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As I languished during the isolation of the pandemic in March 2020, I was forced to live in the present.
Moment of Impact, June 2020
I was luckier than most when the global pandemic erupted in early 2020. I had a car, and I lived near the country. I was still deeply impacted by the necessary isolation, and as the weeks dragged on a sense of lethargy, maddening boredom and loneliness began to creep around me.
The snow soon thawed, and I took to my car for refuge. When I’m driving, even to 7/11 for snacks, it’s like I’m doing something, going somewhere. This illusion kept me grounded during a time where life seemed so desolate.
As the eerie stillness gnawed at me, my drives grew longer. I discovered places where I could sit, breathe, and observe nature. I noticed things as I drove, and soon I began to pull over when I saw something appealing, whipping out my phone and hopping out of the car while it was still running.
Spring bloomed into summer, and I spent my days driving listlessly and taking pictures. Slowly, my cameras accumulated in the passenger seat, and a new habit was born. My car and cameras became my closest companions, and I started to use photography to truly experience “living in the moment.”
The photos weren’t extraordinary –– a tree shrouded in the mist, its bare branches swaying; a bright orange sun reflected in a silent stream –– but I didn’t photograph these things because they were profound. They grounded me in the present, which was new to me.
I’m a planner. I need to know what’s next, to map every step forward meticulously. I’ll often enter a perfectly planned stage of my life without giving myself time to revel in my accomplishment before I start planning my next move.
That being said, the forced stagnancy imposed in 2020 stressed me out. Not knowing what was next, just not knowing made me tense and distracted.
Before, when I began taking photos more seriously, I’d photograph things in a clean-cut, symmetric sort of way. If there was a silhouette, I’d frame it in the centre. I required perfect days, and the photo would need to be what my eyes saw exactly, not creatively framed, or abstract at all. Once, my sister told me my photos looked like Google Image results, that if she searched a location photos like mine would appear, and that nothing about them was unique.
This annoyed me then, but now I get it. My photos were too poised, plastic even. Totally lacking in originality.
This period of my life enabled me to appreciate living near the country. Anytime the elements shifted, orienting themselves in a way that grabbed me, I’d head in the direction of that ephemeral muse. I began capturing moments with a transformed perspective and objective.
One morning, a fog blanketed the ground. I jumped in my car and drove deeper into the country, taking pictures of cows grazing, sprawling farmlands, birds swooping low over the river. I also did this during a lightning storm, after a heavy rainfall, and in the hour before sunset and sunrise nearly every day. I focused on what I could see, hear, and sometimes touch. I carried this new skill with me, and I genuinely believe that I am a better photographer and artist altogether.
When I had no future to predict or curate, I had the present. I had what was around me all along, and I’ve managed to immortalize it in a way I never could before. Instead of trying to capture something that seemed authentic, I began to take pictures of moments as they happened.
Now, as I adjust to my new normal –– living in a different city, embracing new experiences, meeting new people –– I can actually enjoy the present instead of trying to predict the future.
The anxiety about the future is still there, but it’s dulled by the realization that one day the future will be the present and I’ll have been busy making the most of it, cultivating perspective which will benefit me today and forever.
Author: Aishah Khan
A recent writing and communications student who is slowly settling into her niches of feminism, mental health awareness and editorial writing. She is an avid reader and media consumer, and one of her all-time favourite books is A Tree Grows in Brooklyn. In her spare time, Aishah can either be found drawing or painting in the winter, and camping, canoeing and swimming in the summer.
Today in Canada, thirteen people will die by suicide.
At least six of those people—nearly half—will have seen their family doctor in the four weeks prior to their death.
Nearly 45 per cent of people who died by suicide saw their primary care provider in the four weeks before their death.
-Talking About Suicide, Lesson 13: Your Role in Changing Suicidal Behaviours
For older adults, this number rises to almost 60 per cent.
The impact of a death by suicide ripples outward, like a rock tossed in a pond. I know this from over a decade of working alongside partners and lived experts in the suicide prevention space. Family, friends, and colleagues are left behind with broken hearts and unanswered questions.
As we mark World Suicide Prevention Day, we have the power to change this narrative.
That’s why the Mental Health Commission of Canada (MHCC) has teamed up with CHA Learning, the professional development division of HealthCareCAN. Together, we’re equipping health-care providers with the confidence and skills to open the door on difficult—but potentially lifesaving—conversations.
In Ontario, the demand for adult mental health services surged by 47 per cent between 2021 and 2022, while the need for children and youth services spiked by 104 per cent.
Our updated training, now called Talking About Suicide: Empowering Healthcare Providers, Instilling Hope in Clients, is available for free as a self-directed online course.
We took essential feedback from our original offering and refreshed the training to better reflect the post-pandemic reality.
The result is an engaging, informative, and easy-to-digest course that elevates health-care providers’ unique skills and cements their position as trusted patient confidants.
“The impact of a death by suicide ripples outward, like a rock tossed in a pond. I know this from over a decade of working alongside partners and lived experts in the suicide prevention space. Family, friends, and colleagues are left behind with broken hearts and unanswered questions.”
The Talking About Suicide training is accredited by the College of Family Physicians of Canada and the Canadian Nurses Association; however, it’s designed to be helpful to all health-care providers and allied health professionals.
A Course Designed for the Real-World
In our post-pandemic reality, health-care providers are stretched thinner than ever.
That’s why we’ve challenged ourselves to make this training even more accessible and immediately applicable than the original. For example, participants will wrap up their learning by applying their newly minted knowledge to two case studies. This practical, scenario-based context is yet another way we’ve responded to the need for relevant, hands-on experience.
With 6.5 million people in Canada lacking a family doctor, the front line of suicide prevention is expanding. We want to support everyone from physicians and pharmacists to registered nurses and physiotherapists. This includes those stepping into a role—like at a walk-in clinic—where trust has to be gained quickly.
What can Health-care Providers Expect to Learn?
Talking About Suicide is designed to walk participants through everything from understanding suicide and its complex causes to practical interventions and appropriate language to use. It will help practitioners:
- Move beyond fear to have direct, confident conversations
- Create a trusted connection, even when short on time
- Identify and explore suicide risk factors and warning signs
- Tailor responses to individual needs and circumstances
- Collaborate on a safety plan with practical tools
- Reduce stigma and promote hope and recovery
Talking about suicide won’t ‘put an idea in someone’s head.’ In fact, it often helps free them from feelings of isolation.
– Talking About Suicide, Lesson 12: Suicide Myths and Realities
We’ve heard from early participants that the training’s emphasis on “Asking Questions” is especially valuable, providing tried-and-true examples of how to phrase tough questions. (Directly, with empathy, and avoiding euphemisms are good places to start.)
Following the training, 96 per cent of the health-care providers we surveyed reported feeling confident about discussing suicide with their clients. Many specifically highlighted how valuable it was to learn practical ways to ask difficult questions and build rapport quickly—even in time-constrained settings.
