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(De)constructing Barriers

Mental health has long been a taboo topic — best not mentioned in polite company — as people often suffer in silence; this stigmatization and isolation has had predictable effects; death by suicide, ideation, substance abuse, and other forms of self-harm. Like unwed mothers and consumption patients, those who have gotten mental health and/or addictions treatment, have traditionally gone away, often with family excuses of an unwell or elderly family member who needed care.

Society attached shame and culpability to certain illnesses, as though somehow the person is to be blamed for mental illness. Human rights evolved; late twentieth-century mental health reforms have moved treatment for mental illness and addiction out of institutional settings and into community best practicum based services, accessible when needed or on a continuum of care.

In the twenty first century, we have unveiled the vulnerability of humanity in the hopes that open conversations about human beings innate infallibility normalizes and destigmatizes living with mental illness including substance use disorders. Still, there seems to be a disconnected dichotomy in the perception of the general public as to what living with a mental health condition looks like; by unmasking the faces of mental illness, we see not all are marginalized, live in poverty, the archetypically “crazy” or “drunk” pontificating from a street corner; rather, most people are highly functional members of society.

Even as we deconstruct the wall of public misconceptions, stereotypes and labels (such as those I used above) continue to plague those who live with these conditions. Stigma and discrimination, what others will think of them, continue to be one of the greatest barriers to accessing services; as are antiquated policy solutions to complex issues put forth by well-intentioned politicians.

In the fall of 2018, a local piece of infrastructure began to make headline… and not for the OPP investigation into allegations of wrongdoing during construction. Death by suicide began making its way out of the home and into public spaces at an unprecedented rate – according to Dr Hirji, Acting Medical Officer of Health for the Region of Niagara, between October 2018 and March 2019, 28% of death by suicide in Niagara was at that structure compared to historic regional data showing 14.8% of deaths in public spaces and 6.2% of deaths by falling from a height. This spike in deaths at one location has made that piece of infrastructure the 2nd most popular place in North America to die by suicide.

Community rallying at the grassroots level has paid off for residents as the April meeting of Niagara Region saw Council approve increased suicide prevention initiatives including barriers at the bridge and the creation of two new full time Public Health and Emergency Services positions to “support mental health resiliency and community capacity-building” with a two-year focus on the suicide burden in Niagara.

According to Dr Hirji, “means restriction at only one location, will end the very significant spike in deaths by suicide at that location, but not address the broader burden of deaths by suicide across Niagara. As well, a comprehensive approach is necessary to address the complex, multi-factorial causes of death by suicide.”
During the debate, councillors suggested volunteers at the infrastructure until the barriers are in place but, as Dr Hirji pointed out, trained volunteers would need to be taken from other services leaving them understaffed, The Distress Centre for example, and Dr Hirji ultimately spoke against placing untrained volunteers at infrastructure

Put simply, we can’t send untrained people to handle situations many veteran first responders would have difficulty processing. There is a reason the requirements to volunteer with crisis organizations is strict and involves weeks of training, including role playing and mentorship, a supervisor for advice, co-workers to decompress with; self care is essential for helpers and built into existing frameworks.

St Catharines Regional Councillor Laura Ip, a vocal supporter of suicide awareness and prevention, asked that the section of the motion pertaining to supporting a public role in patrolling the bridge be separated out.

“Beyond feasibility and liability, I have grave concerns about the impact this kind of role could have on those who might volunteer to do it. A friend and constituent said to me the following day, ‘anyone who thinks putting people on the bridge is a good idea has never experienced trauma in their life,’ and I have to agree with her. The potential for witnessing someone still fall from that piece of infrastructure is too great and the impact too detrimental, and I don’t know that the standard vetting procedure around a volunteer’s readiness could ensure that someone is adequately prepared for such a role,” she said.

If people asking for help are on waitlists, how can we expect to cope with an additional influx of trauma survivors? Further, while anecdotal evidence does support sharing messages of hope around infrastructure, there is no evidence to support an initiative such as volunteers on the infrastructure. Just as death by suicide can spike due to contagion, trauma affects us all in different ways; I know of many veteran first responders who have died by suicide following a work related trauma, we can’t expect unsupported volunteers to have more resiliency; I, myself, suffer from Post-Traumatic Stress Disorder and I have years of training in trauma recovery.

Our overburdened mental health system simply can’t support any further stressors. Those who overcome stigma, face the reality that the demand continues to outgrow the availability of service – which is why it is important to focus the same attention we’ve given on wide-spread Naloxone training to suicide awareness and prevention. Thankfully, the Region is taking an active role and completing the work started with the creation of the Niagara Suicide Prevention Coalition (NSPC) in 2003.

The new regional Public Health positions, aimed at reducing the suicide burden, will focus on training the greater community in safeTALK (mental health first aid and suicide prevention skills) in the hope that by giving the community the skills necessary, we will be able to better identify those who may be contemplating suicide. Further, public health will provide enhancing training for frontline workers in Applied Suicide Intervention Skills Training (ASIST) and facilitate a forum to give workers the skills to safely assess whether clients need immediate professional intervention.

Meanwhile, St Catharines MPP Jennie Stevens continues to advocate for provincial mental health funding for Niagara – including the $2.5 million promised for three 24/7 walk in crisis centres to be located in StC, Niagara Falls, and Welland, which was shockingly absent from the recent provincial budget.

If you would like to help, please write premier@ontario.ca requesting mental health crisis funding for Niagara. If you feel you would be a good candidate, The Distress Centre is always looking for volunteers and training is provided. If you aren’t sure where you might be best suited to help, reach out to CMHA Niagara Branch, they have diverse volunteer needs from peer support to event assistance. Everyone is able, it’s just a matter of finding the right fit for you.

In closing, I would like to acknowledge the courage of some very special individuals who spoke about their lived experiences with mental illness at regional council; you faced stigma head on, spoke your truth, and you were heard. Heather Anne and Derek Tuba, Julie Taffs, thank you for your bravery.

If you are in immediate risk, call 9-1-1
If you are in crisis or know someone who may be in crisis contact
Crisis Outreach and Support Team (COAST) 1-866-550-5205 (for adults)
Pathstone Mental Health 24-hr Crisis Line 1-800-263-4944 (for children & youth)

Written by Emily Spanton

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