Dan Rubinstein Archives - Mental Health Commission of Canada https://mentalhealthcommission.ca/post-author/dan-rubinstein/ Thu, 04 Sep 2025 16:04:44 +0000 en-US hourly 1 https://wordpress.org/?v=7.1 https://mentalhealthcommission.ca/wp-content/uploads/2026/09/mhcc-logo.png Dan Rubinstein Archives - Mental Health Commission of Canada https://mentalhealthcommission.ca/post-author/dan-rubinstein/ 32 32 Care for Care Providers https://mentalhealthcommission.ca/catalyst/care-for-care-providers-the-mental-health-of-support-workers-should-matter-to-everyone/ Tue, 25 Feb 2025 13:46:04 +0000 https://mentalhealthcommission.ca/?post_type=catalyst&p=80063 The Mental Health of Support Workers Should Matter to Everyone

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Debra Slater is the type of person you want looking after your loved ones. A self-proclaimed born nurturer, she took care of her grandmother in Saint Vincent and the Grenadines and went to school to become a personal support worker (PSW) after moving to Canada. Slater loves talking to and learning from the older adults under her watch at a long-term care home on the outskirts of Toronto. She greets them by name, with eye contact and a smile, and strives to develop a rapport regardless of their cognitive condition. She treats clients as individuals while helping with activities of daily living – often referred to as “ADLs” in support work communities – such as bathing, getting dressed, and eating.

“You need to take time to understand their emotions and feelings,” says Slater, who has worked as a PSW on and off for more than 20 years. “You kind of become their family. They’re not ‘my patients.’ They’re people who want to be as independent as possible and this is their home. My job is to bring comfort and peace, love and companionship. It’s a whole vibe.”

Debra Slater

Debra Slater, a personal support worker, also coordinates the Empower PSW Network to advocate for better working conditions.

Slater maintains this attitude even though, on a typical shift, she has eight residents with diverse needs to juggle. One might have had a rough night; another could be dealing with a medical issue; and if any of Slater’s colleagues are absent, she’ll probably have additional clients. “On a difficult day, you have to work harder to be present,” says Slater, reflecting on all the de-escalation and problem solving she must do. “That takes a toll. My mental health is a roller coaster.”

Many care providers are in this profession because they have similar nurturing mindsets, yet 80 percent have considered changing careers, according to a report published last year by the Canadian Centre for Caregiving Excellence (CCCE).

Across the country, PSWs, direct support professionals (DSPs) – who work with clients with disabilities – and other paid health-care attendants are feeling stressed, overworked, and underpaid. The labour pool consists largely of racialized women, many of whom are newcomers to Canada, and they face high rates of abuse and discrimination on the job.

Working in congregative living facilities and providing home care for a patchwork of public and private employers, the majority are essentially gig workers without benefits such as paid sick days or access to counselling.

Fewer than half of the PSWs surveyed by the joint University of Toronto and St. Michael’s Hospital-based Upstream Lab said their health was good or excellent, which is lower than the national average. More than 20 percent likely had some form of depressive disorder, the researchers concluded in a 2022 paper, “significantly exceeding the prevalence of major depressive episodes among Canadians.”

In a country with an aging population, this is a significant challenge. If we don’t take care of PSWs and other care providers, how can they be expected to look after our most vulnerable citizens?

Risky business 

More than 650 PSWs in the Greater Toronto Area responded to the Upstream Lab survey, which found that:

  • 97% are born outside Canada.
  • 86% are precariously employed.
  • 89% lacked paid sick days.
  • 90% are women.
  • Many are casual employees, with wages that range from $17 per hour in home or community care to $25 per hour in public long-term care facilities.

This snapshot is representative of care providers across the country, according to the Upstream Lab paper, and their precarity is “significantly associated with higher risk of depression.”

Health-care jobs in Canada have traditionally been secure, but over the last three decades, “disparities in pay and work conditions have grown between registered professionals (such as physicians, nurses) and other staff whose jobs are part-time, temporary, on contract and not unionized,” the researchers wrote. A national focus on discharging people from acute care and aging in place has ramped up the demand for PSWs, who now constitute about 10 percent of all health-care workers. This workforce grew relatively quickly, says Upstream Lab director Dr. Andrew Pinto, without much scrutiny or consideration of the consequences.

