During the COVID-19 pandemic, Canada’s fields of therapy, counseling and psychiatry were overwhelmed by a spike in demand. Now that the restrictions have expired, Canadians have begun to migrate towards these fields to treat the pains that grew in times of great uncertainty. While most have been able to consistently see their preferred professional, the lingering demand has had the system bursting at the seams.
In a 2021 study, the Institute for Advancements in Mental Health (IAM) published The Future of Mental Health: A Strategic Foresight Study, which focuses on new approaches and possible responses to the “increasingly urgent and complex mental health needs of Canadians.” The report calls the path we’re on now, “the access squeeze,” describing a bleak future where we maintain our current clinical model of care and push for economic recovery, at the expense of the social and mental cost to Canadians. Overburdened and lacking necessary funding, it bears striking similarities to our current system which has begun to emphasize virtual or remote appointments.
“If you think about it from a medical perspective, we feel we have a right to go and see our family doctor. The government recognizes that it’s important we have access to medical services and I would argue, from a human rights perspective, it should also be the case with mental health.”Clinical Psychologist, Dr. Corrick Woodfin
Much like a chiropractor takes care of the needs of spinal health, psychiatrists, counselors, and psychologists help us develop the skills and frameworks we need to take care of our minds. For those who are being pushed past their limits, opportunities for help can feel few and far between. Whether due to funding, benefits or pure demand, patients seeking out appointments can be pushed back weeks or months — patients will not be seen earlier unless they are experiencing a mental health crisis, which suggests that our current system is struggling to bear the load.
Within the United Nations Declaration of Human Rights, Article 25 outlines that everyone has the right to a standard of living adequate for their health and well-being, including medical care and necessary social services. Our current care systems place a heavy emphasis on the physical side of health, and Clinical Psychologist Dr. Corrick Woodfin says that it doesn’t need to be that way. Working at Now In Colour, a psychological services organization based in Calgary, Woodfin started his journey as a nurse 23 years ago in England, and was inspired to pursue the field of psychology after experiencing first hand how simply talking to patients about their mental health and challenges could improve their physical health.
“If you think about it from a medical perspective, we feel we have a right to go and see our family doctor. The government recognizes that it’s important we have access to medical services and I would argue, from a human rights perspective, it should also be the case with mental health,” says Woodfin.
MOVE FROM INSTITUTIONALIZED “PILLS AND POTIONS” TO GRASSROOTS SELF-HELP
In August of 2022, the Public Health Agency of Canada announced its investment of $150,000 towards supporting crisis lines during the pandemic. Part of a 50 million investment announced during 2020’s Fall Economic Statement, it demonstrates our system’s focus on crisis intervention, putting too much effort into what could be described as an ambulance at the bottom of a cliff.
“We need to be thinking about prevention. We need services at the top of the cliff and multi-faceted services that are community based, that are inclusive and equitable and address these human rights issues,” says Woodfin.
Woodfin also suggests that we should focus on evidence-based approaches and move away from our medicalized approach to mental health, stuffed with “pills and potions.” He encourages the community to take care of itself through the development of grassroots programs. One way that he personally accomplishes this is through his YouTube channel. He focuses primarily on producing meditation and self-help videos aimed at Body Focused Repetitive Behavior or BFRP. This encompasses skin picking, nail biting, cheek biting, hair pulling and similar behaviours.
Because current mental health systems were set up using a traditional medical framework of checked boxes and diagnostic labels, they can act as self-limiting barriers to people’s well-being. For the conditions that can’t simply be cured or fixed by the traditional medical model, the acceptance and commitment therapy developed by Steven C. Haye can act as a strong anchor point for those people, but no two people are made alike.
“If we determine the signs and symptoms as problems to attack and there’s something deep rooted as being, if you’ve got these symptoms then it must mean that you’ve got this mental illness,” says Woodfin. “That pathology creates challenges for people because really what you might be experiencing could just be normal life. It might just be what we as human beings experience.”
He adds, “We’ve also got social determinants as well. So if you think about affordable housing, the financial impacts of COVID-19, food security, we’ve got these inequalities in the provision and availability of food and social connections, these are all important determinants of mental health as well.”
With the current difficulties faced by Canadians, taking the time to ground yourself and realizing that you’re not alone in these struggles can help greatly.
“I think it can be helpful to recognize that other people are having a hard time as well,” says Woodfin. “And what I would ask people to consider including [is that] it can be helpful sometimes to say to yourself, ‘You know, is it any wonder that I’m having trouble or I’m thinking about having difficulty finding food, I’m having difficulties making ends meet in terms of money when worried about, you know, post pandemic and the increase in risks,” says Woodfin.
It appears that the more advocacy for mental health rights and awareness exists, the more it becomes background noise to the general public due to the stigma associated with corporate sponsorship and the strong fatigue with non-profit programs. It results in people quite often ignoring it or passing by and giving it no second thought. A lot of the time, mental health itself is stigmatized or callously swept under the rug. There seems to be an unhealthy focus on attempting to fake happiness or appear like everything is fine.
“I think often there’s a myth about happiness where if you think about social media and the internet, much of it is about trying to retain a sense of happiness and well-being,” says Woodfin.
