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A lack of economic awareness or control over one’s finances can have long-term impacts. We look at the link between intimate partner violence and money in the third article of our series for Financial Literacy Month.
At the start of her marriage, Margaret Williams (a pseudonym) was perfectly OK letting her husband take the lead and do all the planning around their finances and work lives.
“He told me it was best for the family if I raised the kids and worked part time doing admin tasks for his company,” Williams said. “And so, basically what happened was that I wasn’t gaining any marketable skills. He saw to everything regarding the finances. I didn’t find out till later that all the things he did were advantageous to him.”
By “later” she means when her husband’s physical and mental abuse had pushed her to a breaking point — and she was thinking of leaving the marriage.
“When everything escalated, he threatened to take all his money out of the joint account,” she says. “Since he was the only one officially working, that was all of our money.
“And that’s exactly what happened after I ended the marriage,” Williams adds. “I was left with nothing.”
But emptying the joint account wasn’t the end of the economic abuse. After the divorce, her ex-husband not only refused to pay all the court-ordered child support, he also damaged her credit history and left her with little choice but to rack up debt on a family member’s line of credit.
Coercive control
Unfortunately, such stories are all too common. While people often think of intimate partner violence (IPV) in physical, sexual, and emotional terms, economic abuse also occurs in an estimated 99 per cent of IPV cases.
Economic abuse can make it especially difficult for the person being targeted to leave their situation. It’s also a significant barrier to a survivor’s recovery and positive mental health outcomes.
“If you don’t have the financial resources to obtain mental health services, your recovery is going to take much longer than it otherwise would,” says Dr. Kristina Nikolova, whose research at the University of Windsor focuses on economic abuse. Yet, despite its damaging effects, supporting those who are subjected to it is an often neglected issue in Canada.
“We have good shelters, good food banks, emergency support systems, and crisis lines,” says Meseret Haileyesus, CEO and founder of the Canadian Center for Women’s Empowerment (CCFWE). “But survivors also need a strong economic empowerment program.” To meet this need, the CCFWE offers several resources, including financial literacy workshops and checklists for financial abuse survivors, and also advocates for systemic change — which starts by raising awareness.
“This form of violence has not really been defined properly in Canada,” notes Haileyesus, “When it is, it’s usually divided into three parts, starting with economic control: deliberately restricting access to bank accounts, communication, and transportation but also to work, education, and training.”
The second part is economic exploitation, which may involve physical destruction (e.g., houses, cars) or destroying a partner’s finances by gambling, overspending, or drawing out expensive custody and divorce proceedings. “With economic exploitation, the perpetrator might rack up debt in the name of the victim,” says Nikolova. “Technically, we do have fraud legislation for this, but in an intimate relationship it’s very hard to prove whose debt it actually is.”
The third part is employment sabotage, a deliberate pattern of keeping victims from working by withholding transportation, confining them, or stalking them at work. According to Nikolova, because employers are often unaware of economic abuse, they tend to blame absenteeism or poor performance on the victim, even though it can stem directly from IPV.
Meseret Haileyesus
“In Ontario, workplaces are supposed to have guidance and safety protocols for dealing with domestic violence, but people rarely receive that training,” she says. “As a result, it often isn’t recognized unless somebody shows up screaming and yelling and wielding a weapon. That’s the only form in which the victim might actually get some leeway and not lose her job because of the abuse.”
Other researchers in the field and people with lived experience of economic abuse suggest that employers, in a sense, collude with the abuser, even if unwittingly. Throughout her separation and divorce, Williams says her experience led her to believe that the courts have little understanding of economic abuse, which makes it easy for abusers to exploit the system.
“I always expected that, when things went south, the law and the courts would protect the well-being of children,” she says. “I believed that but had no idea that this is absolutely not the reality whatsoever. I’m really sad to say that this isn’t the society I would hope for my kids to have one day.”
Systemic change
Although Canada’s Divorce Act was revised in 2021 to acknowledge the role financial abuse plays in gender inequity, the overarching system needs an overhaul to make any significant difference. For example, Williams says that family responsibility offices are toothless when it comes to enforcing child-support payments — at least in her province.
There’s also significant room for improvement when it comes to people’s awareness of economic abuse, from housing to health care. According to the CCFWE, roughly two-thirds of social and health-care workers have no training in screening for economic abuse, which is why the organization has launched a screening tool for service providers.
But the biggest impact would probably come from the financial industry, since it’s where the vast majority of economic abuse occurs. “In Australia and the United Kingdom, programs are now set up in banks to help victims of economic abuse,” says Haileyesus, referring to recent initiatives that make it easier for survivors to access credit and private personal bank accounts.
Earlier this year, one British bank changed its app to allow users to mute the messages that accompany money transfers, so they can avoid seeing any threats abusers might send with alimony or child support payments. While that may sound like a minor change, compared with repairing damaged credit, it’s an instructive example of the many systemic gaps and oversights that allow economic abuse to continue, even after a relationship has ended.
Unfortunately, banks in Canada still have a lot to learn in this area. “Simply put,” Haileyesus says, “due to a lack of awareness and a lack of policy, our banking system is not designed to help these victims.” Earlier this fall, the CCFWE launched a national scorecard on economic abuse that included policy recommendations targeting the financial sector.
For Nikolova, these gaps have immediate real-world repercussions on survivors that hinder recovery and positive mental health outcomes. According to her research, this is especially so for Indigenous and African, Caribbean, and Black women, who typically suffer greater discrimination from the legal, health-care, and financial systems. “We now measure financial stress as one of the assessments with survivors to see how that’s impacting them, and we have found that it’s very highly correlated with things like anxiety, depression, and worsening PTSD symptoms,” she says. “We are seeing that even five or 10 years after a relationship has ended, women who have experienced economic abuse are still at a lower socio-economic status than their peers.”
Williams continues to deal with her ex-husband’s put-downs and ongoing financial abuse several years after being apart. “He always says I’ll never make it on my own, which certainly isn’t the case,” she says. “It’s almost like the abuse continues and adds insult to prior injury, so you’re not able to just focus on healing and getting your life back in order, which is hard since I’m trying so hard to be in rebuild mode.”
Despite these challenges, Williams is confident that her newfound commitment to independence — something she wants to model for her kids — will make it possible for her to recover from the economic abuse. It’s that hope that gets her through the daily struggle of balancing work, parenting, retraining for a new career, and dealing with the courts.
Further reading: The Day I Decided to Leave: The Catalyst
Resource: Support services from across Canada from the Canadian Women’s Foundation.
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The lack of housing options brings its own kind of homesick feeling. We look at the link between housing and health in the second of the series for Financial Literacy Month.