These poor working conditions can be detrimental to physical and mental health, says Dr. Pinto, who, in addition to his role as a public health specialist, is also a family physician. In a system that incentivizes “reducing costs” and “doing more with less,” he says that many PSWs fear reprisal from their employers if they raise concerns about problems on the job. Pinto knows this from his research, and from the PSW patients he sees as a physician. “They’re really dedicated to caring for others and take pride in their work,” he says, “but they’re not given the respect they deserve.”

Dr. Andrew Pinto

Dr. Andrew Pinto: Better working conditions lead to better health outcomes. Photo by: Upstream Lab

Despite economic and demographic pressures, Pinto believes this system can be reformed. Because it’s funded predominantly by the public, a collective push for “a basic set of rights” — living wages, paid sick days, access to health resources, opportunities to flag systemic issues — will improve conditions for care providers, whether they work for government or private employers. “The public doesn’t want gig workers looking after their loved ones,” says Pinto. “Better quality jobs will not only improve the health of PSWs, they will also improve care and health outcomes for all Canadians.”

To continue the campaign for policy reform, the Upstream Lab’s research project has spawned the Empower PSW Network, a coalition of care providers seeking to raise awareness and advocate for change. Slater, the network’s coordinator, says that foremost, PSWs need more structured support. “It’s not the work that’s the problem — it’s how we’re treated.”

The silent treatment

Liv Mendelsohn, executive director of the CCCE, knows PSWs who live in their cars because they can’t afford housing. She’s heard stories about the stress of rushing between nursing homes and private residences from PSWs who cobble together gigs. “We rely on them to provide really intimate care,” she says, “but we don’t do enough to support their health.” Moreover, because a care provider’s permission to be in Canada can be tied to a particular employer, they often remain silent when facing discrimination or exploitative situations.

The CCCE has called on the federal government to implement a $25 per hour minimum wage for all PSWs. Mendelsohn also emphasizes the need for consistent benefits to prevent burnout and reduce the number of PSWs migrating to jobs in acute care for more stability. Despite the scale of this transformation, she’s hopeful. “We can’t not improve things,” she says. “There’s no way our system can continue without better support for PSWs.

“We don’t just need bodies,” adds Mendelsohn, envisioning a new era in which, for example, a senior with dementia is cared for by the same provider every day, improving their quality of life. “We need skilled, compassionate people and we need to acknowledge that they’re a critical part of our health-care system.”

In a different world, Kezia (last name withheld to protect her employment prospects) could have been one of those providers. Born in India and raised in the Bahamas, she moved to Prince Edward Island for university and supported herself by working as a DSP and PSW. Kezia assisted with ADL, cooked, cleaned, and accompanied clients to day programs and medical appointments. The learning curve was steep, but with supportive co-workers, she got into a groove. “We tried to foster a feeling of being at home,” she says. “After a while, it felt like a calling.”

But Kezia, who was in her early 20s at the time, also experienced racism and inappropriate sexual comments. Telling her manager about problems “was like hitting into a wall.” She felt unappreciated by her employers, even after working a 16-hour shift. If she missed a shift, she didn’t get paid, which meant she might not have enough money for rent or groceries. Exhausted, she was neglecting her own health. After three years, Kezia left the profession.

“If we were treated better, I might have stayed,” she says. “PSWs are the backbone of our health-care system, but I can never go back to working in the that field.” Instead, Kezia is going to school again. She’s studying to become a nurse.

Further reading: Mental Health at Work: It Matters: How to Start the Conversation.

Learn more: Caregiver resources from the Canadian Centre for Caregiving Excellence (CCCE).  

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The Therapeutic Power of Blue Space https://mentalhealthcommission.ca/catalyst/the-therapeutic-power-of-blue-space/ Tue, 18 Feb 2025 16:06:00 +0000 https://mentalhealthcommission.ca/?post_type=catalyst&p=79864 How spending time in, on, or around water can reduce stress, encourage physical activity, and kindle social engagement.

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In 2009, experienced kayakers Zac Crouse and Corey Morris were descending a rain-swollen river in Nova Scotia when Morris was swept over a waterfall and died. At the time, the men were planning a kayak expedition from Ontario to the Atlantic Ocean. Traumatized by the death of his close friend, Crouse entered therapy and began taking medication, and two years later, he embarked on a 1,500-kilometre solo journey as part of his healing.

“At a basic level, it was a physical challenge, but there were also higher-level cognitive things happening,” says Crouse, who used to work as a recreational therapist and now teaches rec therapy in a university program. “You get into a trance-like state after so many hours of paddling. Your brain is seeing patterns on the water that don’t easily fall into slots and boxes. You’ve also got the sounds and feel of the wind. There’s a calming effect,” he says.

