Joanna Cheek: Mental health care is not available to those who need it most

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As our world collides and collapses around us, it’s no surprise that one in two of us will be diagnosed with a mental health disorder by the age of 40, with one in five people experiencing an active episode each year, according to the Mental Health Commission. Canada.

I am one of the people who struggle. You probably do too.

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Our discomfort and despair, our anxiety and anger, these are appropriate alarms for a world on fire. Because we need to feel deep anxiety when our world is threatened. Because right now it is. If mental health symptoms are the canary, then our coal mine is toxic.

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We live in a time of unrelenting crisis. About climate collapse and pandemics, injustice and conflict. Our alarms are constantly going off because we are relentlessly exposed to the mounting problems of our world that constantly assault us with toxic stress.

As a queer mom this week, I felt the appropriate pressure as I answered my children’s questions about why people across Canada are protesting the “harmful indoctrination” of children with the 2SLGTBQIA+ school curriculum. Demonstrators held signs saying that schools were “raising” children to be queer – which many shouted was a sin, evil and in need of eradication. Exposure to this type of toxic stress is the source of the skyrocketing number of mental health symptoms reported in 2SLGTBQIA+ youth and other groups facing discrimination.

But then the people who experience the most toxic stress experience the one-two punch of mental health inequity: Adversity and inequity create mental health symptoms and also limit access to mental health support because the current system is out of reach for these people. who need it most. This is why our mental health system, like schools, must have equity, diversity and inclusivity at the heart of every step of its implementation.

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Steve Cole, a professor of genomics at the University of California, Los Angeles, studies how social stress causes inflammation by affecting our gene expression. When we anticipate a threat, our distress prompts us to respond in life-saving ways, with our bodies primed for an increase in inflammation, preparing us to repair a potential wound from a terrifying creature with large teeth and sharp claws.

This stress system works well if what we’re fighting against is a one-off encounter with a saber-toothed tiger, Cole says, but not if the threat is the constant social stress we face in modern society. Our response to stress is not that specific; it is still stuck in the Stone Age because it is believed that the most useful response to all threats is to prepare the body to heal from injury.

But when our stress response is continually weakened, our body becomes stuck in a state of chronic inflammation. Research by Cole and many others shows that chronic stress increases our risk of inflammation-mediated diseases such as mental health conditions, cardiovascular disease, diabetes, Alzheimer’s disease, cancer and many other diseases.

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The pandemic has exposed incontrovertible evidence of the damaging inequalities we have observed for decades.

“Blacks, Native Americans, and people of color were overrepresented, their bodies subject to all kinds of inflammation, long before the SARS-CoV-3 virus took up residence in their lungs,” writes Rupa Marya, a physician and associate professor at the University of California, San Francisco and Raj Patel, a public health researcher at the University of Texas, in Inflamed: Deep Medicine and the Anatomy of Injustice.

“To wonder why some things settle in some bodies and not others is to start asking questions about power, injustice, and injustice,” they continue.

Then, COVID created what the Canadian Mental Health Association called an “echo pandemic” of mental health, with the people most affected being those who had already experienced the most injustices, such as women, LGBTQIA2S+ people, individuals with insufficient financial resources or employment. or housing insecurity, newcomers to Canada, racialized communities, aboriginal people, and people with disabilities.

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And yet, these people most in need of mental health services were unable to access them. Even before the pandemic, a Stats Canada survey showed that Canadians reported that mental health counseling was their most unmet need, and those in greatest need were the least likely to access it.

With the cost of mental health services a major barrier outside the public health system, 80 percent of people attempted to manage their mental health care needs within the publicly funded primary care system, the Mental Health Association reported. And yet we also have a primary care crisis, with more than half of British Columbians having difficulty or no access to a family doctor, the 2022 Angus Reid survey said.

Driven by the moral distress that we cannot serve those most in need in our current system, our team of doctors created the CBT (Cognitive Behavioral Therapy) Group Skills Program in Victoria in 2015 to fill a gap in public services by offering fair, affordable and timely evidence-based mental health treatment for early intervention at scale.

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With initial funding from the Shared Care Committee (a partnership between Doctors of BC and the Ministry of Health) and the Victoria Division of Family Practice, we developed an eight-week program to improve access to mental health services by seeing patients more effectively and efficiently in groups of 15, with all benefit from the destigmatization and promotion of group affiliation.

Because of its local success, the Shared Care Committee funded a provincial expansion of the project in 2020 to train more than 100 physicians across the province to offer these groups in person and virtually. These groups provide patients with the best evidence-based strategies that draw from Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, Acceptance and Mindfulness Therapy.

But we soon realized that even the evidence-based practices we drew from required updates to ensure our program focused on equity, diversity, and inclusion.

With funding from the Shared Care Committee and the Vancouver Division of Family Practice, we consulted with diverse voices, including people who identify as Indigenous, 2SLGTBQIA+, neurodiverse, disabled, and diverse cultural identities, to improve the safety and accessibility of our program. We also trained our facilitators with workshops on anti-oppression and racism, gender inclusiveness and trauma care.

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We sought new facilitators who represented the diverse lived experiences of our participants and offered affinity groups for participants who felt more comfortable in groups with shared experiences, such as age- or gender-specific, 2SLGBTQIA+, people of color, and Indigenous identity groups.

The program offers a number of groups, all available to participants through a single referral from a primary care provider, as it is funded by the BC Medical Services Plan.

As well as our Foundations programme, there are Mindfulness, Insomnia, Raising Resilient Children groups to support parents and carers and the ADHD Skills for Success programme. With 397 different groups offered by doctors across the province this year, new participants can start attending with few hurdles and little or no wait time.

If we want to create a healthy society, all the doors of our system must be inclusive and accessible. And only when our world feels safe and just can our emergency alarms finally rest in good health.

Dr. Joanna Cheek is a psychiatrist, co-founder and medical co-lead of the CBT Skills Group (cbtskills.ca) and Clinical Associate Professor of Medicine at the University of British Columbia.

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