I recently received an all-too-familiar mass text from a friend: “Do you know anyone moving out of a 2-bedroom? Our landlord got a permit to renovate, and we have to be out asap.”
Unfortunately, leads are hard to come by. This is Halifax. While it has an easygoing seaside city reputation, the rental market is giving off a different vibe. With no real solutions, I texted my friend back with good luck wishes, knowing very well that it wasn’t going to help.
If it could, I would ship it in great quantities to Canada’s largest province, where an Ontario Chamber of Commerce housing report found that 1.85 million units would be needed — beyond what’s already in the development pipeline — to restore housing affordability.
These massive numbers loom large for Canada’s young people — a cohort I am part of as a university student looking at my future. For many, faith in an affordable future has been shaken. Yet those with a more optimistic outlook are seeking ways to find agency and new ways of living.
Head, heart, house
A home is more than just a house; its psychological value far surpasses its four walls. It’s about reliability and routine, says Madeleine Hebert, who works as a senior housing specialist with Happy Cities, an urban planning, design, and research consulting firm in Vancouver.
“What’s most challenging for mental health is when affordability causes renters to live in more transient situations,” she says. “We’ve found a really strong link between how long you live in a place, your ability to build social connections, and a sense of belonging and meaning. Forming roots is difficult for renters in cities with little housing security from private landlords, who can ask them to leave at any time.”
Affordability pressures push people to make tough life decisions like leaving their communities, finding a new home for a pet, or moving in with a partner sooner than they’d like.
“There’s a huge variety of needs for different people,” Hebert notes, citing availability and affordability as key needs when looking at housing. “Choice gets removed from the equation for many lower-income renters, and that’s where we start to see mental health struggles.”
It’s this lack of affordable options that intersects with other barriers people face. Valery Navarrete experienced the crux of it in 2022. That was the year her mother died. Her mom had been the primary caregiver for Navarrete’s brother, who lives in Toronto and has a serious mental illness and substance use issues. When Navarrete started looking for supportive or subsidized housing options for her brother, she hit a wall.
“If you’re lucky enough to find something, there is no guarantee it will be close to the person’s medical and personal support,” she says. Navarrete is a consultant for nonprofit organizations and has spent decades working in health policy and advocacy. She has also produced a podcast about communal housing models. But while she understands the access points and barriers, this knowledge is up against the reality of the demand. Wait-lists for supportive housing in Toronto are in the double digits — 14 years — leaving her family without options. Her brother is currently in family care with a support person who is elderly. So, the situation is not long-term.
“Most families are not in a place where they can afford long-term medicalized options,” Navarrete says, “and many people want to preserve their autonomy.” For her, Canada needs more public housing — and fast.
As people grapple with the high cost of living, calls for more affordable housing are getting louder and becoming an election issue in Canada. At the same time, long wait times for systemic change in the face of immediate housing needs are spurring new models and reviving old ones.
Diana Lind offers details on co-living models and micro-house communities in Brave New Home: Our Future in Smarter, Simpler, Happier Housing. Her 2020 book focuses largely on New York City, first looking back at epic growth in the 19th century, through tenement models, and finally into Airbnb and other temporary forms. In Lind’s view, the single-family unit we are socialized to aspire to is unsustainable. Just entering the market requires a large investment, and the units themselves have an inefficient use of space. For many people today, that white picket fence has become an image from another era. And Lind believes that the time has come to give up the American dream of a house with a two-car garage. Not only are they overpriced and lonely, other housing models would be better at helping us live together as communities, given that many people live alone, marry later in life, have smaller families, and are more virtual and mobile. In other words, housing models are lagging behind our current needs.
Hebert speaks of one such project, which Happy Cities calls “co-housing lite.” Tomo on Main in Vancouver is a housing model without major upfront costs (and with “tomo” standing for “together more”). The complex houses 12 families under one roof with a common structure and courtyard. The smaller individually owned units leave room for large common spaces, including a shared kitchen, dining room, and living room. Shared meals are available three times a week, with residents rotating kitchen duties, and multiple committees making various self-governing decisions.
“It’s about building mutual support and helping people take care of each other,” Hebert says, “and the benefits are significant,” noting that such buildings have high retention rates and stronger communal ties. “People also tend to feel a greater sense of ownership and take better care of the spaces,” she adds. “Neighbours who have better relationships settle disputes more easily among themselves.”
Getting older
As we age, our housing needs also change based on compounding factors, from mobility to health to loneliness, and more of us are living longer. According to Statistics Canada the number of people 85 and older has been steadily increasing as a share of the total population over time. In 1971, 139,000 people in Canada were over 85; by 2021, it was more than six times that at 871,400. Projections show that between 2031 and 2050, this cohort will grow even further as baby boomers enter their golden years. Will they do so with their typical countercultural leanings and independence?
One model leans that way. NORCs — that is, naturally occurring retirement communities — have been growing in popularity. The term designates a street block or apartment building that happens to house a large population of older adults. These communities can include support services such as health, social, and recreational activities, which may be offered through public or private funding or a combination of the two. The reasons for each vary and can include the desire or inability to maintain a single-family home, economic pressures, or a wish to be closer to people and amenities. They’re a promising option for building a community while letting people maintain their independence and receive support.
Having a place to call home is key to our stability and building a foundation for life. The connection to mental health is also undeniable, as the Housing First movement demonstrated. Its underlying principle — that people can better move forward with their lives if they are first housed — allows them to invest in their social, occupational, employment, and recreational activities to support recovery, and well-being, and stem the cycle of homelessness.
In fact, the Housing First model was found to be the most effective way of reducing homelessness. This was a key finding of the At Home/Chez Soi study launched by the Mental Health Commission of Canada in 2008. The four-year, five-city project aimed to provide practical, meaningful support to Canadians experiencing homelessness and mental health problems.
What’s next?
I’d like to say that we’re all in this together, but clearly some of us are more in crisis than others. Housing isn’t a one-size-fits-all situation, and one’s sense of housing security can shift based on life circumstances. We’ll need a range of housing options to ensure we can address a diversity of needs – without relying on luck alone. Until that happens, I may still feel cynical at times. But with new options to housing affordability becoming available, I’ll also try to stay hopeful when I text my friends back.
Further reading: Money & Mental Health series
Elsewhere in The Catalyst: Home Alone: Aging Without Support is Becoming More Prevalent for Older People in Canada. How Can We Stem the Tide?
Lucas Tennen
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Uncertain financial futures are taking a toll on our mental health. We look at the link in this series kickoff for Financial Literacy Month.