“The repetitive motion, the exertion, all the little things you have to pay attention to in order to make progress — those create a sense of flow,” Crouse adds. “And the problems you’re solving are very basic and immediate, not future vague ones.”

Crouse’s trip provided a break from rumination and regret. It helped him recover. And although people experience and respond to trauma in different ways, his journey exemplifies the curative potential of “blue space.”

Zac Crouse.

Zac Crouse teaches recreational therapy. He took a long kayak journey to help with healing after the death of his close friend, Corey Morris.

Second nature

The benefits of hanging out in nature are well-documented: lower blood pressure and stress-hormone levels, less anxiety, more self-esteem. Now, a growing body of research suggests that spending time in, on, or near water can have a more positive impact on our health than other outdoor settings. A 2022 paper, published by a pair of University of California, Davis psychology researchers, for example, concluded that even looking at a creek or pool is enough to lower blood pressure, improve heart rates, and increase relaxation among respondents, a result they attribute, in part, to the evolutionary link between successfully detecting drinking water in arid environments and stress reduction.

Aquatic environments can also be hazardous, of course. Drowning is the third-leading cause of unintentional injury death around the world, according to the U.S. Centers for Disease Control and Prevention. Flooding is among the deadliest consequences of climate change, and it tends to displace or kill those with the least capacity to escape or adapt. Yet, as a species, we have a deep-rooted biopsychological bond to this molecular combination with two parts hydrogen, one part oxygen. Over the past decade or so, researchers have begun to deconstruct the affinity we feel for water, and they are exploring how integrating blue space into our communities and lives could pay tremendous dividends.

According to environmental psychologist Jenny Roe, director of the University of Virginia’s Center for Design and Health, blue space has four triggers that activate the human parasympathetic nervous system, a network of nerves that relaxes our bodies following stressful or dangerous experiences.

First, water instills a sense of being away. It can be either tranquil or dynamic, conditions that can make you introspective or dialed in to your surroundings, both of which serve as escapes from habitual behaviour.

Second, blue space – especially large bodies of water – conjures a feeling of “extent,” of being in a boundless environment where possibilities feel limitless. Although one can also experience these glimpses of an infinite existence while, say, hiking up a mountain, they’re amplified in blue space by acts like looking to the horizon or into the depths of a lake.

Third, the sounds and sights of water — as it runs over rocks, for example, or dances in the sunlight — can spark “hard fascination,” a concentration of our focus through stimulation, and “soft fascination,” an unconscious partial capturing of our attention that requires little effort and frees the mind to roam. Both can contribute to restoration. And fourth, water confers a sense of compatibility with our location; of comfort and belonging.

Dan Rubinstein

Author and stand-up paddleboarder Dan Rubinstein departing from Ottawa in June 2023 at the beginning of a 2,000-kilometre journey to explore the curative potential of blue space — an expedition that formed the basis of his upcoming book, Water Borne. Photo: Lisa Gregoire.

Flow states

Another environmental psychologist, Mat White at the University of Vienna, is arguably the world’s leading authority on blue space. He studies what happens when we do anything (paddle, swim, surf, walk, sit) around any type of water, from vast oceans to urban fountains. After leading several research projects and crunching some big numbers, White has concluded that these environments provide a boost by offering increased opportunities for both stress reduction and physical activity.

For one paper, White analyzed a UK census of approximately 48 million adults and found that the closer people live to the coast, the healthier and happier they are. “The crucial point about that research was that it was the poorest communities and individuals who got the benefits,” he says, referring to both mental and physical health. “If you’re rich, it doesn’t matter how often you spend time in blue space. You’re healthy and happy anyway. But if you’re poor, it matters hugely.”

The idea that a place with specific environmental attributes can reduce socioeconomic health inequalities is called equigenesis. Rich Mitchell, a population health researcher at the University of Glasgow, coined the word after publishing a paper that suggested income-related health disparities were less pronounced in neighbourhoods with better access to nature.

The quality of blue spaces affects their therapeutic properties, according to White, as does how we interact with them. Those variables are influenced by geography as well as cognitive and cultural differences. For example, people often prefer places they visited as children, and there are dramatic differences between walking and sitting, and different outcomes depending on how close we live to a blue space and how frequently we visit. But on the whole, when we’re near water, we tend to lose track of time and be more active, and every extra minute of movement is good for our health. “The goodness isn’t just the water,” says White, explaining that people tend to enjoy quality time with one another at places like beaches because of the sense of belonging they feel. “It’s a behavioural interaction that water encourages. This is one of the reasons we think blue spaces tackle health inequalities. They’re social spaces that draw us into cross-generational play.”