Talking About Suicide also considers the well-being of providers. As one participant reflected, “The self-care reminders were exceptionally helpful, validating, and something to be mindful of as healthcare providers.”
Supporting patients experiencing suicidal ideation isn’t easy. But by taking the pulse on their own mental wellness and using effective self-care strategies, health-care providers will be better able to care for themselves and others.
Because you can’t pour from an empty cup.
Learning from Those Who’ve Lived It
One of the greatest strengths of Talking About Suicide is the “nothing about us without us” ethos.
The course features powerful testimonials from suicide attempt survivors like Megan, who shares her experience of discussing suicidal thoughts with her family physician. She explains that being linked up with a counsellor who could connect her with cultural practices was key to her recovery.
Likewise, Saadiye advises practitioners that survivors of a suicide attempt need to be reminded of their strengths.
These insightful “dos” are key to helping health-care providers unlock compassionate care and create safe, supportive spaces.
The MHCC and CHA Learning are grateful to our Talking About Suicide Advisory Committee—made up of family doctors, registered nurses and nurse practitioners, suicide prevention experts, and crucially, people with lived and living experience.
Their guidance grounded this learning in real-world wisdom, helping ensure providers are equipped with the skills to meet the authentic needs of those experiencing thoughts of suicide, while being mindful of their own wellness.
An Investment Worth Making
Three hours. That’s all it takes.
On World Suicide Prevention Day, I urge health-care providers across Canada to make this small investment of time.
Three hours to learn from lived experience.
Three hours to change the narrative.
Three hours to build a lifetime of confidence.
The revised Talking About Suicide course is free, accredited, and accessible—built to meet rising demands within an overstressed system.
To take a page from the Centre for Suicide Prevention, “The vast majority of people who receive a caring intervention do not re-attempt. People considering suicide want an active listening ear more than anything else.”
Remember, you’ll never know what someone is thinking until you ask them.
And having the right words can make all the difference.
This training is part of MHCC’s broader commitment to “Changing the Narrative on Suicide”—this year’s World Suicide Prevention theme—and complements our community-based Roots of Hope initiative and other evidence-based suicide prevention strategies.
About the MHCC:
The Mental Health Commission of Canada (MHCC) is a national not-for-profit organization, committed to reducing stigma and improving access to quality mental health and substance use services across Canada. The MHCC collaborates with leading experts, nationally and internationally, including people with lived and living experience, to develop national standards and strategies, promote innovation, enhance mental health literacy, and advise and equip all levels of government to improve mental health outcomes for those living in Canada.
About CHA Learning and HealthCareCAN:
CHA Learning is Canada’s only national, fully online learning provider serving all of healthcare and the professional development division of HealthCareCAN. For nearly 75 years, CHA Learning’s distance learning programs and courses have helped tens of thousands of health professionals from across Canada to be successful in their careers.
HealthCareCAN is the national voice of hospitals, health authorities, health research, and healthcare organizations across Canada. We foster informed and continuous, results-oriented discovery and innovation across the continuum of healthcare.
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Founder Taryn Ellens’ tech startup came together from a confluence of systems-level observations, lived experience, and persistent gaps that weren’t being addressed, especially in First Nations communities in the Yukon.
Ainome—pronounced like “I know me” is a mental wellness organization in Whitehorse that supports overlooked communities with “a sustained effort to reimagine how tech can reflect lived realities in underserved communities,” says Ellens, who is also a PhD neuroscience researcher at the University of Alberta.
In 2022, Ellens was working as a youth clinical counsellor when she realized that artificial intelligence tools could help identify gaps in her field and issues related to accessing care. The more she examined the data, the more she observed that traditional Western approaches to mental health were not working in many Indigenous communities.
Whitehorse along the Yukon River. Photo: AscentXmedia.
Covering the distance
“In these isolated communities, the lack of access to health services is compounded by the emotional toll of their geographic isolation,” Ellens wrote in late 2024 in the Yukon News. “Most of these areas are located far from urban centres, where mental health care is typically concentrated. The burden of travel, both financial and emotional, prevents many people from accessing the care they need.”
Geography is one part of the issue. “Historical trauma continues to have a profound impact on First Nations’ mental health. Colonial practices, such as residential schools and the forced suppression of Indigenous cultures, have directly caused intergenerational trauma. This trauma, combined with systemic discrimination and forced disconnection from traditional lands, has created a mental health crisis that mainstream services have often failed to address adequately.”
Tech support
Yukon dedicated the largest share of its federal bilateral health funding to mental health, according to a 2024 Canadian Mental Health Association report. The investment is designed to complement wellness and substance use strategies to address high rates of self-harm and deaths. Ellens says these investments help to boost what’s happening locally.
After three years of examining mental health access gaps for First Nations people, Ellens began to design a mental health index – a collection of data that includes numerous social determinants of health (the non-medical influences on our health) and their links to accessing mental health supports. For example, housing is considered a social determinant of health. If you have stable housing, you are in a better position to care for your mental health and access services than if you lack shelter.
The index is nestled into a larger vision—one of a dynamic, community-owned tool designed to surface what mainstream systems might miss regarding non-medical indicators, along with indicators of wellness and cultural practices, such as access to Elders and availability of ceremonial activities. It’s less about scoring or grading and more about making invisible patterns visible to support a self-determined strategy.
Ellens and her team develop models that interpret layered, anonymized data sets drawn from online mental wellness tools. By detecting subtle patterns, such as indicators of distress or early shifts in wellness, the models help decision-makers anticipate mental health trends, even in contexts where formal diagnostic data is limited. The goal is to support proactive responses, including culturally grounded approaches such as land-based healing, traditional storytelling, and community gatherings. All data remains fully anonymized and under the governance of First Nations communities.
In widening the lens on what defines wellness, Ellens wants to invite Indigenous knowledge systems into the mental health field. Part of that means confronting the shortcomings of traditional talk therapy and harnessing technology to support positive outcomes and approaches to care – something clients have been asking for.
“Instead of a deficit-based model, focused on what is wrong, technology can be used to look back at what factors were in place in order to move toward a rehabilitation narrative,” she says.
“Even a basic term like ‘trauma recovery’ implies that when you have ‘recovered’ you are no longer affected by the trauma, but that’s not true,” she says, noting that the act of talking it out can be re-traumatizing for some, but it may work for others, depending on the context. “Sometimes it’s more about talking about successes and mapping out how resilience happens to gain insights,” she says. To account for this approach, Ainome’s tools ask questions to develop additional options for existing therapeutic modalities.
Taryn Ellens founded Ainome – pronounced “I know me” to support self-determined strategies for mental health and wellness in Indigenous communities. Photo: Manu Keggenhoff.
New approaches to therapy
A shift in approach is one way of adopting and adapting mental health in Indigenous communities; another is improving access through online resources, which can make a difference between having and not having care, particularly in geographically remote communities. Virtual counselling was very appealing to Colbi Mike; it was the first place she looked when searching for a new therapist.