Everyone has a money complex. And it’s a mindset that may be intensely volatile — suddenly flaring up to overpower all else — or cool and calculated like an uninterrupted stream of data points. Contemporary psychologists tell us that beliefs about money develop mostly in adolescence — they take shape around the examples offered by those who raised us and bear on our financial present. At a time when the cost of living is at an all-time high, it’s worth asking: Is your money mindset still working for you?
Many of us live in a different financial situation than we did growing up, but nothing puts our money scripts to the test like the turbulence of new responsibilities and unexpected changes. Of course, we can’t simply wish our way out of an affordability crisis. The high cost of living has added a very real burden to our food, housing, health, and mental health expenses, particularly for communities that experience health and social inequities. These include rural and remote, newcomer, racialized, and 2SLGBTQI+ communities; people experiencing precarious work and housing; individuals with disabilities or serious mental illness; single parents, unpaid caregivers, and others. And there is an interconnected relationship between financial and food insecurity, housing unaffordability and our mental health and well-being.
The connection
When financial stress replaces stability, it can dash the futures we imagined for ourselves. Summertime polling from Mental Health Research Canada (MHRC) found that financial stressors are greatly impacting the mental health and well-being of people in Canada. In the study, conducted online with 3,819 adults, 39 per cent said economic issues were affecting their mental health, and 41 per cent who were going through financial challenges reported having had thoughts of suicide.
The number of respondents who paid out of pocket for mental health services due to insufficient benefits coverage also rose from 23 per cent in May to 30 per cent in August. As well, 29 per cent said an inability to pay was why they didn’t access mental health care despite needing it, an 11 per cent increase from the previous MHRC polls.
Election issue
Given these findings, it’s hardly surprising that affordability is shaping up to be a major election issue in Canada. After all, no matter what your specific circumstances are, it’s likely to affect your life. To delve into its impacts on mental health, we spoke to financial planner Natasha Knox, principal of Alaphia Financial Wellness in Vancouver. Knox serves on the board of directors of the Financial Therapy Association, a member organization comprising financial and mental health professionals that integrate cognitive, behavioural, relational, and financial aspects of well-being. Knox uses various strategies to help her clients uncover their own internal narratives and the needs they are trying to fulfil. For instance, asking questions such as, “If you could explain your current situation to a younger version of yourself, how would you describe the way you got here?”
Natasha Knox
In different ways, her clients’ answers bring out their money scripts. Among the most common are money status (equating self-worth with net worth), money focus (seeing money as the true key to happiness over other life factors), money vigilance (constant planning that may lead to security and/or anxiety), and money avoidance (the belief that money is bad, the confirmation of which may lead to sabotaging one’s financial future).
Whether you recognize one or more of these scripts in yourself or other people, we are all affected by the influence of money and economic life — no matter how we respond.
Margaret Landry has now come to realize that first-hand. After graduating from Dalhousie University’s film studies program, she had a promising start in the growing East Coast film industry. But after the TV and movie writer’s strike caused many productions to pull out of the province, she found herself with little work. It was as a result of this change that she started re-examining her childhood and current experiences and began feeling a sense of scarcity and avoidance about money.
“I wouldn’t look at the numbers. I would live frugally, but I wasn’t budgeting. I didn’t want to think about how much it costs to live. But in my attempt to suppress it, I found the anxiety seeping into everything I did.” While working through these thoughts, Landry is trying to adapt her career to the changing labour conditions.
Articles on finances often focus on the small cuts people can make — think of all the advice about going without lattes and avocado toasts — but as many point out, such a narrow focus overlooks the various systemic issues that can affect people’s finances.
In terms of tracking and budgeting tactics, which can be found on the internet and via apps, Knox tries not to be prescriptive, since no matter what a client chooses, it needs to suit their situation. “It can be down to the penny or broad categories you track monthly,” she says. “You try stuff to see what sticks because different things work for different people.” Her preferred advice is for clients to stick with it: “Commit for a month, and if you don’t like it, that doesn’t mean you can’t budget; it just means you haven’t yet found the right method that works for you.” Knox notes that the baseline of financial literacy is “all over the map” but points to GetSmarterAboutMoney.ca and the McGill personal finance course as helpful, accessible resources to increase knowledge during Financial Literacy Month or any time of the year.
Learning and looking ahead
After the public-health emergency phase of the pandemic, people in Canada are facing unique economic challenges that are affecting their mental health. The country’s current high cost of living has increased financial insecurity, pressures on food and housing affordability, and income inequality. Inflation and the rising cost of borrowing are also adding up. In 2022, Canada’s average non-mortgage debt reached over $21,000.
Financial security and mental health have always existed in relationship with one another: not only are negative mental health outcomes more prevalent at lower income levels, but mental health problems and illnesses can lead to financial insecurity. In this context, even if you find a budgeting and tracking method that works for you, you may still feel in over your head and need to seek help through a credit counsellor.
Our Money & Mental Health series touches on themes related to housing, the cost of accessing mental health benefits, and financial empowerment, with one story a week in November. Find them at The Catalyst: Conversations on Mental Health, where you can also sign up for our newsletter.
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How to start the conversation
When celebrated children’s author Robert Munsch began to struggle with his mental health, the first step toward wellness was the simplest. It was also the toughest.
“The stigma attached to mental illness kept me from going for help for 20 years,” he said. In a 2013 conversation with the Mental Health Commission of Canada (MHCC), Munsch spoke about his long struggle with the stigma around mental illness, prior to his diagnosis of bipolar disorder, and his related dependence on alcohol.
That first step of “going to talk to someone” was a “no-brainer,” he explained, but it required an enormous amount of courage because of the negative stereotypes toward mental illness. “It doesn’t matter who you are. It doesn’t matter how good you are. You can have a problem. Being open and having a support group is vital to beating it.”
For people who live with mental and substance use disorders, being open about mental health can definitely help. But building understanding and reducing stigma more generally is also crucial for helping them get the care they need without hesitation.
Stigma is a pervasive problem
A 2022 poll conducted by Leger found stigma to be a pervasive problem for people living with mental or substance use disorders in Canada: 95 per cent reported experiencing stigma in the past five years, while 72 per cent reported experiencing “self-stigma” (internalizing negative prejudices). Perhaps more tellingly, the survey found that people in Canada “expect individuals with mental health or substance use disorders to be devalued and discriminated against in their day-to-day lives.”
Survey respondents also cited stigma reduction as one of three main priorities for improving recovery and access to care (alongside greater access to care and more preventive mental health services). Clearly, reducing stigma and all of its negative effects is a crucial step in giving those who experience mental health and substance use problems the care they deserve.
Why it matters
The MHCC’s Opening Minds training division was developed for just that reason: to reduce discrimination resulting from negative attitudes around mental illness and substance use. It’s now the largest systemic effort dedicated to reducing stigma in the country. Since it began in 2009, almost a million people in Canada have been trained in at least one of the Opening Minds courses or programs. That number continues to grow as workplaces, classrooms, and companies (large and small) recognize the importance of fostering a psychologically healthy and safe environment.
