningful conversations soon followed — and that had a domino effect. When FAMHAS presented its first Black Men Experience workshop, there were just two participants. But as word spread, it grew to 15, then 20. The Real Talk: Black Youth workshop saw a similar pattern.
“So many people are suffering in silence, and simply knowing that there’s help out there can change somebody’s life,” Marie said, noting that support is needed for those experiencing mental health challenges and other issues. She therefore advocates through FAMHAS for support systems that spread across networks and communities in a culturally relevant way, while acknowledging the complexity and diversity within ACB communities, which comprise numerous religions, cultures, languages, and ethnicities beyond a single “Black umbrella.”
That said, more work is needed to treat people in these communities with mental health concerns. Recent research from the Mental Health Commission of Canada (MHCC) found that trust is improved when the help seeker believes a health professional can relate to their experience. From the deep-rooted impacts of anti-Black racism to intergenerational trauma and cultural biases, sharing common ground facilitates connection building between patients and care providers. Unfortunately, few ACB psychotherapists are available in Canada today.
Because representation, cultural competency, and questions of affordability loom large — as do long wait lists — Marie sees that endorsing mental health work as a viable career path for ACB individuals is an important step in meeting this challenge. In the meantime, other steps being taken can be seen in the MHCC’s Case for Diversity project, a compilation of practices that are working in communities across the country.
So far, FAMHAS itself has also been able to offer 1,629 hours of free counselling — across seven provinces and territories in nine languages — to 701 applicants through a network of mental health professionals who have dedicated their personal time to the success of its mission. About 20 ACB professionals were able to see more than 400 applicants in three months, with a maximum wait time of just two weeks.
Marie is intent on building the foundation’s directory so more people can access such services. While free counselling is on hold until FAMHAS reignites its fundraising events, a gala is in the works for May 2023 that will help them generate funds while bringing communities and organizations together to celebrate ACB art and contributions to mental health awareness.
She is keen to continually cultivate community — the identity, belonging, and connection that lead us to a sense of safety, security, and happiness — in other words, the things that make us all feel supported and less alone.
Aishah Khan
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Do more. Be more. Get more. Be successful. Strive. Hustle. Achieve. Be a winner. Don’t waste time. Sound familiar? Time flies. Yes, it does. All the more reason to slow down. ‘Stop and smell the roses’ is a cliché for a reason. You deserve the quiet moments to nourish your well-being.
As a motivated and ambitious person, I was fully subscribed to the achiever mentality, perpetually running on the hamster wheel. I wanted the success, the accolades, the big career, and everything that I thought went with that level of achievement. What I didn’t know was that I was missing out on a lot of important things. Balance. Wellness. Spiritual growth. The journey of becoming a fully self-actualized human being.
Running on empty
I think we can all relate to the fatigue that can descend when we get lost in the hustle and bustle of life. Each one of us has made a difference to someone else, as the go-to friend, the superhero mom, the devoted partner, or the supportive leader. But if we don’t protect our own well of energy and vitality, we can end up on empty pretty quickly.
My self-care always hovered near the bottom of my list despite my best efforts. I should do some yoga. I should get a massage. I should go to bed earlier. I should, I should, I should. The self-care somehow always got shuffled to the bottom of the endless list. Going to bed exhausted and feeling guilty because I didn’t get to my self-care to-dos is pretty dysfunctional.
As hard as I tried nothing changed. But it’s not a matter of trying harder and harder. It’s about looking at things differently. You eventually learn the lesson: you cannot give to others before you give to yourself. Sometimes you learn the lesson the hard way, like I did. One burnout and years of therapy later, things have changed for me.
I have honed my self-awareness after many years of not paying enough attention to the level in my gas tank. I don’t wait until it’s empty to act. Now, when I hear myself complaining, and getting bothered by trivial things, I know that it’s time to fill my cup.
The power of gratitude
When I first learnt about the gratitude thing, I thought it was silly new-age bunk. I had a bad attitude, so I was being judgmental, and I wasn’t really open to it. Why? Let’s just say I was going through a tough time, and I was too focused on my unhappiness.
