Amber St. Louis Archives - Mental Health Commission of Canada https://mentalhealthcommission.ca/post-author/amber-st-louis/ Thu, 28 Aug 2025 17:32:53 +0000 en-US hourly 1 https://wordpress.org/?v=7.1 https://mentalhealthcommission.ca/wp-content/uploads/2026/09/mhcc-logo.png Amber St. Louis Archives - Mental Health Commission of Canada https://mentalhealthcommission.ca/post-author/amber-st-louis/ 32 32 Seeing People, Not Problems https://mentalhealthcommission.ca/catalyst/seeing-people-not-problems/ Mon, 10 Apr 2023 16:30:25 +0000 https://mentalhealthcommission.ca/?post_type=catalyst&p=57584 How compassionate health care can alter the trajectories of people who use substances.

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How compassionate health care can alter the trajectories of people who use substances.

Jes Besharah doesn’t remember how long they’d been living on the street and using opioids by the time they sought medical care, but they remember being in bad shape.

“I was sick, I was hurt, I was crying, I had abscesses and wounds all over my body. I had many needs that needed to be addressed,” they say. But when the nurse came in and looked Besharah up and down, all she saw was a drug user.

“We didn’t take care of anything at all. She told me she would pray for me, and that was the best she could do.”

For Besharah, it was a crushing response. “It just makes it seem like there’s no point in trying when that’s the answer that you’re met with.”

Unfortunately, Besharah isn’t alone. People who use opioids and other substances often encounter stigmatizing attitudes and discrimination, including from the health-care workers they turn to for care.

The Mental Health Commission of Canada (MHCC) invited Besharah to share their experiences of stigma and its impact in a video called Use Your Voice — Reducing Stigma Toward People Who Use Substances.

“For people who use opioids and other substances, stigma can be a powerful barrier to seeking and receiving quality care,” says Julia Armstrong, manager of MHCC’s mental health and substance use health team. “We created this video (and discussion guide) to start important conversations about stigma in health-care settings — the kind of conversations that lead to better understanding and a higher standard of care for these individuals.”

The video also features the nurse that helped change Besharah’s life — Melinda Billett.

As a primary care nurse practitioner, Billett has had years of experience supporting people who use substances. She has also seen first-hand how small choices can have a powerful ripple effect.

“In health care we can make the choice to treat people with respect,” she says, for example in the notes providers make in a patient’s file. “That’s my voice that someone else is going to read. So, I can choose to say that this person is a drug addict, or I can choose to say this is a person who uses substances.”

In making that small change, Billett is drawing on the power of person-first language, which can help distinguish who someone is from the substances they use or the mental illness they live with.

While both describe other changes that health-care workers — and anyone interacting with people who use substances — can make to help curb stigma, every example comes back to one overarching message: treat individuals who use substances as people, not problems.

Besharah credits the compassion they received from Billett and others for the life they lead today, working as a community harm reduction support navigator and peer support worker. “Part of the reason that I do it is because, when I was on the streets, there were people doing outreach that didn’t judge me, that cared about me, that would go out of their way to make sure that I was still around,” they explain. “That made a huge difference in me wanting to take back control of my life.”

Billett emphasizes that people who use substances have a great deal of inner resilience, and it’s up to health-care providers at every level to recognize it. “If we can tap into that, and be kind to them, and care for them and meet them where they’re at . . . then those things together is what can help change the trajectory of someone’s path.”

Author:

Amber St. Louis

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Why We Use “Substance Use Health” https://mentalhealthcommission.ca/catalyst/words-matter/ Wed, 29 Mar 2023 19:50:44 +0000 https://mentalhealthcommission.ca/?post_type=catalyst&p=57371 Putting substance use on a spectrum creates a space for more open conversations about safer, healthier, more manageable consumption.

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Putting substance use on a spectrum creates a space for more open conversations about safer, healthier, more manageable consumption.

Part of the Mental Health Commission of Canada’s work involves education on the distinction between mental health and mental illness. Mental health — an aspect of overall health — exists on a spectrum we all share. One end of the spectrum reflects optimal mental health, while the other shows where mental illness or mental health problems occur. A spectrum model is also helpful when we talk about substance use.

What it means
Toward one end of the substance use health spectrum, a person might abstain entirely or engage in sporadic use without any adverse consequences. At the other end are substance use disorders with far-reaching effects on overall health and well-being. Depending on the circumstances and a multitude of factors, anyone can move along the spectrum at any time.

Talking Illustration

Why it matters
Due in part to a long history of criminalization and secrecy around drugs and alcohol, a negative undertone persists. This way of thinking may lead people to see all substance use as problematic. On the other hand, putting substance use on a sliding scale helps create a space for more open conversations about safer, healthier, more manageable consumption — whatever that looks like for each individual.

Reducing stigma around substance use is also an important part of fostering recovery. The less negatively we judge substance use, the more comfortable a person might be about disclosing a concern about their own or someone else’s situation. For someone struggling with substance use, understanding that they can achieve safer, healthier consumption without (or before) complete abstention can help instil hope when they need it most.

How you can use it
Adopting the term substance use health can challenge personal biases and binary thinking. Substance use isn’t black and white. It’s not about being addicted or abstaining entirely. There’s a wide, grey area of movement, nuance, and individual circumstances in between. As with all mental health, the way we think and talk about substance use matters. The better we understand the substance use health spectrum, the better we can support people through every stage of recovery.

Author:

Amber St. Louis

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From condemnation to compassion https://mentalhealthcommission.ca/catalyst/from-condemnation-to-compassion/ Tue, 14 Mar 2023 18:47:14 +0000 https://mentalhealthcommission.ca/?post_type=catalyst&p=56914 The shift away from saying “committing suicide” goes beyond semantics.

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The shift away from saying “committing suicide” goes beyond semantics.

This article is part of the Catalyst series called Language Matters.

Outdated language has a way of sneaking up on you. Sometimes it’s egregious — like a racial slur, for instance. Other times, it’s more subtle — like an expression you suddenly realize you haven’t heard for a while. For many people, the language around suicide is likely to fall into the second category.

Until a few years ago, it was common to hear that someone “committed” suicide after taking their life. The expression was pervasive across all forms of media and in everyday conversation. Then, the paradigm started to shift. More and more people, from health-care workers to journalists to people with lived and living experience of mental illness, adopted “died by suicide” as the better alternative.

