Mental Health

The World Health Organization (WHO) defines Mental Health as

“A state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community.”^[1]

The Mental Health Continuum Model in Figure 2.1 illustrates different behaviors that individuals may manifest as they move back and forth along the continuum. Do you notice any similarities to the behaviors depicted in the Stress model in the previous chapter?

Since March 2020, the COVID-19 pandemic has impacted the life of everyone in the world. The mental health of Canadians was hard-hit by the pandemic. The most recent statistics available from Statistics Canada state that “during the period from April to June 2021, one-quarter of Canadians reported experiencing high levels of stress most days, and nearly half of Canadians considered that their stress levels were worse than prior to the pandemic”.^[2] Does this fit your experience with yourself or what you have witnessed in those around you?

Broken down into age groups, “Canadians aged 35 to 44 (36%) were the most likely to indicate that they found most days quite stressful or extremely stressful, followed by those aged 45 to 54 (30%) and those aged 25 to 34 (29%)”.^[3] This indicates that 25-54 year olds appeared to feel the stress of the pandemic more acutely. In fact, 77% of Canadian adults reported negative emotions such as being ‘worried or anxious,’ ‘bored,’ ‘stressed,’ ‘lonely or isolated’ and ‘sad’ as a result of the COVID-19 pandemic.^[4] Suicidal thoughts and feelings in the general population have elevated to and remained at 8% since the pandemic began- a marked increase from the previous stable 2.5% statistics from 2016.^[5] This is alarming!

Globally, the World Health Organization (WHO) found that since the beginning of the pandemic, global prevalence of a decrease in mental health, specifically anxiety and depression, increased by 25%, reflecting the Canadian average. ^[6]These are startling percentages that indicate an acutely urgent need for more mental health resources.

Are you stressed?

Some days are better than others. That’s a normal part of life. However, it’s also important to “check in” with your emotions every so often to keep yourself as mentally and emotionally well as possible. Self-awareness is key for ensuring overall good health.

Sometimes, it’s hard to know if it’s stress or anxiety affecting you. While both stress and anxiety cause physical and mental symptoms, generally stress is a response to an external cause, and it goes away once the situation is resolved. Anxiety, on the other hand, is generally an internal reaction to stressors. It usually involves a persistent feeling of dread or apprehension that doesn’t go away, and that interferes with how you live your life. Figure 2.2 illustrates some differences and similarities between stress and anxiety.

While anxiety is generally characterized as undue worry and unwarranted fear, depression usually involves a deep sense of sadness and hopelessness. Depression can have overlapping symptoms with anxiety, yet there are significant differences between the two disorders.

Anxiety and depression are umbrella terms that cover various mental health disorders. Anxiety, for example, can include conditions such as generalized anxiety disorder, phobias, and panic disorders. Depression can include various disorders such as major depressive disorder, seasonal affective disorder, and post-partum depression, to name a few. Many people experience anxiety and depression concurrently. In fact, nearly 50% of people with depression are also diagnosed with anxiety.^[7]

According to a January 2022 survey completed by the Centre for Addiction and Mental Health (CAMH), approximately 25.1% of Canadians currently reported feeling moderate to severe anxiety, with 24.1% reporting feelings of loneliness and 22.3% disclosing feelings of depression.^[8] Of note, “those between 18 and 39 years old reported the highest levels of moderate to severe anxiety, loneliness, and feelings of depression of any age group (33.5 per cent for anxiety, 29.1 per cent for loneliness and 27.7 per cent for feelings of depression).”^[9] All of these percentages rose about 6% compared to the last survey done in July 2021, indicating a worsening of mental health as time goes on. Also of concern was 24% of Canadians stating they were unable to access mental health care help.^[10]

These percentages are in severe contrast to a Statistics Canada study that analyzed Canadian mental health statistics between 2000 and 2016. Their findings illustrated that the prevalence of reported depression and anxiety remained stable during those 16 years, with depressive disorder approximately 5.4%, and anxiety disorder 4.6%.^[11] I’ll do the math for you – that is currently a 23% increase in depression and a 28.9% increase in anxiety during these pandemic years.

Despite these alarming percentages of people who participated in a survey disclosing they have or have had mental health issues, in reality, many are not so keen to speak up about it. While awareness and understanding of mental health may be on the rise, stigma continues to be an issue for many people. There are multiple reasons for this. Discomfort or avoidance in admitting there’s a problem. Embarrassment in asking for help. Shame. Aversion against “shrinks”.