“Now let me hear what you’re grateful for” my therapist would say, and I would sigh, roll my eyes, and rhyme off the list. “I’m grateful for my job. I’m grateful for my car. I’m grateful for my friends.” You get the picture. A lazy, half-hearted litany. What I eventually learned is that you have to go deeper. A wise person and spiritual advisor once told me that the practice of gratitude is powerful and transformational, but the key is generosity of spirit. Don’t approach the immensity of the ocean with a little cup and then complain about the stinginess of the ocean.
How I find joy in the ordinary
I slow down. I shift my focus from the doing, doing, done and quiet my mind. For myself, nature is the remedy for busy brain, the catalyst for the shift in perspective.
I go outside and I open my eyes. I notice things. It takes patience. Sometimes it takes hours, but I always find something to marvel at. Small things that you would normally miss, because your eyes are open, but you aren’t really looking. The magic of nature. A sunset. A flower. A butterfly. The keen and watchful eye of a wild bird.
Sometimes an ordinary walk, with the shift of the light, takes on a magical quality, if only for a few minutes. As a collector of sunset moments, I have learned to have patience, because it is worth the wait. In that magic moment, my joyful heart sings, and sings. Inspiration is everywhere.
Author: Nicole Chevrier
An avid writer and photographer. A first-time author, she recently published her first children’s book to help children who are experiencing bullying. When she isn’t at her desk, Nicole loves to spend her time doing yoga and meditation, ballroom dancing, hiking, and celebrating nature with photography. She is a collector of sunset moments.
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Talking to retail, front-line, and essential workers about their pandemic experiences
For employees, the past two-plus years have been a whirlwind. After COVID-19 threw the world into disarray, people were forced to grapple in the dark and adjust to new work environments.
While the months passed, we went from lazy days on the couch and socially distant driveway beers with neighbours to becoming lethargic, lonely, and frustrated as the lockdown cycles began taking their toll. Wave after wave kept crashing, but we slogged through while feeling imprisoned in our homes day after day.
Megan Di Lucca
Well, at least some of us did.
This experience of COVID-19 is not universal. Lounging on the couch and lingering on the driveway is an option if you have shelter. But the reality is that many people don’t have the free time or space to enjoy these luxuries. Complaints about Zoom fatigue can sound trivial if you’re on the front lines doing essential work and have never had the option of working from home.
Yet that’s the case for the vast majority of Canada’s employees who sustain our society, whether they work in retail, manufacturing, and construction or as medical personnel, social workers, and delivery drivers.
Among them is Megan Di Lucca, a cashier at Save-On-Foods in Victoria. Looking back to those first frantic days of 2020, she recalled the unusual behaviour from some customers; in particular, how they relieved their stress by snapping at one another or at staff members.
“With everyone buying as much toilet paper, canned goods, and random products (like yeast) as they could, all I could do was to ring in their unusual choices with a smile and do my best to help ease their stress by listening. While hearing what customers had to say helped them, it also helped me realize that it was important not to let others’ personal matters affect me.”
Yet Di Lucca was experienced enough to be able to find her way through such challenging situations. For those who are new to the workforce, that isn’t always the case. As Ottawa theatre-chain manager Shane Bennett pointed out, “many people in front-line and retail roles are young and inexperienced or are trying to balance personal issues while working in fast-paced environments.” Beyond those challenges, most of these roles are paid less on average than other jobs and are classified as contract or “gig positions” that offer few if any benefits or leave provisions. Because such employees can’t work from home if they’re ill or fear being exposed to the virus, their choice is as harsh as it is simple: go to work or sacrifice a day’s wages.
Shane Bennett
Compounding factors
In speaking with friends and colleagues who work in essential roles, it’s clear that they’re trying to come to terms with the shifts their lives have taken during the pandemic. Many are contending with personal issues, which have been made more difficult by stressors such as the threat of illness, financial strain, job insecurity, and diminishing mental health.
Not only have front-line workers faced layoffs and uncertainty in their jobs, they are also at greater risk of exposure to the virus. Many go home to immunocompromised family members after having to work a shift with inadequate personal protective equipment.