Mike was looking for a way to bridge cultural teachings from her Indigenous background with standard mental health approaches. The 27-year-old is from Poundmaker Cree Nation in Saskatchewan and is the first generation in her family to grow up outside of the residential school system. Mike sits on the Youth Council of the Mental Health Commission of Canada, offering insights on addressing barriers to maternal mental health and the effects of oppression on Indigenous peoples.
“I grew up with different teachings – go to Elders, do ceremony, be with family,” Mike says. “So, when I first started seeing a therapist when I was very young, it felt like an internal struggle, like I was betraying someone,” she says. She started to move from in-person to online therapy to find an approach that would meet her needs. She says it took a bit of work to ensure the services would be covered under her health plan, and the get-to-know-you sessions felt a bit slow. However, once things ramped up, Mike felt that she hit a stride with her current practitioner.
“We had a lot to say to each other,” she says. “I’m an info-intake person, and my therapist is willing to share her personal experience in connection with mine, as she has children too.”
Online therapy offers other opportunities, Mike notes. “Being in the comfort of my own home, I’m able to smudge,” she says. “Having a space that I’m able to cleanse myself, before and after therapy, has been really important to me.”
As practitioners and organizations seek to improve access to mental health, considerations are being made for data sovereignty, online safety, and culturally appropriate care, while also considering what innovations are possible, such as through the work of Ainome and other startups, that make space for culture and connection.
It’s a chance to imagine better, Ellens says. “Ainome was born from frustration with existing systems that weren’t telling the full story around mental wellness and Indigenous self-determination, and with the hope that we could use technology in ways that heal rather than harm. Our work is about co-creating tools that reflect lived experience and community-led definitions of care.”
Taryn Ellens will present at the Electronic Mental Health Collaborative’s (eMHIC) 10th annual congress in Toronto, November 19-21. This year’s theme is Global Mental Health Equity: Digital Solutions for an Interconnected World. Find the full list of speakers here.
Dayanti Karunaratne runs the family farm in rural Hawaii and takes a keen interest in food sovereignty when not researching and writing on topics of human interest.
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Older adults are more likely to suffer from social isolation and loneliness is increasingly being recognized as being bad for our health. The good news is that mattering and belonging can flip the script. Our series explores these and other related concepts.
Some get frustrated by the feeling of “invisibility” that many older adults experience. Others, though, consider it their super-power.
“The feeling of being invisible comes up in the hit show Matlock, with Kathy Bates, where she says that, as women get older, they ‘become damn near invisible’,” says Dr. Gordon Flett, Honorary President of the Canadian Psychological Association 2024-2025 and former York University Canada Research Chair. “And then she goes on to say that she can use that to her advantage because people don’t see her coming.”
Not everyone is able to find a silver lining in the cloud of invisibility, probably because “feeling seen” is an important part of feeling like you matter to the world around you. And “mattering” is important to our well-being, according to Flett’s research, which has shown that feeling like you matter is associated with resiliency. Conversely, “anti-mattering” is connected to stigma, discrimination, psychological distress, depression, and loneliness. “Feeling invisible to others is at the heart of anti-mattering,” says Flett.
Although some older men complain that they feel invisible on occasion, the phenomenon is so widely felt for women over 50 that it’s been dubbed the “Invisible Woman Syndrome.” What this suggests is that stigma for older adults isn’t only a matter of age. We also experience age stigma in relation to our intersectional identities—class, ethnicity, gender, religious beliefs, and other identity markers.
Kathy Bates stars as the brilliant septuagenarian Madeline Matlock in drama series, MATLOCK, inspired by the classic television series of the same name. Madeline achieved success in her younger years and decides to rejoin the work force at a prestigious law firm, where she uses her unassuming demeanor and wily tactics to win cases and expose corruption from within. Photo: Brooke Palmer/CBS via Getty Images.
Who turned on the cloaking device?
For this reason, Dr. Susan Braedley, Professor at Carleton University’s School of Social Work, says that, after fifteen years of studying long-term care and age-friendly communities in national and international research projects, one of her teams’ key findings is that inclusivity must guide the planning and designing for care homes, retirement communities, and programming for older adults.
“We’ve seen a lot of promising practices,” says Dr. Braedley. “And then we’ve seen some things to avoid, things that caused great distress to older adults.”
For example, she recalls a day program designed for people with mild cognitive impairment in a Canadian community where many residents’ first language was Mandarin. Personal support workers didn’t speak Mandarin, and the activities all assumed that participants were familiar with mainstream Canadian customs and holidays.
“If you think you’re supposed to know the answers but don’t, it can be really confusing, because you start to think your memory is worse than it is,” Dr. Braedley explains. “The program produced a lot of anxiety. It was supposed to reduce social isolation for people living with dementia and, actually, I think it was having the opposite effect. Cut-and-paste programs don’t work.”
It’s not all bad news, though. In the course of her research, Dr. Braedley observed scores of programs that were culturally appropriate, community-based, and well-designed for the actual participants. And, in those spaces, Dr. Braedley witnessed and, herself, felt, a lot of joy. One of her many favourites was a program offered at the 519, a non-profit agency in Toronto that serves 2SLGBTQI+ communities. This program matched younger volunteers from the community with older adults experiencing loneliness.
“The older people had amazing experiences, sometimes just by having someone to help them negotiate the city when they were feeling uncertain about being out on their own,” she says. “But what was so interesting is that many of the younger people were working remotely and were saying, ‘We’re lonely, too. We’re isolated’.”
Eddy Elmer, a Vancouver gerontologist and research consultant specializing in aging and mental health, says that older people from 2SLGBTQI+ communities are far more likely to be socially isolated and lonely.
“Some of it’s just because it’s a smaller population base, so it’s harder to meet people or find a partner,” says Elmer. “LGBT people over the age of 70 also grew up at a time when being gay was highly stigmatized. It was illegal, it was criminalized, and it was pathologized, so they’re more afraid of being rejected and discriminated against.”
Elmer fears that we’re taking steps backwards now, with changes in our online climate, and a general rise in anti-2SLGBTQI+ sentiment. As such, he warns that risks are on the rise, particularly for transgender older adults.
The mysterious case of the vanishing older adult
Older people experiencing income insecurity, homelessness, incarceration, or pre-existing depression all tend to be more vulnerable, as are older men who have recently experienced a life transition, such as retirement. Some attribute this to the fact that, broadly speaking, women have larger social networks. When men stop working, by contrast, many lose their most important social space.
For many, though, it’s also about a shift in self-perception and a loss of identity.
“People are saying to me, ‘I was a high school principal, or a professor, or a lawyer and I had all these different roles and identities’,” says Dr. Raza Mirza, Director, National Partnerships for HelpAge Canada. “And then they retire, and their perception is that ‘Now all I’m seen as is as an older person and we’re all kind of lumped into this one big group. That’s my identity now’.”