What’s the difference?
The third edition of the Mindset media guide for reporting on mental health offers one of the best rationales behind the change: “Don’t say a person ‘committed suicide.’ This outdated expression, linking suicide with illegality or moral failing, can make it harder for others to seek help, or for families to recover.”

The term “commit” is most often associated with some sort of crime. For example, we still regularly hear that someone “committed murder” following a homicide, or “committed fraud” after a scam. These expressions imply a disregard for the rules of law and moral or ethical standards while casting judgment on the actions taken.

Talking Illustration

When talking about a suicide, such implications have no place. Suicide is preventable with the right interventions. But if admitting thoughts of suicide feels like confessing a crime, it’s not hard to imagine why someone might hesitate to reach out for support. When you factor in the feelings of low self-worth and hopelessness that often accompany suicidal ideation, the stakes involved in the language we choose are raised even higher.

Then there are those left behind. Following a suicide, it’s estimated that 135 people are affected by the loss, with 7 to 10 being significantly impacted. So outdated language can further complicate the grieving process by adding undue stigma.

By contrast, saying or writing that someone “died by suicide” helps reframe the death as a loss rather than a crime. It’s an opportunity to replace condemnation with compassion, and swap stigma for support.

For someone struggling — with their own thoughts of suicide or the death of a loved one — that can mean the difference between staying silent and speaking up.

New hope on the horizon
By the end of 2023, Canada is set to launch a three-digit suicide prevention number. When someone dials or texts 988 from anywhere in Canada, they’ll be connected to a free mental health crisis or suicide prevention service. Experts say this nationwide number can not only reduce the stigma associated with reaching out for help, it will also save people the time it would take to remember or search for a crisis number. When it comes to preventing suicide, every second counts.

Did you know?

  • It may not be obvious that someone is thinking about suicide. Learning the warning signs can be helpful for knowing how and when to offer appropriate support.
  • Asking someone if they are contemplating suicide will not make it more likely. In fact, showing concern can be a helpful way to establish social connection and promote hope in the moment.
  • Removing or limiting access to things like firearms and prescription medications is often enough to prevent suicide. This kind of means restriction is effective in preventing suicide, as many people won’t seek out alternatives.

Resources
If you or someone you know is in immediate danger, call 911. 

Author: is a writer at the Mental Health Commission of Canada.

Amber St. Louis

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Pace, Plan, and Prioritize: One Woman’s Story on Coping with Long Covid https://mentalhealthcommission.ca/catalyst/pace-plan-and-prioritize-one-womans-story-on-coping-with-long-covid/ Tue, 28 Feb 2023 05:00:46 +0000 https://mentalhealthcommission.ca/?post_type=catalyst&p=56374 Since there’s no cure, those affected must work to manage their symptoms. An innovative hospital program takes an interdisciplinary approach encompassing physical, cognitive, and psychosocial care.

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Since there’s no cure, those affected must work to manage their symptoms. An innovative hospital program takes an interdisciplinary approach encompassing physical, cognitive, and psychosocial care.

When Lisa Evans gets up each day, she’s faced with a tough choice: shower or wet wipes.

It’s a decision she never dreamed she’d be making a year and a half ago, when she was full of energy, exercising several hours a week with ease.

More than a year into her battle with post-COVID-19 condition, also known as long COVID, Evans is grateful if she can walk more than a few blocks. It’s just one of the many changes that have made her life feel surreal.

In fact, Lisa Evans isn’t even her real name. She requested anonymity because she fears discrimination by her employer and judgment from her peers.

“This is the height of vulnerability,” she says. “Every day I’m scared of something. Will my symptoms get worse? Will I need a caregiver? Will I be able to breathe? I can’t afford to worry about negative perceptions about my work on top of it.”

For me, her precaution needs no explanation. When my own COVID-19 symptoms lingered several months longer than news coverage led me to expect, I dreaded every question about my progress from well-meaning colleagues. I relied on tried-and-true responses like, “still not quite 100 per cent,” when what I wanted to say was, “Every work day feels like a marathon I didn’t train for.”

While my own symptoms subsided half a year later, Evans continues to suffer from debilitating fatigue, dizziness, headaches, irregular heartbeat, and disturbances of taste and smell. With her once favourite foods having lost all appeal (tomatoes now taste like “rotten socks”) and cooking becoming a Herculean task, she has also lost nine kilos.

We are far from alone in these experiences. Initially, the World Health Organization estimated that between 10 and 20 per cent of people who were infected by the virus experienced a post-COVID condition — defined as “the continuation or development of new symptoms 3 months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least 2 months with no other explanation.” Updated research suggests that 30 to 40 per cent of people who have caught COVID still report symptoms beyond three months of their initial infection, with new data changing these numbers all the time.

Beyond the statistics
Few people can put faces to the figures quite like Wendy Laframboise, a nurse practitioner who coordinates the post-COVID rehab program at The Ottawa Hospital. With 287 referrals and more than 400 sufferers and caregivers reaching out for support (so far), Laframboise is intimately aware of the realities of long COVID.

“Most of our patients are not the people you’d expect to have lasting symptoms,” she explains. “These were very high-functioning, athletic, successful people with little if any previous medical history. Now, almost all have had to put their jobs — and their lives — on hold.” For the few who remain employed, she tells me, the decrease in functionality often means an increase in stress and anxiety around work.

Ottawa Hospital, General Campus

The Ottawa Hospital

Since there’s no cure for long COVID, the program aims to help patients manage their symptoms and improve their quality of life across three domains: physical, cognitive, and psychosocial. The model is based on the hospital’s chronic pain program and draws on research from the rehabilitation unit’s work with traumatic brain injuries and chronic respiratory diseases.

Over four weeks, patients work with a nurse practitioner, a respiratory therapist, an occupational therapist, a physiotherapist, a dietician, and a psychologist in highly interactive, virtual sessions. Through education, discussions, and goal-setting workshops, they learn to cope with symptoms like breathlessness, stress, and poor concentration (often referred to by long-COVID patients as “brain fog”).

The results so far have been overwhelmingly positive, with patients showing improvements across all three domains, both at the end of the program and at the three-month followup stage. For some, improvement means breathing more efficiently. For others, it’s the difference between playing with their child and being confined to bed.