While managing their own stress, these workers have also been forced to deal with the stress of countless others each day. This may not be a new phenomenon for those who work with the public, but the situation has certainly gotten worse during the pandemic. In addition, they’ve been made responsible for enforcing ever-changing public health mandates — safety measures that are new to everyone, including themselves. When employers expect them to monitor actions to keep patrons and themselves safe, front-line workers take the brunt of the frustration from the customers who refuse to comply. With so many other stressors in their lives, that’s an enormous responsibility — one that has increased the abuse, harassment, threats and violence they face. According to Bennett, his theatres have been forced to call police on multiple occasions to help them deal with such incidents.
Because employees can’t work from home if they’re ill or fear being exposed to the virus, their choice is as harsh as it is simple: go to work or sacrifice a day’s wages. —
Pathways to support
Front-line workers do jobs that are typically undervalued and require a lot of physical and emotional energy. One example is “Sabrina,” a veterinary technician at an animal hospital in Eastern Canada who worked in emergency and critical care as well as speciality surgery. The hospital was the only 24-hour location in her region. It also accepted cases from remote locations (including Nunavut and Newfoundland and Labrador), making it essential to locals and clients across this wider area.
At the beginning of the pandemic, Sabrina’s workplace provided room for dialogue and supported employees who had to care for their children, were themselves unwell, or experienced reservations about bringing the virus home to immunocompromised family members. But after a few months this open approach seemed to change. Still, she worked her regular shifts and often stayed longer to assure the job was done correctly, putting in 10-12 hours on her feet while backfilling for others who had left the clinic. As demand continued to surge, Sabrina put in many extra weekends. Yet eventually, she became burned out and — with a sense of disillusionment — decided to leave.
“Sabrina”
As with many care workers in this situation, her decision was a difficult one. Contending with a sense of guilt about what would happen to the clinic’s quality of care if she left didn’t allow much time to tend to her own health. When she did start down the path of addressing these concerns, she pushed them from her mind when she thought about the tedium of it all. “You have to do a lot of legwork to get the help you need, and so you can feel less inclined. When you’re physically and mentally exhausted, the last thing you want to do is go figure out how to help yourself,” she explained.
Sometimes that sense of bureaucracy does become a barrier. That’s especially so for front-line workers in short-term or contract positions, who must endure long wait times and probationary periods to access care. Having to change roles and negotiate new contracts can also feel like too many hoops to jump through, especially when people are also dealing with financial and other stressors.
At the same time, such experiences are opening conversations around the workplace shifts that are needed to support front-line and essential workers — beyond platitudes. For example, employers are helping their staff implement empathetic listening in their interactions. Or, like Bennett’s theatres, they are investing in The Working Mind, evidence-based training from the Mental Health Commission of Canada that helps participants overcome stigma around mental illness. “The Working Mind is all about giving managers the tools to see changes in their staff and identify where they are on the mental health continuum,” he said. “It gives us a template to frame difficult conversations and be mindful about the mental health of our teams.” Once managers have the skills and tools they need, his company intends to roll out The Working Mind to all its employees. “I hope that makes it easier to discuss mental health in the workplace,” he added, “and that it allows our workers to feel better supported.”
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I do my hair. Paint my face. Iron my blouse and press it just so. Earrings, a matching necklace. Glasses the complement the look. I’m ready for my close-up – in a Zoom meeting, of course. I am put-together and professional. Trendy, even. Successful.
From the waist down I look more like I feel – stained pajama bottoms and slippers, legs unshaven. I am barely able to drag myself from bedroom to home-office. Yesterday’s coffee cup holds today’s tepid brew. I am feeling down and depressed. Mentally ill, even. A mess.
This contrast is not lost on me. Day in and day out I manage to fool everyone in my virtual world. For 40-minute Zoom calls I am upbeat and on-the-ball, leading discussions and asking relevant questions. In between these calls, however, I dissolve into a heaping pile of wreckage, trying hard not to let my tears ruin my make-up. The second that I hang up from the call, the smile drops from my face and my shoulders automatically slump. I can’t help it. It is all I can do to harness the energy to appear on camera but when the eyes of the world are shut, I revert to my depressed self.
