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This article is part of the Catalyst series called Language Matters on terminology and usage.
Like the problem of homelessness itself, the issue of language around homelessness is complex and multifaceted, with researchers, experts, and those with lived experience asking if there is a different way of talking and thinking about housing that would drive the conversation rather than mire it in stigma, prejudice, and discrimination. Like those experiencing housing insecurity – something that can be viewed on a spectrum of risk in terms of access to and maintaining shelter – there is no one right answer.
The term homelessness can broadly encompass “the situation of an individual, family, or community without stable, safe, permanent, appropriate housing, or the immediate prospect means and ability of acquiring it,” according to The Canadian Observatory on Homelessness.
This can refer to those who are living in emergency shelters, couch surfing, living in encampments, those who are living in environments not intended for human habitation (such as cars, garages, or makeshift shelters), and those at risk of moving to these living arrangements. The definition encompasses not only income and housing, but also access to employment, health care, clean water and sanitation, schools, and childcare.
Word choice
The words we use do not, themselves, change the experience or impact of homelessness – but they can shape the conversation. For example, terms such as “houseless” or “unhoused” are emerging to place the emphasis away from the individual, and toward the bigger problem – a lack of affordable housing, something that is of great concern to 45 percent of people in Canada, as of late 2024 reporting from the Canadian Social Survey.
Al Wiebe knows these concerns. He is a housing advocate in Winnipeg who has experienced homelessness and describes himself as having no fixed address. He uses the word “homeless” to describe his experiences because, “a house is just a shelter, a roof over your head,” he says, noting that some people living in encampments, for example, may feel they have a “home” even though they are without a traditional “house.”
Further, Wiebe notes that more than 31 percent of homeless people come from Indigenous communities, with many people from within those communities noting that “unhoused” or “houseless” are more appropriate terms for those who may consider Earth their home.
Person-centred language
This term aligns with person-first language – something that focuses on the individual. For example, in the case of mental health conditions, you could describe a person as living with schizophrenia as opposed to “having” or “being” an illness, disability, or condition. In the case of housing – a lack of affordable options is the problem – not the person.
Pearl Eliadis talks about this nuance in “Turning Off the Tap: Preventing Homelessness for Victims of Violence,” her chapter in Ending Homelessness in Canada: The Case for Homelessness Prevention (2024), edited by James Hughes.
Eliadis is an associate professor at McGill University and a lawyer with more than a decade of experience, including work with the United Nations and the Canadian Human Rights Commission. She was working with Melpa Kamateros on a research project in 2021 as part of the Quebec Homelessness Prevention Policy Collaborative. At the outset, they were having a conversation on language.
Kamateros – co-founder and executive director of Montreal’s Shield of Athena Family Services – offering emergency shelter for those experiencing intimate partner violence – says care is needed in the use of the term.
“These women are not homeless, at least not as long as they are with our shelter!” Kamateros explains to Eliadis, who writes: “There is a feminist argument at play here: framing the experience of a woman fleeing violence as ‘homelessness’ places the focus of the policy problem on her; it reframes who she is, even though her circumstances were the product of someone else’s violence. The woman may be temporarily unhoused, but that does not make her ‘homeless’.”
Evolving ideas
Some sources, such as Regeneration Outreach in Brampton, Ontario use “homeless” to refer to someone with no fixed address and “houseless” to refer to someone who does not have a traditional home, but does have a place to stay, such as an RV or other non-permanent structure. Blanchet House in Portland, Oregon uses both “houseless” and “unhoused” interchangeably over the more stigmatized term, “homeless.”
However, as advocates are noting, changing the terms may eclipse the bigger issues.
“Even the benefit of switching from a word loaded with negative connotations to one that is denotationally the same thing but without those connotations only has a negligible benefit that lasts a few years, until stigma grows on the new word too,” wrote Frances Koziar, a young, disabled, retiree, and a social justice activist living in Kingston, Ontario in an Ottawa Citizen op-ed.
While language continues to evolve, it is only one part of a much larger issue. The debate over terminology should not be used as a form of virtue signaling without meaningful efforts to tackle the deeper challenges of housing affordability, mental health, and substance use.
Further reading: A Roof of One’s Own: The lack of housing options brings its own kind of homesick feeling.
Jessica Ward-King researches and writes as The StigmaCrusher. She feels most at home when learning about and advocating for mental health.
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Welcome to the eighth installment in the MHCC & series, designed to get to know our HealthPartners membership, and discover how we can best support one another.
To mark Kidney Health Month, I sat down with Elizabeth Myles, National Executive Director of The Kidney Foundation of Canada, to learn about the organization’s remarkable journey and the critical connection between kidney disease and mental health.
Silent workhorses: Understanding our kidneys
Core childhood memories stay with us well into adulthood. Often they inform our outlook, even if we don’t realize it. That was the case for me when I was asked to choose a HealthPartners charity to learn more about. I picked The Kidney Foundation of Canada without hesitation.
Of course, it only took a moment of reflection to figure out why.
Many years ago, my best friend’s father was very sick. I remember playing with her in the backseat of the car, almost weekly, as we drove with her mom to collect him from the hospital.
I knew little about his condition, just that he was having a medical treatment to clean his blood, something invisible and automatic that I’d never given any thought to. I understood his kidneys needed help to work, but I couldn’t grasp why he wasn’t getting well. The seriousness of his chronic illness only hit home after he died. Kidney disease took my best friend’s dad, and left us both with more questions than answers.
My conversation with Elizabeth was an opportunity to fill in the blanks left empty all those years ago.
During our discussion, I was struck by how little most of us know about these vital organs. Our kidneys are the body’s filtration system. They remove waste and excess fluid from our blood to create urine; regulate our blood pressure; produce hormones that help make red blood cells; and activate vitamin D for healthy bones.
For our kidneys, it’s all in a day’s work.
“Most Canadians don’t spend much time thinking about their kidneys,” Elizabeth explains, referring to a recent poll conducted by The Kidney Foundation. “Yet these fist-sized organs process about 200 liters of blood each day. They’re truly the unsung heroes of our body.”
Elizabeth Myles, National Executive Director, Kidney Foundation of Canada
Six decades of progress: From certain death to hopeful possibilities
The Kidney Foundation celebrated its 60th anniversary last year, prompting me to ask Elizabeth about the good news stories in kidney health over these last six decades.
It turns out there’s plenty to celebrate. Back in 1964, kidney disease was essentially a death sentence. Dialysis was for acute treatment – not life-sustaining as it is today. Transplant science was in its infancy.
Fast-forward to 2025 and we’re seeing rays of light in a once a very dark space. At-home dialysis is a reality. A transplanted kidney can function for 20 years or more, enabling recipients to thrive not just survive. Anti-rejection medicines are growing in availability and sophistication, and new treatments include powerful drugs that can slow, and even reverse damage.
“It’s an exciting time to be doing this work,” Elizabeth says with genuine enthusiasm. “We’ve come so far, and there’s real hope on the horizon.”
The physical and emotional burden of kidney disease
But the flip side of medical progress is the many challenges that remain. It’s these that will be the focus of The Kidney Foundation’s next chapter.
Kidney disease is sneaky, offering little in the way of physical symptoms until it’s advanced. “Imagine going to hospital and learning that you’re direly unwell overnight,” says Elizabeth, emphasizing that a diagnosis this serious isn’t just about the physical reality, but also about the mental health and financial implications.
While more options are available today, dialysis is still a significant burden for those who need it. In-centre dialysis is typically three four-hour sessions each week. Not only is it time-consuming, but it’s also invasive and disruptive. Beyond this, it causes emotional distress, especially when, for most people, the diagnosis itself comes as a complete shock.
“Suddenly you’re faced with the harsh reality of your own mortality, dependent on a dialysis machine, and shouldering the mental load of a now uncertain future. This often brings on feelings of anxiety, depression, and deep grief for the life you once envisioned.”
