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When I left my job at the height of the pandemic, it wasn’t after months of quiet quitting. Nor did I do a happy dance. I didn’t see myself reflected in the media narratives about quitting one’s job.
I wasn’t like the flight attendant who went viral by dramatically announcing his departure over a loudspeaker before throwing himself down the emergency slide in an inglorious exit. And neither was I someone who’d phoned it in with the bare minimum, recusing myself from any extra duties in a form of silent protest.
I was resigning, in the truest sense of the word. I was conceding defeat without being checkmated. I had come to accept that something undesirable could no longer be avoided.
After nearly ten years, I had slowly come to the realization that a job I’d loved and been devoted to hadn’t given back to me as assiduously as I’d given to it.
Like a frog in a pot, I was brought to a slow simmer over time. And while apparently that myth has been debunked, and frogs do, in fact, have the good sense to leap out when they start to cook, I opted to braise in my own juices.
It wasn’t a choice I made consciously.
Like so many women of my age, working in professional careers while balancing a personal life, I was torn between wanting to make a difference in my work while needing to be present for my family. But my generation was sold a bait-and-switch.
We could have it all, society told us. Be powerful working moms: bosses in the board room who baked cookies on the weekend. (No one told us we’d likely get burned.)
Many of us, myself included, tried to cash in on that promise, only to discover the coupon was time-limited. At first, it’s easy to climb the ladder. But it gets harder if you find yourself stepping off and back on, as the needs of your kids, spouse or older parents ebb and flow.
So many of us wind up mid-way, too far down to be the masters of our fate, but just high enough to feel the weight of responsibility. My solution was to double down. To make the maximum input possible while stranded mid-rung.
So, I launched myself into learning everything I could about mental health, the purview of my organization’s mandate. I had a stack of books on my nightstand. I read Simon Sinek and Adam Grant, who put organizational psychology in simple terms.
I poured over countless personal accounts of lived experience.
I delved into the imprint left by intergenerational trauma, and the indelible scars of racism on the psyche.
I composed op-eds in the shower. I practiced interviews while doing the dishes. I scribbled tip sheets on damp paper while watching my daughter’s swimming lessons. I was constantly scanning the news landscape to see how our organization could be more relevant. I listened to podcasts, watched documentaries and read articles late at night. Instead of winding down on the commute, I did some of my best writing on the bus.
Yes, I truly wanted to understand better. But my motivation wasn’t entirely altruistic. I also wanted to be the best. To affirm my place as a trusted source of information and underscore my value. I derived a sense of meaning from this work, but I should have seen the danger signs when it began to define me.
I wasn’t reading the mysteries I’d always loved. I was rarely writing for the sheer joy of it. I’d let my physical wellness take a back seat. The irony of working to advance mental health and wellness, while risking mine to burn out, didn’t dawn till later.
My work slowly became not just something I did, but a central fact of who I was. If you work hard enough in a (fruitless) effort to become irreplaceable, your stock in a workplace can only climb so high before the law of diminishing returns kicks in.
You work more diligently. You put in longer hours. You never turn down a colleague in need. You constantly put up your hand. “I have an idea,” was my watchword in a meeting. Inevitably, the work I suggested would fall to me. And I relished it. Because it conformed to the myth I was making about my own invincibility. I could do it all, I told myself. I was the person that could always be relied upon. I wouldn’t ever let anyone down.
And the cycle ticks along just fine…Until slowly you become tired. Then you start to make little mistakes. Finally, your judgement clouds and your temper shortens. Soon, I was disappointing myself. My very efforts were working against me. I was my work, but I no longer liked who I was.
And that, for me, was the point of no return. I wasn’t a healthcare worker, or a first responder. I wasn’t someone whose job puts them in harms way. There is heroism and sacrifice in that kind of selflessness.
I, on the other hand, was making a choice, which meant I could also un-choose it.
But giving up a job that’s come to mean too much to you isn’t done easily or without cost.