Laframboise credits the interdisciplinary team with much of the program’s success, which includes the active involvement of a rehabilitation psychologist.

“Long COVID takes a significant mental toll on everyone,” she says, noting that depression and anxiety often appear for the first time or get worse in those who already have it. “The most common feeling patients express is a loss of their previous self. There’s lot of frustration and guilt about what they’re no longer able to do — in their relationships, for their kids, and for themselves.”

Laframboise adds that there’s a very real stigma associated with invisible illnesses, especially one as new as long COVID. “People can’t believe it’s possible to go from 100 per cent to 10 per cent. But it is.”

To complicate matters further, she tells me, there’s no clear healing trajectory. Unlike a broken leg with established healing milestones each week, long COVID is neither linear nor consistent. One week someone might have a headache and dizziness; the next it could be ringing in the ears and shortness of breath.

Misunderstood — and missing out
Evans is all too familiar with the roller coaster of symptoms, and the isolation that comes with it. “I spent the whole summer on the couch. All I wanted was to be outside in the sunshine, but my body wouldn’t allow it.”

While physical limitations continue to keep her isolated from the world beyond her apartment, it’s the lack of understanding that isolates her from her friends and family.

“People in my life have suggested that I try just getting a little more sleep,” she says, adding that friends have grown impatient with her absenteeism and cancelled video calls. “There’s not enough sleep in the world that could fix this.”

In search of some common ground, Evans joined a Facebook group for so-called COVID long haulers in Canada. The group is private, and only those with long COVID and their families are permitted to join. At this point, it has more than 18,000 members.

“There are new posts every day about experiences like mine,” Evans tells me. “Some people are into their third year with these symptoms and have run out of hope. No one else understands what it’s like.”

In working with the post-COVID rehab program, Laframboise has been surprised most by two things: the impairment wrought by the condition and the power of validation.

Even before starting the program, patients on the wait list are assured that what they’re experiencing is legitimate and, despite how it may feel, they are not alone. The program also leaves plenty of room for open discussion, both in group and one-on-one sessions with experienced clinicians. Giving patients these opportunities to share their experiences without judgment is more beneficial than Laframboise could have imagined.

“Once patients feel validated in their experiences, it’s easier for them to focus on techniques to cope with what’s happening,” she says, explaining that everyone is taught to “pace, plan, and prioritize” their daily actions within the confines of severe fatigue — the most pervasive of long COVID symptoms.

Wendy Laframboise, Nurse Practitioner

Wendy Laframboise, Nurse Practitioner

Pacing, planning, and prioritizing are concepts Evans has had to learn on her own, and she credits them with her ability to keep working. “I’ve learned to perform a cost-benefit analysis for my day, calculating exactly how I’m going to use my energy,” she says. “I have to choose if I’m going to work, cook dinner, or do laundry because there’s only energy for one.”

Rethinking productivity — and everything else
Evans’s other takeaway from her experience has been somewhat harder to process. She’s learned that, in many ways, society isn’t made for people with disabilities. Necessities like groceries cost more when you always have to pay for delivery. Likewise, the mobility scooter that could give her added freedom would mean paying for an extra parking space in her building, or else heaving it over the threshold of her front door.

But Evans has realized that ableism goes much deeper than our pocketbooks. “We’re programmed to put productivity above everything,” she says. “We ask, What did you do today? instead of, What did you think today? What did you feel today? Maybe those are the questions we should be asking each other.”

Hearing this, I can’t help but think of recent headlines touting new research that says most long COVID symptoms should resolve themselves in a year. My own post-COVID symptoms lasted six months, and the thought of doubling it leaves a knot in my stomach. A year of missed opportunities and unmet goals. A year of choosing rest over writing. A year of tuning out conversations and in to my own breathing. A year of foggy milestones — two full holidays I barely remember. I learned that being semi-present is a lot like not being there at all.

As for Laframboise, she is grateful for the relief The Ottawa Hospital program has brought to so many, but she knows it’s not enough to meet the need. “I want the word to get out about this for people like my patients. They need more programs to help them get their lives back, and they need them now.”

Evans agrees that there is much to be done to support people like her, with research, resources, and understanding all sorely lacking. Still, she isn’t giving up hope. “I’m determined not to let another summer pass me by,” she says. “Even if it takes all of my energy, I’m going to feel the sunshine on my face.”

Resources:

The Ottawa Hospital’s post-COVID self-management program
COVID-19 Resources Canada

Author: is a writer at the Mental Health Commission of Canada.

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Shifting the Narrative https://mentalhealthcommission.ca/catalyst/shifting-the-narrative/ Tue, 07 Feb 2023 20:06:41 +0000 https://mentalhealthcommission.ca/?post_type=catalyst&p=55072 Valuing lived and living experience

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Valuing lived and living experience

This article is part of The Catalyst series called Language Matters.

While many social movements use the saying “nothing about us without us,” it also applies to the fields of mental health and substance use health. To make meaningful improvements in policies, support services, and systems of care, the voices of lived and living experience must be part of the conversation. This way, assumptions can be replaced with real experiences, and solutions can be challenged by those who stand to gain or lose the most.

Illustration of two people talking

The Mental Health Commission of Canada (MHCC) places great emphasis on using “lived and living experience” because it emphasizes individuals over the stigmatizing effect of labels that demean and prevent people from seeking treatment. So, instead of referring to someone as a “former addict,” it’s more respectful and more in line with the process of recovery to say, “a person who has had lived experience of a substance use disorder.”

In the mental health and substance use health context, the term “lived experience” refers to someone who has previously had a mental health problem or illness or used one or more substances. Similarly, “living experience” refers either to a current mental health problem or illness or an ongoing use of one or more substances.

Sometimes, lived and living experience includes family members and caregivers. While a close relative may not have first-hand experience of a mental illness or substance use disorder, they are often intimately familiar with challenges such as accessing services for their loved ones.

As a concept, consider finding new ways to incorporate lived and living experience into your work or conversations about mental health and substance use health. In this respect, the MHCC is fortunate to have Hallway Group members’ valuable insights into lived and living experience to help guide our work.   

Author:

Amber St. Louis

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Power to the People https://mentalhealthcommission.ca/catalyst/power-to-the-people/ Mon, 19 Sep 2022 17:40:37 +0000 https://mentalhealthcommission.ca/?post_type=catalyst&p=49182 Using person-first language to make an important distinction

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Using person-first language to make an important distinction

This article is part of the Catalyst series called Language Matters.