To add insult to injury, the financial burden can also be overwhelming. “We’re seeing people diagnosed younger and younger, many in their prime earning years,” Elizabeth notes. “Between time away from work for treatment, medication costs, and transportation expenses, kidney disease can devastate a family’s financial stability.”
Finding community: The power of peer support
That’s where The Kidney Foundation’s peer support network becomes not just a source of comfort and information, but a veritable lifeline.
In recognition that one-size-doesn’t-fit-all, the organization has three different kinds on offer: one-on-one, online private forums, and virtual peer-support groups, because everyone who is diagnosed may process the news differently.
“We offer more than 200 different support groups,” Elizabeth explains, “catering to the diverse needs of those seeking support — from individuals at various stages of illness to caregivers and parents.”
The value of peer support is something I’ve seen firsthand working in the mental health space. Connecting with others who share our experiences can normalize our challenges and give us practical wisdom above and beyond clinical advice.
“There is immense reassurance in seeing others coping well,” Elizabeth adds. “It transforms the narrative from ‘my life is over’ to ‘I can still live meaningfully with this condition.’”
The gift of life: Transplantation and organ donation
While innovative medications are now available, with more under development, a kidney transplant remains the gold-standard for successful outcomes. But demand far outstrips supply.
“Did you know that 71 percent of Canadians waiting for an organ transplant are waiting for a kidney?” Elizabeth asks. “That’s thousands of people whose lives are on hold, sometimes for years, hoping for a call that might not come in time.”
Elizabeth and her team are working to create favorable conditions that support living donors – both emotionally and financially. They are advocating for changes, such as paid leave from work during recovery, to make altruism less costly for those inclined to give.
“Organ donation is the greatest gift someone can receive,” says Elizabeth, “and most Canadians support it, but sometimes, life gets in the way of people taking the step to formalize their wishes [to be a posthumous donor]. We’ve worked to create avenues that make that choice front-and-center. For example, in British Columbia, Ontario and Nunavut, it’s now possible to indicate your intentions on your income tax form.”
Given that the only two certainties in life are death and taxes, I couldn’t help but marvel at the brilliance of something so simple. In fact, the number of organ donors jumped by 2.5 million following this change.
“It just reinforces that Canadians are some of the most altruistic people in the world. The gift of life shouldn’t incur a financial cost for donors, nor should it be difficult to register your wishes in advance,” says Elizabeth.
Legacy of compassion: The Logan Boulet effect
Perhaps no single person has had a greater influence on inspiring organ donation in Canada than Logan Boulet, a young hockey player who was tragically killed in the 2018 Humboldt Broncos bus crash.
“Logan had registered as an organ donor just weeks before the accident,” Elizabeth tells me with visible emotion. “He lost his life in the crash, but he saved six others. His selfless choice inspired what we now call the ‘Logan Boulet Effect’ – tens of thousands of Canadians registering as organ donors in the weeks following his story becoming public.”
His legacy continues to shine brightly, with April 7th designated as Green Shirt Day, a testament to how one person’s compassion can change the trajectory of countless lives.
“Those six recipients and their families will carry Logan’s gift with them – and keep his memory alive,” says Elizabeth. “Until we find a cure, transplants are the best hope we have to treat kidney disease – but we can’t ignore the power of prevention.”
Prevention: The best medicine
While The Kidney Foundation strives to help those living with kidney disease today, it’s also working to prevent more people from needing lifesaving treatments in the first place.
Given the silent nature of the illness, Elizabeth and her team are pushing to have kidney function testing done at the primary care level, especially for those who have known risk factors, which can include genetics, diabetes, high blood pressure and certain medications.
“Simple blood and urine tests as part of routine health check-ups could do absolute wonders in catching and treating kidney malfunction early,” says Elizabeth. “Early intervention can dramatically slow or halt progression of the disease. We’d like to see testing for kidney problems become as common as breast cancer screening.”
In fact, shining a spotlight on kidney health is the Kidney Foundation’s goal for Kidney Health Month, because greater awareness and education can make a significant difference in enriching the quality of lives – and ultimately saving them.
“We want people in Canada to know their risk factors and to ask their healthcare providers about kidney function tests,” Elizabeth emphasizes. “Everyone should feel empowered to advocate for their own health.”
And the stakes couldn’t be higher. Current estimates indicate that over 4 million Canadians may have, or be at risk of, chronic kidney disease – without having the slightest clue.
The inseparable connection: Mental wellness and kidney health
As we wrap up our conversation, I share with Elizabeth how my work leading a collaborative on mental health and chronic disease at MHCC has shaped my understanding of the kidney health journey.
I also highlight that during our extensive conversations with HealthPartners, we’re hearing that people living with chronic disease, who also have adequate mental health support, will stick to their treatment more readily, enjoy stronger social connections, and often show improved physical outcomes.
“From our perspective at the MHCC, it isn’t an either or. It’s an ‘and’” I say.
Elizabeth nods emphatically. “We see it every day. When someone feels hopeless or overwhelmed, it can affect everything from medication adherence to their willingness to consider transplantation. That’s why we’re increasingly focused on the whole person, not just their kidneys.”
Looking ahead: A vision for the next sixty years
With 60 years under its belt, The Kidney Foundation has a strong foundation on which to build its future work.
“Our vision is unwavering – we are determined to see a future free of kidney failure, where kidney disease is prevented through early diagnosis and treatment, and where patients are well-supported throughout their journey,” she says. “We’ve made incredible strides, but we won’t stop until kidney disease no longer shortens or diminishes lives.”
It’s an ambitious goal, but after our conversation, I’m convinced The Kidney Foundation has the passion, expertise, and community to make it happen.
That little girl who once played in the backseat with her friend now understands she was a support and distraction from the complex reality of kidney disease. A disease that requires those who face it, and their families, to draw on remarkable resilience – a resiliency I still admire in my best friend, to this day.
Most importantly, I understand that supporting kidney health means supporting the whole person, mind and body together.
To learn more about kidney health, find support, or discover how you can help, visit www.kidney.ca.
This MHCC & conversation is dedicated to Allan. You live on in our memories.
Author: Sandra Koppert, Director of Mental Health Advancement, MHCC
Sandra has extensive experience in strategic planning, outreach and promotion, and stakeholder relations within the national non-profit health sector and research consulting. Under her leadership, the MHCC championed the development, release, and ongoing promotion and uptake of the National Standard of Canada for Mental Health and Well-Being for Post-Secondary Students. Sandra also oversees a range of other initiatives related to the justice system and the Schizophrenia Quality Standard(s).
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If you’re in certain filter bubbles, it can feel like mental health is everywhere. “So many people are consuming mental health information, but without a critical eye,” says Jessica Ward-King a self-described fierce mental health advocate with a PhD in experimental psychology who uses the moniker The StigmaCrusher (“heavily educated and heavily medicated”). She uses online talk therapy and also finds information through TikTok and YouTube. “I consider that e-mental health too,” she says. Ward-King informs her influence with research from her doctoral studies, her lived experience with bipolar disorder, and other evidence-based sources, but this isn’t necessarily the norm for online mental health.
Technology is undoubtedly transforming the way people in Canada receive health care with countless applications, influencers, and digital tools popping up everywhere, but how does one sort through the many options?
“E-mental health services in Canada provide crucial benefits—offering anonymity, reducing stigma, and allowing people to access support in ways that work for them,” says Maureen Abbott, Director of Innovation at the Mental Health Commission of Canada. “Whether it’s the flexibility of choosing their own time and format or the ability to find help in urgent moments when in-person services are unavailable, e-mental is transforming mental health care. One individual shared with us that accessing a peer support group in the middle of the night literally saved their life,” Abbott says.
