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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.
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Getting started on a new plan for meaningful change
“I used to believe I was a bad person trying to be good,” says Steven Deveau, executive director of the 7th Step Society of Nova Scotia, a peer-run organization offering support to individuals who’ve been incarcerated. “My mindset changed when I realized I was a sick person trying to get well.”
As a person with lived experience of criminal justice involvement, Deveau’s sentiments could be widely shared among those who interact with the criminal justice system. Among federally incarcerated individuals, 73 per cent of men and 79 per cent of women meet the criteria for one or more current mental health disorders. Such statistics point to a need for increased access to quality mental health services, both within corrections and the community, as well as other prevention and early intervention supports like housing and education. As with all mental health concerns, it’s critical to ensure that people get help when they need it. Yet tangible progress toward these goals has so far been wanting.
Not just another report
“People ask me for my opinion. They ask, ‘What can we do to make things better?’” says Mo Korchinski, executive director of Unlocking the Gates Services Society. “And then it sits on a desk, and it stays in a report. I just want to see action.”
Inspired by this and other calls to produce meaningful change, the Mental Health Commission of Canada (MHCC) is developing an action plan for Canada to support the mental health and well-being of people who interact with the justice system. It draws on the expertise of those with lived and living experience, along with other experts who have highlighted these issues for years. The action plan also relies on relevant work from the past two decades — including the MHCC’s 2012 Mental Health Strategy for Canada, which lists criminal justice as a priority — and what is currently being done to focus on actions capable of implementation. The scope of this national project will be broad and comprehensive, including a focus on upstream prevention and early intervention, structure, law reform, and system transformation, and an assessment of mental health supports for all types of criminal justice involvement, from first contact with police to community reintegration and every stage in between.
Inside the system
“I articled in a criminal court duty counsel office, and in that role I immediately recognized the intersectionality of mental health and the justice system,” says A.J. Grant-Nicholson, principal lawyer with Grant-Nicholson Law and project adviser for the action plan.
A.J. Grant-Nicholson
“All too often, I saw accused persons with cognitive challenges, trauma, psychiatric illness, and/or substance use and mental health concerns that related to their criminal charges. Quickly, I deduced that the justice system was the system of last resort — and sometimes the default system — for persons with mental health-related issues,” he says.
Grant-Nicholson’s career has long been focused on the topic. Following his articling program, he worked as a mental health staff lawyer at Legal Aid Ontario, the first position of its kind in the province. There, he represented clients who came before the Consent and Capacity Board and acted as duty counsel at a forensic psychiatric hospital as well as in mental health court.
“I observed that the justice system was not an ideal place to remedy mental health conditions,” he says. “Defence lawyers, prosecutors, justices of the peace, and judges are not clinicians. Criminal law is a blunt instrument that is limited in its ability to provide therapeutic support for accused persons with mental health-related needs.”
Grant-Nicholson acknowledges that there is “increasingly more mental health support in criminal courts, such as having a designated mental health court where accused persons can be connected to mental health workers and mental health-related programming.” However, he finds that “the availability and overall level of support is not consistent across all jurisdictions — and sometimes, accused persons are not aware of the mental health supports available to them.”
As a legal representative for detainees, Grant-Nicholson has seen a significant portion of incarcerated people with serious mental health and/or addiction issues, and he finds the intersection between mental health and the justice system readily apparent in detention facilities.
“It has been my experience that correctional institutions are suboptimal for mental health recovery and that incarceration itself exacerbates mental illness,” he says. “I have also seen the frequent pattern of clients with mental health conditions backsliding once they are released from detention and, subsequently, their almost inevitable re-entry into the justice system. This is often due to barriers in accessing health and social services in the community and/or finding suitable housing when they are discharged or released.”
Seeing these gaps, Grant-Nicholson is seeking to make meaningful change. “My hope is that the action plan will provide stakeholders with insights so the justice system will be better equipped to support mental health, and over time, fewer people with mental health conditions will be incarcerated and the recidivism rate will decrease for this population.”
Grant-Nicholson says that is why an action plan for Canada on mental health and criminal justice is so vital. Deveau of the 7th Step Society of Nova Scotia also sees hope with the project and the people who are part of the committee. It has the power to change lives and change communities, he says.