As an organization, the MHCC has deep expertise with the National Standard of Canada for Psychological Health and Safety in the Workplace (the Standard), which was developed and launched in 2013 to provide guidelines on how to promote mental health and recognize and support those experiencing mental health concerns or illnesses. While more and more organizations are recognizing the benefits of psychological health and safety, many don’t know where to start. In such cases, one of the best foundations for building such a culture is Opening Minds training.
Opening Minds training also includes Mental Health First Aid (MHFA), The Working Mind (TWM), and The Inquiring Mind (TIM) programs. With so many people, organizations, and communities across the country taking part, you may already be one of their graduates (and even have the certification on your LinkedIn profile).
People who have participated in Opening Minds programs feel more confident and empowered when talking with someone experiencing a mental health problem or crisis. Firefighter Steve Jones said he felt that he’d saved more lives as a trainer with The Working Mind — First Responders program than in his 20 years of experience in the job.
Mental Health First Aid
MHFA is similar to regular first aid: It trains people on how to provide immediate help for someone experiencing a mental health problem or crisis until appropriate treatment can be found.
While it can prevent a current difficulty from becoming more serious, it also has wider benefits. Evidence shows that MHFA reduces stigma, increases understanding of mental crises signs and symptoms, and gives participants the confidence to approach a person who is experiencing such a problem.
MHFA participants have said the program changed them for the better by making them more empathetic and understanding toward people experiencing mental health problems.
The Working Mind and The Inquiring Mind
TWM’s evidence-based courses are designed to reduce stigma in the workplace. Along with the standard TWM course, versions tailored for people working in the first responder, health care, legal, and sports sectors are also available.
The course has been adopted by corporate, non-profit, and government organizations across the country, with more than 260,000 people trained so far.
Participants and trainers have also found that TWM has increased their empathy and understanding and has also had an immediate positive effect on their workplaces.
TIM is an adaptation of TWM to suit university or college settings.
Simple communication
Now, the Opening Minds website has re-launched, with a new, simplified design and a web portal that make it easier to browse courses or conduct searches based on specific criteria. Users will also be able to view detailed course outlines and facilitator profiles while keeping track of their own learning history.
These enhancements will enable the MHCC to continue working toward ensuring that everyone can expect a workplace or learning environment that values and supports their psychological safety. The more streamlined and efficient format will also help Opening Minds continue its leadership in delivering evidence-based programs to reduce stigma.
Getting past stigma, his own and others, has made all the difference for Munsch.
“People have to realize that mental illness is something wrong with the way our brains work, and there are various things now that you can treat it with.”
Resource: The new Opening Minds website
Wes Smiderle
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Navigating stigma, grief, and loss and finding healing, hope, and community support after a death by suicide. A personal story.
Each November, people around the world take part in special events to mark International Day for People Impacted by Suicide. Those directly affected by suicide loss often use this day to remember loved ones and share their stories and experiences. Here is just one. Names have been changed for privacy reasons.
Rachel died by suicide on June 15, 2022, six weeks after her 30th birthday. I had known her for just over a year. We had been neighbours, then close friends, then briefly lovers. My relationship with her, though affectionate, was fraught with conflict and I have felt immense guilt for my self-perceived role in her death, for not being the partner she needed me to be, for not loving her the way she needed to be loved.
I’m sharing my story because suicide continues to carry an immense stigma, and loved ones who remain can feel isolated in their grief.
As with any tragedy, suicide reaches far beyond the act itself; its ripples are extensive. I think about the many people who have been, and will likely continue to be, affected by Rachel’s death: her best friend, who discovered her in her home two days after she died; her colleagues, who valued her for far more than her productivity and perfectionism; members of her biological and chosen families, who reached out to me on Facebook, searching for answers in the weeks following her death; her transgender teen cousin, who looked up to Rachel as a queer role model and confidante; and her ex-partner, Nigel, with whom she had had a nine-year relationship and who bore the unenviable responsibility of selling the home they co-owned and sorting through all her personal belongings.
Joy and Jessica Ruano.
Honest conversations
When I heard about Rachel’s death, my first thought went to my daughter Joy, who was not quite two and a half years old at the time. Joy had known Rachel for half of her short life, and their beautiful bond included visits to the Canada Agricultural Museum farm and sitting on her lap to play piano together. As a solo parent raising a young child during a worldwide pandemic, I was grateful to have Rachel as one of the few people I trusted to care for Joy.
I believe in being transparent and truthful with children. So I told Joy as soon as she asked that we wouldn’t be seeing Rachel anymore because she had died, that it was very sad, and that we were going to miss her and it was okay to talk about it.
The following week, we visited with several of our former neighbours, many of whom came out to sit with me and Joy in sadness and solidarity. I answered their questions, as many of them were still very much in the dark regarding the circumstances of Rachel’s death. Yet a new awkwardness and a weighty cheerlessness hung over our little cul-de-sac. The previous year, I had hosted Junkyard Symphony, an environmentally conscious percussion group, in the middle of the street. It was one of many events that spoke to the atmosphere and culture: a place where the kids would always come out and play together, where the neighbours didn’t mind if Joy picked and ate the tomatoes right from their front yard, and where we knew all the names of the dogs and the cats (even the tortoise, Miguel) who lived there. Rachel adored this community, which she lovingly referred to as Sesame Street, and her little house she had wanted to live in forever.
After two weeks off, I tried to go back to work. For brief periods, I was able to focus on the tasks at hand; other times, I found myself staring into space. Often, I felt raw, on the brink of crying, or having a panic attack — my emotions volatile. I did what I could, then requested more time off with the support of my family doctor. But knowing where to direct my energy and how to find healing was hard. The people who had been showing up for me in the first few days and weeks were quickly dispersing, moving on with their lives as people do. Then, some of my close friends stopped talking to me. Most made excuses about being busy, even though before Rachel’s death we regularly got together, and one actually sent me an email citing Rachel’s suicide as one of the main reasons she needed to take a “break” from our friendship. This was a hard blow, as my relationship to my immediate family was strained, so I yearned for the support of my chosen family during this time.
Finding support
In mid-August, feeling lost and very much alone in my grief, I reached out to Bereaved Families of Ontario and started attending their Thursday afternoon support group over Zoom. I also attended an LGBTQ2S+ Death Café hosted by the Home Hospice Association on Tuesday evenings, which focused on political questions around death, dying, and illness as they pertain to the queer community; for example, relying on chosen family rather than non-supportive biological family. I started listening to Paula Fontenelle’s Understand Suicide podcast, which recently reached 100 episodes.