When talking about mental health, the language we use falls into two broad categories: person-first or identity-first. At the Mental Health Commission of Canada (MHCC), we typically use and recommend person-first language, but that choice may not apply in all situations.

What’s the difference?
Identity-first language leads with the illness or condition as opposed to the person experiencing it. For example: “schizophrenic person” uses schizophrenia as a descriptor before referencing the individual. Conversely, person-first language focuses on the individual while de-emphasizing the illness or condition. So, in this instance, if using person-first language, you could say, “an individual who lives with schizophrenia.”

two people talking

The language used to talk about mental health or substance use can play an important role in reducing — or reinforcing — stigma. By focusing on the individual, person-first language underscores the fact that a diagnosis is only one component of someone’s overall being. It also shows respect for an individual as a person rather than as “abnormal,” “dysfunctional,” or “disabled.” For that reason, it is considered less stigmatizing and is often preferred in the mental health and substance use context.

That said, it’s important to bear in mind that this preference is not universal. As one friend explained, “I don’t live with bipolar disorder. It’s not my roommate.” For her, using identity-first language — “I’m bipolar” — better represents how deeply intertwined the condition is with every aspect of her life, while person-first language has a minimizing effect.

For others, identity-first language is rooted in the relationship between their personal and cultural identities and their condition. For example, deafness, which has a rich culture unique to those who share the experience, often emphasizes abilities over disabilities. In that case, “deaf person” might be preferred over “person who lives with deafness.”

How to choose?
In an American Psychological Association survey of 3,000 individuals living with a range of conditions, 70 per cent chose “person with a disability” when asked about the language that best describes them. “Disabled person” was chosen by just eight per cent.

When writing, the MHCC recommends person-first language as a first choice, unless you know that an individual or group describes themselves otherwise. When talking to a person with lived and living experience, listen for or ask them about the language they use. It’s not about getting it “right” on the first try. It’s about listening, learning, and championing the use of respectful, non-stigmatizing language — whichever form that takes.

Author:

Amber St. Louis

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Meditations on motherhood, mental illness, and resiliency https://mentalhealthcommission.ca/catalyst/meditations-on-motherhood-mental-illness-and-resiliency/ Fri, 22 Apr 2022 21:22:05 +0000 https://mentalhealthcommission.ca/?post_type=catalyst&p=38032 It’s easy to make assumptions about people based on their academic accomplishments, professional successes, or philanthropic contributions. But sometimes if you pull back the curtain, you discover untold depths and hardships that reveal a more valuable story than a five-sentence biography can.

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Featuring: MHCC board directors Carole Shankaruk, Kellie Garrett, and Cheryl Fraser

It’s easy to make assumptions about people based on their academic accomplishments, professional successes, or philanthropic contributions. But sometimes if you pull back the curtain, you discover untold depths and hardships that reveal a more valuable story than a five-sentence biography can.

A recent Zoom conversation with three Mental Health Commission of Canada (MHCC) board directors is a powerful reminder that the most important accomplishments may be the ones without accolades.

The passion for mental health shared by Carole Shankaruk, Kellie Garrett, and Cheryl Fraser was born from deeply personal experiences. For each woman, walking through a place of darkness has motivated them to be the light for others.

Accidental advocates

Carole Shankaruk

Carole Shankaruk

All three women calling in seemed to be visibly collecting their thoughts before recounting their personal journeys — which undoubtedly unfolded more neatly in retrospect than in reality.

“I’ll be honest,” said Shankaruk from her home near Winnipeg, “part of me was dreading this conversation. Reliving the past can bring up so many painful emotions.”

Rather than bury them or hold back, though, she brandished her Kleenex and began relating the story that changed her life. As a clinical social worker, Shankaruk thought she had the necessary tools to handle whatever motherhood might throw her way.

“But when it’s your own child who is suffering, who’s in pain, you might as well throw the playbook out the window.”

At age seven, the debilitating pain her son Noah had been experiencing was diagnosed as Crohn’s disease, an ailment that causes a notoriously painful inflammation of the bowel.

In Fraser’s case, the journey began only a few months after her son Jamie was born. “He started to appear constantly frustrated, he wasn’t eating properly, and then his development seemed to slow down,” she said. “The doctors couldn’t find anything medically wrong with him, but we knew he needed help, and more importantly he needed someone to advocate for him.”

A mother’s love (and guilt)

Kellie Garrett

Kellie Garrett

One of the first things Shankaruk recalls was the difficulty of dealing with her son’s pain. “We tried so hard to manage it, but it interfered with virtually everything.” She remembers feeling tremendous guilt, a burden she still bears today. “Did I intervene forcefully enough? Was there more I could have been doing?”

As she expressed this thought, tentatively at first, she was encouraged by Garrett, an executive coach, speaker, and consultant, calling from her home in Regina.

“Oh, the guilt!” she said. “As mothers, I don’t know if we can ever entirely free ourselves from it.” Garrett herself experienced undiagnosed postpartum depression following the birth of her second child, which occurred on the heels of her mother’s death and a cross-country move.

“I had this notion that ‘this’ is what motherhood is,” she explained. “Exhaustion, being overwhelmed, isolation . . . that it was all just part and parcel of what you have to trudge through. Being in a new city, I didn’t have friends to confide in. Also, my partner wasn’t able to recognize the signs and symptoms, and I had had a less than ideal family life growing up, so I didn’t have a positive model to draw on.”

Garrett gathered herself before delving more deeply into the mental illness that had left its mark, both on her mother and her grandmother before that. “My grandmother faced unimaginable hardship when her husband abandoned the family. She had a breakdown, went through shock treatment several times, and was ultimately diagnosed with bipolar disorder. My mother also lived with major depression throughout her adult life. When my own son began to experience depression, I felt like it was his rightful legacy. And feeling like somehow my bloodline was toxic, that it had poisoned the well . . . it’s hard to reckon with that.”

Here Shankaruk jumped in. “We blame ourselves for so much, and in doing that we not only contribute to the stigma that surrounds mental illness, we’re also left trying to pour from an empty cup. When it comes to motherhood, we experience traumas big and small, but we don’t necessarily have the language to name them or the tools to address them. So we soldier on without realizing that we’re perpetuating some of the harms we most wish to avoid.”