Maureen Abbott, Director of Innovation at the Mental Health Commission of Canada at the Electronic Mental Health International Collaborative (eMHIC) conference in Ottawa in September, where the strategy was launched. With countless e-mental health solutions available, clear guidelines are essential to ensure clinical quality, user safety, and data security. Photo: eMHIC.
A strategy for the future
The Mental Health Commission of Canada launched Canada’s first E-Mental Health Strategy in 2024. It provides guidance for the development of e-mental health with emphasis on clinical safety, frameworks for data collection and retention, and culturally appropriate care.
“While e-mental health services offer many advantages, challenges like privacy and service quality must also be addressed. That’s why the Mental Health Commission of Canada, with the support of Mental Health Research Canada, developed a national strategy—shaped by a diverse advisory committee, with more than half the committee comprised of those with lived experience of mental health challenges,” Abbott says. “This guiding star document sets priorities for the future of digital mental health, ensuring meaningful engagement and collaboration across the sector.”
By supporting those creating e-mental health policies and solutions, the MHCC can inspire and improve the field at a systemic level ensuring that best practices cascade through to app developers, policy makers, and healthcare leaders and empower them to establish and adopt standards that will improve user outcomes.
In this way, it is a strategy that meets people where they are – because e-mental health keeps growing. According to the American Psychological Association, in 2021, more than 20,000 mental health apps were available on the market.
The proliferation is bound to continue because e-mental health tools can offer greater choice, convenience, lower cost, and, in some cases, higher-quality care than traditional services, according to an editorial called The “Uberisation” of Mental Health Care: A Welcome Global Phenomenon? by Ian Hickie, professor of psychiatry, Brain and Mind Centre, University of Sydney, Australia.
“If those with lived experience and research capacity in this field don’t respond appropriately, it leaves room for others to step in to respond consumer priorities: access, choice, competitive pricing, and user experience. Worldwide, demand for personalized mental health services far outstrips supply,” Hickie writes.
Here in Canada, the E-Mental Health Strategy serves as a blueprint, offering six recommendations and 12 priorities to chart the future direction of development of e-mental health in Canada and drive innovation – with consideration.
For example, one priority is to address the quality of e-mental health solutions and services, including privacy and data protection concerns. The strategy references the First Nations principles of ownership, control, access, and possession to guide health leaders, provinces and territories, jurisdictions, community organizations, and researchers around consent, collection, and data sovereignty.
“Trust is at the heart of e-mental health,” says Michel Rodrigue, president and CEO of the Mental Health Commission of Canada. “The efficacy and safety of e-mental health apps and supports should be paramount. People in Canada need assurance that these options meet the highest standards of safety and quality, prioritize equity-first data governance, maintain confidentiality, and include the perspectives of people with lived experience of mental health challenges.”
Stigma Crusher Jessica Ward-King notes that when people are in the midst of a crisis or struggling with their mental health, they may not be necessarily asking about how their data is being managed.
“Privacy is a huge concern that many don’t even think about,” she says. “Safety is another big issue. If a chatbot responds to suicidal thoughts, what protection is in place? If you’re getting advice from someone who doesn’t know your medications, what’s the risk there? A strategy makes sure someone is asking those questions before they become problems.”
Some of the recommendations in the strategy touch on issues of workforce and user readiness. People want help determining the quality and safety of options when there are so many options and no common standard. As e-mental health solutions continue to improve in quality and efficacy, there needs to be a means of communicating about evidence-based solutions with practitioners and to prove that they are both safe and efficacious.
With the speed of change, the e-mental health community is calling for specific guidelines related to AI use in mental health care; something that goes deeper than existing domestic and provincial guidelines and standards on the ethical use of AI in Canada.
Throughout the strategy-development consultations, the creation of a mental health app library and assessment process was one of the most discussed topics among both international experts and domestic collaborators. A database for assessed apps and a national assessment process would directly address some of the largest issues facing e-mental health in Canada, along with ongoing reviews and updates of best practice guidelines, since technology, legislation, and research evidence are constantly changing, particularly in relation to data security and privacy standards.
Addressing risks and readiness
E-mental health can offer access to care for people in rural areas who may not be able to travel to a care provider. It allows people to find culturally appropriate care for their situation, preserves privacy, and is usually less expensive than in-person services – for both the provider and the user. During the peak period of the pandemic, electronic mental health solutions allowed people to access care while physically distancing, isolating, or recovering from COVID-19.
Virtual consultations for mental health, substance use, and healthcare services went up during the spring and summer of 2022, with nearly three in five people in Canada accessing care this way, according to Statistics Canada.
According to a 2021 Canada Health Infoway survey, 63 percent of people said they would not have sought mental health care if virtual options had not been available.
Shaleen Jones knows this firsthand. She is the founder and executive director of Eating Disorders Nova Scotia, a community-based charitable organization that offers all of its services without a referral or a diagnosis.
Like many organizations, Eating Disorders Nova Scotia became 100 percent virtual in 2020, delivering all their services, supports, and training online, something that allowed the organization to expand its reach, says Jones.
“Technology is really a tool that allows us to connect with others – I believe it is that personal connection that has the greatest impact,” she says. “Like any new tool, thoughtfulness in how it is utilized is critical. The MHCC e-mental health strategy serves to identify potential challenges and strategies as we work to chart the future course of e-mental health services in Canada.”
Canada’s First E-Mental Health Strategy: The Six Priorities
- Improve perception, awareness, and engagement in e-mental health.
- Develop resources for evaluating the effectiveness of e-mental health solutions and programs.
- Address the quality of e-mental health solutions and services, including privacy and data protection concerns.
- Reduce barriers and address system challenges to e-mental health solution adoption.
- Embed IDEA (inclusion, diversity, equity, and accessibility) principles in all e-mental health development, tools, and delivery.
- Support the mental health workforce to integrate e-mental health into their practice.
Canada’s First E-Mental Health Strategy: The 12 Recommendations
- Advance the development and promotion of a readiness assessment tool for service providers.
- Develop and launch comprehensive e-mental health training for the mental health workforce.
- Advance and promote a best-practice guideline for using e-mental health tools.
- Increase safety with the use of artificial intelligence in mental health care.
- Develop a national mental health app library.
- Establish a champions network.
- Develop a navigation site and public awareness campaign for quality e-mental health solutions.
- Leverage e-mental health to support the continued utilization of interdisciplinary health-care teams, including mental health professionals.
- Consider the role of e-mental health in Canada’s high-speed bandwidth initiatives.
- Invest in the development of e-mental health solutions for a spectrum of intensity of services.
- Allow for e-mental health solutions in all funding models for provincial and territorial health systems.
- Advance interoperability of mental health data between providers and personal data ownership.
Further reading: Find the strategy in full.
Resource: E-Mental Health: What is the Issue?
Author: Fateema Sayani is the manager of content at the Mental Health Commission of Canada.
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Debra Slater is the type of person you want looking after your loved ones. A self-proclaimed born nurturer, she took care of her grandmother in Saint Vincent and the Grenadines and went to school to become a personal support worker (PSW) after moving to Canada. Slater loves talking to and learning from the older adults under her watch at a long-term care home on the outskirts of Toronto. She greets them by name, with eye contact and a smile, and strives to develop a rapport regardless of their cognitive condition. She treats clients as individuals while helping with activities of daily living – often referred to as “ADLs” in support work communities – such as bathing, getting dressed, and eating.
“You need to take time to understand their emotions and feelings,” says Slater, who has worked as a PSW on and off for more than 20 years. “You kind of become their family. They’re not ‘my patients.’ They’re people who want to be as independent as possible and this is their home. My job is to bring comfort and peace, love and companionship. It’s a whole vibe.”
Debra Slater, a personal support worker, also coordinates the Empower PSW Network to advocate for better working conditions.
