Good mental health helps your creativity, productivity, personal well-being, interpersonal relationships, and physical health (Ministry of Children and Family Development & Ministry of Health Services, 2010). Positive mental health is essential in early development for emotional growth, resilience, learning, and self-esteem (Ministry of Children and Family Development & Ministry of Health Services, 2010). According to the World Health Organization, mental health is (Ministry of Children and Family Development & Ministry of Health Services, 2010):
"A state of well-being in which the individual realizes his or her own abilities, copes with the normal stresses of life, works productively and contributes to his or her communities."
Stigma surrounding mental illness has many consequences, including (Ministry of Children and Family Development & Ministry of Health Services, 2010):
1) Decreased quality of life
2) Emotional turmoil
3) Obstacles to education
4) Reduced employment opportunities
5) Inadequate housing
6) Financial strain
7) Barriers to health or social services
The discrimination faced by those with a mental illness results in a lack of sense of belonging within the community (Ministry of Children and Family Development & Ministry of Health Services, 2010). This can make certain populations more vulnerable for mental health problems including but not limited to: People with chronic conditions, low-income families, Aboriginal peoples, new immigrants to Canada, and seniors (Ministry of Children and Family Development & Ministry of Health Services, 2010; Immigration, Refugees and Citizenship Canada, 2020; Canadian Institute for Health Information, 2018).
Video 1. Mental health for new immigrants to Canada (Immigration, Refugees and Citizenship Canada, 2020).
Video 1 highlights some of the stressors and various changes that newcomers to Canada may experience (Immigration, Refugees and Citizenship Canada, 2020). For example, adjusting to new living conditions, learning English or French, and finding a new job can be difficult (Immigration, Refugees and Citizenship Canada, 2020). Even the different seasons in Canada can be a big change for certain newcomers (Immigration, Refugees and Citizenship Canada, 2020). During all of this change, it is very common to feel sad, lonely, angry, frustrated, scared, or hopeless (Immigration, Refugees and Citizenship Canada, 2020). The immigration process itself is arduous and there are unique challenges to adapting to a different country's way of life. Video 1 mentions Canada's stance on mental health and asks new immigrants to learn about it to help eliminate stigma (Immigration, Refugees and Citizenship Canada, 2020). Newcomers are encouraged to speak to settlement service organizations and community groups about their experience to find commonality and normalize their feelings (Immigration, Refugees and Citizenship Canada, 2020). Video 1 points out that in Canada, 1 out of 2 people experience poor mental health in their lifespan (Immigration, Refugees and Citizenship Canada, 2020).
As described in Video 2, social networks are essential for positive mental health (Canadian Institute for Health Information, 2018). Interpersonal relationships protect seniors from loneliness and increase their chances of engaging in physical activity and eating well (Canadian Institute for Health Information, 2018). Many seniors may experience social isolation after losing a spouse or friends, which can make them more at risk for depression and suicide (Ministry of Children and Family Development & Ministry of Health Services, 2010; Canadian Institute for Health Information, 2018). Moreover, maintaining social connections can be difficult if a person has limited mobility due to chronic health conditions (Ministry of Children and Family Development & Ministry of Health Services, 2010). The vast majority of seniors with mental health issues have underlying chronic conditions; 94% of Canadian seniors with anxiety, depression, or other mental health problems are managing a chronic medical condition (Canadian Institute for Health Information, 2018). Seniors are also at risk for mental health challenges after negative experiences with a caregiver, spouse, or adult children (Ministry of Children and Family Development & Ministry of Health Services, 2010). This includes physical, emotional, or financial abuse, which 7% of Canadian seniors report experiencing (Ministry of Children and Family Development & Ministry of Health Services, 2010). In Canada, 14% of seniors have depression, anxiety, or another mental health problem (Canadian Institute for Health Information, 2018). As highlighted in Video 2, the amount of Canadian seniors that felt their emotional distress was difficult to cope with on their own was 1 out of 5 (Canadian Institute for Health Information, 2018). A sense of belonging to the community and cognitive stimulation are important for senior's mental health, factors that are addressed by the Age-Friendly Communities Initiatives (Ministry of Children and Family Development & Ministry of Health Services, 2010).