I have high-functioning bipolar depression. This is not a diagnosis that you will find in the DSM-V, but a popular term we put to the kind of life that I am describing. For the outside world I am able to put on a grand performance, like the thespian wearing a mask on stage I take on the persona of someone like me, but a much more successful version of me. My audience never knows what is going on behind that mask, they see only the performance and, unaware that they are in a theatre at all, take that mask at face value. Literally. Unless they read this blog, my colleagues would have no idea that I am struggling as much as I am.
This is not something I can just turn on or off whenever I feel like it. I am compelled to perform like a circus animal. “The show must go on” is my unwilling motto. On those rare days when I am determined to buck the status quo, when I refuse to put on make-up or I wear a ragged t-shirt to work, when I insist on remaining quiet and deflated in a meeting, soon my resolve wavers and I wave off my colleagues’ concerns with a more characteristic humorous quip, a coat of mascara and some lipstick and a scarf hung around my neck to hide how I’m really feeling.
High-functioning is less a choice and more an imperative – a symptom of the disorder itself. Initially masquerading as a protective factor, allowing people to remain active at work and in the community, this insidious symptom shuts the sufferer off from all outside help by masking the other symptoms of depression so effectively that no one even knows that the person is struggling. At home – the only place the person can take off the mask and really show themselves – things rapidly fall apart as there is no excess energy left for the partner, family, and chores. This Jekyll and Hyde routine is as exhausting for those close to the afflicted person as it is for the person themselves, leaving families to feel confused, incredulous, abandoned, and unsupported by an oblivious community.
Even if one does manage to reach out, we are often met with disbelief – “Jessica? Depressed? But she’s too with it, together, successful, and downright happy to be depressed!” – and who can blame them? The outside world believes what it sees and doesn’t like the wool pulled over its eyes. Yet does anyone watching a Hollywood blockbuster think for a moment that the characters and the actors playing them are one and the same?
And so, I urge you: believe me when I say that high-functioning depression is real. High-functioning mental illness in general is real. Believe your family member when they tell you that they are putting on an Oscar-worthy performance for the outside world. Support your loved ones who are reaching out for help with an impossible illness. And if you are struggling with high-functioning depression please know that you are worthy of help. Even though you can still go through the motions and do well at work and seem successful. You are struggling and you don’t have to be. I know you feel like you are the only one who is feeling this way, but that is the definition of high-functioning – nobody else knows that you’re struggling just like you can’t see anyone else suffering in silence behind their mask. So, reach out for help. You’ll be glad you did.
Author: Jessica Ward-King
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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They’re called comfort foods for a reason: sugar, salt, and carbs give us a quick boost of flavour and familiarity. Making the case for comforting foods that nourish our mind and body.
“You are what you eat” — We’ve all heard the saying. It’s meant to nudge us toward healthier choices, but it doesn’t reflect all the links between diet and health, including the connections it has with chronic conditions such as diabetes, high blood pressure, obesity, and stroke. It also doesn’t include research over the past 50 years showing how much nutritional choices effect our brain and mental health, which is so striking that we should probably add “Good food for a good mood” to the phrase.
Dr. Bonnie J. Kaplan
Research into the connections between nutrition and mental health began in 1972, when Bonnie Kaplan, then a grad student in experimental psychology, started looking into the physiological and psychological effects of malnutrition during pregnancy and the first few years of life. When she published “Malnutrition and Mental Deficiency” in the Psychological Bulletin that same year, her results struck a chord. She was deluged with requests for reprints of her groundbreaking research, which became the precursor to the field of nutritional psychology. The article’s key takeaway still resonates: “We can’t control our genes, but we can control what we eat so that we can be better nourish our brains and our mental health,” wrote Dr. Kaplan, now a retired research psychologist.
