Just in case you have forgotten today: You matter. You are loved.

You are worthy. You are magical.

Elyse Santilli.

Written by: Annamarie Fuchs, Creator. Partners in Health | Conversations

When I was 21 and my brother Andy was 31, he committed suicide. In the days and weeks that followed, the shock and disbelief transformed into guilt and shame. We experienced tremendous guilt that we weren’t there for him and didn’t recognize that he was obviously suffering. Shame was associated with the fact that someone in our family had done something that to this day remains shrouded in stigma, mystery, and confusion. My parents spent years waiting for a suicide note that never arrived; they waited for some explanation that would help them to understand what had happened and why. But in their opinion one thing was certain; mental health or mental illness was NOT the cause of Andy’s death. Accepting that would have simply been too much for them to bear. My own confusing and painful journey with the effects of survivor’s guilt continues to this day, some 39 years later.

In the past few weeks, I’ve had many conversations with a woman whose adult son (we’ll call him John) has been experiencing profound and frightening symptoms of mental illness. He’s a married father of two with well managed bipolar disease that was diagnosed years ago. However, just recently he began hearing voices, many of whom are telling him to end his life so that he can do what he calls ‘a reset.’ These voices have also convinced him that he’s lived several lives already, so death is not seen to be an end but an opportunity to start over – to enjoy a reset so to speak. His family are naturally terrified. There appears to be no way to reason with him and no urgent or emergent services available to him unless he reaches out for help on his own. There’s just one problem; many people with serious mental illness do not recognize they are ill and as a result, generally do not reach out for help. This is Mental Health week in Canada. Let’s explore the issue and what we know about mental health and illness in Canada, particularly in context to the COVID-19 crisis and John’s situation. What can we do to cope and how might we help others?

Let’s start with what John’s family has accomplished or attempted so far. My first question to his mother was to ask whether they had taken him to the local emergency department. They indeed had convinced him to go to the ED but because of the restrictions associated with COVID-19, his wife who would have been his advocate and a valuable source of information about his illness, wasn’t allowed to join him. Consequently, after several hours in the emergency department, John was able to convince the physician and the staff that he was competent and not at risk of suicide. He was discharged home in the early hours of the following morning. On a side note, never ever think that advocacy doesn’t save lives. Everyone should have access to an advocate when navigating the health system. Everyone.

Since that visit to the ED, he refuses to seek treatment of any kind and his family are understandably on a rollercoaster of emotions ranging from feeling overwhelmed, traumatized, and frightened, to uncertainty and with occasional glimmers of hope when John is relaxed and calm. They’ve been told that unless and until John does something that demonstrates he is a danger to himself or others, there’s nothing anyone can do to intervene.

Despite having been part of the health system for 35 years, I was honestly shocked at the lack of options available or the actions the family has been able to initiate on John’s behalf. I’ve spent time over the past weeks tracking down any resources, supports, or hotlines I can find that might enable them to advocate for him.  While there are dozens of websites describing services and supports that appear to be available, gaining access to these services is far from being as straightforward (or affordable) as one might think.

When I lost my own brother to suicide in 1982, mental illness and mental health were highly stigmatized and rarely discussed in families, in churches, or virtually anywhere in society. However, since then things have begun to change. We have slowly been learning more about the importance of good mental health and the stigma and shame are beginning to decline. People are beginning to reach out for help and more importantly, they’re beginning to talk more openly about their own experiences with mental health and illness. But there’s one problem. Mental health services are very poorly funded and when people reach out, there’s at best a waiting list and at worst no affordable resources readily available at all.

In 2019 David Grauwiler, Alberta’s Executive Director for the Canadian Mental Health Association (CMHA) released a provincial election toolkit to support political candidates in their  discussions. In that toolkit, he explained the following:

Province wide, the Government of Alberta must acknowledge and act on chronic underfunding of mental health services in Alberta. Based on health-equity spending approaches, spending targets for mental health and addictions should approach 12 – 13% of the total health budget. However, in Alberta, an estimated 6% of the entire health budget is spent on mental health and addictions. There is some variability on how this number is calculated; however current spending by the Government of Alberta is not in line with other jurisdictions and must be increased.

The Government of Alberta must adopt a health-equity parity lens, placing mental health on the same standing of importance as physical health. Chronic underfunding of mental health care is creating an environment for a two-tiered system to emerge. (You’ll note that I mentioned earlier that access to some services for John is not affordable.)

The mental health of our population affects everyone’s quality of life. All Government of Alberta Ministries have a role to play, not just the Ministry of Health.[1]

Since Grauwiler released the toolkit, COVID-19 emerged as a devastating world-wide pandemic. Alongside the obvious physical and social devastation of death, longstanding chronic illness, and an overwhelmed health system, we are also seeing a rapid increase in reports of mental health challenges among citizens. So, it begs the question; if services to people with mental health needs were grossly underfunded before COVID-19, how can we expect that the right services and the right access will be available now? The simple and heartbreaking answer is that they simply are not. It’s clear to me that the services that John and so many others need are indeed not available and timely access can be incredibly challenging. Wait lists to see psychiatrists are completely unreasonable because demand simply outstrips capacity and it has for some time. When John was diagnosed with bipolar disease years ago, the wait list to see a psychiatrist in the community was reported to be up to one year.