Slater maintains this attitude even though, on a typical shift, she has eight residents with diverse needs to juggle. One might have had a rough night; another could be dealing with a medical issue; and if any of Slater’s colleagues are absent, she’ll probably have additional clients. “On a difficult day, you have to work harder to be present,” says Slater, reflecting on all the de-escalation and problem solving she must do. “That takes a toll. My mental health is a roller coaster.”
Many care providers are in this profession because they have similar nurturing mindsets, yet 80 percent have considered changing careers, according to a report published last year by the Canadian Centre for Caregiving Excellence (CCCE).
Across the country, PSWs, direct support professionals (DSPs) – who work with clients with disabilities – and other paid health-care attendants are feeling stressed, overworked, and underpaid. The labour pool consists largely of racialized women, many of whom are newcomers to Canada, and they face high rates of abuse and discrimination on the job.
Working in congregative living facilities and providing home care for a patchwork of public and private employers, the majority are essentially gig workers without benefits such as paid sick days or access to counselling.
Fewer than half of the PSWs surveyed by the joint University of Toronto and St. Michael’s Hospital-based Upstream Lab said their health was good or excellent, which is lower than the national average. More than 20 percent likely had some form of depressive disorder, the researchers concluded in a 2022 paper, “significantly exceeding the prevalence of major depressive episodes among Canadians.”
In a country with an aging population, this is a significant challenge. If we don’t take care of PSWs and other care providers, how can they be expected to look after our most vulnerable citizens?
Risky business
More than 650 PSWs in the Greater Toronto Area responded to the Upstream Lab survey, which found that:
- 97% are born outside Canada.
- 86% are precariously employed.
- 89% lacked paid sick days.
- 90% are women.
- Many are casual employees, with wages that range from $17 per hour in home or community care to $25 per hour in public long-term care facilities.
This snapshot is representative of care providers across the country, according to the Upstream Lab paper, and their precarity is “significantly associated with higher risk of depression.”
Health-care jobs in Canada have traditionally been secure, but over the last three decades, “disparities in pay and work conditions have grown between registered professionals (such as physicians, nurses) and other staff whose jobs are part-time, temporary, on contract and not unionized,” the researchers wrote. A national focus on discharging people from acute care and aging in place has ramped up the demand for PSWs, who now constitute about 10 percent of all health-care workers. This workforce grew relatively quickly, says Upstream Lab director Dr. Andrew Pinto, without much scrutiny or consideration of the consequences.
These poor working conditions can be detrimental to physical and mental health, says Dr. Pinto, who, in addition to his role as a public health specialist, is also a family physician. In a system that incentivizes “reducing costs” and “doing more with less,” he says that many PSWs fear reprisal from their employers if they raise concerns about problems on the job. Pinto knows this from his research, and from the PSW patients he sees as a physician. “They’re really dedicated to caring for others and take pride in their work,” he says, “but they’re not given the respect they deserve.”
Dr. Andrew Pinto: Better working conditions lead to better health outcomes. Photo by: Upstream Lab
Despite economic and demographic pressures, Pinto believes this system can be reformed. Because it’s funded predominantly by the public, a collective push for “a basic set of rights” — living wages, paid sick days, access to health resources, opportunities to flag systemic issues — will improve conditions for care providers, whether they work for government or private employers. “The public doesn’t want gig workers looking after their loved ones,” says Pinto. “Better quality jobs will not only improve the health of PSWs, they will also improve care and health outcomes for all Canadians.”
To continue the campaign for policy reform, the Upstream Lab’s research project has spawned the Empower PSW Network, a coalition of care providers seeking to raise awareness and advocate for change. Slater, the network’s coordinator, says that foremost, PSWs need more structured support. “It’s not the work that’s the problem — it’s how we’re treated.”
The silent treatment
Liv Mendelsohn, executive director of the CCCE, knows PSWs who live in their cars because they can’t afford housing. She’s heard stories about the stress of rushing between nursing homes and private residences from PSWs who cobble together gigs. “We rely on them to provide really intimate care,” she says, “but we don’t do enough to support their health.” Moreover, because a care provider’s permission to be in Canada can be tied to a particular employer, they often remain silent when facing discrimination or exploitative situations.
The CCCE has called on the federal government to implement a $25 per hour minimum wage for all PSWs. Mendelsohn also emphasizes the need for consistent benefits to prevent burnout and reduce the number of PSWs migrating to jobs in acute care for more stability. Despite the scale of this transformation, she’s hopeful. “We can’t not improve things,” she says. “There’s no way our system can continue without better support for PSWs.
“We don’t just need bodies,” adds Mendelsohn, envisioning a new era in which, for example, a senior with dementia is cared for by the same provider every day, improving their quality of life. “We need skilled, compassionate people and we need to acknowledge that they’re a critical part of our health-care system.”
In a different world, Kezia (last name withheld to protect her employment prospects) could have been one of those providers. Born in India and raised in the Bahamas, she moved to Prince Edward Island for university and supported herself by working as a DSP and PSW. Kezia assisted with ADL, cooked, cleaned, and accompanied clients to day programs and medical appointments. The learning curve was steep, but with supportive co-workers, she got into a groove. “We tried to foster a feeling of being at home,” she says. “After a while, it felt like a calling.”
But Kezia, who was in her early 20s at the time, also experienced racism and inappropriate sexual comments. Telling her manager about problems “was like hitting into a wall.” She felt unappreciated by her employers, even after working a 16-hour shift. If she missed a shift, she didn’t get paid, which meant she might not have enough money for rent or groceries. Exhausted, she was neglecting her own health. After three years, Kezia left the profession.
“If we were treated better, I might have stayed,” she says. “PSWs are the backbone of our health-care system, but I can never go back to working in the that field.” Instead, Kezia is going to school again. She’s studying to become a nurse.
Further reading: Mental Health at Work: It Matters: How to Start the Conversation.
Learn more: Caregiver resources from the Canadian Centre for Caregiving Excellence (CCCE).
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In 2009, experienced kayakers Zac Crouse and Corey Morris were descending a rain-swollen river in Nova Scotia when Morris was swept over a waterfall and died. At the time, the men were planning a kayak expedition from Ontario to the Atlantic Ocean. Traumatized by the death of his close friend, Crouse entered therapy and began taking medication, and two years later, he embarked on a 1,500-kilometre solo journey as part of his healing.
“At a basic level, it was a physical challenge, but there were also higher-level cognitive things happening,” says Crouse, who used to work as a recreational therapist and now teaches rec therapy in a university program. “You get into a trance-like state after so many hours of paddling. Your brain is seeing patterns on the water that don’t easily fall into slots and boxes. You’ve also got the sounds and feel of the wind. There’s a calming effect,” he says.
“The repetitive motion, the exertion, all the little things you have to pay attention to in order to make progress — those create a sense of flow,” Crouse adds. “And the problems you’re solving are very basic and immediate, not future vague ones.”
Crouse’s trip provided a break from rumination and regret. It helped him recover. And although people experience and respond to trauma in different ways, his journey exemplifies the curative potential of “blue space.”
Zac Crouse teaches recreational therapy. He took a long kayak journey to help with healing after the death of his close friend, Corey Morris.
Second nature
The benefits of hanging out in nature are well-documented: lower blood pressure and stress-hormone levels, less anxiety, more self-esteem. Now, a growing body of research suggests that spending time in, on, or near water can have a more positive impact on our health than other outdoor settings. A 2022 paper, published by a pair of University of California, Davis psychology researchers, for example, concluded that even looking at a creek or pool is enough to lower blood pressure, improve heart rates, and increase relaxation among respondents, a result they attribute, in part, to the evolutionary link between successfully detecting drinking water in arid environments and stress reduction.
