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Catalyst

When I first learned that Carolyn Bennett had been named Canada’s inaugural minister of mental health and addictions, I was overcome with gratitude.

Naturally, I was grateful for the growing spotlight on mental health and substance use — a light that has expanded both in scope and intensity over the past two years. But I was equally thankful to be gaining a new ally — one that I hoped could help answer the question that drives all of us at the Mental Health Commission of Canada (MHCC): How can we best support the people of Canada through these challenging times?

Last month, I had the opportunity to sit down with the minister for a virtual interview that would answer that question and many others.

Taking a holistic approach
As we began our conversation, it didn’t take long to recognize that, while Minister Bennett may be new to the role, she was well steeped in the topic. When asked which misconception about mental health she would most like to correct, she answered without hesitation.

“Everyone needs to understand the difference between mental health and mental illness,” she told me. “When Dr. Brock Chisholm (The World Health Organization’s first director-general from 1948 to 1953) said, ‘there is no true health without mental health,’ he was right. We can’t talk about physical health without considering the mental, emotional, and spiritual aspects of a person’s well-being.”

With a long career as a family physician before entering politics, Minister Bennett carries a deep understanding of the inextricable link between mental and physical health. She also knows first-hand what happens when that link is overlooked.

“Working in family medicine,” she said, “you hear about people’s difficulties every day. I remember seeing executive reports come in, knowing the patient was struggling with family problems and other issues, but none of those things were included. Someone’s cardiogram or body mass index doesn’t paint a full picture of how well that person is.” Such a disjointed approach, she added, contributes to the stigma around mental illness.

Fortunately, she said, COVID-19 has given us a new opportunity to make a change for the better. As the disease has taken a steep toll on both physical and mental health, it has also underscored the intersection between the two.

“With COVID, people have gotten better about admitting when they’re struggling,” she explained. “If even one out of every two people can speak up when their mental health is deteriorating, it will reduce the stigma and we’ll be in a much better position to address the issues long term.”

Opening new doors to care
Of course, as Minister Bennett was quick to point out, stigma is just one piece of the puzzle. And responding to the new and existing mental health needs in Canada will require innovation and co‑operation at every level.

One example of that innovation is the Stepped Care 2.0 © model — championed and scaled up by the MHCC — which provides the least intensive form of support deemed appropriate, which is then “stepped” up or down as needed. In Newfoundland and Labrador, the model contributed to a 68 per cent reduction in wait times for mental health services — and Minister Bennett is hopeful for similar success elsewhere.

“In post-secondary institutions, for instance, it’s not that every student needs a psychologist,” she explained. “They may get the support they need from proper orientation or peer counselling.”

In another example, the minister cited a study of 40 women in need of perinatal mental health support. Of those 40, only two met the criteria that would require a specialized perinatal psychiatrist.

“The provinces and territories are excited about this model. They’re doing a great job working together and learning from each other to implement these sorts of programs and advance our understanding in many areas,” she said, noting their shared focus on developing culturally safe, trauma-informed care. “They’re working across boundaries to share the best ideas and make them even better.”

The high praise for provinces and territories brings up the question that some have asked since the Minister of Mental Health and Addictions post was created. Where does the federal government best fit into the health care equation?

“The delivery of health care is provincial or territorial. But whatever we can do at the federal level to lighten the load, we should. Health — including mental health — is a shared responsibility between all orders of government,” she said.

One of the best examples of this, we agreed, is the federal government’s rapid response in addressing the mental health impacts of COVID-19 though Wellness Together Canada, an online portal offering free mental health resources ranging from self-led courses to crisis support. To date, 2.2 million people in Canada have used the portal, which was built on the Stepped Care 2.0 framework.

The minister is also passionate about the federal government’s other role in improving mental health, one that starts from the inside.

“We have mental health challenges across all branches of government,” she said. “Veterans, Corrections, Indigenous, RCMP. So how do we become an exemplary employer? We have to be able to take care of our own people and walk the talk when it comes to mental health.”

Drawing on outside strength
When our discussion turns to safeguarding her own mental health, Minister Bennett’s insights reaffirm much of what we know about protective factors.

She talks about the importance of social connection, expressing gratitude for her great team at work, and her partner, Peter, who she describes as her number one supporter. “I could be working all night for three days, and he still greets me like I’m Gretzky after a hat trick when I get home.”

She also talks about physical activity, describing walks with her yellow lab, Ripley, beneath the magical tree cover of Toronto’s Beltline Trail, and hobbies like Oscar homework, which comes with the territory when you’re married to someone in the film industry.

Finally, she talks about the peace she finds in nature, particularly during visits to Georgian Bay. “I need to look out at that point where the sky meets the water — to notice how the water looks different every time,” she said. “Being able to see something bigger than yourself, something that you can’t control, is a good reminder that plans can change.”

And it’s exactly that philosophy that the minister hopes to help instill for Canada’s people during this pandemic period and beyond.

Charting the path forward
“There are two kinds of immunizations important for Canadians right now,” she said. “One is for COVID-19, and the other is immunization against uncertainty.”

Here, she is referring both to the pandemic and other global issues like climate change, which increase our levels of stress and anxiety.

“Resilience is recognizing that your day isn’t going to go exactly as you planned it out in your agenda —and learning to be OK with that,” she said. “We need to provide people with the tools to build that kind of resilience and autonomy when things don’t go according to plan.”

“I also hope we’ll get better at being able to reach out to those who may be struggling, those who don’t seem like themselves. COVID has taught us that we can be together while apart. How can we leverage that to build resilience and show people that they aren’t alone?”

Answering that question on a nationwide scale is at the heart of the minister’s ambitious mandate — one that she is ready and eager to fulfil.

“We aim to have a mental health strategy that everyone can see themselves in. That will mean looking to national standards and establishing minimum expectations to build on,” she explained. “Out of that, we’ll ensure that money meant for mental health goes to mental health through transfers and collect more research and data in the process. Understanding those outcomes will be critical in making the best decisions in the future.”

Over the longer term, the minister hopes to help build a more cohesive system of care.

“We’ve been fighting this patchwork quilt of non-systems for a long time. How do we make sure mental health is totally integrated into systems of health? This can’t be the turf of this profession or that,” she said. “We need to move away from a scope of practice with hard lines and toward core competencies that can expand. That’s how we’ll create a more modern and effective way of getting people what they need when they need it.”

It’s a tall order, but Minister Bennett has spent her career proving that she’s not afraid of a challenge.

“We can do this,” she said. “Canadians are counting on it.”

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