Video 2. Mental health for Canadian seniors (Canadian Institute for Health Information, 2018).
Mental Health & Substance Use in BC
The cost of mental health and substance use services in half of the main ministries in BC alone in 2008-2009 was found to be over $1.3 billion (Ministry of Children and Family Development & Ministry of Health Services, 2010). The yearly indirect costs of mental illness and/or substance use in BC are more than $6.6 billion out of the $51 billion spent throughout Canada (Ministry of Children and Family Development & Ministry of Health Services, 2010). Children and youth with mental health and/or substance use problems tend to have difficulties living at home, are unable to attend school, and have experience in the criminal justice system (Ministry of Children and Family Development & Ministry of Health Services, 2010).
Mental Health & Homelessness in BC
Housing Matters BC helps people with mental illness and/or substance use disorders find stable, affordable housing (Ministry of Children and Family Development & Ministry of Health Services, 2010). Homeless people in Vancouver, Surrey, Victoria, Prince George, and Kelowna also receive support through the Homelessness Intervention Project, an initiative that addresses housing needs and directs people to income and support services (Ministry of Children and Family Development & Ministry of Health Services, 2010).
Mental Health & Co-Morbidities in BC
People with severe mental health problems are more susceptible to chronic health conditions and are disproportionately within correctional facilities or admitted to hospital compared to the general population (Ministry of Children and Family Development & Ministry of Health Services, 2010). As a Neurophysiology Technologist, I have seen mental health problems manifest as psychogenic non-epileptic seizures (PNES). These events have clinical features that can look like epileptic seizures such as shaking, yelling, or being unresponsive but they occur without abnormal brainwave activity (Benbadis et al., 2019). In other words, PNES events do not have an electrographic correlate on an electroencephalogram (EEG) that would indicate an epileptic seizure (Benbadis et al., 2019). The term pseudoseizures is no longer used because it implied that the patient was intentionally faking a seizure. However, PNES events are generally subconscious and felt to be out of the patient's control (Benbadis et al., 2019). PNES events are related to conversion disorders and somatic symptom disorders (Benbadis et al., 2019). The underlying cause of PNES can sometimes be traced back to a specific traumatic event and are more prevalent in patients with anxiety or post-traumatic stress disorder (Benbadis et al., 2019). The prevalence rates of PNES are comparable to multiple sclerosis and trigeminal neuralgia (Benbadis et al., 2019). An estimated 2-33 per 100,000 of the general population have PNES (Benbadis et al., 2019). 20-30% of patient's with a history of epilepsy also have PNES events, therefore admission to a seizure investigation unit to capture events both on camera and on an EEG helps us differentiate them and characterize spells (Benbadis et al., 2019). Effective treatment for PNES is typically cognitive behavioural therapy, but serotonin re-uptake inhibitors have also shown to be beneficial (Benbadis et al., 2019).
Mental Health Disorders in BC
Over the years there have been a steady increase in adult community mental health beds to address the needs of British Columbians. From 2001 to 2010 there was a 75% increase in the amount of beds which represents 3722 new beds (Ministry of Children and Family Development & Ministry of Health Services, 2010). The Ministry of Children and Family Development and the Ministry of Health Services (2010) highlight the significant mental health problems in BC, stating:
"Over any 12-month period, about one in five individuals in the province will experience significant mental health and/or substance use problems leading to personal suffering and interference with life goals."
Mental Health Research in BC
BC has funded mental health research at some of the province's top universities including the University of British Columbia (UBC), University of Victoria, Simon Fraser University (SFU), and University of Northern B.C (Ministry of Children and Family Development & Ministry of Health Services, 2010). For example, UBC has been at the forefront on translating research findings about mood disorders into effective clinical treatments through the BC Leadership Chair in Depression Research (Ministry of Children and Family Development & Ministry of Health Services, 2010). Another university that is focusing on mental health is SFU, with researchers from the Faculty of Health Sciences in the Children's Health Policy Centre aiming to improve children's mental health (Ministry of Children and Family Development & Ministry of Health Services, 2010). The province has invested millions of dollars into specialized centres based out of Provincial Health Services Authority, Vancouver Coastal Health, and Providence Health as well (Ministry of Children and Family Development & Ministry of Health Services, 2010).