Aquatic environments can also be hazardous, of course. Drowning is the third-leading cause of unintentional injury death around the world, according to the U.S. Centers for Disease Control and Prevention. Flooding is among the deadliest consequences of climate change, and it tends to displace or kill those with the least capacity to escape or adapt. Yet, as a species, we have a deep-rooted biopsychological bond to this molecular combination with two parts hydrogen, one part oxygen. Over the past decade or so, researchers have begun to deconstruct the affinity we feel for water, and they are exploring how integrating blue space into our communities and lives could pay tremendous dividends.
According to environmental psychologist Jenny Roe, director of the University of Virginia’s Center for Design and Health, blue space has four triggers that activate the human parasympathetic nervous system, a network of nerves that relaxes our bodies following stressful or dangerous experiences.
First, water instills a sense of being away. It can be either tranquil or dynamic, conditions that can make you introspective or dialed in to your surroundings, both of which serve as escapes from habitual behaviour.
Second, blue space – especially large bodies of water – conjures a feeling of “extent,” of being in a boundless environment where possibilities feel limitless. Although one can also experience these glimpses of an infinite existence while, say, hiking up a mountain, they’re amplified in blue space by acts like looking to the horizon or into the depths of a lake.
Third, the sounds and sights of water — as it runs over rocks, for example, or dances in the sunlight — can spark “hard fascination,” a concentration of our focus through stimulation, and “soft fascination,” an unconscious partial capturing of our attention that requires little effort and frees the mind to roam. Both can contribute to restoration. And fourth, water confers a sense of compatibility with our location; of comfort and belonging.
Author and stand-up paddleboarder Dan Rubinstein departing from Ottawa in June 2023 at the beginning of a 2,000-kilometre journey to explore the curative potential of blue space — an expedition that formed the basis of his upcoming book, Water Borne. Photo: Lisa Gregoire.
Flow states
Another environmental psychologist, Mat White at the University of Vienna, is arguably the world’s leading authority on blue space. He studies what happens when we do anything (paddle, swim, surf, walk, sit) around any type of water, from vast oceans to urban fountains. After leading several research projects and crunching some big numbers, White has concluded that these environments provide a boost by offering increased opportunities for both stress reduction and physical activity.
For one paper, White analyzed a UK census of approximately 48 million adults and found that the closer people live to the coast, the healthier and happier they are. “The crucial point about that research was that it was the poorest communities and individuals who got the benefits,” he says, referring to both mental and physical health. “If you’re rich, it doesn’t matter how often you spend time in blue space. You’re healthy and happy anyway. But if you’re poor, it matters hugely.”
The idea that a place with specific environmental attributes can reduce socioeconomic health inequalities is called equigenesis. Rich Mitchell, a population health researcher at the University of Glasgow, coined the word after publishing a paper that suggested income-related health disparities were less pronounced in neighbourhoods with better access to nature.
The quality of blue spaces affects their therapeutic properties, according to White, as does how we interact with them. Those variables are influenced by geography as well as cognitive and cultural differences. For example, people often prefer places they visited as children, and there are dramatic differences between walking and sitting, and different outcomes depending on how close we live to a blue space and how frequently we visit. But on the whole, when we’re near water, we tend to lose track of time and be more active, and every extra minute of movement is good for our health. “The goodness isn’t just the water,” says White, explaining that people tend to enjoy quality time with one another at places like beaches because of the sense of belonging they feel. “It’s a behavioural interaction that water encourages. This is one of the reasons we think blue spaces tackle health inequalities. They’re social spaces that draw us into cross-generational play.”
New depths
The kicker to all of this, the multiplier of multipliers, is that time spent in blue space, especially by children, promotes pro-environmental behaviour, which is another way of saying “taking better care of the planet.”
One of White’s frequent collaborators, British landscape architect Simon Bell, came up with the term “blue acupuncture” — basically, adding a splash of blue space to a community to help improve public health. For example, a recent project in a low-income neighbourhood in Plymouth in southwest England transformed a small neglected beach into a launch for personal watercraft, swimming area, and park with views of the harbour. The cost was around $150,000 USD and surveys assessed the well-being of area residents before, during, and after construction. Psychological health increased, as did perceptions of community cohesion. Families played in the park, seniors sat on benches, and teenagers took forays into the sea.
What does all this have to do with Zac Crouse’s kayak journey? The common denominator is water. Paddling all day helped Crouse’s brain “catch up to reality,” he says, supplanting a traumatic experience with new memories. But even if one’s connection to blue space is more subtle — a picnic beside a pond, a sunset stroll along a river — it can provide a restorative break from the tensions of daily life. These benefits are not a panacea, but because they “apply to millions of people,” says White, “the overall public health benefit is huge.”
Adapted from Water Borne: A 1,200-Mile Paddleboarding Pilgrimage by Dan Rubinstein, forthcoming in June 2025 from ECW Press.
Further reading: Good Grief: Is there a right way to grieve—and for how long?
Resource: Where to Get Care – A Guide to Navigating Public and Private Mental Health Services in Canada.
Author: Dan Rubinstein
A writer and stand-up paddleboarder based in Ottawa, Canada. His latest book, Water Borne (2025), chronicles his 2023 paddleboarding expedition from Ottawa to Montreal, New York City, and Toronto, exploring the deep connections between water, health, and community. Dan’s work, featured in publications such as The Walrus, The Globe and Mail, and Canadian Geographic, often focuses on outdoor adventures and the environmental importance of blue space.
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A confession
My conversation with Christine began with a confession.
A year and a half ago, I experienced a heart attack that came seemingly out of nowhere –despite having no known risk factors. This unexpected health challenge was a transformative experience, connecting me more deeply with the world of heart disease and mental health.
After my admission, Christine and I dove into a compelling conversation, ranging from individual responsibility to national accountability.
She began by pointing out that while there are factors over which people have some control, there are others, like my age for example, which are incontrovertible. She highlighted decisions we can take to improve our overall health and wellness, from getting good quality rest, to eating well, and exercising.
But her advice comes with a big caveat.
Uncovering inequities
“We have to remember,” she said, “these choices aren’t always available. Not everyone has the same access to affordable, nutritious food, and the time and opportunity for physical activity.”
So, while eight of every 10 cases of premature heart disease and stroke are preventable, risk factors aren’t so easily boiled down.
“Ethnicity, family history, genetics, age, sex,” Christine explained. “These are just the beginning. Where you live and your economic situation play equally critical roles in heart health.”
This insight underscores a crucial truth: social determinants of health aren’t peripheral –they’re central to understanding disease prevention and recovery.
Given her professional role, and her academic background in population health, Christine naturally views challenges through an equity lens. During our conversation, I found my own understanding of the complexities facing those living in recovery expanding well beyond my personal experience.
The sex factor
One striking revelation was the historical gender bias in medical research.
Until now, two-thirds of all heart and stroke research has focused on men. This statistic is particularly alarming given that heart disease is the number one cause of premature death among women, with many experiencing unrecognized symptoms.
To be honest, I felt left in the dark about this inequity, which disadvantages my wife and daughter.
If you want to learn more, Heart & Stroke has some great resources to help women better understand their own risks and have conversations with their healthcare providers.
It’s all part of an effort Christine and the organization are mounting to improve women’s heart and brain health through research, education, and dismantling systemic barriers.
Heart & Stroke has launched awareness campaigns featuring prominent Canadian women like television and film producer Lisa Meeches, R&B artist Deborah Cox, and actress Julie Du Page. Their stories normalize conversations about recovery and provide platforms for shared experiences.
For example, women are hit hardest by depression following stroke, as explored in Stroke and mental health: the invisible and inequitable effects on women, a report that looks at the higher risk of mental and emotional challenges women face after stroke.
Christine Faubert, Vice President, Health Equity and Mission Impact
Creating a life-saving culture
Beyond their focus on priority populations, Heart & Stroke is also a big proponent of collective action for various conditions including cardiac arrest – which is when the heart suddenly and unexpectedly stops beating.