One of Mirza’s many research projects aimed at helping older adults is a study with Men’s Sheds Canada of called “Men’s Sheds,” a program designed to help people establish new roles as mentors in society and connect and engage with other men of all ages.
“The idea is to empower older men,” he says. “It’s also about health promotion, though, because they can talk to one another through life transitions, share resources and share information that impacts the mental and physical well-being of older men.”
That could have a serious impact given that, simple preventative measures and screening can make a big difference when it comes to the social, mental, and physical health of older adults. Hearing aids and eyeglasses, for example, are a low-intervention way to reduce social isolation and improve well-being.
“Sensory loss is very important because many older adults have hearing or vision problems,” says Dr. Fereshteh Mehrabi, post-doctoral research fellow in Concordia University’s department of psychology. “Dramatic hearing loss is much more prevalent among men than women and, often, they choose not to even try to communicate of socialize at all because it seems like too much of a bother, which can contribute to frailty over time, as reduced communication and social engagement may lead to physical decline and isolation.”
Seen, heard, and invited to the party
There’s some debate about why older men experience hearing loss, but there’s little doubt as to why many older men don’t want to use a hearing aid, namely, because that’s associated with older people. In other words, people often choose to withdraw from the world rather than deal with age stigma. (Incidentally, the new generation of hearing aids are far more discreet, and the tech allows users to do neat things like tune out ambient noise to focus on the person speaking, which, if you think about it, sounds like a good superpower to have).
Older women aren’t immune to hearing problems, but, by the numbers, Mehrabi says that, for women, screening for and preventing frailty should be the top priority. Women are far more likely to experience frailty than men and her recent study, published in Age and Ageing found that, over a long-term period, frailty leads to social isolation and loneliness, perhaps for the simple reason that it’s harder to go out and join in social and physical activities. It doesn’t help that, even though women’s fitness is a massive growth industry, there are plenty of cultural and systemic barriers keeping older women from building muscle with good diets and resistance exercises.
“The perfect neoliberal older person has enough money to last them the rest of their life and is using their Fitbit to keep them active and healthy,” says Dr. Braedley. “The idea is that we have so much control and we can keep ourselves healthy if we eat right and do all the good things. Which is ridiculous because we all die.”
“Many, many people, and disproportionately women, don’t fall into that model of the perfect, self-reliant, older person,” she adds. “So, I think it’s about that. I think it’s about classism, sexism, racism, and ableism all combined.”
Back to those invisible women, it’s important to note that it can feel like a superpower for some, but it’s damaging to others. “The older person who feels invisible and comes from a marginalized background will not see being invisible as having any sort of benefit,” says Flett. “For folks experiencing co-occurring injustice, inequity and invisibility, that’s a very painful combination.”
That makes it everyone’s responsibility to find a way to make people secure in the knowledge that they matter—no matter what their age.
Author: Christine Sismondo is a Toronto writer who hopes to one day live with friends in a communal living project modelled after The Golden Girls. We still need a cheerful character like Rose Nyland to join the collective and entertain us with her stories. And, it almost doesn’t need saying, but Kathy Bates is always welcome!
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Older adults are more likely to suffer from social isolation. Loneliness is increasingly being recognized as being bad for our health. The good news is that mattering and belonging can flip the script. Our series explores these and other related concepts.
“I think I was 50 the first time a younger person in the office asked me when I was going to retire,” recalls Pamela, a 62-year-old government employee who lives in Edmonton. “He said it was high time people like me got out of the way to make room for people like him.”
Pamela, a pseudonym to protect her identity, has worked for the same department since the mid-1990s. She’s qualified, knows all the ins and outs and, according to her, actually trained her last two bosses for roles she applied for. She never even got an interview. She recently filed a workplace discrimination complaint against her employer, because she believes she’s the victim of ageism.
“Being constantly passed over for promotions is frustrating,” says Pamela. “Worse than that, though, is being made to feel like you’re a burden.”
Dr. Alison Chasteen, a social psychologist at the University of Toronto.
Pamela isn’t alone. A recent Employment and Social Development Canada survey found that almost half of respondents 55 or older felt they had experienced ageism, a form of discrimination that the World Health Organization says is one of the “most socially normalized.” Not only is age stigma prevalent, but it can also damage older adults’ abilities, says Dr. Alison Chasteen, a social psychologist at the University of Toronto.
“If you activate negative stereotypes in older peoples’ minds, that can elevate a cardiovascular stress response that can also affect memory function, so they don’t do as well on, say, a free recall test where you have to recall a list of items,” says Dr. Chasteen, noting that it’s also been shown to impact motor function.
Fixed mindsets
Internalizing negative stereotypes to the point that they feel like they define our characters isn’t unique to older adults experiencing ageism. Self-stigmatization is a common phenomenon that runs across all forms of stigma but, when it comes to ageism, there’s another layer, because older adults may, themselves, have held negative ideas about ageing when they were younger.
Given how pervasive and complicated age stigma is, an essential first step in tackling it is to stop using terms that carry negative connotations, such as “the aged,” “old-old,” “senior citizens” and “the elderly.” These imply a fixed identity and/or evoke images of frailty. By contrast, the term “older adult” reminds us that age is relative and ever-changing.
“Really what we’re talking about here is ageism,” says Katie Ellis, Program Manager at the Mental Health Commission of Canada, who recently led a research project on mental health and older adults in Canada. “Using language with negative associations really does have a negative impact on quality of life, because stigma can stop people from thinking they can get better access to care or participate in certain activities.”
Stigma and social exclusion go hand in hand. Pamela says that, even though she’s resisting the push for her to quietly retire from her life-long career, she’s often left out of after-work gatherings and finds that holiday parties can be awkward because she’s not in the cool kid crowd. She’s lucky to have good friends outside of work, but it’s easy to see why age stigma is closely associated with mood disorders, diminished well-being, and feeling less inclined to seek medical treatment, as well as loneliness and social isolation.
Mental Health Commission of Canada program manager Katie Ellis led a research project on older adults and mental health. Stigma can lead to a negative impact on quality of life.
Mattering and belonging – what’s the difference?
“I think the big thing with discrimination and prejudice and stigma is that you’re no longer seen as a unique person with valued attributes,” says Gordon Flett, Honorary President of the Canadian Psychological Association 2024-2025 and former York University Canada Research Chair. “A key element of ‘mattering’ is just being seen as an individual with valued attributes and, instead, you’re seen according to a prescribed box that you’re put into, and you feel unvalued or devalued.”
“Mattering” shares a lot of space with the idea of “belonging” but takes it a step further. It’s possible to belong to a club but still feel unimportant. Mattering means that people value your contributions and, simply enough, you matter. That sense of purpose and meaning seems to offer protective qualities, since it’s correlated with resilience and better health outcomes. Anti-mattering, on the other hand, is closely associated with discrimination and stigma.