New depths

The kicker to all of this, the multiplier of multipliers, is that time spent in blue space, especially by children, promotes pro-environmental behaviour, which is another way of saying “taking better care of the planet.”

One of White’s frequent collaborators, British landscape architect Simon Bell, came up with the term “blue acupuncture” — basically, adding a splash of blue space to a community to help improve public health. For example, a recent project in a low-income neighbourhood in Plymouth in southwest England transformed a small neglected beach into a launch for personal watercraft, swimming area, and park with views of the harbour. The cost was around $150,000 USD and surveys assessed the well-being of area residents before, during, and after construction. Psychological health increased, as did perceptions of community cohesion. Families played in the park, seniors sat on benches, and teenagers took forays into the sea.

What does all this have to do with Zac Crouse’s kayak journey? The common denominator is water. Paddling all day helped Crouse’s brain “catch up to reality,” he says, supplanting a traumatic experience with new memories. But even if one’s connection to blue space is more subtle — a picnic beside a pond, a sunset stroll along a river — it can provide a restorative break from the tensions of daily life. These benefits are not a panacea, but because they “apply to millions of people,” says White, “the overall public health benefit is huge.”

Adapted from Water Borne: A 1,200-Mile Paddleboarding Pilgrimage by Dan Rubinstein, forthcoming in June 2025 from ECW Press.

Further reading: Good Grief: Is there a right way to grieve—and for how long?

Resource: Where to Get Care – A Guide to Navigating Public and Private Mental Health Services in Canada.

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Off You Go https://mentalhealthcommission.ca/catalyst/off-you-go/ Tue, 23 Aug 2022 17:19:39 +0000 https://mentalhealthcommission.ca/?post_type=catalyst&p=47899 One of the main ironies of parenting is that your job is to make yourself irrelevant. Babies are born, children are nurtured and grow up, and then one day — eventually — most are independent enough to move out of the family home.

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Navigating the transition from full house to empty nest

One of the main ironies of parenting is that your job is to make yourself irrelevant. Babies are born, children are nurtured and grow up, and then one day — eventually — most are independent enough to move out of the family home.

At least that was a typical trajectory in Canada. These days, the transition isn’t always so linear. Economic challenges such as the high cost of housing and precarious employment, as well as socio-demographic shifts like the need for more post-secondary education, mean so-called “boomerang” kids leave and then return, sometimes repeatedly.

For the parents who are left behind, whether temporarily or forever, this passage into the next phase of life can be difficult to navigate. Yet, as a parent, it also represents an opportunity to renew relationships with yourself, your partner, your friends, and your family, including the child or children who are making the leap into their adult lives.

My wife and I are on the cusp of this change: Our twin daughters will be starting university this fall. To help prepare for this double departure, Lisa and I are spending a lot of time talking to friends, neighbours, and colleagues whose children have already left or are about to leave home.

One friend told us that her kids moving out changed her life more profoundly than when they were born. Another, whose father-in-law moved in after his daughters went to university, talked about the sense of flux in his household, with caring for aging parents also affecting the configuration of his nest. My own mother cautioned me that our house might feel like a train station for a while: you won’t know who’s coming or going, or how long they’ll stay.

Next station
Although the range of reactions and circumstances varies greatly, as a whole what people told us reflects research findings and advice from mental health professionals. For Simon Fraser University gerontology and sociology professor Barbara Mitchell, the “stereotype of the empty nest syndrome has largely been debunked as a cultural myth.” She takes a matter-of-fact view of this and other major changes in life. That is, to approach the empty nest phase as one of many junctions in a fluid existence while staying mindful and ready for whatever might follow.

Mountain biking in Charlevoix

Mountain biking in Charlevoix, Quebec: The author with Daisy, Lisa Gregoire, and Maggie. Transitioning from full house to empty nest is an opportunity to renew relationships with yourself, your partner, your friends, and your family, including the children who are making the leap into their adult lives

“Most parents actually find it to be a positive experience,” Mitchell says. “They’ve done their job and are now free from day-to-day responsibilities. They’ve established roots for their children — and wings — so they can become autonomous adults.”

Despite that general trend, if rooted in a traditional mom-as-homemaker role, some women feel a strong sense of loss when the kids leave, as of course do some men. While this sadness and disorientation (commonly called “empty nest syndrome”) are often short-term, she points out that about 20 per cent of parents struggle with it, and in extreme cases it can require intervention.