Fraser’s self-blame wasn’t centred on Jamie’s condition but on an inability to offer protection in his most vulnerable setting — the classroom. While he’d always had challenges in school — exacerbated by his learning differences, limited coordination, and towering stature — Grade 6 was a turning point.

“At a birthday party for Jamie, I overheard a boy mention a teacher who was throwing things,” she explained. “When I asked about it, the floodgates opened. All the boys began to tell me how their teacher had been forcing Jamie to fetch his coffee and throwing chalkboard brushes at him when he gave incorrect answers in class. I was horrified.” As it turned out, the teacher had a history of mistreating students with extra needs.

Fraser and her husband removed him from the school, only to have to transfer him twice more. By the eighth grade, Jamie had had enough. Frustrated by years of being misunderstood, by students and teachers alike, he walked into his principal’s office and announced: “If you don’t do something, I’m going to kill myself.”

“At that point, we really had to step in and take over,” Fraser said. “Jamie had a hard time trusting adults, but he needed to trust us. Thank God he did.”

In Shankaruk’s case, the middle years saw an improvement in Noah’s general happiness. Although he still battled waves of pain, as a young adult he was doing well. “He was working and the future was bright,” she said, growing visibly emotional. “But then one day on a job site Noah complained of his pain to a friend. Without thinking, he took a pill that was offered. And while it relieved his immediate physical symptoms, it also unleashed an addiction that would eclipse the pain of his Crohn’s.”

The decisions her son made while using substances led to an arrest and a court appearance. “I was so terrified, I was carrying so much anger at how he was being treated, I was literally shaking from head to toe with repressed feelings. Yes, he’d make a mistake. Yes, he’d taken pills that altered his behaviour and clouded his judgment. But where was the rest of the story? Why wasn’t anyone asking about his chronic illness? Why wasn’t anyone painting a picture of all that he had achieved? Why is the system so punitive when rehabilitation — or in my son’s case, medical intervention — should be the goal? This is such a beautiful human being, and he’s been reduced to a number on criminal registry.”

“I’m so sorry,” Garrett interjected. “I didn’t know any of this.” The two pause for a moment, as if in solidarity for the lonely paths so many mothers must walk before finding some peace or solace.

“My one son was born with autism,” she said. “And I spent much of my time focused on his needs, while my other son slipped into anxiety as a child and later depression. . . . I feel badly that he was lost in the shuffle.”

Both women threw themselves into work, a soothing balm when their home lives were feeling chaotic. “I was good at my job,” Garrett recalled, “and I knew what I was doing. There was no manual for motherhood. It felt like a science experiment. You’re flying blind, yet it’s the thing that women are conditioned to believe should come most naturally. When I was younger, I didn’t know how to reach out for help. Worse, I would have felt shame for needing it.”

Finding reprieve

Cheryl Fraser

Cheryl Fraser

Today, Shankaruk, Garrett, and Fraser are aware that the wisdom gained from their hardships may help someone else who has begun that kind of journey — it’s the reason they agreed to share such personal stories.

“The advice I would give to anyone struggling, whether it’s as a new mom or for any other reason, is to reach out and find your people,” said Shankaruk. “For me, it was a women’s spiritual group. Most were much older than I was, and that age gap was such a blessing. They were further down the road, were able to see potential pitfalls before I could, and had invaluable advice born from experiences I hadn’t yet had.”

Ultimately, Garrett also found solace in female friendships, although she noted that the narrative around women’s desire to compete rather than lift others up needs to be rewritten. “I don’t think women are inherently more competitive with each other or are driven by a desire to undercut. I think society has set impossible expectations and put us in a perpetual state of scarcity.” The solution, she said, “is to reframe the conversation. It should be about the way so many women are very supportive. How can we create space for and celebrate the women in our lives who are clearing new paths and forging opportunities that benefit us all?”

Both Garrett and Shankaruk have also found their footing by embracing nature. “To go into my garden, to be surrounded by natural beauty, that’s where I feel most at home,” said Shankaruk, who is Métis and often turns to the land for healing.

“There is power in giving our experiences room to breathe,” she added. “There is power in naming our traumas, in owning our challenges and, in turn, sharing the hard-won knowledge with others.”

As Fraser points out, sometimes that hard-won knowledge stems from a gut feeling, and that’s exactly her advice for other parents. “Trust your instincts. If you feel like something is wrong — with your child or yourself — it probably is,” she said. “It might take a long time to get the answers and solutions you need, but don’t stop searching, and don’t stop advocating.”

“It’s also so important,” Garrett emphasized, “to find people who are able to see and love you for yourself. If you have a sick child or are overwhelmed by the demands of motherhood, it can feel like you’re only two dimensional — like you’re just a mom and an employee, for example.”

She also believes carving out some personal time, just for yourself, is critical (while giving any partner the same privilege). “Finding the space to connect with yourself and pursue what matters to your soul outside parenting actually makes you a better parent.”

“When Connor was diagnosed with autism, I cried for two years straight. I wouldn’t wish that on anyone. I thought about suicide more than once. The only thing that kept me alive was my children, and some visceral, bone-deep conviction that I couldn’t leave them.”

A fresh perspective
Today, all three women have gained some of the objectivity that comes with time.

“I didn’t realize it then,” Fraser said, “but the sum of my experience with Jamie led me to be a different kind of caregiver for my own mother when she started to decline with Alzheimer’s. I learned to truly prioritize joy, and that it’s possible for someone to be happy, no matter what stage they’re in or what form that happiness takes.”

Garrett had a similar epiphany. “For a long time, I was angry with my own mother. But with some distance, I now believe she was doing the best she could. In forgiving her shortcomings, I’ve been able to extend some of that compassion to myself. That is the ultimate gift.”

Shankaruk agreed. “This is what we hope for. That we forgive our parents their imperfections and hope our children give us that grace. Because motherhood, in all its messy complexity, has led me to discover untold strengths and unimaginable love. But we need not walk that road alone.”

Amber St. Louis

Illustrator: Kasia Niton – https://sunnystreet.studio/  Instagram: @sunnystreet.studio

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A tale of two illnesses https://mentalhealthcommission.ca/catalyst/a-tale-of-two-illnesses/ Tue, 12 Apr 2022 18:04:20 +0000 https://mentalhealthcommission.ca/?post_type=catalyst&p=36804 Dr. Manon Charbonneau remembers the day vividly, though she’d rather forget it.
“So that’s it, then — cancer,” she recalls saying in disbelief with her eyes locked on the digital images of her mammogram. The radiologist confirmed the diagnosis, and in a moment her world was “completely dismantled.”