“I have this saying that I woke up today sober and not in prison — the physical or the mental one — so it’s a good day,” he says. “Some of the smallest things can be the greatest motivators.”
Learn more about the action plan and how you can contribute to its success.
Resources: Mental Health and Criminal Justice: What is the Issue?
Further reading: A Name and a Face: A filmmaker illustrates how easy it is for someone living with mental illness to end up on the street or get caught up in the criminal justice system.
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It’s time to reframe masculinity — one step at a time
Beyoncé and Kendrick were crooning about America’s problems as our truck wound its way toward the trail. My husband, in the driver’s seat, was his usual jovial self as he chatted about music aligning with historical movements. It was 6:30 a.m. My husband is disgustingly and unabashedly a morning person, and we were on our way to an eight km hike along the Gatineau escarpment in Quebec.
Our son — who is in no way a morning person, or a hiker — was in the back seat. He was in charge of the music, and he was there to win a bet.
Despite my more taciturn demeanour, I was happy to be heading out that morning for the anticipated hike. It was the dynamic brewing between father and son that had me feeling cautious. Men can be weird and competitive, even when they’re trying to be chill.
Macho, Macho Man
The machismo started in the parking lot when my son stepped out of the truck wearing a sweater and holding his coffee.
“Leave your sweater and coffee here,” my husband said, which prompted my son to slip on his mutinous face and grip both his coffee cup and his sweater with determination.
Before the world’s dumbest argument over knitwear and a travel mug could unfurl, I said to my husband, “You’re not carrying it or wearing it, so stop trying to control it.” To my son, I added, “It’s going to be hot, and there will be bugs — are you sure you want to bring those?”
I started the hike in the lead spot to avoid the inevitable male jockeying for the alpha position. This is one of the reasons I think men are weird. Why does it matter who goes first? It’s not a race. There are no prizes. Societal norms do men no favours when they inspire them to be dominant.
My son has no idea which direction we are taking, and yet he edges forward to take the lead. My husband, who regularly encourages me to go first when it’s just the two of us, suddenly wants to set the pace. The scene makes me think it’s no small wonder that men’s mental health is in the state it is. How can you seek help when you are convinced you should have all the answers?
Yes, I know, not all men are the same. But the statistics weigh heavily and are unignorable.
In Canada, 12 people die by suicide every day — with Statistics Canada reporting up to 4,500 annually — and men’s suicide rates are three times as high as women’s.
According to research by the Mental Health Commission of Canada, compared to men in the general population, Indigenous men exhibit higher rates of suicidal behaviour, including suicidal ideation, attempt(s), and death. Suicide attempts are 10 times as high among male Inuit youth, compared to non-Indigenous male youth, and compared to heterosexual men, sexual minority men (such as those who identify as gay, bisexual, or queer) are up to six times as likely to experience suicidal ideation.
Boys don’t cry
My husband is brilliant in many ways — including being low-key when big things are happening to him — but I’m starting to wonder if this stoicism by him and our male friends is a mask for bottling emotions, something men are socialized to do. Health issues? It’ll go away on its own. Business problems? No big deal. Family woes? Don’t go there.
When you give it any thought at all, the statistics should come as no surprise. Men living in environments where they are expected to uphold norms such as strength, toughness, and self-reliance can feed into negative beliefs about mental health. Men who adhere strongly to these norms may find it more difficult to recognize signs of mental illness in themselves and others and be less likely to access mental health support.
Reframing “masculinity” to allow greater expression and recognition of emotion and help seeking is a good first step.
A new generation is getting this lesson at Eskasoni First Nation on Cape Breton Island. GuysWork, a Nova Scotia program that started in 2012, bills itself as “a safe space to address masculine toxicity.” It does so by having male facilitators talk with groups of adolescent boys about different issues — things like health care, mental health resources, intimate partner violence, and keys to healthy relationships. Elsewhere, NextGenMen’s Cards of Masculinity box set presents 50 bold questions on topics like objectification and hook-up culture to facilitate meaningful discussions about boys’ beliefs and behaviours.