I still remember powering down my laptop for the last time. Switching off my phone. Carefully folding up my power cords. Placing the whole lot in a cardboard box and sealing it up like a time capsule. And in a way, that’s exactly what it was. I was packing in the formative years of my professional career, not entirely certain what my next chapter would hold.
And while I would miss my colleagues terribly, and, much later, mourn the loss many aspects of my work that brought me joy, I knew that I had something important to do. Quitting a job doesn’t have to be a celebration. Nor does it need to be done quietly. Sometimes it’s too complicated to be boiled down to a single emotion.
Maybe that’s when it’s time to hand in your notice to go in search of yourself.
An Ottawa writer and former speechwriter, and Manager of Communications at the Mental Health Commission of Canada. A homebody who always has her nose in a book, she bakes a mean lemon loaf (some would call her a one-dish wonder) and enjoys watching movies with her husband and 13-year-old daughter. Suzanne’s time with the MHCC cemented her interest in mental health, and she remains a life-long learner on the subject.
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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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I’m going to go to a bit of a dark place, and I would invite you to follow me there because it is important. I have had (and the way bipolar disorder goes so cyclically, likely will have again) suicidal ideation, and I would like to tell you what it is like. I’ve never told anyone this before, but I would like to tell you this now because of suicide awareness day, which is commemorated each September 10 in honour of all those who have died by suicide and those living with suicide attempts or suicidal ideation and their loved ones.
Suicidal ideation, or thoughts of suicide, are undoubtedly different for everyone, so I can only tell you about my experience. If my experience can make even one person feel seen or understood, it will be worth it.
Most often, my thoughts of suicide are passive, as in “I would be better off dead” or “It would be better if I didn’t wake up.” These are the thoughts I will be describing in this blog post. Certainly, when I am in more distress, these thoughts can become more active, culminating, for me, in plans to die by suicide, but these are more rare (and these, particularly when accompanied by plans, are where interventions need to be made by loved ones and mental health professionals).
For me, my thoughts of suicide are a study in opposites. They are equal parts horrifying, foreign thoughts, and soothing, familiar thoughts. Let me explain what I mean. Thoughts that I would be better off dead come unbidden into my mind and are not welcome there. I am deeply ashamed of them. I know they are “deviant” (at least, I choose to label them as such), and they seem to come at me from some outside force, and I don’t want them to. But at the same time, they are soothing and familiar – they offer a way out of a situation that I have thought through and thought through and for the life of me cannot find a way out of (my depression). They offer a seductively easy way out of my situation at that, almost like a mother soothing me with a “there, there” and a pat on the back, promising me that it will all be alright – there is a solution (and it is easy).
Suicidal ideation changes volume, too. Sometimes, it is a whisper in the back of my mind, barely there but just audible. Sometimes, it is insistent, like a child asking for screen time tugging at my sleeve. Sometimes, it feels like it is literally screaming to be heard, and nothing else can drown it out and I am just left to listen to it suggest, cajole, demand, insist and request that its ideas be heeded.
Does having these thoughts mean that I am planning to die by suicide? No. As dark and insistent as they are, these thoughts are just thoughts. Just like the thoughts in traffic that you would like to ram that car in front of you or any of the other fantasies that pass through your mind throughout your day, suicidal ideations are just that – fantasies. Fantasies that make life more livable. It is because they are so stigmatized that they are so frightening and so difficult to talk about. Now, we have to be careful to walk the line between reducing the stigma around suicide and making it a genuine option, but I believe that that line is thick enough that there is room to reduce the stigma and give relief to people like me, who struggle with guilt and shame over their suicidal thoughts to the point that they won’t seek help.