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Dr. Manon Charbonneau remembers the day vividly, though she’d rather forget it.

“So that’s it, then — cancer,” she recalls saying in disbelief with her eyes locked on the digital images of her mammogram. The radiologist confirmed the diagnosis, and in a moment her world was “completely dismantled.”

As a clinical psychiatrist, Charbonneau had dedicated much of her life to helping other people. “I’d wanted to be a doctor since I was five years old,” she said.

Yet, the long road unfolding before her would mean a marked shift. “While I used to say I was going to grow up and cure cancer, instead cancer found me.”

At the time of her diagnosis, Charbonneau had been practising at a hospital in rural Quebec. And although her medical background helped prepare her for what cancer would do to her body, it did not prepare her for the toll it would take on her mind.  

A legacy of battling stigma
Many years before her diagnosis, Charbonneau was confronted by another debilitating illness — depression.

Manon Charbonneau

Manon Charbonneau

“I had reached such a low place that I almost left my residency. Then, one of my professors told me that whatever I chose to do, I should never talk about my depression because it would hurt my career,” she said. “So that’s exactly what I did — put my head down and stayed silent.”

Without a word to anyone in her professional sphere, Charbonneau fortunately managed to overcome her depression. Afterward, her career took off, and she eventually became president of the Canadian Psychiatric Association (CPA). At the end of her CPA presidency in 2008, nearly 20 years since she’d first dealt with depression, she decided it was time to break her silence.

In her final address as CPA president, Charbonneau candidly described her personal experience with depression, leaving many in the crowd stunned.

“At the time, no one — let alone health professionals — was talking about their own mental health problems,” she said. “I saw an opportunity to change that.”

Charbonneau’s candour ultimately led to the creation of the CPA’s working group on stigma and discrimination, which she chaired for the next 10 years. “Telling my story was a way for me to close the door on my time as CPA president as well as on my depression.”

What she didn’t know was that her cancer diagnosis would come later that year, opening the door to let depression come back in.

Suffering in silence
“After my diagnosis, everything moved very quickly,” Charbonneau recalled. Before she knew it, she had a treatment plan that included surgery, chemotherapy, and radiation.

Yet, as her intensive treatments began to wreak havoc on her body, she noticed signs of her depression returning. “It was insidious,” she said. “Slowly my thoughts and mood started changing until I was consumed by depression all over again.”

Battling breast cancer and a major depressive episode at the same time, Charbonneau was struck by the stark contrast in support between the two.

“Cancer treatment is like a giant pink hot-air balloon. You’re lifted up with support — good funding, good programs, a team that checks in on you every day. Everyone comes together to take great care of you,” she said. “In mental illness, there is no balloon.”

Even with the robust treatment plan Charbonneau received for her cancer, psychological services were not part of the program. “When it comes to mental health, cancer patients are mostly left to fend for themselves.”

Charbonneau is not alone in her experience of having to deal with cancer alongside mental illness. As a recent Mental Health Commission of Canada (MHCC) fact sheet (developed with the Canadian Partnership Against Cancer) points out, the estimated prevalence of depression and anxiety in people treated for cancer is at least double what it is in the general public.

Citing a large survey of adult cancer survivors in Canada, the fact sheet also notes that nearly 80 per cent experienced at least one emotional concern in the one to three years following their treatment, many of which were not met.

The difference in support between Charbonneau’s cancer and depression extended beyond her care team, who she noted, did the best they could within the limits of the health-care system.

Socially, she says, we think of mental and physical illness very differently — something she realized with striking clarity one afternoon while recovering at home.

“I woke up from a nap to 19 flower arrangements, 37 missed calls, and what seemed like hundreds of messages of support from friends, colleagues, and even patients,” she said, adding that for a moment she wondered whether she’d already died. “But in all those cards and voicemails, my mental health was never mentioned.”

For Charbonneau, that experience was a poignant reminder that the stigma around mental illness was alive and well.

“People just don’t know what to do or say when someone is dealing with mental illness, so they say nothing,” she said. “Without that support, the road to recovery gets pretty lonely.”

The power of hope
In the thick of a second depressive episode and taxing cancer treatments, Charbonneau found herself with little motivation. “Some days I couldn’t even bring myself to take a shower, let alone take the steps I needed to get help for my depression.”

But after some difficult conversations with her husband and two children, she realized that she could no longer push her depression aside. If she was to make a full recovery, it needed to include her mental health.

As she worked with professionals to overcome her depression for the second time, Charbonneau began to feel more hopeful for the future — something she considers key to recovery. “As mental health professionals, a huge part of our job is instilling hope — hope that recovery is possible and that a higher quality of life is waiting for you.”

She also found hope for her physical recovery from an unexpected source when asked to attend a charity event almost a year away. “Suddenly I thought, maybe I’m not dying after all. I think I’m going to live to be at this event. That was a huge turning point for me.”

For others struggling to cope with a serious illness — mental, physical, or both — Charbonneau emphasizes the importance of vulnerability. “Reach out to someone you trust and really open up. It’s only by being honest about how you feel that you can get better. Help is there if you’re willing to ask for it.”

An agent of change
Even for Charbonneau, being vulnerable is easier said than done. She hesitated when the people at Bell Let’s Talk asked her to become an ambassador and share her experience with depression and cancer.

“After taking such a long break from sharing my personal story, I had to overcome self-stigma to do it again,” she said. “Working in health care, it’s hard to admit to being less than 100 per cent. But everyone close to me told me that I had to do it, and they were right. Vulnerability is what leads to change.”

That change in the way mental illness is perceived has become the backbone of Charbonneau’s advocacy work. In addition to Bell Let’s Talk, she has also spread her message as a member of the MHCC’s board (2013-19) and continues to work as a trainer for its Mental Health First Aid program.

As she continues to advocate for change at every level — from individual attitudes to the health-care system and public policy more broadly — she often comes back to her own experience. “I picture that big pink hot-air balloon that carried me through my cancer treatment, and I think, ‘when will the balloon arrive for those living with mental illness? Where is their balloon?’”