Between April and May 2020 (a full year ago) the Canadian Mental Health Association surveyed Albertans across rural and urban areas. Out of the 1,740 people who took part in the survey, the following concerns were expressed in order of greatest to least concern with 29% of all respondents highlighting mental health challenges as a major concern. The first three themes were mentioned by at least 30% of respondents and the following themes were identified by all respondents.[2]

  • Isolation (42% of respondents reported that isolation is their top mental health concern)

  • Access to mental health support and services (33.4% of respondents)

  • Challenges to mental health (28.7% of respondents)

  • Anxiety (24.1% of respondents)

  • Economic concerns (21.8% of respondents)

  • Uncertainty about the future (20.7% of respondents)

  • Family and relationships (9.5% of respondents)

  • Education (8.9% of respondents)

Since this survey was completed, another year has passed. Alberta’s dubious distinction as having the worst COVID-19 rates (per capita) in North America, our overwhelmed health care system, and our weakened economy will all have undoubtedly served to strengthen reports of the concerns expressed here.

Another study done by IPSOS between February 8th and 10th this year for Global news[3] reported that 56% of Canadians are feeling stress or anxiety due to COVID-19. 63% of younger Canadians (aged 18 – 34) are feeling particularly anxious. In Alberta there’s been an 8% rise in people between November 2020 and February 2021 feeling lonely or isolated because of physical distancing measures. In March 2021, more data provided an updated understanding of the issues as follows[4]:

The proportion of Canadians at high risk (for mental health concerns) is up 8% since 2018 and now stands at a shocking 50%.

Canadians have increasingly been looking to medications to help them deal with mental health issues. This now stands at 30% which is up 9% since 2018.

Reports of people feeling so stressed that they have seriously considered suicide or self harm has been steadily rising (5% in April 2016 has risen to 9% as of March 2021).

By region, Alberta leads the country in ‘high risk mental health’ at 60% which means that 60% of people surveyed experienced at least 3 of the 4 items surveyed at least once in the past year, or experienced at least 1 of the items several times and 1 other at least once.

The influence of COVID-19 and the lack of adequate funding has also dominated another devastating healthcare crisis in Alberta and across the country that we’ll talk about in greater detail in a subsequent reflection. Deaths from opioid toxicity were falling before COVID-19 struck. Since then and since the first lockdowns experienced in March of last year, all progress was lost very quickly. Between April 1 to June 30, 1,646 fatalities were reported.[5]

What services are available and what can each of us do?

While there are services available for people with mental health challenges, mental illness, and/or addictions, there simply isn’t enough awareness or a sufficient number of resources available to ensure timely intervention and support for people like John or for those who are continuing to die from opioid overdoses. Alberta Health Services offers “Help in Tough Times” to individuals with stress related issues associated with COVID-19. Emergency help is available through an addiction helpline, mental health helpline, and others. Please see https://www.albertahealthservices.ca/amh/page16759.aspx for access to a detailed list of  resources. Further, Text4Hope https://www.albertahealthservices.ca/topics/Page17019.aspx  was recently launched where free daily text messages help people to identify and adjust to the negative thoughts, feelings, and behaviors that a pandemic might provoke. However, the lack of sufficient funding for mental health has provoked an almost indefensible human crisis, not only in Alberta but across the country and beyond.

So, what can each of us do to help ourselves and others in the meantime?

  1. Pay attention to your loved ones and to yourself. Watch for cues that a loved one might be struggling emotionally and reach out. Swallow your fear and ask, “how are you doing?”
  2. Ask loved ones; “how can I help?”
  3. Reach out for help for yourself if you’re experiencing any increased feelings of worry, fear, or hopelessness. You can’t help others if you’re struggling yourself.
  4. If you have a loved one like John with serious mental illness, don’t give up on them. Text or call them every day or more often. Don’t judge them or try to define their experience. Just let them know: “you are not alone, I love you, I care about you, I am willing to listen any time that you’re willing to talk…” And, try not to express shock at what you might hear. Unless you’re a mental health professional, you are simply not qualified to counsel, judge, or diagnose.
  5. And, if you are convinced that someone is urgently at risk of harming himself or others, call for help. Demand help. And keep demanding help until someone listens.
  6. Educate yourself about mental health and mental illness

When we lost Andy, none of us understood mental health or illness. We didn’t have the tools to recognize the signs that Andy was in trouble. Since then, many in our family have learned much more about how to recognize the signs of a mental health crisis. But it’s been a journey that continues to this day. It’s a journey of recovery, forgiveness (of ourselves), and acceptance. We are learning slowly over time to remember the Andy who lived and not the Andy who was so hopeless that he felt compelled to make that one really bad day his last day. My earnest prayer for John is that he will gain access to the care that he needs before he reaches an even greater crisis. And I hope that one day he will be a grandfather, sitting back and enjoying his family with a grateful heart, knowing that when he was at his most vulnerable, the system and the people who care deeply for him and others like him was available to him.

[1] Making Mental Health Matter in Alberta: 2019 Toolkit. https://alberta.cmha.ca/wp-content/uploads/2019/10/Making-Mental-Health-Matter-in-Alberta_ToolKit_2019.pdf

[2] https://alberta.cmha.ca/wp-content/uploads/2021/02/RMHP-Mental-Health-Impact-of-COVID-19-in-Alberta_8.5_11-1.pdf

[3] https://www.ipsos.com/en-ca/covid-continues-take-heavy-toll-canadians-mental-health

[4] Mental Health and the andndemic: An IPSOS Context Trends report for Canada. April 2021. https://www.ipsos.com/sites/default/files/ct/news/documents/2021-05/Mental_Health_and_the_Pandemic-Report-2021-05-05-v1.pdf

[5] Smith, A. Canada’s hidden crisis: How COVID-19 overshadowed the worst year on record for overdose deaths. The Calgary Herald, March 29, 2021. https://calgaryherald.com/news/postpandemic/canadas-hidden-crisis-how-covid-19-overshadowed-the-worst-year-on-record-for-overdose-deaths

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