“An individual level of awareness around medical emergencies such as cardiac arrest is a good start,” Christine noted. “But we also need a national push to build a culture of cardiac safety.”
This is echoed in an excellent piece in the Globe and Mail by Heart & Stroke CEO Doug Roth. He writes there are about 60,000 out of hospital cardiac arrests in Canada each year, and only one in 10 survive. Those that do owe their lives to a confident bystander, who quickly and ably administered CPR and had access to an automated external defibrillator (AED).
Putting your heart into it
Heart & Stroke is instrumental in upping general knowledge and competence including through programs like CardiacCrash. It’s a dramatic, team-based interactive program that teaches hands-only CPR and AED skills.
When not carrying out duties as Board Chair of the MHCC, I am the CEO of Provident10, which delivers management and oversight of the public service plan in Newfoundland and Labrador – one of Atlantic Canada’s largest public sector pension plans. In that capacity, I’ve committed to building CardiacCrash into our organization’s plans for 2025 – and I’d urge other leaders to do the same. I vowed to become re-certified in CPR this year, a promise I fulfilled in late January 2025.
“AEDs are essential life-saving devices. But we need to ensure they are registered, maintained, and people know how to use them,” said Christine.
And while public awareness and education is one side of the coin, the other is Heart & Stroke’s work in the broad category of policy change.
From policy insights to tangible progress
“We’re working to create healthier conditions across the board, because the onus shouldn’t be on the individual alone,” said Christine, who noted the death rate from heart or stroke related disease has decreased by 75 percent, largely due to concerted policy efforts.
This push has tangible impacts, from eliminating trans-fats in Canada’s food supply, to educating the public about smoking risks. Over the past several years they’ve been turning their attention to emerging health challenges like vaping and nicotine pouches.
But Heart & Stroke is also using its considerable influence to cultivate a nation-wide support network for those affected by heart disease and stroke, and their caregivers.
“We want to scale up things that work, and so we evaluated the peer-support aspect of our Facebook communities, for example – one for caregivers and one for people in recovery – and the feedback from users is tremendous.”
Heartfelt support
Heart & Stroke is extremely fortunate to have an army of supporters and volunteers willing to share their stories, dispense tips and advice, and be a listening ear for others.
This I can relate to.
The weight I felt following my own heart attack was lightened immensely through informal peer support.
And here, I would be remiss if I didn’t name names.
The MHCC’s own president and CEO, Michel Rodrigue, happened to be diagnosed with prostate cancer only weeks after I’d had open heart surgery. This shared experience of ill health threw us together in an intimate and unexpected way.
I described it to Christine as, “Close enough, yet far enough away.” We were able to unburden ourselves to each other, in a way that would have felt too heavy to offload onto our spouses or loved ones.
I said, “It reminded me, yet again, that our brains and our bodies aren’t separate entities.”
To that end, I was interested to learn about a program Heart & Stroke is funding to tackle the emotional impacts of stroke. Dr. Swati Mehta, a psychotherapist at St. Joseph’s Healthcare London’s Parkwood Institute, has developed a 10-week self-directed course that teaches people how to cope in the face of an altered reality.
Drawing on community engagement and the principles of cognitive behavioural therapy, it’s a stepping stone to help people manage their emotional well-being after stroke.
And it’s the kind of approach we should be taking across the board – a beautiful segue to the final question I put to Christine.
A Valentine’s Day wish
As we prepare to mark Valentine’s Day, which has taken on new meaning since my own experience, I expressed that my wish wasn’t for chocolates or a fancy heart-healthy dinner (though that would be nice!) but rather to see a healthcare system that embeds mental health across chronic disease management and major illness recovery, just as Dr. Mehta is doing.
Christine responded in kind.
“I’d like to unwrap new knowledge to better understand what barriers are preventing people from making the best recovery possible or living the best lives they can with a heart condition or stroke. I’d like to see greater access to education, resources, and supports as people navigate a complex and imperfect system. And, of course, my ongoing wish is to put patients at the heart of every aspect of healthcare.”
These are themes that are explored in a report Heart & Stroke just released on congenital heart disease to mark Heart Month.
Interestingly, my own experience has slowly proven to be one of transformation.
And it’s happened from the inside out.
What I once thought of as vulnerability has become a source of strength.
I’ve allowed a private experience to become a public call to action.
And I’ve gained a deep empathy for those battling a health challenge – be it heart disease, mental illness, or both – who don’t have the same resources, access, and choices that I do.
This awareness has sparked a renewed conviction that with privilege comes responsibility.
To that end, I offered to lend my voice as a survivor of heart disease – and as a mental health advocate – in support of Heart & Stroke.
Because we all contain multitudes.
And there is still so much work to do.
To get involved yourself, or to find supportive services and resources, visit www.heartandstroke.ca.
Author: Chuck Bruce is an impassioned leader, lifelong learner, and national mental health advocate with more than 30 years of senior executive experience. As the inaugural CEO of Provident10, Chuck oversees the administration of Newfoundland and Labrador’s Public Service Pension Plan, managing an $11B fund and serving over 60,000 members with integrity and a commitment to excellence.
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The Book Club series profiles good reads that challenge stereotypes and stigmas.
I imagine Jonathan Stea has an “I Heart the Scientific Method” fridge magnet because his book, at times, has the ring of your high school science teacher trying to drum up enthusiasm for the concept to a tough crowd. Eventually it may land.
Mind The Science
Stea comes by it honestly. He is an adjunct assistant professor in the department of psychology at the University of Calgary and a full-time practicing clinical psychologist. He frequently takes to social media to debunk myths and correct facts. (Sometimes his mom even hops online to take on the trolls).
He writes for a lay audience with nuance, avoiding finger-wagging or dumbing-down tones. Stea offers compelling stories along with an overview of how to evaluate research and explains the importance of assessment, testing, peer-review, and various research methods. It’s solid information.
Except that he is battling a tide of speedy hot takes in our online world – a vast hyper-verse of snake oil-type claims from innumerable self-appointed “experts” in physical and mental health, celebrity endorsers, and others that cluster under the all-encompassing nebulous term “wellness.” It’s a vast and largely unregulated domain where many an influencer can hang up their shingle and freely offer tips that can range from cutesy to deadly.
Is it all bad? No. For example, you can shell over good money for a menu plan that aligns with the season and sounds vaguely spiritual. It likely tastes great and offers a cozy kind of comfort, but then there are more grim cases like that of Kirby Brown who attended a “Spiritual Warrior” retreat in Arizona. In 2009, Brown and two other participants died in the final activity of the retreat, a poor imitation of a Native American “sweat lodge.” Twenty other participants were taken to local hospitals.
Consumer safety
The Brown family focused their grief into an organization called SEEK Safely, designed to educate the public about the potential harms of the wellness industry, provide consumer information, and promote safety and accountability. Stea details their story in the book subtitled, “Saving Your Mental Health from the Wellness Industry.”
What might we need saving from? Well, it depends. Stea writes with humility about humanity – recognizing our contradictions, flaws, and changing circumstances. He shares his personal experience of caring for a loved one, grappling with the frustration of ineffective treatments. As a young person, he felt bewildered by science’s limitations. How is it that something capable of sending a man to the moon could also leave those closest to you in “a fog of health uncertainty”? he asks.
As a fellow mere mortal who will eventually fall sick, Stea wonders what he might do in the future. “Will I reach for the healing crystals? Maybe. Desperation is intoxicating.”
That vulnerability in moments of crisis can leave people open to being exploited at a time when they may be seeking growth, deeper meaning, connection, and a soft place to land in a world that is chaotic and confusing. Moreover, ineffective treatments can produce harm, drain your pocket, and erode trust in scientific foundations. At the same time, Stea notes, some wellness treatments may provide coziness and a sense of warmth in a fragmented healthcare system that may not have time for comfort or calm bedside manners. It’s a matter of knowing the difference.