These organizations are working to change the narrative of outdated masculinity that leaves men feeling isolated, unable to express their emotions, and reluctant to seek help when they need it.
Such collective efforts help de-stigmatize mental illness among men, enhance the quality of health-care provider relationships, and open new pathways for building better personal relationships.
Programs that allow for “shoulder-to-shoulder” action-oriented tasks (think camping, sports, art, auto mechanics), rather than face-to-face talk-focused therapy may help get the conversation going.
Moving forward
Back on the trail, my husband points to the preferred path up a rocky incline. My son, of course, takes an alternate and more complex route. Nope, no obvious symbolism there.
We dragged him out of bed to hit the trail because we were getting worried — he needs to do more to get his physical and mental well-being in order. So, my husband bet him he couldn’t get up early enough to join us.
My husband used to run to keep in shape, but after a series of health issues took running off the table, I started to worry about him. I suspect he did so as well. Then we discovered that, while he could no longer run, he could hike — and the world shifted. Running in the neighbourhood was good, but hiking in the forest was transformational.
Even better, hiking is something my husband and I could do together. Some of our best and most rewarding conversations have happened on the trail. We’ve tackled work problems while admiring wild trilliums and resolved deeply personal issues while glimpsing white-tailed deer. Talking things through is good for us; it makes us reflect more.
As we approach the trail’s end two hours later, my son is in the lead. His sweater is around his waist, his coffee mug is full, and we’re all smiling.
Resource: Men’s Mental Health and Suicide in Canada — Key Takeaways
Further reading: Weaving Through the Challenges: The ABCs of Finding Paths to ACB Mental Health Care
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If it’s just not working, then don’t ghost. Name your needs.
In a famous episode of the popular TV series Curb Your Enthusiasm, Larry David, the curmudgeonly main “character” (said to be an exaggerated version of himself), decides he must end therapy after seeing his middle-aged psychiatrist at the beach in a thong. When he announces his intention to leave, the psychiatrist seems surprised by the decision and keeps pressing Larry to tell him why it’s over. Larry keeps hedging, then ungracefully bolts.
In reality, the question of why and how to end therapy — to “break up” with your therapist — is for most more complicated than this scenario suggests. Ideally, the decision to move on is mutual, anticipated, and planned. If your therapist is a good fit, and you’ve developed a trusting relationship, you’ll both probably know when it makes sense to do so. It’s also likely that you’ll be able to discuss it openly: you’re feeling better; you’ve worked together toward gaining insights on the challenges that brought you into therapy, you’ve grappled with grieving, worked to improve or let go of toxic relationships, begun to heal from trauma, etc. Now, you both sense that you have the tools and understanding to deal with situations that trigger anxiety or other issues. You’ve grown, your therapist has genuinely helped you, and with respect and goodwill on both sides, the time to part has come.
But what if you and your therapist are not such a good fit? They’re just not “getting” you, and it seems unlikely that you’ll feel better any time soon. While the most frequent advice is to “shop around,” in practice it can be hard to tell your story — in all its intimate, painful details — multiple times to different strangers. That kind of reluctance can tempt you to stick with the therapist you’ve been working with, despite your reservations.
At this point, it’s all too easy to rationalize your way back into familiar territory. Maybe you’re relying on community or employee services, where choices are more affordable. Maybe you have trouble asserting yourself. Maybe you don’t want to say something that might hurt your therapist’s feelings or invite some kind of judgment. While each of these reasons might be valid, continuing on when you’re not fully invested will be an unfortunate waste of time for you both.
Take “Jean,” for instance, a woman in her 60s who sought therapy when she found herself stuck getting over the death of a pet. Her online therapist, a woman in her 30s, seemed to pigeonhole Jean as a lonely empty nester who needed to get out more. “Yet I’m not lonely,” says Jean, a creative spirit who is happily married, sees her grown children often, and enjoys a wide circle of friends. “She was very nice, but she was off about who I am.” Jean felt stereotyped, but being conflict-avoidant, didn’t know how to convey it. She ended up leaving after completing several sessions and didn’t seek out another therapist. Eventually, she moved past her grief on her own, without the external help and insight she had been looking for. Jean still wonders if, with the right therapist, the process might not have taken so long or been so painful.