So, with that, what makes up the resistance, you might ask? What’s the good news story here? I am lucky. I have a partner I can talk to about these scary thoughts. She doesn’t buckle and collapse. She listens calmly, stroking my hand all the while. Then she asks if I have any plans. She asks what we should do – should we call my psychiatrist (whom I am also fortunate to be able to disclose suicidal ideation to without being summarily put in the hospital) or take me to the hospital, or are we safe just to wait and see, and then she lays with me while I cry. I am lucky. Not everyone has a partner or loved one like this because not everyone understands that just having these thoughts does not mean that I am imminently in danger or, worse, “crazy.” Most people, when they hear of suicidal thoughts, get quite scared themselves, and they lose themselves in that fear. Please, don’t. I assure you, your loved one who is telling you this is more afraid than you are. Keep your cool. Better yet, before you are ever in this situation, get some basic training that will help you cope, like Mental Health First Aid (MHFA) or even more specialized suicide assistance training. Courses like this will help you to be able to assess risk and figure out what to do next, whether that is simply being with your loved one or whether that is making a safety plan and getting help.
Suicide is not something that affects other people. In this country, 12 people die by suicide every day – and that is just the deaths that are verified as suicide. Due to stigma, many deaths are attributed to other causes rather than bringing shame to a family or community. It is the second leading cause of death among youth and young adults (15-34 years), and 12% of Canadians admit to having had thoughts of suicide in their lifetimes. We all love someone who is thinking about or will think about dying by suicide. I hope this little piece of vulnerability will help at least one of them.
BSc, PhD, aka the StigmaCrusher, is a mental health advocate and keynote speaker with a rare blend of academic expertise and lived experience. Equipped with a doctorate in experimental psychology and firsthand knowledge of bipolar disorder, she’s both heavily educated and, as she likes to say, heavily medicated. Crazy smart, she’s been crushing mental health stigma since 2010.
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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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Do you feel like you always have to be doing something? Do you find it difficult to let go of your to-do list and just relax?
I needed to go through burnout to learn that there are drawbacks to being a ‘high achiever.’ The pursuit of excellence comes at a cost. Relentless busyness is not good for us.
Doing, doing, done
Do you ever notice the pressure to ‘be your best self,’ whether in your job or as part of your persona on social media? If you are reading this, I am guessing that you are pretty much tied to your phone and your media feeds. The irony is that we often turn to our devices to relax, but this actually speeds us up and can make us feel even more frazzled.
Constantly checking off the items on your to-do list may lead you to feel like you’re accomplishing things and being productive, but it can spiral into an unbalanced and unhealthy way of living. And if the point is to ‘live your best life,’ it can actually be counterproductive.
“The high value put upon every minute of time, the idea of hurry-hurry as the most important objective of living, is unquestionably the most dangerous enemy of joy. My advice to the person suffering from lack of time and from apathy is this: Seek out each day as many as possible of the small joys.”
Hermann Hesse
Higher, stronger, faster
Do more. Be more. Get more. The pressure to perform can impact your mental health. I wrote about this in a previous post. The problem with the achiever mindset (achievement more than anything else), which is reinforced by the cult of busyness, is the mistaken belief that by focusing on the external markers of success, we will lead a good life. It’s a false promise that the sacrifices we make now will pay off with happiness in the future. So, we deprioritize what brings us spontaneous joy, and important relationships, with the assumption that we can enjoy those things after we achieve our goals.
“Our enjoyment of life is taken from us by the not-enoughness at the hollow heart of consumerism.”
Wendell Berry
The difference between productive and busy
Productivity is different from busyness. And being busier does not mean we are more productive.
Actually, when you are at your busiest, that’s when you need to slow down. Slowing down and taking breaks lets your brain rest, resulting in better focus, efficiency and results.
Productivity has more to do with having time to do the things that matter. When things are in balance, we can handle our day-to-day commitments, and we feel like we have the time to rest, be present, and enjoy life.
Get unstuck
How do you slow down and get off the hamster wheel? How do you become more present, creative, and connected to those around you?
Happiness shouldn’t be put off until the weekend. You can feel it right now, at this moment. Focus on the moment and find ways to appreciate where you are right now.