DIAGNOSES SHOULD BE TAILORED TO INDIVIDUALS
One particularly strong candidate for change that would affect many Canadians as well would be the idea that we need to reset and redevelop the model for diagnosing and taking care of people’s mental health as a lot of different conditions can have a strong effect on social outcomes. Food security and social communication hierarchies can deeply affect mental health, and our system does not take into account that our Eurocentric method of diagnosis does not equally apply to all people, especially those within the Indigenous community. Community-based programs could create different culture specific models to aid in developing wellness in the community, and if a community is seen as a body then the people are its organs.
Most individuals are not quite focused on mindfulness, as in being in the here and now.
Mental health should not be about checking off a string of boxes of what to diagnose people with, it should be tailored to provide value and care to the person. This too has its own operational costs that the government has not been sufficiently meeting. People have been afraid to find help with the worry that their benefits will not cover a visit and that they will be seated with a huge bill. These basic barriers can cause people to avoid treatment and personal advocacy for their health. Should they avoid eating for a few meals or should they take care of themselves? In most cases, the immediate physical needs take precedence over the mental ones.
Then there lies the associated stigma with mental health where, for instance, men are unable to admit that they have problems because of the societal pressure for them to be strong and stoic which can result in males becoming reluctant when trying to reach out for counseling. Sometimes it just takes a little push from someone such as a spouse or a family member, talking to a manager or a supervisor at work and the courage to say that they might need a break.
Dr. Krista Beck of the Calgary Counselling Centre stated that her organization took 36 hours to go fully virtual once lockdowns began in order to serve their patients. Operating on a sliding fee scale and through the use of the internet, these patients have been given better accessibility and the opportunity to better their mental health from afar and especially to advocate for themselves.
“I often feel that in the profession I’m in, there’s just not enough for the need that’s out there. It’s heartbreaking to see that, especially with all of the stressors that people are going through and then how that’s affecting their family, jobs, homes, relationships,” says Beck.
The lack of funding and counselors in the Calgary area has created a distinct sentiment between professionals in the province, as Alberta Health Services does not cover the cost of necessary mental health services.. While the Alberta Government has stepped in before through a one-time grant of up to $25 million during 2020-2021, it has fallen upon organizations such as Counselling Alberta to offer grants, making ends meet for the private sector. While there might be philanthropists willing to contribute to the growing need, it appears that most institutions rely on those grants.
HOLISTIC WELL-BEING THAT INCLUDES THE PHYSICAL AND MENTAL
A strong sentiment among professionals is that too much attention and funding is being given to physical care. Canada is often touted as a champion of “free” health care, but what ends up often being the case is that if you have a need for mental health services, you will pay large sums of money out of your own pocket for these visits if you are not insured.
As established earlier, the psychological well-being of an individual can dramatically affect their physical body as well. Yet, it has not been given the same attention or funding as traditional forms of medical intervention. Why should there not be the opportunity for medical doctors to refer people to affiliated counseling services the same way they would when writing a prescription for medication, or a specialist for that matter? It makes little sense that Alberta Health Services would not consider supporting referrals, as it is an issue that affects everyone. For example, employers being affected by people calling in sick or not going to work because of mental health issues or long term stressors.
“Self-soothing is specific to those situations in which you find yourself distressed and need to find, what are those things that work for me to help me feel calm in those situations versus the general self-care on a daily, weekly, monthly basis.”Dr. Krista Beck, the Calgary Counselling Centre
The concept of psycho-education was coined with a special emphasis on returning to the basics to holistically take care of one’s mental state by approaching wellness from both physical and mental angles. Whether through a good night’s sleep, by exercising, learning how to breathe deeply and physically calm yourself down, these have been mentioned as ways that contribute to your well-being.
It is also important to learn how to take bad or alarming news in a way that doesn’t destroy patients. As the lid comes off on a lot of these stressors and traumas it can be overwhelming. Learning the difference between self care and self soothing can allow many Canadians to support themselves even without direct intervention. For instance, deep breaths, exercising, creating a good ambience and a calm environment; there are many different ways to engage in self soothing including taking a short bath, eating something sweet, or enjoying a nice video game. Spending some time with a pet can help too as even the repetitive motions of petting can act as a way to help relax.
An interesting analogy that Beck uses is how self-soothing is like putting your oxygen mask on first before you help others, referring to emergency protocol in conventional air travel. When the central focus is on how you can help yourself before others, Beck describes it as filling a glass of water. People do activities that they like, which encourages positive mental health and fills that glass. Self-care on the other hand is the long-term practices that sustain your mental health, such as having kindness for yourself and setting meaningful, achievable goals. One is a temporary solution and the other is a long-term project.
“Self-soothing is specific to those situations in which you find yourself distressed and need to find, what are those things that work for me to help me feel calm in those situations versus the general self-care on a daily, weekly, monthly basis,” says Beck.
One advancement that Calgary Counselling Centre has made is a focus on checklists, to help patients and practitioners know where symptoms are at and to collect feedback on how they felt the session went. This in turn offers people a sense of personal advocacy that allows them to formulate goals to reach.
Providing better access and awareness to mental health services could mean people meeting their goals and recovering sooner, but this requires governments to renew a commitment to invest in its people. Through the development of new organizations to care for the under-represented or under-served populations in the care system, and by providing the funding for mental health referrals, they have the opportunity to lift barriers, whether in terms of specialized services, funds, or physical availability.