“Anti-mattering is so destructive because it means treating people like they’re insignificant or invisible or unseen, unheard and unvalued,” Flett explains.
It’s hard to get people to see beyond stereotypes if you rarely, if ever, interact with people outside of your generation, though. Few Canadians do, since “age bubbles” define a lot of peoples’ social lives. As ageist as some workplaces may be, it’s not uncommon for people from different generations to work on projects together on the job site. By contrast, many social spaces are often tightly age-segregated in ways we don’t always even notice.
“I went to a wedding with my sister and my mother recently and we expected to spend the evening together,” says Dr. Raza Mirza, Director, National Partnerships for HelpAge Canada. “But my mother was sat at a table with older adults, and I was sat at a table with younger people who I didn’t have anything in common with. I would have far preferred to sit with my mother.”
The assumption that older adults only want to talk to people their own age is particularly striking to Mirza, whose career is focused on fighting age segregation through intergenerational projects. Although many are in their infancy, there are a lot of pretty cool projects aimed at getting people out of their age bubbles.
In Alberta, the Canadian Alliance for Intergenerational Living launched a pilot project last year that placed students looking for affordable housing into retirement communities in exchange for leading classes in, say, art, scholarship, or fitness.
St. Lawrence, a school in Champlain, Quebec, arranges intergenerational living situations by offering students two meals a day and free lodging in a residence for older adults in exchange for 10 hours of volunteer work in the home per week.
Vancouver’s Volunteer Grandparents has a “Family Match” program that sees older adults sign up to help mentor kids whose biological grandparents can’t play active roles in their lives. Ontario resident Heather Walker wanted to take part in the program but was too far away, so they made her a pen pal to a 15-year-old.
“She seemed like a younger me,” says Walker, who will celebrate her 70th birthday this summer. “Her passions were writing, and social justice and I had so many questions, my letter back was five pages long.”
Now she has a new role as a pen pal with an entire class in an elementary school. She helps them with things like sentence structure and sends them Valentine’s Day cards and other special treats.
Burst your bubble
One of the better-known age bubble-bursting projects is Raza Mirza’s “Intergenerational Classroom,” an initiative that sees a third-year University of Toronto Ageing and Health class pop up in a common room at Christie Gardens, a Toronto retirement community and long-term care home. Students and residents take the class together for the entire semester.
“It’s been highly, highly successful, because we facilitated a platform where people can feel valued,” says Mirza. “We keep hearing that people felt they had a role, felt that their contributions were meaningful, and felt a sense of belonging. But there was also reciprocity, so it wasn’t this older person who was just the recipient of information or sharing information. There was this back-and-forth exchange.”
Nobody gets stuck in the corner at the kids’ table, either. Everyone has a chance to break out of their age bubble and get to be seen as a unique person. It’s a fabulous model showing a path forward for us to fight against stigma, negative stereotypes, and anti-mattering. And, in fact, it might even help people re-define what “being old” means.
“We’ll start the class by asking the students, ‘At what age do you think a person is old?’,” says Mirza. “People say things like 40 or 50 or 60. Then, after being in the class and listening to older adults for 12 weeks we ask them the question again. They say things like, ‘I’m not sure’ or ‘I think old is a perception or a feeling.’ They focus on the similarities they have and the things that they have in common,” he adds. “They don’t focus on the age difference anymore.”
Resource: A free course on dismantling structural stigma in health care aims for meaningful change for people experiencing mental health and substance use issues.
Author: Christine Sismondo is a Toronto writer who hopes to one day live with friends in a communal living project modelled after The Golden Girls. In a perfect world, there’d be someone like Sophia in residence, because intergen living is the best.
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The other day I was walking down the street when my foot hit a divot in the pavement, and I went over on my ankle. I heard – or maybe felt – a snap. My ankle started swelling almost immediately. To the emergency room I went and as I whiled away the hours scrolling, watching videos, and playing word games I watched my phone’s battery dwindle and eventually I was “in the red.” Uh-oh! I needed my phone to call a ride when my ER ordeal was done! With no hope of seeing the doctor soon and no charger in my pocket there was nothing I could do but give the phone a rest and turn it off.
Wouldn’t it have been magical if, when I turned it back on two hours later, instead of finding my battery at 8% it had recovered its charge up to 50%? Wouldn’t it be great if just giving my phone a rest would also recharge its battery?
Alas, that is not how it works – for phones or for people either. Rest is not the same thing as recovery. I need to recharge my phone if I expect its battery life to recover. I need to plug it in if I hope to recharge its battery. Luckily with a phone it is a very simple and linear process – we know exactly what to do when our phone’s battery is in the red. But what do we do when our own “batteries” need to recharge?
Self-care is the obvious answer to mental health recovery, but it isn’t as obvious what self-care looks like, because it looks completely different for different individuals. In fact, self-care is often maligned as an airy-fairy concept, awash with adult colouring books, meditation apps and yoga poses – and if those are your things, then great! But self-care can be and is so much more.
Some people (like introverts) recharge their batteries solo or with smaller group activities – reading, crafting or solo exercise. Others (like extroverts) find they recover better when they can feed off the energies of others and prefer to recharge in the presence of other people – parties, group activities and team sports. However, there are some all-round solutions if you are looking for ways to recover.
Taking care of your body with sleep, exercise and nutrition is a must. We all know this. But there are a lot of moving parts here! When you are in need of recovery it can be overwhelming to see the catalogue of things you are “doing wrong” in this department, and that is not the goal. The goal is to choose practices that recharge your energies, not deplete them. And so, beginning a practice of good sleep hygiene or drinking more water might be more manageable. Don’t try to change everything at once and make it perfect – there is no such thing anyway. Just do something good for your body to help it rest and recover and celebrate that!
Experiencing nature is another powerful way to recharge your batteries. This is one self-care tip that becomes easier as the leaves and flowers bloom. Taking a nature walk or forest-bathing can help but even just sitting in your back garden or eating lunch on a park bench is enough to help restore balance.
These self-care tips are helpful in recovering your mental health, but these are not the tips that will lead you to recovery with mental illness. Medications, talk therapy and a good therapeutic alliance with your caregivers as well as peer support will help with that. And the road to recovery with mental illness is a long and non-linear process. But that process will be augmented by a self-care routine that keeps your batteries charged, giving you the energy to work at that process. In short, we all have mental health, and we all need to mindfully recover our mental health all the time, but mental illness requires a different kind of recovery.
Spoiler alert – my ankle was a simple sprain and I hobbled out on crutches and a prescription for, you guessed it, REST! In a few days it was right as rain. That is the last piece I want to touch on here. While rest is not the same thing as recovery, recovery takes rest. It takes time and relaxation – whatever that looks like for you. Sometimes staying off of it – metaphorically speaking, of course – is the best thing you can do for your mental health. Sometimes you need a crutch. So, take your weekends and vacation days to rest. Do something to take care of yourself. And watch your battery life go up.