More than just fluff: Is your therapist real or a feline? The case of George the Cat illustrates the importance of understanding how wellness practitioners are regulated in your jurisdiction.
Stea seems hopeful and offers faith in people’s capacity to sort through piles of information. I try to share that view, but more often I wonder about our ability to constantly evaluate the material coming at us in order to make informed decisions.
Do most people, moving through life at breakneck speed, pause to reflect on their “favourite” thinking errors and logical fallacies? I am fond of self-awareness, but not everyone may have it at all times, or in moments of heated exchange, the kinds that are perpetuated by online interactions and algorithms.
The key is to develop it. “This awareness is our friend when trying to figure out the legitimacy of particular mental health-related assessments, diagnoses, and treatments,” Stea writes. In addition to quantitative and qualitative scientific methods, Stea talks about Indigenous ways of knowing as something not to be co-opted as well as the value of lived experiences, where people share subjective takes on their lives, events, and ideas.
Things to watch for
Stea offers helpful tips for developing science literacy, and includes a lay overview of randomized control trials, and other evidence-based processes. He warns of pseudo-clinical jargon that masquerades as science but does not adhere to research methods. A key flag – the evasion of peer-reviewed studies.
“Science is a self-criticizing machine,” he says. “Peer review essentially involves having experts in a scientific field grade each other’s work and decide if it passes or fails,” he explains. “People who promote pseudoscience are experts at dodging the peer review process. They will either avoid it entirely or self-publish on blogs, websites, newsletters, or social media. They will claim that their pet theories cannot adequately be tested with current scientific methods, or they will claim that the ‘scientific establishment’ is biased against them,” he writes.
Stea demystifies the concept of science overall, noting that it’s something to regard as a tool or process and not something to believe in, he says. “Science isn’t a God. Or a unicorn.”
Healthy skepticism
To stem the tide, Stea offers an easy-to-implement practice – tame your search bar. Essentially, he explains, it is like going to the grocery store and avoiding impulse buys. The key: Go with a list. “Why are you looking online? Knowing what you need – such as ways to improve your health or a therapist – can keep you out of rabbit holes,” he says.
Thinking critically about information is a helpful skill when navigating an overwhelming online landscape and if you need a reminder, you can make George the Cat your screensaver. The domestic orange-and-white housecat was registered as a hypnotherapist with three UK industry bodies by a BBC journalist, exposing the flaws of certification and credentials. This example, while amusing, can serve as shorthand. “We all fall for fake science news at times to varying degrees, and it’s easier in hindsight to see what went wrong,” Stea writes.
Learning from those errors and developing media and scientific literacy can offer a sense of structure and control, as fake science news continues to perpetuate.
Further reading: Book Club – All in Her Head: How Gender Bias Harms Women’s Mental Health.
Resource: Online Disinformation: If it raises your eyebrows, it should raise questions.
Author: Fateema Sayani feels like “regression analysis” can be used ironically, these days. She frequently writes The Book Club section for The Catalyst.
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Black History Month 2025 is focused on Black legacy, leadership, and uplifting future generations, a topic we’ve explored in The Catalyst through stories on rallying or searching for culturally appropriate care. In this piece, we ask how more equitable futures can be made possible through design for African, Caribbean, and Black communities, and others not represented by the “average.”
I was grocery shopping when a clerk approached and started processing my cart at the self-checkout. It was quiet. I didn’t ask for help, and she didn’t ask if I needed any. She just stood next to me and started putting my items through.
Some people might say that this is good service, but it didn’t feel that way. It felt like she thought I was too stupid or slow to understand how to scan my items. She didn’t approach other shoppers; a young man at one checkout and a mother with a small child at another. So, based on my past experiences, I wondered if she thought I would try to steal the groceries.
I am Black, and I’ve been followed through stores on more than one occasion. Yet my items were neither subtle nor expensive: paper towels, a bag of rice, and a few other items –hardly the slip-it-into-your-pocket selection. It also wasn’t busy enough for me to go unobserved, so what was the deal?
Then, another thought occurred to me as I was leaving, and she made her way over to “help” another client who had not asked. What we had in common was grey hair.
Bias is two steps forward, one step back
I wanted to sigh and dismiss it, but the more I thought about it, the more aggravated I felt. How many biases against you are too many?
I’m comfortable in my skin, doing what I love and doing it well, so why did that clerk bug me? Because her actions belittled me; they made me feel less. It upset me and I’m not alone.
According to an American Association of Retired Persons study, almost two out of three women age 50 and older in the U.S. report they are regularly discriminated against and those experiences impact their mental health.
Women – particularly women of colour – carry the burden of intersectional prejudices of age, ethnicity, gender, and socio-economic status, among others.
If you’re thinking, yes, but that’s the U.S., then know that in Canada, we face a similar picture. A 2024 Women of Influence survey found that eighty percent of women say they experienced ageism in the workplace. An equal number witnessed women in their workplace being discriminated against based on age.
How do they know? It shows up as being ignored when providing advice and then having the same advice applauded when it’s delivered by a younger or male colleague. It’s the snide comments, being passed over for promotion, or any number of things that make them feel unheard, unseen, or incapable.
Average Has Never Worked
Presumably, most people don’t think ageism, sexism, or racism are attributes to aim for, but beyond the morality considerations, the health costs, and the societal impacts, there are bottom-line business costs that come with these biases.
Sharon Nyangweso, founder and CEO of QuakeLab, a niche agency that applies an equity lens to solve corporate and social challenges, puts it best when she says that we need to see equity as a technical skill.
“Long gone are the days of effective business leaders seeing equity as a ‘nice to have’ or social thing done for a few employees,” she says. “Equity is about building better products, services, and processes. It’s about not injuring or killing people because we can’t see beyond the needs of the ‘average person.’”
Take, for example, pulse oximeters. These small sensors are clipped to a finger or toe and use light to measure oxygen saturation in the blood. They are everywhere. According to Fortune Business Insights, the market was valued at $2.24 billion in 2023 and is expected to grow to $3.56 billion by 2032.
It’s been known for decades that everything from skin pigmentation and melanin to nail polish affects a pulse oximeter’s ability to accurately measure oxygen saturation. For Asian, Black, and Hispanic patients, this can lead to inaccurate readings. Further, those inaccuracies may also be associated with disparities in care, according to the Journal of the American Medical Association.
“Would you call that device effective?” Nyangweso asks. “Would you say that someone who engineered a product that didn’t work for its intended audience was a good engineer? When equity is integrated as a skill set, it considers all people in the design process, and that produces better, truly universal products, processes, and services.”
Say what?
Our stores are filled with products that unintentionally fail to serve their intended audiences. If you’ve ever failed to get a response from an AI-assisted audio device because you have an accent, you quickly understand what it means to use a device created for “the average” user.
What happens when we use AI devices to make decisions that impact people? So far, we know that it can wrongfully send more Black people to prison, inaccurately predict healthcare needs of Black patients, produce sexualized images of Asian women, program ageism into job application processes, and the list goes on. AI isn’t awful, it’s just built with our societal biases.
It’s not just AI. We have smartphones, cars, fitness trackers, and knee prostheses built for men – although women and other genders are also users. Given that women are the primary decision makers for consumer purchases, representing 70–80 percent of all consumer spending and representing about half of the population, how is that effective design?
This is what comes from building for the “average,” which is code for white males. It’s an approach that results in ineffective products, processes, and services that show a bias against their target market.
Even more amazing, products built for the average white man don’t properly meet most of their needs either. Flip through The End of Average by Todd Rose to learn more about that.
Equity as a Required Skillset
When you operate in an environment that doesn’t fit you, or support you, and indeed seems engineered to harm you, it takes a toll. That’s in part why there is often an emotional layer that comes with discussions of diversity, equity, and inclusion (DEI).
