mental illness, suicidal ideation, and the canadian mental health care system
“the disease [depression] is now too expensive.”
It seems that May is the month of mental health awareness within Canada – I’m not sure if it is in other countries as well – so I thought it would be the perfect time to chat about the idea of awareness versus action. Because I don’t know if you’ve also noticed this, but rates of mental illness and suicidal ideation have skyrocketed and continue to do so, and although we talk about it, nothing seems to be getting done.
I’m not saying the awareness is not a good thing, I just think it’s time we do something more besides talking about it.
Anna Mehler Paperny is a reporter and writer who wrote a memoir entitled, Hello, I want to Die Please Fix Me. Paperny’s writing combines an auto-ethnographic approach with data-based research but specifically reveals her lived experience of mental illness, suicidal ideation, and treatment within Canada’s psychiatric care system.
A line from the book that struck me is: “The relief I feel from being able to tell people” (Paperny 302).
It’s difficult to tell people about your pain, but it’s overbearing not to. And honestly, that is what drives me towards autotheory: it gives me a way to tell people on my own terms. And perhaps that is the reason for creating this blog.
In Paperny’s memoir, she explains that your family doctor is supposed to be the first point of contact for depression, so it’s important that they know how to diagnose and treat mental illness. Except there’s actually no financial incentive for them, as they are paid on a ‘pay-per-see’ basis: the more patients they see, the more money they get. And it’s much easier to deal with a runny nose than attempt psychotherapy. But let’s give the physicians the benefit of the doubt, for the ones out there that actually do empathize, because they are out there: physicians aren’t even set up to provide the particular treatment needed to help you with mental illness.
Psychotherapy is just not a part of their training (Paperny 189).
So, why are they considered to be the ‘first point of contact’? And if you can’t send someone who is suffering to a doctor, you should be able to at least send them to the hospital right? Well, apparently not, as all hospitals can do is ask the patient “are you suicidal?” and if they say no, and there’s no sign, they have to let them go.
Patients just lie to the doctors (and I know this because I’ve done it), and because there is no help for them, there have been so many reports of people committing suicide, not even more than 24 hours after they’ve been released from the hospital—at least three alone just in the Lower Mainland of British Columbia in 2015: Brian David Geisheimer, Sarah Louise Charles, and Sebastian Pavit Abdi (Paperny 220).
But on top of all of this, there’s also the issue of trust. As Paperny notes in her memoir:
“You can have an awful doctor in any sphere and it can fuck with your trust for life. Surgery sucks. Intubation is awful. Chemotherapy is harrowing. But why is mental illness the only sphere of medicine characterized by a deep mistrust of caregivers and caregivers’ profession? Cancer foundations are multi-billion-dollar industries yet it’s depression—the world’s leading cause of years lost to disability, which boasts no ice-bucket-challenge or money-making marathons, which gets fewer public dollars, and whose practitioners make less than the average medical specialist—that’s derided as a marketing-driven capitalist fiction.” (Paperny 284)
In 2018, I was enrolled in a program called Bounce Back Canada, as my doctor declared me to be “passive suicidal”.
This is the day I learned that there are two different kinds of suicidal ideation: active and passive. My doctor explained the difference to me as: Active means you have a plan. Passive means you don’t have a plan and you are not planning on coming up with a plan, but if you got hit by a bus and died on your way home, you wouldn’t mind.
And just in case you haven’t heard of it (not many people have), Bounce Back is described as a free skill-building program managed by the Canadian Mental Health Association (CMHA). According to their website, Bounce Back is designed to help adults and youth 15+ manage low mood, mild to moderate depression and anxiety, stress or worry. Delivered over the phone with a coach and through online videos, patients are given access to tools intended to support them on their path to mental wellness.
At first glance, it sounds like an incredible program.
My Bounce Back program involved six phone calls with my assigned coach that had to be completed within the span of six months. In short, my coach would call me every two to three weeks to make sure I didn’t have a plan to kill myself (i.e., gone from passive suicidal to active). I noticed I would lie to my coach. Not because I wanted to but because I didn’t know how to tell her the truth.
… Why six phone calls in six months? I have no idea, but it doesn’t seem like a lot of time to even gain trust from someone, let alone, gain the courage to tell them you hope to not wake up in the morning.
I mean, even with all my medication, it can still take me years to trust someone, and I’m expected to tell a stranger that I want to die right when I first meet them? On a phone call that’s being recorded?
… I know I’m writing all of this in a blog that strangers are probably going to read, but for some reason this feels different. I don’t feel like I am being examined. I feel like I’m telling my story. On my own terms.
About a year after I had finished the program, I reached out and asked for my medical records. I can’t remember why I did this after so long. I think it had to do with advice from my mentor during my MFA.
An incredibly fabulous mentor I might add.
The page amongst my medical records that struck me the most, was the one that states, ‘Kaitlyn did not endorse suicidality.’ This made me angry at first, and then frustrated. My medical records were not mine. They were not written for me. They were written the way one would write a scientific report after doing an experiment. This one specific sentence hit me hard, with its lack of empathy and academic language.
And I’m not entirely sure what I was expecting, but after telling a person your deepest feelings and fears, you expect a little more humanity.
Mental illnesses are diseases of the mind: emotional and thought-based diseases. So why are my medical records so emotionless? Why is there no empathy? Why do they hold so much power?
Paperny ends her memoir with this beautifully written, hopeful statement for the future of psychiatric medicine:
“For a society that’s gone so far in so many civil and scientific arenas, there are some things we still do astonishingly badly. Treating the most debilitating chronic illness out there is one of them. So let’s fix this goddammit, and move on to bitching about something else” (Paperny 307).
So, what would a medical document sound like if they were actually made for the patient?
Although my own experience with suicidal ideation involves me persisting as I ‘did not endorse suicidality’, many others have experienced a different story. This artwork uses my experience to showcase that although I am lucky enough to have risen up from it, many others have melted into it.
… still battling but winning so far.
I don’t know what the perfect answer would be. But what I do know is that we need a little bit more empathy when discussing mental illness, suicidal ideation, and the canadian mental health care system.
And a little bit more action.