There needs to be a shift in attitudes and behaviors where talking about your mental health is as natural as saying you have a headache.

Because mental health is as important as physical health, and it’s nothing to be ashamed of.

How many times have you automatically asked someone “How are you?” and their automatic reply is “Good, you?” Would it make you uncomfortable if they said “Not great, really. I’m feeling down today”? Is that more of an answer than you were looking for, thinking “Ugh, I was just being polite”? Or can you look at this as an opportunity to really listen to what someone has to say, giving them an outlet and perhaps making a world of difference in their life?  And reciprocally, what would it take for you to be honest when asked the question “How are you?” You are hereby challenged to give this a try – the results might surprise you.

Mental Health First Aid

Barriers to accessing mental health care in Canada are mainly due to not knowing where to get help, an inability to pay for services, excessive wait times, scarcity of available mental health professionals, insufficient government funding, and lack of access due to geography (rural) or demographics (youth or Indigenous populations).^[12]

The Canadian Federal government, along with Provincial/Territorial governments recognized the need to attend to increased mental health demands for Canadians, so in 2017 they formed an agreement called the Common Statement of Principle on Shared Health Priorities.^[13] This agreement conceptualizes interventions to increase mental health access for Canadians, including increasing access to community-based mental health and addiction services for children and youth (age 10-25) and those with complex health needs.^[14]They recognize that preventative measures and early interventions can reduce the burden on the health care system overall.

Canadian mental health services have recognized the need for E-mental health access, and such programs are becoming increasingly available. Federal mental health programs vary as do the resources available across the provinces and in communities. Here are a few specific to Canada and British Columbia.

The LifeLine Canada Foundation is a non-profit that focuses on suicide prevention by cultivating knowledge about risk factors, offering access to online resources and developing local support programs. The site also has an app with a plethora of information and guidance including e-counselling, text and chat functions, and self-management tools.

The HeretoHelp.bc.ca website features mental health and substance use information, including personal stories, magazine articles, information sheets, workbooks, screening self-tests, and help by email to find community resources.

Further, HereToHelp has a series of 11 Wellness Modules that support well-being. The modules are as follows:

• Mental Health Matters
• Stress and Well-Being
• Social Support
• Problem-Solving
• Anger Management
• Getting a Good Night’s Sleep
• Eating and Living Well
• Healthy Thinking
• Finding Balance
• Staying Mentally Healthy with Technology
• Mindfulness

The Network for Aboriginal Mental Health Research offers a database that is intended to help Indigenous people support their mental health, together with suicide prevention groups, groups specific to youth, and addiction services.

The Peer Support Canada program unites people with someone who has had a similar mental health experience to provide one-on-one guidance and support.

Knowing where to find access to mental health professionals and mental health support is imperative. The online resource Psychology Today has a vast directory of therapists, treatment centres, and support groups. Individuals are able to filter their search by a number of different variables to customize their results. The website also contains a plethora of informative articles in a variety of topics.

Anxiety Canada is an online resource for those with anxiety disorders, and it also created the app MindShift to keep anxiety-coping tools at your fingertips. They also offer an anxiety management program based on cognitive-behavioural therapy (CBT) called My Anxiety Plan (MAP).

While social media definitely has its cons – especially in the area of negatively impacting mental health – some mental health initiatives via social hashtags promotes open discussions and helps normalize the conversation by connecting people with others struggling with similar issues. Some examples include:  #EndtheStigma, and #BellLetsTalk.

BounceBack is a free online or phone-based skill-building program designed to help adults and youth aged 13 manage low mood, mild to moderate depression, anxiety, stress or worry.

Living Life to The Full is an interactive course to help a person understand their thoughts and feelings, and that provides practical skills for coping with stress, problem solving, and mood issues.

eMentalHealth has a variety of resources including info sheets, screening tools, and news about mental health.

Centre for Addiction and Mental Health is all things mental health related, including extensive health information, research, and education.

Crisis Intervention and Suicide Prevention Centre provides confidential, non-judgmental, free emotional
support for people experiencing feelings of distress or despair, including thoughts of suicide. Call toll-free 1 800 SUICIDE (784-2433), or visit the website.