The Government of British Columbia also provides funding for community programs, professional organizations, and community health and social services that target mental health through the Community Action Initiative (Ministry of Children and Family Development & Ministry of Health Services, 2010). This $10 million grant supports community-based actions that aim to prevent mental illness and substance use problems and promote good mental health (Ministry of Children and Family Development & Ministry of Health Services, 2010).
Mental Health Plans & Resources in BC
The Government of British Columbia created a decade-long vision for evidence-based action on mental health and psychoactive substance use in the province (Ministry of Children and Family Development & Ministry of Health Services, 2010). Social and emotional development, particularly in children and families, are top investment priorities in order to see long-term positive outcomes (Ministry of Children and Family Development & Ministry of Health Services, 2010). Healthy childhoods and early interventions are key to minimizing the severity of mental illness, delaying the impacts, or preventing future illness from occurring altogether (Ministry of Children and Family Development & Ministry of Health Services, 2010). BC was a leader within Canada in terms of promoting children’s mental health and supporting children and youth with mental disorders, by creating the Child and Youth Mental Health Plan for British Columbia in 2003 (Ministry of Children and Family Development & Ministry of Health Services, 2010). Helping children to build social skills and resiliency is the focus of the StrongStart BC early learning program (Ministry of Children and Family Development & Ministry of Health Services, 2010). Strong interpersonal skills enhance cognitive, physical, and emotional development, which are protective factors against mental illness (Ministry of Children and Family Development & Ministry of Health Services, 2010).
Another important plan implemented by the province in 2007 is the Tripartite First Nations Health Plan, which addresses mental health and substance use concerns for BC’s Aboriginal population with an emphasis on young adult suicide (Ministry of Children and Family Development & Ministry of Health Services, 2010).
Mental health promotion strategies are important for all British Columbians, shown in Figure 1 (Ministry of Children and Family Development & Ministry of Health Services, 2010). This includes various healthy behaviours such as eating healthy foods, avoiding tobacco, and performing physical exercise (Ministry of Children and Family Development & Ministry of Health Services, 2010). The ActNow BC health promotion initiative is globally recognized for its efforts to prevent chronic disease by encouraging people to make healthy choices (Ministry of Children and Family Development & Ministry of Health Services, 2010).
Figure 1. Intervention approaches across population groups (Ministry of Children and Family Development & Ministry of Health Services, 2010).
In BC, the multi-disciplinary Assertive Community Treatment (ACT) team is available 24/7 for crisis intervention to help individuals with complex mental health needs (ACT AP, 2014). Video 3 describes the ACT team and the wide range of services they provide to clients with severe and persistent mental illness (ACT AP, 2014). For example, home visits and grocery shopping are included to help clients meet basic needs (ACT AP, 2014). The high practitioner to client ratio and collaborative team-based approach is useful for treatment, rehabilitation, and support services (ACT AP, 2014).
Video 3. The Assertive Community Treatment (ACT) team (ACT AP, 2014).
Overall, BC's approach to improving mental health is to use best practice to serve those currently suffering from mental illness as well as targeting social determinants of health to reduce the risk for all British Columbians (Ministry of Children and Family Development & Ministry of Health Services, 2010). Life skills, employment, income, education, and early childhood development are key factors in the action plans that BC has put forth (Ministry of Children and Family Development & Ministry of Health Services, 2010). In order to cope with life's challenges and changing circumstances, prevention approaches are important across the lifespan. However, early childhood, school-age years, and adolescence are especially critical stages where early intervention is required (Ministry of Children and Family Development & Ministry of Health Services, 2010). In fact, the Ministry of Children and Family Development and the Ministry of Health Services (2010), believe that focusing efforts early in life is "the most effective and sustainable way to move towards achieving a healthier population."
“Ontarians are happier, more resilient and more likely to succeed in school, work and life when they are able to cope with stress and manage the ups and downs in life” (MOHLTC, 2011).