These were the voices I needed to hear: people who were willing to push through their discomfort with death and suicide to talk about their feelings openly, whether the loss was last month or several years ago. I found myself thinking outside my own grief to empathize with the man who lost his wife of fifty years to cancer, with the young woman who lost her father in a politically charged murder, with the people who had suffered multiple losses over the years and felt utterly destabilized by the repeated blows. I knew I was not alone in my experience, though it often felt that way, and connecting with other people, even strangers I might never meet outside the virtual world, helped me remember that.
Through all this, I wanted to make sure I was being a consistent parent for Joy. A friend of mine asked me recently how I managed to keep it together over the past year, and my best answer was simply Joy — you don’t have the option to fall apart when your child needs you. At least, I didn’t. I couldn’t.
But it wasn’t easy. Joy frequently brought up Rachel — the places they went together, games they would play, and items in our home — like kitchen utensils or pieces of clothing — that reminded her of Rachel. I always tried to respond positively, even though it sometimes pained me to hear about her. One night, Joy woke up screaming and later expressed between sobs: “I’m sad . . . because Rachel went away.” For many months, she had been sleeping comfortably in her own bed, but after Rachel’s death, she became increasingly resistant to spending nights apart from me. I questioned her about it, and she eventually explained that she was afraid to let me sleep alone without her — because I might die like Rachel did. And the questions continued:
“Why did Rachel die?”
She was sick, my love.
“Was she old?”
No, baby, she was young. Younger than me.
“I don’t want her to be dead.”
Me neither.
“I miss her.”
Me too.
While I couldn’t bring Rachel back or promise that we wouldn’t lose other people in the future, I did my best to reassure her that “Mama and Joy are forever” in case there was any doubt in her mind.
“And Ba, too?” she asked, about her stuffed beluga.
And Ba, too.
More than one year later, I continue to feel the effects of Rachel’s death, including symptoms of post-traumatic stress disorder. The difficulties I’ve been having with concentration and managing anxiety, especially when in front of a computer, mean that I’m unable to work like I used to. So, I recently made the shift from salaried employment to freelance work to allow for more flexibility in my schedule. With regular therapy, I’ve been working through my feelings of guilt and on being the best possible parent for Joy. I’ve been building back my community of support, finding comfort in the people who showed up for me at the most challenging times. I exercise and meditate to maintain a healthy body and tranquil mind. And I write as much as I can.
Earlier this year, perhaps in a reactionary move, I booked flights for us to London, England, where I lived for four years just over a decade ago. For four weeks this past July, we travelled across Europe by train with only a carry-on suitcase and a backpack. It was good to step out of our routine and leave behind all the reminders of last summer. Apart from the usual challenges of travelling with a young child, such as meltdowns stemming from ever-changing environments, it was a wonderful bonding experience for us.
I am so grateful for my life and for wanting every day to be alive and to stay alive, even on the hardest days. I have a fierce desire not only to survive but to thrive in this life. So, with Joy by my side, that is exactly what I will continue to do.
Wellness Together Canada crisis support: If you’re in distress, you can text WELLNESS to 741741 to connect with a mental health professional at any time. If it’s an emergency, call 911 or go to your local emergency department.
Assistance: People in Canada experiencing mental health distress can get assistance through Talk Suicide Canada. Dial toll-free: 1-833-456-4566.
Resources:
- Suicide Prevention (Mental Health Commission of Canada)
- Talking to Children About a Suicide
Jessica Ruano
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Writing your end-of-life story has therapeutic effects. The art of getting to the end.
The obituary — a written announcement of a person’s death, including biographical details — has been with us for centuries.
The sombre, even forbidding word, from the medieval Latin obituarius, was first used in 1703, according to the Merriam-Webster dictionary. Over the years since, it has become common practice for a family member or friend to write such a notice for a loved one who has died. While never a happy task or one to be taken lightly, it has become so customary that the best obituaries are collected in books. Besides that the funeral industry now provides how-to advice and templates, news organizations pre-write them for the famous, ghostwriters will write one for you — and increasing numbers of people are writing their own.
Some irreverent, self-written obituaries, after being appreciated by complete strangers for their refreshing candour about personal failings, family conflict, and mental illness, have gone viral. One of them, from Angus Macdonald of Glace Bay, Nova Scotia, is also now listed for its poignancy and humour under “Funny Obituaries” on Legacy.com. “I think I was a pretty nice guy, despite being a former punk and despite what some people would say about me,” he recounted in the obituary he wrote before his death at age 67 in 2016. “What did they know about me anyway? I loved my family and cared for them through good times and bad; I did my best.”
As they face death, some autobiographical scribes are motivated by a wish to set the record straight, settle scores, or comfort those left behind, with honesty, humour, and courage. They may also see it as an opportunity to reflect on the entirety of their lives — the triumphs and accomplishments, failings and regrets, lessons learned, and in the mind of the writer at least, a chance to leave behind words of wisdom worth preserving. Those who know they are close to the end may gain valuable perspective from writing authentically about their lives and, in the process, find a way to accept and be at peace with the inevitable.
An examined life
Now, therapists, counsellors, and writing coaches are seeing the mental health benefits of asking clients to write their own obituary, regardless of age or how much life they have left.
While some might find the idea morbid, it’s gaining popularity as a therapeutic exercise in self-examination and as a way to help clarify important issues that we all face as we go through life.
We may have a hard time facing our own mortality, but thinking about what we’d want in our obituary when we die, experts say, might lead to a better, happier, and more meaningful and productive life. It’s worth noting that obire, the Latin root word of “obituary,” means “go toward” or “go to meet.”
“Sometimes people will do this exercise and stop and look at their lives and say, ‘I’m actually living a life that is completely opposite to what I want to be remembered for,’” says Talia Akerman, a licensed mental health counsellor working with Humantold, a group practice based in New York City. Most of Akerman’s clients are in their early 20s, dealing with depression, anxiety, and trauma and searching for answers to life’s big questions as they try to heal from painful experiences and build their adult lives.
In the context of existential therapy, based largely on ideas developed by renowned psychiatrist Viktor Frankl in the early 20th century, writing an obituary for yourself is a means of exploring how to find genuine, self-determined meaning and purpose. “It forces you to hold up a mirror to your life, your actions, your values, the people around you,” says Akerman. “It gives you a very intense moment to say, ‘This is not what I want for myself. Let me change that.’ And then, I’ll ask, ‘What are the common themes in this obituary? If you need to make a change, how do you go about that?’” On the other hand, she says, a person might find they are more on track than they realized after writing down an account of their life.