More recently, she co-authored The Better Brain: Overcome Anxiety, Combat Depression, and Reduce ADHD and Stress with Nutrition with Dr. Julia Rucklidge. The book takes a nutrition-first approach to mental health in relation to resilience with a focus on tryptophan — an essential amino acid in the nutrients we can consume — and its connection to serotonin, the “feel-good hormone” that can affect our mood. A short article like this could never fully explain the process of enzymes, co-factors, and chemical reactions involved, but a building-block effect Kaplan describes in her lectures has led her students to the “aha” moment where they can see these connections and are inspired to improve their diet.
The book’s suggestions for healthy eating are by now well known — whole foods (not ultra-processed), fewer carbs, less salt and saturated fats, and a preference for Mediterranean-style cooking — and originate in the “SMILES” trial (2017). In that study, participants with severe depression were randomly placed into two groups, one receiving social support and the other nutrition counselling that recommended a Mediterranean diet of fruits, vegetables, legumes, seafood, olive oil, and seeds. While both groups’ symptoms improved twelve weeks later, people in the Mediterranean diet group saw greater improvement, with 32 per cent of participants’ depressive symptoms going into remission (versus eight per cent for the social support group).
You seem “hangry”
I ask Kaplan: Can you give me a sense of how that happens? Well, she explains, “We cannot eat serotonin in food, right?” Like a rapt student I jot down the key point: “There is no food that contains the feel-good hormone, so we must eat things that enable our bodies to manufacture serotonin and other necessary micronutrients.”
Suddenly, I feel peckish. Chips come to mind — mmmm, all that satisfying salty, carby crunchiness. Except that I also just learned we need at least 30 different micronutrients to properly support our brain’s metabolism, which runs every minute of every day. Such ultra-processed foods can fill our stomach, but they also starve our brain because they’re deficient in vitamins and minerals. It’s the cerebral equivalent of feeling hangry when you’ve waited too long to eat. Kaplan calls this state “hidden brain hunger,” which happens when we consistently lack necessary micronutrients, so the brain lacks what it needs to function optimally and support our mental health. Why is this “hidden”? Because the resulting effects are not always directly felt.
These days, price hikes from inflation make stocking the pantry with such foods a costly challenge for many. Having limited access to fresh foods is also a problem, particularly for those living in food deserts, who must pay even more with the additional time and travel. —
No easy answers
It turns out that our brain is actually the greediest organ in our body: while it accounts for just two per cent of body weight, it absorbs at least 20 percent of all the nutrients we consume, Kaplan says. Feeding that beast means nourishing the brain with micronutrients. Canada’s latest food guide snapshot shows us what this could look like: filling half the plate with a rainbow of fruits and vegetables, and each of the other two quarters with protein and whole grains.
If only it were that simple.
These days, price hikes from inflation make stocking the pantry with such foods a costly challenge for many. According to Food in Canada magazine, grocery prices have spiked more than seven per cent over the past year — the fastest increase in 13 years. Canada’s Food Price Report forecasts that the most significant increases for 2022 will be in the healthy food category, including dairy and vegetables. That means, an average family of four will pay nearly $15,000 for food this year, almost $1,000 more than in 2021. Having limited access to fresh foods is also a problem, particularly for those living in food deserts, who must pay even more with the additional time and travel.
While Kaplan’s findings can tempt us to draw easy parallels between a change in food and mood, depression is a complex state for those who experience it. We should also keep in mind that changes in diet alone are no substitute for seeing our physician or therapist and taking prescribed medications. Still, as the field of nutritional psychology grows, it is helpful to see its recommendations become part of an integrative or alternative treatment for mental health challenges, something that one in five people in Canada live with.
Views and opinions expressed in this article do not necessarily represent the views and opinions of the Mental Health Commission of Canada.
Estimated reading time: 4 minutes
We often associate hunger with our stomach.
Yet, what if I told you, it’s your brain that’s hungry?
From the food choices we make, to what we put on our plate, our brain demands the most energy from our food. Dr. Bonnie J. Kaplan explains. She is a pioneer in nutritional psychology who is also a semi-retired professor at the University of Calgary, Cumming School of Medicine.