Perhaps the only thing stronger than Charbonneau’s drive to find that balloon is her belief that we can all help. In describing how motivated she is by the power of individual actions, she cites a favourite quote: Be the change you wish to see in the world. “We are all agents of change,” she said. By shifting the way we think about, talk about, and care about mental health, we can create the change we wish to see.”

Author:

Amber St. Louis

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More than skin deep https://mentalhealthcommission.ca/catalyst/more-than-skin-deep/ Wed, 09 Mar 2022 21:57:48 +0000 https://mentalhealthcommission.ca/?post_type=catalyst&p=33201 “I’m so glad you’re Black.”
That’s the first thing Donna Richards hears from her new client. But as one of the few African, Caribbean, and Black (ACB) clinicians working in the client’s Employee Assistance Program (EAP) — and one of the few ACB psychotherapists in Canada — she hears it a lot.

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Rewriting the personal narratives born from anti-Black racism

“I’m so glad you’re Black.”

Donna Richards

Donna Richards

That’s the first thing Donna Richards hears from her new client. But as one of the few African, Caribbean, and Black (ACB) clinicians working in the client’s Employee Assistance Program (EAP) — and one of the few ACB psychotherapists in Canada — she hears it a lot.

As her client runs through some of the difficulties she’s having at work, another familiar sentiment emerges: exhaustion. Not the exhaustion that comes from long hours and little rest, but the mental exhaustion born of racial microaggressions — small, insidious acts of anti-Black racism that are beginning to take a noticeable toll.

Among the incidents she describes are being overlooked for well-deserved promotions, having others take credit for her work, and even getting mocked for attending a Black Lives Matter demonstration.

When asking her client about the possibility of speaking up about them at work, Richards can nearly predict the response before she hears it.

“There’s no point. No one will care. Nothing will ever change.”

Unlearning that belief, as Richards knows, won’t be easy.  

Death by 1,000 cuts

Rohan Thompson

Rohan Thompson

For Rohan Thompson, a psychotherapist in private practice who works mostly with ACB men and youth, the cumulative effects of racial microaggressions occur every day.

“Clients often come to me after a crisis,” he explained. “They don’t seek help each time they’ve been passed over, put down, or treated as less than. They do so when the compounding effect causes a much bigger mental health problem. It’s like death by 1,000 cuts.”

Those problems can range from high stress levels, to anxiety and depression, to post-traumatic stress disorder, among others.

Richards has seen a similar effect in her work. “Every tiny act of discrimination, no matter how veiled or well-intentioned, leaves an invisible mark. And when these incidents are downplayed or ignored, it sends the message that those marks, and those experiences, don’t matter,” she said. “I see a lot of damage to self-esteem as a result of that message, and a lot of self-medicating to cope with it.”

The disparity in perception about anti-Black racism extends far beyond the workplace. According to a 2019 survey, while nearly half of all participants agreed that discrimination against Black people in Canada was no longer a problem, 83 per cent of Black participants said they were treated unfairly at least some of the time.

As Richards points out, whether that discrepancy stems from genuine ignorance or denial, its effects are costly. “I’ve had clients quit their jobs because they fear retribution for speaking up or trying to hold their employer to account. For so many, it’s just not worth it.”

It’s not hard to understand how a seemingly endless pattern of discrimination alongside a lack of acknowledgment could lead to feelings of resignation — both figurative and literal. But beside the slow burning fuse sparked by microaggressions, there’s a transformational fire waiting to be lit — one that begins with a paradigm shift.

The meritocracy myth

“As kids we’re taught that hard work pays off and success is earned. But when you’re Black, it’s more complicated than that,” said Thompson, adding that that shift in how we understand equality and success is powerful.

“When my clients describe their experiences at work, they don’t always realize when they’re talking about anti-Black racism. They just know they’re bowing under the weight of being overlooked, underutilized, and treated as inferior to their peers,” he said. “I see a lot of high anxiety and self-blame from clients who subscribe to the meritocracy myth because their effort doesn’t match the outcome. Then there’s a lightbulb moment when they realize their experiences aren’t unique and have nothing to do with inadequacy.”

For many of Thompson’s clients, understanding that their negative experiences stem from broader systemic problems brings clarity and validation, but sometimes getting a person to that point takes work.

Thompson likes to present clients with data, using numbers to help them rewrite their narratives of self-doubt. He points to statistics showing that ACB university graduates earn only 80 cents for every dollar earned by White university graduates with the same credentials.

Or the jarring research around job call-backs based on “White-” versus “Black-sounding” resumés — again, with the same credentials — where Black-sounding resumés receive calls as little as one-third as often.

These statistics, on top of data showing that ACB leaders hold fewer than one per cent of executive roles at major Canadian companies, help paint the picture of a fundamentally uneven playing field.

Under-representation starts early

Yet that lack of ACB representation isn’t just an issue among company executives, Richards said. “For instance, I wanted to get into psychotherapy earlier than I did, but no one in a clinical setting looked like me — which, as an ACB woman, told me that I didn’t belong there.”

Long before post-secondary school, the under-representation of ACB teachers, principals, and guidance counsellors creates a skewed image of the options available for racialized youth. With half as many ACB teachers as students (by percentage of the population), the disparity is hard to miss, even for a child.

“Students need to see Black guidance counsellors, right from elementary school,” said Richards, adding that, as education progresses ACB students have little encouragement to pursue anything in a clinical stream. This gap, in turn, contributes to the extreme shortage of ACB psychotherapists in Canada.

As a former assistant director of equity and community partnerships for the Peel District School Board, Thompson wholeheartedly agrees that increasing ACB representation in schools is needed.

“In many cases, the meritocracy myth and the self-destructive patterns that follow start in schools,” he said. Statistics from Toronto high schools show that ACB students are disproportionately suspended and expelled, and they receive half as many “excellent” ratings from teachers as other students do, even with the same standardized test scores.

Studies also show that having an ACB teacher increases the likelihood that students will enrol in post-secondary education and decreases their likelihood of dropping out.

But as Thompson explains, it’s not enough to have more ACB representation in the school system if those schools aren’t actively addressing anti-Black racism among staff. “How can Black educators be the supports students need if no one is supporting them?”