For someone dealing with depression, it’s an opportunity to work with a therapist on boosting self-esteem, reconnecting with the good, and finding hope for the future. “It’s reminding them of the strengths they have, and it is very beneficial. Other times with depression, or whatever mental health issue you might be experiencing, it’s a little harder, and that person might not be at the point where they’re ready to see that,” says Akerman. “This is where I think a good therapist comes into play. You need to be the person instilling hope in somebody before they’re ready to metaphorically grab the hope from your hands and hold it for themselves.”
It may also help a person to go back to the obituary in later months or years to see how their lives have changed, for better or for worse, and reflect again on what path they really want to take. “I will have them keep it somewhere, and if they don’t want to keep it because it’s a little too jarring, I’ll keep it somewhere safe and private for them, and we can revisit that,” says Akerman. “They can ask themselves, ‘Have I made the changes I want, or am I in the same place? And if I’m in the same place, why am I here?’”
Changes in direction
During the pandemic, so many people were forced to “pivot” in their choices of employment or deal with all kinds of losses that in some cases led to mental health crises, Akerman says, which made obituary writing an even more relevant exercise for her clients.
“I think this tool was really helpful during COVID. People could say, ‘I can’t control everything on a social level, but I can look at what I want to do with my life, look at my values, and what I care about and figure out, do I need to change anything professionally or relationally?”
Whether young or old, close to or far from death, reflecting on the lives we’ve led, are now living, or will lead clearly has benefits — from finding peace to changing directions to simply appreciating who and where we are and what we’ve accomplished or would still like to before the end.
Resource: Sharing Your Story Safely
Related reading:
Moira Farr
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Exploring the impact, resources, and strategies for suicide prevention
September is Suicide Awareness Month. It serves as a poignant reminder of the importance of mental health, offering an opportunity to educate, empathize, and advocate for those affected by suicide.
The scale of the issue
Suicide remains a significant public health concern in Canada, affecting individuals of all ages, genders, and backgrounds. According to Statistics Canada, about 4,500 people in our country die by suicide every year, which is around 12 people each day. And for every person lost to suicide, many more experience suicidal ideation or attempts. COVID-19 has also had a negative impact on mental health, including a significant increase in reports of suicidal ideation. Among young people (15-24), suicide is often reported to be in the top three leading causes of death, an incidence rate further magnified by its effects on families, individuals, and communities across the country (and worldwide).
The reasons for suicide are complex: they include biological, psychological, social, cultural, spiritual, economic, and other factors. According to a leading researcher in the field, the people who think about and attempt suicide are seeking to end deep and intense psychological pain. And yet, despite the complexities, there is reason for hope.
A combination of mental health and public health approaches can reduce Canada’s suicide rate and its impact. In this context, Suicide Awareness Month takes on a vital role in increasing public awareness of the issue and encouraging dialogue.
Addressing the issue
Several resources the MHCC supports or has helped create emphasize the importance of open and non-judgmental communication when discussing suicide. While initiating a conversation about suicide can be challenging, it’s a vital step in helping those who need support and assistance to seek it out.
Talking to Children About a Suicide is a conversation tool to help caregivers, parents, and guardians understand how to speak with children when a suicide happens in the community or if someone they know has died by suicide. Research has shown that talking about suicide does not increase a child’s risk of suicide; in fact, it can be a helpful experience.
Suicide: Facing the Difficult Topic Together is an online module designed to assist medical professionals in preparing for such conversations. Health-care providers play a pivotal role in preventing suicides in Canada. They’re often in the best position to identify those at risk of suicide and to provide or link them with the care they need.
These days, many of our interactions happen online. Recognizing this behaviour, the Australian organization Orygen developed #chatsafe guidelines for online conversations among young people, though the tools can also be helpful for all ages.
The Mindset: Reporting on Mental Health media guide is aimed at journalists, but it is useful to anyone writing about suicide or other sensitive issues. Central to its encouragement of safe and responsible reporting are the following recommendations:
- respect for the privacy and grief of loved ones
- including local helplines that readers can reach out to for support
- representing suicide as preventable
The guide also discourages the romanticizing of suicide, characterizing it as a solution to an individual’s problems, detailing methods used, and publishing suicide notes.
Safe and responsible media reporting has long been a key element in national suicide prevention strategies. It figures prominently in the UN’s prevention of suicide guidelines, the Canadian Association for Suicide Prevention’s blueprint, and WHO’s preventing suicide reports. Still, we often find problematic depictions in films and television shows, making these tools an important conversation starter to shift narratives.
Addressing stigma and misconceptions
A key component of Suicide Awareness Month is challenging the stigma and misconceptions around mental health and suicide. One of the issues the MHCC has highlighted for many years is the harmful impact of such stigma on individuals struggling with their mental health. Stigma can be a significant deterrent to individuals seeking help. It can also exacerbate their struggles and potentially lead to tragic outcomes.
By instead promoting understanding and empathy, we can create an environment where people feel safe and comfortable discussing their mental health challenges. This includes recognizing that seeking help is a sign of strength — not weakness — and that mental health is just as important as physical health.
Moira Farr wrote After Daniel: A Suicide Survivor’s Tale about the death of her partner. She is a journalist and instructor who researches and writes on a variety of topics for international and national publications, including The Catalyst. She noticed a change in the conversation since the publication of her book in 1999.
“I would say there has definitely been a shift in people’s willingness to openly discuss mental health issues, including suicide, in the past 20 years,” she says. “The campaigns to raise awareness about how and where to get help and to get people talking more honestly about their own mental health struggles seem to me to have been a positive force,” she says.
“Whether this has led to a decrease in the overall suicide rate in Canada, I imagine, is tricky to pinpoint. It can still be difficult to find the mental health resources you need – with greater awareness and willingness to seek help, the demands for mental health care have increased, with not necessarily enough to go around.”
Wait times
While having mental health supports in place is important to suicide intervention, the Canadian Institute for Health Information pegs the national average wait time for community mental health counselling at 22 days.
Yet, provincial strategies to reduce wait times are offering promise. Prince Edward Island is emphasizing the need to increase access points for care, both inside and outside hospital settings. Reflecting on the province’s long waits for mental health services, it began looking to Newfoundland and Labrador, which recently reduced wait times by 67 per cent. P.E.I. is now following suit by also implementing Stepped Care 2.0, the model is used to provide more timely and holistic services through a range of methods such as telehealth, web-based services, and walk-in clinics.
Stepped Care 2.0 is organized around nine steps, including informational support, self-directed care, acute care, systems navigation, case management, and advocacy. To implement the model, service organizations select strategies in conjunction with client needs and preferences (e.g., e-mental health interventions, self-guided support, peer support, group programming, and in-person therapy) that align with the structure and number of steps available in each community.