Mental Health & Substance Use in Ontario
Mental health and addictions issues are present within our families, circle of friends, communities and workplaces across Ontario. The Government of Ontario has reported that more than one million Ontarians experience a mental health or addiction issue every year, with 500,000 Canadians per week calling in sick because of mental health and addictions issues (Ministry of Health, 2020). Mental health and addictions have a burden in Ontario that is more than 1.5 times that of all cancers and more than seven times that of all infectious diseases (Figure 1) (Ratnasingham et. al, 2012). Not only does mental health and addictions affect the individual dealing with this illness, but it can also have a significant impact on the quality of life of everyone around them. It can reduce their ability to go to school, make a living or raise a family (Ministry of Health, 2020).
Mental Health Disorders in Ontario
Figure 1. Burden of mental illness and addictions compared to cancers and infectious diseases in Ontario, by years of life lost due to premature mortality (YLL) and year-equivalents of reduced functioning (YERF) (Ratnasingham et. al, 2012).
According to the Canadian Mental Health Association – Ontario, the delivery of mental health services in rural Ontario communities significantly differs from urban communities (CMHA-Ontario, 2009). Individuals living in rural communities face multiple mental health and geographic disparities for mental health services due to barriers created by availability of local accessible and comprehensive services (CMHA-Ontario, 2009).
In my rural community of Haldimand and Norfolk counties in southwestern Ontario, these disparities for mental health services have been shown to have a greater burden when compared to the province. The following statistics were reported in the 2019 Community Needs Assessment Report (HNHSS, 2019).
• Rates of hospitalization for intentional self-harm are significantly higher in Haldimand and Norfolk counties compared to Ontario (91.3 vs. 71.1 per 100,000).
• Annual counts of death by suicide in Haldimand and Norfolk Counties ranged from 10-20 individuals per year.
• The self-reported rate of exceeding the Low-Risk Drinking Guidelines is 52% for residents of Haldimand and Norfolk counties compared to Ontario (44.4%).
• The self-reported current smoking rates for adults were similar in Haldimand and Norfolk counties (19.5%) to the provincial rates (18.1%).
• Opioid related emergency department visits were 67.9/100,000 in Haldimand and Norfolk counties compared to 63.4/100,000 in Ontario.
• Opioid related general hospitalizations in Haldimand and Norfolk counties were 23.2/100,000 compared to 14.6/100,000 in Ontario
Mental Health Barriers in Ontario
In 2014, Public Health Ontario released the following informatic titled “No health without mental health” (Figure 2) (PHO, 2014). This is a useful illustration that summarizes the impact that mental health and mental illness, both distinct but related concepts, are important to the health of Ontarians (PHO, 2014).
In my professional experience, I have witnessed the difficulties those dealing with mental illness and addictions have accessing the resources they require. Ross et al. summarized three barriers that are relevant to my experience: client, provider and health system barriers (Figure 3): (Ross et al., 2015)
• Client factors are those that make it difficult for clients to access primary care, keep appointments, and/or prioritize their own health care.
• Provider factors, including knowledge and personal values related to mental health and substance use, determine the extent to which clients report their specific needs are met in the primary care setting.
• Health system factors, such as models of primary care delivery, determine the context within which both client and service provider factors operate.
Figure 3. Barriers and facilitators to primary care access for people living with mental health and/or substance use issues in Ontario (Ross et al., 2015).
Our booking and electronic health records systems are not the most robust options available. Patients, after they have made an appointment, do receive a reminder call but no additional options such as text messages or emails are available. Our on-site services for mental health and addictions are only available once a week as our counsellors and team of experts rotate through multiple sites in our region to support our community. If an individual or family require in-person assistance outside of this availability, they are required to travel at least thirty-five minutes to connect with resources, or complete a virtual assessment. Moreover, our electronic health record is not complete so most of the patient record is not accessible electronically to those outside our campus, unless they request a fax or hardcopy.
Mental Health Plans & Resources in Ontario
The current strategy for mental health and addictions developed by the Ontario
government in 2019 is entitled Roadmap to Wellness: a plan to build Ontario’s mental
health and addictions system. This plan's vision is to create a province where all
Ontarians have access to high-quality, easily accessible mental health and addictions
support throughout their lifetime, where and when they need it (Government of Ontario,
2020). Through this plan, Ontario is investing $3.8 billion over 10 years to expand
existing programs and fill gaps in care with innovative solutions and services
(Government of Ontario, 2020).