“The brain is the greediest organ for micronutrients, or the vitamins and minerals from our food. While the brain is two per cent of our body weight, it absorbs 20 per cent of all the nutrients fed to our body.”
But why is this statistic important for us to know?
Because emerging research shows food does affect our mood, for better or worse.
According to evidence-based research in nutritional psychiatry, several nutrition researchers claim there is a correlation between our dietary intake and mental health outcomes.
While books, shows, and articles in the media promote a healthy lifestyle, they mostly preach the same mantra: “eat more healthy, real foods”.
Yet the stark reality is that more than half of what North Americans are putting into their mouths is not real food. Why?
The unseen answer: the concept of “hidden brain hunger”
More than 50 per cent of us are filling our bellies with ultra-processed ‘foods’, while at the same time, we are also keeping our brains hungry. How?
The concept is called “hidden brain hunger” – a negative consequence that our brain experiences when it becomes deficient in essential micronutrients, such as vitamins and minerals.
The brain’s silent starvation becomes more intense when we consistently eat ultra-processed foods high in sugar, salt, and fat. These ‘food-like substances’ lack essential vitamins and minerals optimal for brain health and the absence of these key nutrients impact the brain’s overall performance, especially when in crisis mode.
Dr. Kaplan compares this brain-nutrient phenomenon to pregnancy. “When a woman is pregnant, if she’s not getting enough food, the food preferentially feeds the fetus, moving nutrients and oxygen to where it’s most needed critically, in a crisis.”
“Similarly in the brain, when handling a crisis and it involves fight or flight, our bodies preferentially move the nutrients to where we need to be activated…if you are not providing your body and brain enough nutrients, everything is preferentially diverted to handle the crisis, the stressful situation – parts of your brain and body are going to be deficient.”
Why nutrition is a key ingredient in the recipe towards better mental health
Dr. Kaplan’s life mission has been distilled into a cutting edge 368-page book called The Better Brain: Overcome Anxiety, Combat Depression, and Reduce ADHD and Stress with Nutrition.
Inside its pages, you will find evidence-based research, sage nuggets of nutritional insights, plus mood-boosting, whole food recipes scientifically proven to help nourish our brains.
For example, foods like leafy green vegetables, fatty fish, dark berries, nuts, and olive oil (found on the Mediterranean menu) have been linked to boosting our brain power: whether proactively as we age, or protectively, slowing down mental decline and improving cognitive function.
And why should we think about what we put into our mouths, for our brain’s sake?
You may think, well, “I already know what to do” (in theory) when it comes to eating healthily: typically, the “how.”
Yet where most of us usually stumble is in the application, or the “why.”
Focusing on the why in creating and implementing change can be a powerful motivator to achieve better physical and mental health.
Brain food for thought
As an eminent researcher in nutritional sciences for more than 50 years, Dr. Kaplan aims to continue convincing skeptics within the medical profession that nutrition does indeed play a role in our psychological and emotional resilience.
“Every mental health clinic should be educating about the importance of whole foods and getting rid of the ultra-processed chemicals [and] about what nutrients do in the brain That should be step one,” Dr. Kaplan states.
And step two? Pulling back the curtain on what eating whole foods could look like for patients, so they can replicate this healthy dietary lifestyle at home.
“It should be pre-treatment when a patient is first referred to any mental health setting before they’re assigned for treatment of any kind, they should learn about how to eat a whole foods diet,” Dr. Kaplan says. “And they should be asked to track the cost because people who track the cost as they move to a healthier diet are amazed that they can save money – we have to teach them inexpensive ways to do it.”
Another goal Dr. Kaplan shared with me is her desire to also influence us (thanks to her interest in the physiological basis of human behaviour) – to not only understand how to eat better, but also why we should eat better. And why it matters.
“People don’t know why they should improve their eating habits,” Dr. Kaplan says. “Probably the reason why is lack of education or knowledge…it’s not enough to know how and what to eat when it comes to healthy nutrition. Nutrition is the foundation of our mental resilience.”
Author: Janelle Jordan