Three digits
Another major support — the 988 suicide prevention and mental health crisis hotline — will be implemented in November. People in need of immediate mental support will be able to call or text for help and be directed to a mental health crisis or suicide prevention service free of charge.
That idea has been under serious study in Canada for several years, with enthusiastic support among suicide prevention experts, mental health professionals, and political representatives at every level of government. Over the past few years, other countries like the Netherlands and the United States have also implemented a three-digit suicide prevention number.
Ways forward
In other developments, the Senate standing committee on social affairs, science and technology released a report in June titled Doing What Works: Rethinking the Federal Framework for Suicide Prevention and made a number of recommendations. These include:
- recognizing the impact of substance use on suicide prevention in Canada and funding research into interventions
- creating a nationwide database to better collect national data related to suicides, attempts, and effective prevention measures
- replacing the concepts of “hope and resilience” in the framework with “meaning and connectedness”
This shift in language echoes other perspectives. For example, in many Indigenous communities, terms like life promotion or wellness are often used when discussing suicide prevention. The First Nations Mental Wellness Continuum Framework — developed by the Thunderbird Partnership Foundation with Indigenous and non-Indigenous partners (including Health Canada) — identifies hope, meaning, belonging, and purpose as underpinning many Indigenous ways of knowing. As the framework explains, aligning these four aspects in a person’s everyday life brings that person a feeling of wholeness that protects them and acts as a buffer against mental health risks and potential suicidal behaviours.
The importance of community and support
During Suicide Awareness Month, communities across Canada come together to offer support and resources to those affected by suicide. These efforts include awareness campaigns, educational events, and initiatives aimed at reducing stigma and fostering mental health support networks.
The MHCC’s resources emphasize the importance of building a strong and supportive community to help prevent suicide. By working together and fostering connections, we can create an environment where individuals in crisis feel valued and understood. Suicide Awareness Month in Canada serves as a reminder that we can all play a role in suicide prevention.
Wellness Together Canada crisis support: If you’re in distress, you can text WELLNESS to 741741 to connect with a mental health professional at any time. If it’s an emergency, call 911 or go to your local emergency department.
Assistance: People in Canada experiencing mental health distress can get assistance through Talk Suicide Canada by dialing toll-free 1-833-456-4566.
Course: Mental Health First Aid teaches you how to provide help to someone developing a mental health problem or experiencing a mental health crisis or worsening mental health.
Resources: Suicide Prevention (Mental Health Commission of Canada)
Further reading: Three Easy Digits We’ll All Soon Know
Fateema Sayani
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Author Dr. Jennifer Mullan’s new book takes a critical look at care.
There are too many roadblocks to care, resulting in “an outdated system of wellness that is void of wellness.” So says Dr. Jennifer Mullan, a New Jersey-based clinical psychologist and author of the forthcoming book, Decolonizing Therapy: Oppression, Historical Trauma, and Politicizing Your Practice.
According to Mullan, many of those seeking care run into obstacle after obstacle, an experience that reflects what she calls the mental health industrial complex. In response, she has become part of a “growing movement of practitioners who are unlearning colonial methods of psychology,” which seeks nothing less than completely overhauling and restructuring the system.
The book’s 10 chapters are full of scathing observations and critical insight, with titles like “From Lobotomies to Liberations,” “Diagnostic Enslavement,” and “Emotional-Decolonial Work.” Throughout its 400-plus pages, Mullan explores a wide range of problems impairing the mental health system in the United States and elsewhere.
These systems operate like revolving doors, processing many clients but hardly ever dealing with an individual’s pain at the root level. She is convinced that this shortcoming helps explain the spasms of violence erupting with increasing frequency across the U.S., such as school shootings, rising depression levels, and increases in mental health concerns.
Mullan has spent much of her career conducting therapy sessions with children and adults who have experienced domestic violence, unhealthy substance use, child abuse, poverty, and gender identity issues. Over the years, these encounters have chipped away at her optimism and fuelled her frustration.
Ignoring the past
While Mullan’s book examines many different roadblocks to effective treatment, her most blistering criticisms are reserved for the system’s failure to acknowledge intergenerational trauma — which she insists is the root cause of many mental health problems.
She therefore sees her book as “a CALL to ACTION to mental health practitioners, space holders, and wellness workers everywhere. If we are to ‘treat,’ heal, and educate the individual, the group, and/or the organization,” she asks, “is it not essential to also include history, life experiences, and cultural traumas?”
Intergenerational trauma is not a new concept. It gained credence when researchers started studying the impact of the Holocaust perpetrated by Nazi Germany. Nowadays, a growing body of Canadian-led research links the abuse suffered at residential schools with this same kind of trauma. A Historica Canada video describes the experience this way: “For many, the trauma of the mental, physical, and sexual abuse [residential school survivors] suffered hasn’t faded. The children and grandchildren of survivors have inherited those wounds; they have persisted, manifesting as depression, anxiety, family violence, suicidal thoughts, and substance use.” A definition from the American Psychological Association describes how such trauma can make its way across generations. It is “a phenomenon in which the descendants of a person who has experienced a terrifying event show adverse emotional and behavioral reactions to the event that are similar to those of the person himself or herself. These reactions vary by generation.”
Mullan draws heavily on these themes in Decolonizing Therapy, pointing to the history of slavery, internment camps, dictatorships, and residential schools, while arguing that the failure to look at these events dooms future generations to ongoing cycles of pain. Her prescription for therapy means not only exploring family history but probing culture, traditions, rituals, religious beliefs, and practices. Once the buried trauma is revealed, the patient can then receive more focused treatment.
Unfortunately, most therapists are taught almost nothing about revealing intergenerational trauma and are often cautioned against bringing up the past.
“The way many therapists and social workers have been educated,” she says, “is to consistently keep a blank slate, don’t have opinions, don’t have anything in your office that is too forward-facing or political. We’re not going to talk about Black history. We are not going to talk about enslavement. We are not going to talk about racism.”
Waiting and wanting
What is discussed in counselling sessions usually amounts to a short conversation with little time to delve deeper into an issue. Mullan underscores the point by recounting a colleague’s workload at a community clinic that involved more than 90 clients over two weeks. In Mullan’s previous work as a university staff psychologist, she said that nearly 100 students were on a counselling wait-list for six months straight. “Resources have been poorly and criminally allocated,” she says. So, in many settings “money needs to be reallocated.”
A related issue is the crushing workload, which is causing mental and physical health problems for therapists themselves. The book details dismal conditions some therapists are experiencing, such as working other jobs to meet basic needs, paying student loans, dealing with intense vicarious trauma due to the material they are helping to hold, being overworked with up to 80 or more cases a month, moving from job to job, experiencing burnout, and receiving constant microaggressions, bias, and acts of discrimination.