So, though it may not be easy, if you’re dissatisfied for any reason, you owe it to yourself and your therapist to communicate your feelings and end the therapeutic relationship.
Starting well
Of course, incompatibility can be avoided by finding a good fit from the beginning. Many therapists detail their specialties and training in online biographies, which makes it easier to narrow the field and choose someone with expertise in what you’re experiencing — someone who has a good chance of understanding and appreciating who you are and what you need.
According to Lindsey Thomson, a registered psychotherapist based in Kanata, Ontario, and public affairs director for the Canadian Counselling and Psychotherapy Association, with 13,000 members across the country, as you go through this process “it’s important to be truthful about your preferences. Let’s say you’re a woman who wants to work on your experience of a past trauma that makes you uncomfortable talking with a man. Or maybe you’re part of a marginalized community and feel more comfortable with someone who shares the same cultural background. If you have preferences like that,” she says, “you need to find someone who meets them.” Many therapists, including Thomson, offer a 30-minute complimentary session to help potential clients test the waters and see if the fit is good for both people.
Also essential is understanding what type of therapy the counsellor is offering and what their overall philosophy is. As Thomson points out, studies suggest that what matters most is the dynamic between client and therapist. “This is a working relationship we’re dealing with,” she says, “you know, human to human. If something comes up that you don’t agree with, or if you don’t like the way the therapist has framed something — or you were challenged, and you weren’t ready for it — bring that up. It’s really important. Yes, it can be uncomfortable. But just know that all therapists want to know what’s going on for you in that process.”
Definitely don’t “ghost”!
While therapeutic situations differ, says Thomson, clients will average between 12 and 20 sessions, particularly with goal-oriented models like cognitive behavioural therapy (CBT).
“Let’s say I’m a client in therapy with generalized anxiety, and I’ve had 10 sessions. I’ve noticed a decrease because I’ve been working on some behaviour changes to help reduce it. At that point, the therapist can do a progress check on my initial goals and see how I’ve been doing with practising those skills — whether it’s behaviour changes, regulating emotions, or challenging an automatic negative thought to let it go and move on. Do I feel confident that I can maintain that without the therapist’s support?” For the therapist in this situation, says Thomson, rather than a complete termination, “maybe we switch the frequency of sessions. I typically see clients every two weeks. So why don’t we try seeing each other once a month for what we call maintenance-type therapy? If the skill implementation isn’t going so well, then we can go back to where we left off.”
At every stage of the process, the key to success is being comfortable communicating your feelings. You’re there to gain insight and develop the skills to grow, heal, and cope. Your therapist should be in your corner all the way.
If they do or say something truly unprofessional, and the organization they are registered with has a code of ethics and disciplinary measures, you can make a complaint. Check the laws and regulations in your province or territory to determine how to proceed in this kind of situation.
Resource: Fact Sheet: Common Mental Health Myths and Misconceptions.
Further reading: Weaving Through the Challenges: The ABCs of Finding an ACB Therapist
Moira Farr
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The Future Ready Initiative’s community-helping-community model supports people to strive and thrive.
Amina (not her real name), a young mother of four, faced serious challenges when she separated from her husband. Although she had lived in Canada for more than 10 years, she was isolated in her home, and the fear and stress of suddenly finding herself on her own were overwhelming. She urgently needed psychological counselling and help with learning English, doing her banking, buying groceries, and navigating the city’s public transport. “It is such a humbling and inspiring story,” says Ramzia Ashrafi, clinical practice team lead for Future Ready Initiative (FRI), which has supported hundreds newcomers across Canada since its inception two years ago.
The Future Ready team connected Amina with mentors, both professionals and volunteers (also called “family navigators”) who recognized her situation as an emergency and fast-tracked the help she needed. Within weeks, she had received counselling from a practitioner who specializes in helping immigrants and refugees. “After eight or nine months she was very comfortable expressing herself in English, and with no additional support, found a house and a job that allowed her to financially sustain herself and her children,” says Ashrafi.