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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Older adults are more likely to suffer from social isolation and loneliness is increasingly being recognized as being bad for our health. The good news is that mattering and belonging can flip the script. Our series explores these and other related concepts.
When Pat Flude was experiencing painful side effects during her breast cancer treatment, a doctor from the pain clinic at Toronto’s Princess Margaret Hospital (PMH) gave her a “social prescription” for a mindfulness-based cognitive behavioural therapy class.
“I went every week for about three months,” says Flude, a 78-year-old retired teacher and cancer survivor. “The psychiatrist who led the program, Dr. Mary Elliott, was marvelous. It was so excellent; I even did a follow-up class in loving kindness.”
Since everyone in the class was also being treated for cancer, there was a real sense of community. Flude says she looked forward to the reunions that took place at quarterly graduate sessions. “For me, at that time,” she recalls, “it was really life’s blood.”
Although not every hospital is as proactive as PMH at offering prescriptions for things other than drugs, the “social prescribing” movement is growing by leaps and bounds. The guiding principle is to address the social determinants of health – non-medical factors that influence health outcomes – that are often neglected in medical settings. To fill that gap, primary health care providers refer a patient to a senior resource coordinator who steps in to “prescribe” wellness opportunities (specifically chosen classes or outings based on interest) often for older adults who have higher rates of being at-risk for loneliness and/or social isolation.
From isolation to inclusion
“The big one is social connection,” says Connie Newman, executive director of the Manitoba Association of Senior Communities. “We’ve got some older adults who haven’t been out of their apartments for too long. With a social prescription, we can connect them to one of Manitoba’s many older adult groups.
“Some might be at the local legion; in other communities, it could be the local senor centre,” Newman explains. “Wherever it is, the clients sometimes need a little support to join.”
Connie Newman, executive director of the Manitoba Association of Senior Communities: Social prescribing can open the door to connecting older adults to others in their communities.
Although research associating social isolation and loneliness with negative health outcomes began, in earnest, a little more than 40 years ago, programs to prevent or reverse these conditions and foster a feeling of belonging are relatively new. Spurred, in part, by the pandemic, which raised awareness of negative mental health effects associated with isolation, “social health” (well-being as an outgrowth of social connection), has become a hot topic lately. Japan and the United Kingdom both have ministries devoted to addressing loneliness, which some consider an epidemic, especially among older adults.
Here in Canada, the Canadian Coalition for Seniors’ Mental Health has recently launched the world’s first clinical guidelines for addressing social isolation and loneliness. Since older adults experiencing isolation often see health and social service professionals, clinicians are key people for identifying at-risk patients, so it’s very important to get them on board.
“Although there’s been a huge amount of research in the area focused on associated health risks there has been relatively little written from the perspective of how to actually help people,” says Dr. David Conn, a geriatric psychiatrist who works at Baycrest Health Sciences and the University of Toronto.
The guidelines, which are making their way into healthcare and community settings, are designed to help clinicians screen for loneliness and isolation, assess the problem and its causes and make helpful recommendations. In some cases, a social prescription might transform the quality of life of a person experiencing isolation but, for those with chronic loneliness, recovering from those feelings is often much more complicated. Neuroscientists have even suggested that loneliness can re-shape the brain in ways that make social contact less rewarding, thereby making it harder—but not impossible—to “cure” loneliness. A meta-analysis of research found that a range of therapies including animal therapy, exercise, and cognitive behavioural therapy were associated with reduced feelings of loneliness in older adults.
The power of place in fostering connection
That’s a nugget of good news but, as we should all know at this point, prevention is, by far, the best intervention. Some researchers advocate for social prescriptions for people of all generations, as well as working to remove health equity barriers, so that we have a population that’s in good health as it moves into middle age. As Dr. Conn points out, problems with depression, hearing, vision, mobility, and chronic pain can impact our capacity for socializing and staying active.
Providing an environment for people to stay fit and connected to the community goes far beyond healthcare and even public health, since it involves reimagining a range of public spaces, some of which we take for granted. Over the past 20 or more years, we’ve heard a lot about the “third place”—spaces like barber shops, cafés, and shopping malls that are neither work nor home but can foster community and a sense of belonging. The next frontier may well be “fourth place”—streets, squares, bus stops—which, if well-designed, can help promote social health and cohesion. That can only work if they’re truly accessible, however.
“The design is often good in a privileged neighbourhood,” says Julie Karmann, PhD candidate at the University of Montreal’s School of Public Health. “But if you go into a more deprived neighbourhood, you can see that the street is no longer that accessible and not that pleasant for walking.”
Karmann’s work is based in the idea that the simple act of walking can help social health, of which connectedness is an important component. Even relatively well-designed fourth places, though, often miss the mark when it comes to being truly age-friendly.
“Basic improvements like more accessible and affordable transit, safer intersections, and well-maintained sidewalks are essential,” says Eddy Elmer, a Vancouver gerontologist and research consultant specializing in aging and mental health. “People don’t want to go outside if the streets are dark or feel unsafe, regardless of age, but this is especially true for older adults who worry about slipping, falling, or other hazards.”
Maintenance, regular snow and ice clearing, as well as accommodations for persons with disabilities should seem like a bare minimum, but austerity measures in various municipalities have often led to worsening conditions. While we wait for political change, social health programs such as prescriptions can help, especially the ones that move beyond the individual and involve the community.
More walks, more smiles
“One of my favourite programs is from the Netherlands, which has a whole strategy and campaign against loneliness,” says Conn. “One of the programs is an app that connects older people who don’t have a pet with a younger person who has a dog but doesn’t have enough time to walk the dog because they’re out working all day long. It has many benefits for all involved including the dogs!”
Burnaby B.C.’s “Say Hello” campaign is arguably even more effortless. Initiated in 2020 by local physicians worried about pandemic-induced social isolation and loneliness, the project encouraged folks to be a little friendlier to the people they passed on the street.
“It’s super simple, but yet requires a whole paradigm shift, because it has nothing to do with a physician or a clinic,” says Karmann. “Just implementing the norms of greeting in the neighbourhood or smiling to the person you meet in the street can make a huge difference with your sense of belonging.”
Karmann says it’s a tiny gesture that can have a big impact on the population, not just the individual.
“It’s just knowing the people around you,” she adds. “It can be as easy as asking, ‘How are you doing?’.
Author: Christine Sismondo is a Toronto writer who hopes to one day live with friends in a communal living project modelled after The Golden Girls. She’s not sure she’s met her Blanche yet, but hopes to soon, since someone’s got to keep things spicy. And pay the bills.
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Older adults are more likely to suffer from social isolation. Loneliness is increasingly being recognized as being bad for our health. The good news is that mattering and belonging can flip the script. Our series explores these and other related concepts.
In the summer of 2023, Vancouver Island resident Linda Fedun was feeling pretty lonely, even though social distancing measures had been lifted the year before.