One therapist quoted in the book describes the aftermath of a heart attack she’d had in her office. “It’s not their fault. I thought it was my fault. I changed my diet and worked out more. I went back to work and had panic attacks in between clients. My supervisor told me, ‘You need to get more rest. Are you sleeping? Seeing a therapist of your own?’ No self-care is gonna fix my heart and my anxiety and my nervous system.”
Changing gears
A few years ago, Mullan decided to stop accepting patients and concentrate on reforming the system through public speaking and writing her book, which also lists ideas for deeper reform.
While her views were shaped in the U.S., her calls for change will likely get a thumbs up in many countries. Here in Canada, initiatives like Stepped Care 2.0 are already in place in Newfoundland and Labrador, the Northwest Territories, Nova Scotia, and elsewhere that have radically reduced wait times for mental health services. More organizations are also recognizing Indigenous ways of healing to provide informed and culturally aware forms of therapy. As well, a recent program by the Mental Health Commission of Canada and the Centre for Addiction and Mental Health culturally adapted cognitive behavioural therapy for South Asian communities.
Like many publications covering mental health, Decolonizing Therapy includes exercises, review questions, and detailed references. What makes it stand out is its feisty, passionate, and challenging voice — and Mullan’s personality, which is always present. “I’m holding the Mental Health Industrial Complex accountable and, along with you dear reader, I’m demanding change,” she writes.
Her views are perceived as controversial in certain circles, and some in the profession do not support her activism: a former professor she respects advised her against mixing psychology and politics. Yet Mullan sees it otherwise. In fact, by putting tough topics front and centre, the book is intentionally designed to change that narrative.
Resource: Fact Sheet: Common Mental Health Myths and Misconceptions
Further reading: CBT For You and For Me: A suite of culturally adapted cognitive behavioural therapy tools is designed to break through barriers.
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When one size does not fit all. A look at Waypoint’s approach to structured psychotherapy.
There’s a specialty mental health hospital on the shores of Georgian Bay in Penetanguishene doing especially innovative work these days. In addition to its 301 beds, the Waypoint Centre for Mental Health Care is home to Ontario’s only high-secure forensic mental health program for patients served by the mental health and justice systems. The range of services covers acute as well as longer-term psychiatric inpatient and outpatient services for the region. Of late, their delivery of the Ontario Structured Psychotherapy (OSP) Program is receiving recognition for its ability to have a major impact.
I was honoured to present the group, which includes Jessica Ariss, Waypoint’s program manager, and Jeannie Borg, director, of system innovation at the Waypoint Centre, with the 2023 Award of Excellence in Mental Health and Addictions Quality Improvement from the Canadian College of Health Leaders in June. I asked the team about their approach to improving mental health outcomes.
Transformative care
The OSP offers publicly funded treatment for individuals experiencing depression, anxiety, and anxiety-related conditions by providing access to short-term, evidence-based cognitive behavioural therapy (or CBT), a form of care that helps people examine how they make sense of what’s happening around them and how these perceptions affect the way they feel.
Waypoint delivers CBT via partnerships with more than 20 organizations, meaning that people can access care in their communities rather than having to travel to a central hub. Through this model, the therapy is offered at no cost to clients. While it’s a highly effective treatment that improves symptoms and reduces the likelihood of mental health concerns becoming critical, Waypoint is far from the only organization offering CBT.
So what makes its program different and award winning?
Mind the gap
Waypoint won the award for its tenacity in addressing gaps in care. They did so by working to enhance access to CBT for priority populations, including Indigenous, francophone, and 2SLGBTQI+ individuals, which increased referrals to its programs. In one instance, Waypoint used its communications channels to promote the services to priority communities online and track the path from clicks to referrals. This part of the project took a wrap-around approach that covered training, communication strategies, and service modifications. Those modifications were informed by advisory circles that included patients and others with lived and living experience from various communities.
Members of the OSP Program and the Indigenous Health Circle, who worked together to adapt and enhance services for Indigenous clients: (from left) Charity Fleming, David Thériault, Jessica Ariss, Germaine Elliott, Leah Lalonde, Melissa Petlichkov, and Melissa Moreau.
For Indigenous populations, the Waypoint team worked with the Indigenous Health Circle, B’Saanibamaadsiwin, and the Barrie Area Native Advisory Circle to develop clinical protocols and integrated care pathways for CBT services. These were based on client feedback, research evidence, and a training course (offered by Wilfrid Laurier University) called Sacred Circle CBT — Mikwendaagwad, an Anishinaabemowin/Ojibwe word for “It is remembered, it comes to mind.” The Indigenous service pathway — called Minookmii or “sacred tracks upon the earth” — uses an adapted intake assessment process conducted by an Indigenous clinician and services that include spiritual healers. These Indigenous health promotion practices ensure that the perspectives and needs of priority populations are central to Waypoint’s service development and evaluation processes.
Data and demeanour
The organization tracks those processes using a dashboard system that takes quantitative and qualitative measures into account. Qualitative feedback is incorporated into clinical reviews as part of a continuous improvement loop. But Waypoint never lets its commitment to dashboards and data inhibit the personal touch. It has mastered the balance between analytics and empathy, making sure that the human elements and the patterns add up to meaningful care.
For example, a clinician will meet with a client to determine the service that best fits their needs. Whether it’s a sweat, a smudge, connecting with an Elder, or another Indigenous approach to care — or something else like clinician-assisted bibliotherapy — it’s about meaningful, involved, and engaged care. As one participant put it: “Within the first few minutes of our meeting, the therapist I was paired with created a space that felt safe for sharing. Her kindness, knowledge, and warm demeanour encouraged me to speak more honestly and openly about my anxiety than I ever had before. She shared information, statistics, studies, anecdotal evidence, and examples that helped me to see my health anxiety from a different perspective — and also to make me feel less alone in my struggles.”
It’s these differences that make the program stand out, something that Heather Bullock, Waypoint’s vice-president of partnerships and chief strategy officer, sees as notable.
“The program runs close to its vision,” she points out. In other words, these elements are not nice-to-haves; rather, they are embedded processes. “There’s no gap between the vision and reality,” she says, citing their work with colleges, clinics, and different cultural environments. “We’ve managed to come together as communities and as different types of providers under a shared goal. We’re building something the way we want it to be built — and that’s something that aligns not with what we need in the future but with what we need today.”
Resource: Webinar – E-Mental Health and Indigenous Partnerships in Suicide Prevention. How Kids Help Phone uses e-mental health services to break down access barriers to inform its suicide prevention work.
Further reading: The Catalyst: Conversations on Mental Health article. CBT For You and For Me.