Amina’s is one of many success stories to emerge from the initiative, which has multiple programs targeting youth, families, and seniors in need of support with mental health, education, settlement, and employment. “It’s the community helping the community build resiliency,” says Aleem Punja, national operations officer at Future Ready Initiative, whose stated core values are “individual agency, dignity, and equity.”
Not surprisingly, the number of people in need of their support has increased significantly since the pandemic hit three years ago.
“It has not been easy,” says Punja, “but we are doing our best.” FRI is a new national organization with 24 staff members and 500 community volunteers across Canada, yet it is able to provide the range of support services so many need.
The positive energy generated by all those involved in FRI is reflected in the virtual exhibition, Journey Upstream, a moving showcase of art, photography, music, spoken word poetry, graphics, and testimonials illustrating the experiences, hopes, and dreams of those new to Canada looking to connect with others. According to the exhibition’s description, it “aims to tell the story, via different and unique perspectives, of how the Future Ready Initiative fosters hope and builds resilience, and equips families and individuals with resources that enable them to confidently overcome challenges and thrive.” The priority given to mental health support is sharply illustrated in one of the photographs: a chain-link fence adorned with three simple black and white signs — YOU MATTER, YOU ARE NOT ALONE, DON’T GIVE UP.
The multidisciplinary Future Ready Initiative mental health case management team includes social workers, nurses, and psychotherapists specially trained in crucial areas such as suicide prevention, addiction, grief, and post-traumatic stress disorder. For those fleeing war and persecution, there is a particular need to offer care “in a trauma-informed way,” says Punja. That means building partnerships with numerous sister organizations, such as ABRAR Trauma and Mental Health, that can offer timely support, virtually or in person. Whether it’s the loss of loved ones to COVID-19, pandemic-related mental and physical health issues, or disruption to income and education due to the disease, war, settlement, or political upheaval — all have had a massive social impact on individuals and families.
For some, reaching out for help still carries a stigma, says Punja. Admitting you are having trouble finding a job, paying bills, or feeding your family is stressful enough, but dealt with in isolation such problems can seem impossible to overcome. Making it easier for people to ask for and receive help means connecting with them in a way that lets them see how everyone has challenges and everyone benefits from helping others. “Maybe a cousin helps you with English, or a neighbour does your taxes,” he says. Changing the language and the dynamics between the helped and the helpers also makes the process of helping someone get back on their feet less stigmatizing. “We don’t talk about ‘poverty’ but rather ‘vulnerability.’”
It also helps to focus on goals: an individual or family may be in a tough place now, but by helping them map out a path to better times, Future Ready emphasizes people’s agency and resilience as they find their own best strategies for success.
As well, helping others be “future-ready” means focusing on community connections as vital to mental health (in addition to direct interventions like counselling and coaching). Events that bring people together, such as musical performances, art exhibitions, sports, and those tailored especially for youth, families, or seniors have been successful in integrating newcomers and helping them stay positive and optimistic despite challenges and obstacles.
FRI’s Impact Report 2022 notes a number of positive milestones for the organization. “Since its inception in 2021, FRI delivered holistic and tailored support in the areas of family mentorship, future of work, mental health, settlement excellence, and youth mentorship to over 727 individuals.” It provided 560 hours of service to people with mental health risks. This included helping individuals on long waiting lists find care from a mental health or primary care doctor and supporting family members who were worried about the mental health of a loved one. Future Ready Initiative also assisted more than 100 family navigators and mentors “to competently manage sensitive situations while avoiding burnout.”
Ali Masroor Bigzad, who emigrated with his family from Afghanistan in September 2021 and currently lives in Sherbrooke, called his submission to the Journey Upstream exhibition “Spark of Hope.” It was FRI that gave him that hope. “Upon our arrival, the FRI officer came to our place and welcomed us on behalf of the community leadership and asked if we needed anything. We were all so happy that these institutions were here, reigniting that hope in us for a better future. The staff supported our settlement in different ways. The FRI member gave me advice about the different education pathways I could take. Without him, it would have been difficult for me to seek out the right path to start my educational journey.”
FRI staff, family navigators, and mentors have every intention of carrying on with the initiative to provide hope and real service to help every member of the community thrive on their journeys.