“The pandemic started it, but it was when my back pain became serious that things got really bad for me,” says the 63-year-old retired daycare worker. “I couldn’t really go out. I’d be out for half an hour and then I’d have to go home in tears.
“Social isolation is hard,” she adds. “Especially since it’s just me and my two cats.”
Many older adults in Canada can relate. It’s hard to pin down exact numbers, but Statistics Canada has estimated about 30 percent of older adults are at risk of experiencing social isolation and, in 2019 and 2020, almost one in five reported feeling loneliness.
Social isolation is defined as having both a low quantity and quality of contact with others. It’s marked by an absence of mutually rewarding relationships and can lead to poor health, loneliness, emotional distress, and other negative health outcomes.
For some, that feeling is chronic. For Fedun, things improved after the doctors figured out a treatment plan for her osteoarthritis last October and she could finally reconnect with her community and get back to things like taking regular walks. One of these took her by an encampment she hadn’t even realized existed, even though it was only a few blocks from her home. There, she recognized an old acquaintance who told her she and her partner had been unhoused for months.
“I went right home and started looking for what I could spare,” says Fedun. “And then I realized it’s more than that. They needed much, much more than that.”
Fedun started asking for help from neighbours through her Nextdoor app, a social networking site that helps people connect with local folks for potlucks, buy-and-sell, and other exchanges. Members of her community responded enthusiastically with food, warm clothing, and propane for a Coleman stove. She organized pick-ups and drop-offs and connected with an advocate for the unhoused who gave her a “crash course” on housing insecurity. The pair launched a Go Fund Me campaign to help their unhoused friends get an apartment.
Social isolation is a thing of the past for Fedun and, perhaps unsurprisingly, so is loneliness. “I have a sense of purpose now,” she says.
For many, though, the answer isn’t as simple as getting back out, largely because social isolation and loneliness are two different things.
Social isolation and loneliness—what’s the difference?
“Social isolation is objective, such as the number of people in your life and how often you interact with them,” says Eddy Elmer, a Vancouver gerontologist and research consultant specializing in aging and mental health. “Loneliness, on the other hand, is more subjective. It’s the feeling that there’s a mismatch between the relationships you want and those you actually have, whether in terms of quantity or, especially, quality.
“One person can be fairly isolated but not feel lonely, whereas another can have a large social network, but feel quite lonely,” Elmer continues. “It all depends on their unique social needs and expectations.”
Since they’re two distinct problems, they require completely different approaches. And, generally speaking, it’s easier to reverse problems associated with social isolation than it is to help people overcome chronic feelings of loneliness.
“It’s probably normal to have some degree of loneliness from time to time,” says Dr. David Conn, a geriatric psychiatrist who works at Baycrest Health Sciences and the University of Toronto. “But for people who feel intense, chronic loneliness, the origins of that are often rooted in early life relationships and how they feel about people in general.”
Despite not being interchangeable, both social isolation and loneliness are associated with a range of negative health outcomes. In older adults, social isolation is correlated with frailty, cognitive decline, and depression, as well as increased chances of a premature death.
“The key word here is ‘correlated’ because establishing causation is not straightforward,” says Elmer. “But studies find that both loneliness and social isolation are associated with increased inflammation, weakened immune function, hypertension, cardiovascular disease, diabetes, and poorer sleep quality.”
That last symptom may be an important piece of the puzzle. According to the evolutionary theory of loneliness, poor sleep is part of a “hyper-vigilant” state triggered by social disconnection. In a nutshell, for early humans who lived in smaller hunter-gatherer tribes and had to work together closely for survival, being alone was dangerous. Loneliness is an unpleasant emotional response that might be an adaptive mechanism, since the pain of being alone can serve as a biological signal to restore social relationships and get back to safety.
Vancouver gerontologist Eddy Elmer: You can be isolated and not lonely; you can also have a wide social circle and still feel lonely. It all depends on one’s needs and expectations.
Mattering is good for the grey matter
Even though way fewer sabre-toothed predators are prowling around these days, being a member of a clan is still the safer and healthier choice for most people. A recent study from Carleton University found that higher belongingness is connected to better health outcomes for people of all ages—but particularly for older adults.
“What we found was that older individuals who felt they belonged to their neighbourhood were about six or seven percent healthier than people who didn’t,” says Mehdi Ammi, Associate Professor at Carleton’s School of Public Policy and Administration. “Belonging reduced most chronic conditions and was preventative in arthritis and anything connected to chronic stress.”
Social psychology proposes that high levels of belonging can help chronic stress, so it may offer a protective benefit to folks who feel like they have a place at the table. Though some positive psychologists say that while belonging is a good start, an even stronger protective benefit can be seen in people who feel like they matter.
“Belonging is fitting in and having a place,” explains Gordon Flett, Honorary President of the Canadian Psychological Association 2024-2025 and former York University Canada Research Chair. “Mattering is feeling a sense of significance and value within that place. For example, a person could be part of a community, but still feel they’re not being taken seriously.”
The correlation between loneliness and the feeling of not mattering is very robust, he says. “The research about loneliness and the elderly show that there are just too many people who don’t have any meaningful engagement of a prolonged nature with the people who matter to them,” Flett continues. “And they’re left to feel lonely. And when people feel alone and insignificant at the same time, we call that ‘double jeopardy’.”
Conversely, mattering is thought to provide a buffer of sorts that protects individuals from significant stress, whether it’s caused by loneliness, caregiving, loss of independence, and even financial issues.
“The bottom line is that knowing people value and care about you is very comforting,” says Flett. “And I think it also means that you’ll be more likely to ask people for help when you need it.”
It can be difficult for older adults to feel valued and have a sense of meaning, especially in North America, where the culture valorizes youth, fails to provide age-inclusive spaces or age-friendly cities, and views health as an individual responsibility as opposed to a collective one. All these things are factors in widespread loneliness amongst Canada’s older adult population.
While we wait for societal changes, many older adults who have the ability are finding ways of aging in community and generating mattering experiences for themselves. For some, that might be grandparenting. For others, it might be volunteering to help other older adults.
“My wife’s uncle Derek, who almost made it to 100 and lived by himself his whole life in Fort Qu’Appelle, Saskatchewan, was well-known for his volunteer work,” Flett offers. “He delivered Meals on Wheels to people younger than him into his 90s because he was in great shape.
“I once asked him if he ever felt lonely and he cut me off. He said, ‘Not for a second. Because I know there’s people out there who care. And I can get to them, and they can get to me’.”
Further reading: Home Alone: Aging without support is becoming more prevalent for older people in Canada. How can we stem the tide?
Author: Christine Sismondo is a Toronto writer who hopes to one day live with friends in a communal living project modelled after The Golden Girls. Since it was her idea, she gets to be Dorothy.