Ontario Health has created the Mental Health and Addictions Centre of
Excellence to support building a comprehensive and connected mental health and
addictions system across Ontario (Ontario Health, 2020). Some partners across the
health care system they are currently working with to develop programs and resources
include Ontario Structured Psychotherapy for depression and anxiety, Virtual care, and
Quality standards (Ontario Health, 2020).
Closer to home, the Community Addiction and Mental Health Services of
Haldimand and Norfolk is a not for profit agency funded by the Ministry of Health and
Long-Term Care through the Hamilton Niagara Haldimand Brant Local Health
Integration Network responding to individuals who have mental health or addictions
concerns (CAMHS, n.d.). Their Mental Health Program is for those 16 years of age and
older and the Addiction Program responds to those of all ages (CAMHS, n.d.).
Improving Mental Health in Canada
The Centre for Disease Control and Prevention identifies that mental health is an important part of our overall health and well-being and includes our emotional, psychological, and social well-being (CDC, 2020). Given that all Canadians, British Columbians and Ontarians alike, can be impacted by mental health issues, identifying ways to continuously improve our health are valuable to all. The Government of Canada provides excellent resources that describe how to take care of your mental health. Just like practicing to improve your slapshot or exercising to ensure you can outrun your children in a game of hide-and-seek, taking care your mental health requires practice, patience and support (Government of Canada, 2020).
The main benefits of being mentally healthy are improvements in (Government of Canada, 2020):
• Coping skills ➡️ Better handle difficult experiences and stress.
• Self-esteem ➡️ Feel confident in your worth and abilities.
• Resiliency ➡️ Successfully move on after a negative event and regain control of your life.
Increasing coping skills, self-esteem, and resiliency encourages people to create healthy relationships, positively interact with their community, and talk openly about their mental health including needs and wants (Government of Canada, 2020).
Maintaining Good Mental Health:
(Government of Canada, 2020)
• Know and accept that life can be challenging.
• Know and accept your strengths and weaknesses.
• Set realistic goals for yourself.
• Accept yourself and others. This is the basis of self-esteem.
• Learn to recognize and understand that everyone has both positive and negative feelings.
• Create a meaningful life by learning and trying new activities, like starting a hobby.
• Create healthy, trusting relationships with people who accept and support you.
• Follow a healthy eating pattern which supports a healthy body and brain.
• Be physically active, which reduces stress and helps with concentration.
• Have fun in nature and explore the outdoors.
• Get enough sleep, which makes you more alert and able to cope with stress
• Improve environmental conditions.
➡️ Live in a safe community that is accepting, supportive, and free of violence.
➡️ Make meaningful connections in your community.
➡️ Live in a house that is clean and well maintained.
➡️ Get an education.
➡️ Have a steady job.
Each of our journey's toward mental well-being will be unique as we all have our own goals, challenges, talents and supports- but good mental health is within everyone's reach (CHMHA-Ontario, n.d.). In Canada, there are a variety of resources available to help us deal with mental health issues. A couple of those resources that are supported by the Canadian Mental Health Association include the “Living Life to the Full” course and the “BounceBack” skill building program. BounceBack is a free national skill-building program designed to help adults and youth fifteen years of age and older manage low mood, mild to moderate depression and anxiety, stress or worry (CMHA, 2021a). This program is delivered over the phone with a coach and through online videos to support you on your path to mental wellness (CMHA, 2021a). Living Life to the Full is described as a fun and engaging eight-week course that provides people with effective tools to maximize their ability to manage life’s challenges (CMHA, 2021b). This is a national program that is available in ten provinces and one territory across Canada. (CMHA, 2021b). Mothers and fathers that learn parenting and coping skills are less likely to be depressed or anxious and are more likely to have positive self-esteem and healthy relationships (Ministry of Children and Family Development & Ministry of Health Services, 2010). Families can benefit from regular post-natal follow-up and home visitation programs, especially those that are young and from low-income neighbourhoods (Ministry of Children and Family Development & Ministry of Health Services, 2010).
The examples of programs listed above are all great resources that are evidence-based and required multi-disciplinary collaboration and input from people with lived experience. Clients, families, and care providers should be used to guide effective planning that will create positive changes (Ministry of Children and Family Development & Ministry of Health Services, 2010).
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