Employer empowerment

Richards is passionate about the potential employers have to create transformational change in the workplace, although she admits it won’t be easy. “Diversity inclusion and training is a great start, but it’s going to take a lot more than a one-off course to create real change. It has to become an integral part of the way you work,” she said. “Employers need to remain cognizant of how they’re interacting with employees and lead by example. That means taking the time to really learn about the people they work with and become critically aware of their own biases.”

When it comes to creating behaviour change across the organization, Richards added, employers must be willing to hold everyone to a higher standard. “Accountability is non-negotiable. It’s not only about creating new opportunities to learn and do better. It’s also about addressing individuals, behaviours, policies, and hiring practices that perpetuate a culture of racism.”

In addition, she noted how employers need to think about expanding their coverage for psychological services, noting that very few people — whether in ACB communities or otherwise — can afford psychotherapy without private coverage.

In Shining a Light on Mental Health in Black Communities, a recent Mental Health Commission of Canada information resource, affordability was a chief barrier to accessing psychological support. Given the lower average incomes among the ACB workforce, bolstering coverage for their psychological services is even more critical.

Even as a provider of EAP counselling, Richards pointed out that coverage is often inadequate to address the need. “For someone who has experienced decades of racial trauma, a handful of solutions-based EAP sessions won’t go deep enough. To help ACB people get to the root of their experiences and truly begin to heal, they need access to longer term counselling.”

Writing a new ending

For those who do seek professional mental health support, Richards and Thompson agree: the journey through counselling involves a great deal of rebuilding.

“Deconstructing individual experiences and giving yourself permission to acknowledge the impact they’ve had can be a difficult process,” Richards said. “But then you pull lessons from those experiences and your self-perception slowly begins to change from someone who is less than to someone who is more than enough.”

For Thompson, another important part of therapy is cultivating joy. He often encourages his clients to think about what brings them joy and how they can integrate more of those things into their lives.

“Ultimately, I’m trying to build resiliency and instil a sense of agency,” he explained. “I want my clients to understand that, despite what society has taught them, their experiences matter, they are important, and they have the power to change their lives for the better.”

Author:

Amber St. Louis

Illustrator: Dorcas Markwei of, LynSow Creative

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Learning to create safe spaces for youth https://mentalhealthcommission.ca/catalyst/catalyst-august-2021-learning-to-create-safe-spaces-for-youth/ Thu, 12 Aug 2021 18:59:56 +0000 https://www.mentalhealthcommission.ca/?page_id=19697 Long before the pandemic, the need to support the mental health of young people was evident. With 50 per cent of all mental health problems established by age 14, the formative years of our youth are some of the most vulnerable.

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New virtual Mental Health First Aid course teaches adults to support the youth in their lives 

Long before the pandemic, the need to support the mental health of young people was evident. With 50 per cent of all mental health problems established by age 14, the formative years of our youth are some of the most vulnerable. Now, by also having to face the impacts of COVID-19, that vulnerability in our youth has only grown.

For adults, it can be difficult to know how to relate to the young people in their lives, let alone how approach them about their mental well-being. To help open up those important conversations, the Mental Health Commission of Canada’s (MHCC’s) updated its MHFA Supporting Youth training and adapted it to a virtual format — and, as adults may be surprised to learn, “relating” isn’t part of the curriculum.

“When you’re talking to a young person about their experiences, it’s not about you,” explained Denise Waligora, a training and delivery specialist at the MHCC. “By the time you’re an adult, you’ve overcome hardship, and learned coping strategies along the way. The same isn’t necessarily true of youth. You have to be able to listen without minimizing their experiences or comparing them to your own.”

That kind of non-judgmental listening is just one of the strategies participants can expect to pick up from the new Mental Health First Aid virtual training. During the highly interactive 10-hour course, they will also learn how to recognize the signs of declining mental well-being and engage in conversations about those observations, assist in mental health or substance use crises, seek outside supports, and care for themselves as a “first aider.”

Focusing on the individual
Rather than offering a step-by-step approach to supporting all youth, course facilitators emphasize the role individuality plays. “Everyone has a baseline set of behaviours, moods, and attitudes,” said Waligora; for example, while one young person’s declining mental health could manifest in low grades or conflicts with friends, those things could be the norm for someone else.

The most important factor to be aware of, she said, is change. “As soon as we recognize a shift in any of these areas, we need to ask, How big of a deviation is this from that person’s baseline and how long has it been going on?”

In a similar way, effective conversational strategies and types of support may also vary depending on the individual. While some youth might be eager to share their feelings if given the opportunity, others may feel embarrassed and need more time. To help create a comfortable atmosphere, course participants are taught to approach youth more casually while engaging in an activity, as opposed to confronting them head-on.

“Whether it takes one try or five, you’re showing that young person someone cares about them.”

An updated approach
While the updates to MHFA Supporting Youth were based on the original in-person course, the content has undergone more than a virtual makeover.

One key addition, says Waligora, is a section dedicated to marginalized groups, including racialized, Indigenous, and 2SLGBTQ+ youth. “A young person from the 2SLGBTQ+ community may have a very different high school experience than their peers, for example. We have to learn about and acknowledge those differences to provide the most effective support.”

Another aspect of effective support (and further addition to the course content) is self-care for first aiders themselves. While participants are largely trained to support the youth around them, they are also taught to acknowledge the toll caring for others can take on one’s own well-being.

Finally, the updated course has shifted to include a more holistic approach to wellness. Rather than focusing on labels, the training follows a recovery-oriented model, emphasizing resilience and overall well-being in all areas of life.

Our collective responsibility
While the course was built for adults who interact with youth, as Waligora points out, that group extends far beyond parents.

“Almost all of us have young people in our lives, whether it’s relatives, neighbours, students, or employees. If you’re close enough to notice a change in a person, you’re close enough to offer your support.”

Late last year, the government of Saskatchewan echoed that sentiment by committing $400,000 to provide MHFA training in K-12 schools across the province.

“Our goal is to have at least one staff member in each school receive Mental Health First Aid training by December 2021,” said Saskatchewan Education Minister Dustin Duncan. “We are excited to support schools in ensuring students have access to mental health resources, and I encourage all provincial school divisions to take part to help remove the stigma around mental health.”

For Waligora, the bottom line is simple: “We have a responsibility to protect our youth. Every young person deserves a safe place to turn. As adults, we can be that place.”

Author:

Amber St. Louis

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