Try these tips for slowing down
- Set up some reminders for yourself to slow down– post-it notes, reminders on your phone, or whatever works for you
- Try spending some time doing nothing, or as little as possible
- Decrease your screentime
- Go outside, or try forest bathing
- Try meditation or mindfulness
- Do more physical activity, preferably in nature
- Journaling
- Stop waiting for everything to be perfect
To recap, here’s why we need to slow down:
- The way we live now, there is a lot of pressure to be busy, to multitask, and to be as productive as possible
- When we multitask, our minds are racing, reducing our effectiveness
- Slowing down can help us become more present, joyful, and connected to those around us
Author: Nicole Chevrier
An avid writer and photographer. A first-time author, she recently published her first children’s book to help children who are experiencing bullying. When she isn’t at her desk, Nicole loves to spend her time doing yoga and meditation, ballroom dancing, hiking, and celebrating nature with photography. She is a collector of sunset moments.
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I was driving my car down the street, heading to a movie with a friend, when all of a sudden: WHAM! A pothole. My tire was in there before I could react, and I don’t know what it did – bent my alignment or twisted my suspension or something (can you tell I’m no mechanic?) – but the next thing I know, I am stranded by the side of the road and being towed to the shop, facing a very hefty bill and a long process just to make her roadworthy again. And I missed my movie.
I feel like my life with a mental illness is like that sometimes. I can be cruising along just fine when some bump in my path derails my whole journey leaving me miffed, frazzled, phoning for help and not really knowing what is going on, missing the things in life that I enjoy, and facing a long (and often expensive) road to recovery.
Now, if you’ll indulge me in sticking with the car metaphor for a while, no amount of oil changes, brake jobs, or filter changes were going to prevent me from hitting that pothole or from my car getting damaged. And that, I propose, is the difference between mental health and mental illness.
Mental health is the general running of my car. I can take care of it – get regular services, change the wipers, fill the reservoirs, change the filters, and keep it clean – or not, and so, the general condition and running of my car can be good or not. Mental health is just like that. We can do the things we need to do to keep ourselves in tip-top condition or neglect our self-care and just barely keep running on fumes.
Mental illness is what happens when something actually goes wrong with my car – it breaks down or gets damaged. Poor maintenance can contribute to things going wrong, to be sure, in both cars and mental health. But sometimes, those (literal or figurative) “bumps in the road” break an axle and send you calling for help and needing care before recovery can happen. They can come out of the blue (like my pothole) or out of a longer, more drawn-out process of becoming worn down (say, wearing out your brakes), but either way, a trip to the professionals for some help is the result.
I mentioned the expense of getting my car fixed by a professional mechanic. Sometimes I can call my dad, or a friend, to come and help me – tweak something, fill a reservoir, change a fuse, that sort of thing. But sometimes, the only way I am going to get my car to run again is to take it to the mechanic. That is sort of frightening and not always accessible – sometimes, I can’t afford either the time or the money it will take. Getting help for my mental illness is like that too. It takes time, and, in the case of private psychotherapy and prescription medication, it can have significant costs. And not everyone can afford it.
No metaphor is perfect, and this one, too, cannot be taken too far or too literally, but it can be helpful to think through the differences between mental health and mental illness and how they are connected.
I missed my movie, but my friend picked me up from the shop, and we got takeout and streamed TV instead. Then I dusted off my bike and made it to work the next day – with sore legs, but successfully. Having my car break down wasn’t the end of the world, and with some time, money, and effort (which I am privileged to be able to invest), I got my car back on the road. My life with mental illness is like that, too – with the help of friends and family, I keep living life (not without hiccups and disappointments but living it nonetheless!) and eventually end up back on my road to recovery.
Author: Jessica Ward-King
BSc, PhD, aka the StigmaCrusher, is a mental health advocate and keynote speaker with a rare blend of academic expertise and lived experience. Equipped with a doctorate in experimental psychology and firsthand knowledge of bipolar disorder, she’s both heavily educated and, as she likes to say, heavily medicated. Crazy smart, she’s been crushing mental health stigma since 2010.
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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.
