Today a major Canadian telecommunications company is promoting the discussion of mental health in Canada with a campaign with the slogan “Let’s Talk.” On one level this is a good idea. We do not, generally speaking, have good, healthy discussions about mental health and mental health care. There is still significant stigma attached to having mental health problems or diagnosed mental illnesses. With its build up in the days and weeks leading up to it this campaign does allow for discussions to start. It may play an important role in helping people to reach out and seek care. That said, what happens after the day is over?
This company does help fund mental health programming such as mental health drop ins. These programs fill an important role in mental health. At the same time we need to go beyond what one company is willing and/or able to do. In Canada we have a single payer health care system for physical health. This system, however does have gaps and mental health is one of them. In order to access mental health care from anyone other than a doctor or psychiatrist one must pay out of pocket or have insurance. There are some agencies that have subsidised counselling and therapy services, but they are limited in what they provide. Moving forward we must talk about making mental health care financially accessible.
If one has coverage for mental health the type of care is often seen as something that has to be finite. It is expected that one will go to a therapist for a set time frame, engage in Cognitive Behavioural Therapy (CBT), and then be ‘cured’ and not need further therapy. While CBT is effective for many people there are a significant number of people for whom it does not work. People may be struggling with mental health problems for which CBT is not the appropriate method for managing the problem. When one needs ongoing therapy or counselling one is often left to fend for themselves because of restrictions on the number of visits. We need to have multiple forms of therapy available in order to help the most people. We need to continue to talk about ongoing mental health care.
For trans people seeking mental health care is often difficult and challenging. Many trans people have been harmed by mental health providers. They may have been subjected to reparative therapy that aims to make them comfortable with their birth assigned sex and gender. They may have faced gatekeepers who have said that they are not really trans because they don’t meet the provider’s view of what being trans means. Some trans people have had providers who have told them they would not be allowed to access care unless they were transitioning and has an end-point defined by the provider. Being trans means that providers may say to a trans person seeking non-transition related care that they don’t have experience working with trans people. Then there are situations in which a trans person has mental health problems that are not transition related.
When transitioning and seeking care the WPATH Standards of Care state that significant mental health issues must be well managed or reasonably well managed in order to access medical transition, namely surgery and hormones (Appendix C of the SOC has a summary of the guidelines). How this is defined is often determined by the provider and they decide if the person meets the threshold. That said, the provider and the person seeking medical transition must work together to determine where the person is at and if they are ready for HRT or surgery. The question should not be one of saying yes or no to the treatment, but how to ensure that the person has the best results possible for them. Yet many, if not most, trans people do not trust the providers. We need to talk about trans people’s mental health and how providers can ensure that trans people are heard and their needs met.
Talking about mental health care needs to be sensitive to the needs of everyone who has had mental health problems or been treated for mental illness. For many the experience of being treated for mental illness has not been a good one. Providers may have treated them poorly. They may have significant trauma that was inflicted by providers. They may have been forced into treatment because they were deemed to be a threat to themselves or others. They may still be struggling and unable to talk about it to anyone. They may find the whole discussion upsetting or triggering memories of their own mental health experiences. We must talk about how to care for people properly when the discussion itself is causing distress.
Yes, let’s talk about mental health care today. Let’s talk about mental health tomorrow. Let’s talk about it next week, next month, and throughout the year. Today is a good start. Let us continue this discussion and seek to improve mental health care so that it is accessible to, and as safe as possible for those who need it.