Mitchell, who has been researching family transitions since she was a graduate student in the mid-1980s and is perhaps the only academic in Canada with this expertise, notes that the empty nest is a relatively recent phenomenon in North America. Historically, at least one child regularly stayed with aging parents, especially in rural areas. But as our population became more urban, as life expectancies rose, and as the affluent middle class boomed after the Second World War, mothers and fathers increasingly found themselves alone in their later years.

Of course, parents from what she describes as “collectivist cultural groups” often have entirely different experiences, such as remaining within a multi-generational household or viewing the departure of a child for education or marriage as a sign of success. “The context of the family environment is important,” says Mitchell. “There are many potential complexities.”

Among these complexities are compounding stressors like health issues or retirement, which can exacerbate negative emotions.

Mental health and wellness in Canada is in fact influenced by numerous factors, including life experience, workplace, and family environments, and social and economic conditions that fundamentally impact our well-being.

Edmonton psychologist Loriann Quinlan, who specializes in treating adults with anxiety and has helped clients with empty nest syndrome and other life transitions, knows that every individual and family experiences this change differently. And since it can be accompanied by a range of emotions, from sadness and grief to excitement and joy, she advises clients to approach the process without judgment, to sit with any discomfort, and to engage in self-care.

Taking the time to become better acquainted with yourself, your partner, and others in your circle can be healthy, she says, because as parents we invest a tremendous amount of time and energy into relationships with our children. No wonder we’re knocked adrift and feel empty when such a critical part of our identity — for so many years — is no longer clearly defined.

As parents, we invest a tremendous amount of time and energy into relationships with our children. No wonder we’re knocked adrift and feel empty when such a critical part of our identity — for so many years — is no longer clearly defined. —

Making the shift
This transition also offers a chance to appreciate the perspectives of the young adults who are leaving and taking steps toward independence.

“It’s an amazing opportunity for parents and kids to see each other through a new lens,” Quinlan says, “and to shift the dynamic and hopefully connect on a deeper level.”

To get there, she recommends keeping the lines of communication open. Talking about thoughts and fears helps us understand where other people are coming from. Not shying away from conversations about well-being also helps us know when it’s time to reach out for support. That could simply be a chat with a friend or connecting with a more formal mental health resource.

While the internet is making that access a little easier, rapidly advancing communication technologies and other recent phenomena, such as the pandemic and the tight housing market, are also influencing how parents deal with the departure of their children, notes Mitchell, who wants to do more research on the impact of these “overlapping factors.”

On one hand, young adults are stepping into an increasingly uncertain world; on the other, you can make a video call with them no matter where they are. At least in theory.

My friend Eleanor Fast, who will be seeing her younger son off to university when my girls leave next fall, confesses to “stalking” her older son online while he’s been away at college in the U.S. for the past two years. He doesn’t always respond to her texts, and it can be difficult to schedule video calls, so she checks his Instagram feed — “for proof of life” — and looks to see if he’s posted any recent running routes on the exercise app Strava.

“The world may be more difficult than it was when I was 18 and left home,” says Fast, “but kids still need to get out there. They’ve been isolated for the past couple years because of the pandemic and have missed a lot of living.”

COVID was Fast’s biggest concern when her son left home — she was worried he would be lonely doing online classes while confined to a dorm room — but turns out he was fine. And although she and her husband truly enjoyed having a full house, they found it really nice when there was just one kid to focus on. They’re already planning activities they can do as a couple, such as taking long-distance bicycle trips together.

“I love my kids and love being with them,” says Fast, “but I want them to have their own lives, and making plans for the future helps counteract the sadness of them leaving.”

That sums up the mindset Lisa and I have as we reflect on the past and prepare for our next chapter. One of our daughters will be moving several provinces away in a couple months, and even though the other will be going to university in the city where we live, and recently decided to stay at home instead of residence in first year, we’re conscious of the fact that this is simply a new rhythm to experience.

Our children are no longer children. They — and we — are both excited and nervous about the journey ahead. And like many times over the past 18 years, we can learn a lot from them.

Author: is the author of Born to Walk: The Transformative Power of a Pedestrian Act and contributes to The Walrus and the Globe and Mail.
Photo main: Maggie Rubinstein riding behind her sister Daisy Rubinstein on their parents’ tandem bike, which they received as a wedding gift 20 years ago.

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