Nyangweso described the intersection this way, “People have conflated the work that we do in this field with morality or moralization and that mixes things up and distracts us from talking about the problem we are trying to solve. Instead of addressing the issue the way you would any workplace challenge, people expect me – someone who works in this field – to be their assessors or the morality police,” she says.
“We need to force the question of equity to be a question of professional obligation and responsibility. I want to walk into the room as a professional. I’m not there to talk about everyone’s feelings. I’m not there to beat back decades of socialization.”
Not only is that an impossible task, but it distracts from the real work of DEI by placing an emotional burden on the people trying to fix real problems that create tangible threats to patients, consumers, and clients.
“To understand equity as a technical skill, and to do the work of the field, you have to appreciate the three segments or aspects of DEI work,” Nyangweso says, listing them as:
- Equity as an intellectual activity or academic process.
- Activism.
- Professionalized equity.
Equity as an intellectual activity or academic process means research and data. For example, saying ageism is an issue can’t happen until someone does the work of measuring perceptions and impacts.
Activism, as Nyangweso describes it, is “that practical process where we are trying to reach liberation in the world.”
This work calls into question the status quo, forces us to have conversations about things we took for granted, and eventually leads people to question the way we do things and why we do them. It is the emotional lift that starts the ball of change rolling. How many conversations were prompted by Black Lives Matters or Every Child Matters?
Professionalized equity falls within change management tactics and is often how organizations implement the change processes required to become more equitable producers, suppliers, and employers.
Nyangweso notes that there are multiple intersection points with the three. “The work of activists supports the DEI sector, and makes professionalized equity work possible, and research is used to inform practices and approaches.”
All three segments are valid and serve different purposes. When we default to one without consideration for the others, then real change is not just hampered, it can become impossible. Similarly, when we try to use the tactics for one, to implement another, we will be disappointed by the results. For instance, using the tools of activism to develop tactics for professionalized equity will leave us frustrated by the constraints of a corporate environment and the speed of change.
Equity works
All workplaces do better when psychological safety, a byproduct of equitable spaces, is present. Psychological safety is about feeling free to be who you are at work. It’s about being able to engage without fear of punishment or other negative consequences. For employers, it not only improves the workplace environment, but psychological safety also means financial advantage through increased productivity and lower absenteeism and turnover.
We all live with the challenge of managing within an inequitable world. We can perpetuate those inequities by pretending they don’t exist, don’t impact us, or those around us – or we can take the initiative and make changes where we’re at. We can question why we ignore the advice of older employees; we can call it when we hear inappropriate comments about people based on age, gender, race, sexual orientation, or anything else that doesn’t reflect respectful engagement.
The absence of equitable thinking in the development of work has real world consequences. To do your job effectively, whether you’re a grocery store clerk or a product developer, you need to learn, understand and live diversity, equity, and inclusion.
Further reading: Rallying While Black.
Resource: Psychological Health and Safety Training and Assessment.
Author: Debra Yearwood looks for silver linings – and not just in her hair – she is the Director of Marketing & Communications at the Mental Health Commission of Canada.
Illustration by Holly Craib
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If we gave The Catalyst magazine a sub-theme for 2024, it would be Learning and Listening. Stories covered lived experience of mental health and new approaches to therapy, as well as deeply insightful reflections on wellness, mental health research, and new ideas. If you missed some of these stories in 2024, we welcome you to take a tour through the magazine with notable highlights from the year that was. Happy 2025.
Good reads and recommendations
Books on mental health cover the gamut from research to personal tales, to a combination thereof. The Book Club series looks at works by Canadian authors, exploring the sub-themes and ideas. For example, the book Lifeline: An Elegy by author Stephanie Kain, centres around the author’s complicated relationship with a woman diagnosed with suicidal depression. Kain writes about the indignities of a locked ward, having to administer heavy medications, supporting someone through the after-effects of electro-convulsive therapy, and her own well-being. This article about this book received a Canadian Online Publishing Awards nomination. The awards will be announced in February 2025.
Read it: https://mentalhealthcommission.ca/catalyst/book-club-lifeline-an-elegy/
Have you picked up a copy of All In Her Head: How Gender Bias Harms Women’s Mental Health? In it, author Misty Pratt shares her story of a nervous breakdown, anxiety, and depression; her strategies, sessions with therapists, and how these intersected with life stages, such as the birth of her children. The Ottawa author and science researcher weaves in her lived experiences with trenchant analysis of contemporary research through a biopsychosocial lens (a model that looks at biological, psychological, and social factors that influence our lives). It’s a great read with captivating storylines and analysis.
Read about it: https://mentalhealthcommission.ca/catalyst/book-club-all-in-her-head/
Did You Know?
Jessica Ward-King is known as the Stigma Crusher and contributes frequently to The Catalyst through service stories that offer insights and tips. She shows how to be a good ally to transgender and nonbinary people in a political and social climate that can be downright hostile and dangerous.
Read: Rallying as an Ally: https://mentalhealthcommission.ca/catalyst/rallying-as-an-ally/
Naloxone kits can reverse an opioid overdose and should be easily accessible. It is not only those members of the population who live with substance use concerns who could owe their lives to naloxone; it is also people who live with chronic pain and take prescription pain medications – or someone who could get into that pain medication by accident. It is all of us who, in our daily lives, could come across other people who – for whatever reason – have overdosed on opioids.
Read: Kit in Hand: https://mentalhealthcommission.ca/catalyst/kit-in-hand/
Hip-hop therapy is a fusion of hip-hop, bibliotherapy, and music therapy. Toronto therapist Freda Bizimana, MSW, RSW, works with Black and racialized youth in conflict with the law at The Growth & Wellness Therapy Centre. She shared how challenging it is to reach Black youth, particularly those who have come to therapy because of their interaction with the justice system. “They don’t want to be there talking to a stranger,” she says. “Hip-hop gives us a bridge, a way to connect through something they love.” This article received a Canadian Online Publishing Awards nomination. The awards will be announced in February 2025.
Read Remix Your Therapy: https://mentalhealthcommission.ca/catalyst/remix-your-therapy/
Her Story and Her Story
A personal narrative offers particular insights into a life story. The Lived Experience section highlights these stories. In 2024, we met 26-year-old Gillian Corsiatto of Red Deer, Alta., a published author – her debut novel, Duck Light, asks the serious question: “How can one break free of societal expectations?” – and more books and plays are underway. She’s also been a keen improv performer with Bullskit Comedy. She has three part-time jobs: She is a community educator and youth group leader for the Red Deer branch of the Schizophrenia Society of Alberta and has been a guest speaker for The Mental Health Commission of Canada’s Headstrong youth program; she manages social media and recruitment for the Red Deer Royals marching band (in which she used to play the tuba); and has taken a job wrapping and packaging caramels for a small, home-based business. If you have never met a person who lives with schizophrenia – you just did.
Read: What is It Like Living with Schizophrenia?: https://mentalhealthcommission.ca/catalyst/what-is-it-like-living-with-schizophrenia/
Meanwhile, Jessica Ward-King, who you know as the Stigma Crusher, frequently shares her personal stories, in addition to writing educational articles. In Yes, Me, the mental health advocate – who has a doctorate in psychology and first-hand knowledge of bipolar disorder – explains why her mental illness has classified Ward-King as a person with a disability under the employment equity act.
Read: Yes, Me: https://mentalhealthcommission.ca/catalyst/yes-me/
Watch for more great stories in 2025 – you can receive them directly in your inbox once a month by subscribing here: Catalyst Sign-Up – Mental Health Commission of Canada
Fateema Sayani edits The Catalyst and contributes frequently to the Representations and Book Club sections.
Fateema Sayani edits The Catalyst and contributes frequently to the Representations and Book Club sections.