This blog post presents a review of the current literature on Indigenous Perinatal Mental Health, exploring key themes, gaps, and emerging insights. Drawing on both academic sources and community-informed perspectives, this review is enriched by the voices of leaders from Indigenous-led associations who offer vital context, critique, and cultural grounding. Their commentary not only deepens our understanding of the complex interplay between perinatal mental health and Indigenous experiences but also affirms the importance of Indigenous leadership in shaping responsive, culturally safe care.
The Gaps in Research: Why Aren’t We Talking About This?
As I began researching this topic, I was struck by how little information exists on Indigenous Perinatal Mental Health (PMH). The absence of data speaks volumes; this issue has been overlooked for far too long. A 2020 systematic review published in the Canadian Journal of Psychiatry by Sawayra Owais & colleagues found that Indigenous women are nearly twice as likely to experience postpartum depression as non-Indigenous women, with prevalence rates reaching 31%. Despite this, culturally safe care remains scarce, forcing Indigenous women to navigate their struggles alone – often in silence.
This silence is not a choice but rather a symptom of a system that has long failed Indigenous mothers. PMH, essential to the well-being of both mother and child, remains riddled with barriers.
While many existing studies examine general barriers to maternal health care, very few explore the emotional toll these challenges create. A 2022 study by Zarish Jawad, Nikita Chugh, & Karina Daddar found that PMH services for Indigenous mothers are often inaccessible, underfunded, and culturally inappropriate, making it even harder for women to seek the support they need.
A Legacy of Mistrust
To understand why Indigenous mothers hesitate to seek PMH care, we must first acknowledge the deep-rooted mistrust in Canada’s health-care system. For generations, Indigenous families have been subjected to policies that severed the bond between parent and child, making it challenging to trust institutions meant to provide care. Health care settings have not historically been places of healing for Indigenous people.
Robin Smoker-Peters, Instructor of Indigenous Health at Western University, reinforces this reality: “These are not just events of the past. The last residential school in Canada closed in 1996, and forced sterilizations were still occurring up until a few years ago. This is not just history; it is still happening and continues impacting how Indigenous people engage with health care.”
Even today, Indigenous mothers fear that seeking PMH care may lead to child welfare involvement. According to Census 2021, Indigenous children make up 53.8% of those in foster care despite representing only 7.7% of Canada’s entire child population. Families are torn apart due to systemic biases rather than genuine concerns about parental capability.
A deeply harmful policy that reinforced this fear was the Birth Alert system, which flagged Indigenous mothers as child welfare concerns, often based solely on their connection to residential school survivors. As Smoker-Peters explains, it operated on the assumption that Indigenous mothers were unfit, leading to newborns being taken from their mothers without cause. While now banned in B.C., many Indigenous women still hesitate to seek PMH support.
The Disconnect
For Indigenous mothers, Western PMH frameworks lack the culturally grounded support they may need. A 2023 study by Christina DeRoche & colleagues found gaps in culturally appropriate care for Indigenous parents after surveying perinatal professionals about barriers diverse populations face in accessing PMH care.
One provider shared, “Do not forget about Indigenous PMH, as they are referred to us for obstetrical care, but we are unsure of what to do after [receiving] a diagnosis,” reflecting a system with no clear, culturally relevant care paths. Another noted the “lack of Indigenous-specific services for perinatal mood issues.” Even providers recognize their limited ability to offer culturally sensitive care, yet these gaps will persist without policy-level change.
Addressing Indigenous PMH means more than acknowledging disparities; it requires action that centers on Indigenous voices, traditional healing, and culturally safe care. Smoker-Peters stresses this point: “There is an overfocus on intergenerational trauma and not enough attention on how the system itself continues to be racist and harmful. Indigenous mothers should not be viewed through a deficit lens. They have immense strength and resilience, and the system needs to recognize that.”
Indigenous-Led Solutions: A Path Forward
Despite these challenges, Indigenous midwives and community-driven health programs are working to bridge these gaps. The National Indigenous Council of Midwives (NICM) has advocated for Indigenous-led maternal care that respects traditional knowledge while integrating modern medicine.
Claire Dion-Fletcher, past co-chair of NICM, emphasizes the systemic issues that Indigenous women face in health-care settings during a Canadian Senate meeting in March 2024: “I understand that doctors and all healthcare providers have expert knowledge in health and medicine… but we also have to recognize that Indigenous people and Indigenous women have expertise in their bodies. When we continuously, as health-care providers, say what we think is best for Indigenous people, we are taking away their ability to say what is best for them and to make decisions about themselves.”
Indigenous midwives are essential in ensuring reproductive care upholds autonomy and informed consent. NCIM Executive Director Ellen Blais states, “We are prevention by applying the principles of free, prior, and informed consent, continuity of care, culturally rooted care, and patient advocacy.”
This advocacy highlights the vital role Indigenous midwives play not only in providing care but also in championing the rights and dignity of Indigenous women.
Incorporating Indigenous midwifery into perinatal care models is more than a health-care improvement; it’s a step toward reconciliation. By supporting Indigenous-led maternal care, we can create a system where Indigenous mothers feel safe, respected, and empowered throughout their perinatal journey.
An important initiative is the Bringing Birth Home project, which aims to restore Indigenous midwifery and support community-based births, reducing the need for long-distance travel. As highlighted in the Association of Ontario Midwives’ article “Bringing Birth Home: Restoring Indigenous midwifery,” historically, every Indigenous community had a midwife providing comprehensive care, but colonial policies disrupted these traditions. This initiative works to restore midwifery practices and keep birth rooted in the community.
What Needs to Change?
For starters, Indigenous-led PMH programs need more funding and support from our government. Organizations are already doing this work but need the resources to expand their outreach.
Another big piece of the puzzle is representation. Indigenous women deserve to see themselves reflected in their care providers, yet there is a shortage of Indigenous health-care professionals. Dion-Fletcher explains that an Indigenous response “would be rooted in relationships and focused on prevention, and [she] thinks one of the key ways that we can do this is through Indigenous health-care providers, Indigenous midwives, Indigenous doctors, nurses, and patient navigators who are there to promote the autonomy.” Encouraging Indigenous students to enter these fields, providing scholarships, and ensuring that non-Indigenous health-care providers receive cultural safety training are all steps in the right direction.
It’s Time to Listen
For too long, Indigenous mothers have been left out of conversations that shape their PMH care. The barriers they face go beyond access – they’re rooted in history, trust, and the right to health care that respects who they are.
But the solutions already exist. Indigenous midwives and community health workers are offering impactful, culturally rooted support. If we genuinely want to see better maternal health outcomes for Indigenous families, policy makers should better engage and include Indigenous voices – by funding Indigenous-led programs, increasing representation, and ensuring that seeking help is seen as a right, not a risk.
As we push for change, we must also recognize the histories and rights of Indigenous peoples, whose voices have too often been ignored. Ultimately, this isn’t just about policy—it’s about people.
I acknowledge that the land on which this article was written and researched is the unceded and unsurrendered territory of the Algonquin Anishinaabe Nation.
Author: Mariam Hasan
