On Jan. 21, a private member’s motion brought by NDP MHA Gerry Rogers achieved something very, very few of its kind do: It succeeded. It unanimously succeeded. An all-party select committee on mental health in Newfoundland and Labrador was born. Things changed.
Such a creature has never existed before in the history of our home. But not only that. The committee, now poised to be tasked with the major role of developing the meat of the upcoming provincial mental health strategy, was foreshadowed in its coming by the unprecedented formation of a community coalition of mental health advocacy and service providers, known formally as the Community Coalition for Mental Health, or CC4MH.
The Coalition sits directly on the Provincial Advisory Council on Mental Health and Addictions with peer organizations, many of whom are members of the coalition itself. The community is thus directly engaged in the formation of mental health policy in Newfoundland and Labrador in a fashion never before seen.
I am honoured to write today as co-chair of the CC4MH. I am also the longest standing president in the history of the Canadian Mental Health Association – NL.
I am also bipolar.
I am still rubbing my eyes in something of a state of disbelief at what has occurred in such an apparently short time. It occurs to me that if I, a long standing advocate within the mental health community is somewhat disoriented by what has unfolded, perhaps the average reader is truly lost. It seems an appropriate time to explain structurally, and culturally, what is occurring.
Long time coming
For decades in Newfoundland and Labrador, not for profit groups enjoying varying levels of government funding have delivered mental health services of varying sorts to the population as effective extensions of government. The realm is one that could be described as semi-private. The philosophy has been private entities can better deliver programming than government, meaning more cheaply and more intelligently than government. Programming is delivered by way of a combination of government funding and private fundraising and charity. Some organizations receive large amounts of funding. Some little to none. All struggle to work within whatever silo and niche they occupy, ministering to whatever fragment of the mental health realm they are mandated to.
Perhaps unsurprisingly, human nature being what it is, the level of overt advocacy appears to correlate with level of funding. This reality is continuously spoken of and visible in the presence and absence of particular players from particular fields.
But we all strive to advocate. We all bristle at the same subjects. We all feel the same affronts to human dignity.
We are an organic lot. We are filled with survivors, family members, professionals, advocates and those who have been there. Many of us are all of the above. We hold men and women of all political stripes, views, ethnicities, orientations and every other human variable you can imagine. Mental illness knows no political or physical colours or shapes. It cares not who you are when it comes for you or your children. The consequence is we, the mental health community, are incredibly diverse in our origins and perspectives. History, good and bad, exists between some of us. Our evolution and relations tell the story of the evolution of the very concepts of mental health and mental illness in our society.
Decades passed in this province before the events of June 2014 up to now. Decades passed before the beginnings of unified coherence in our movement would appear. Decades passed before Ms. Gerry Rogers realized, in her assessment of the situation, that the time had come for a champion, an individual who could draw together the talents and sentiments of an increasingly frustrated population to change the way the mental health community interacts with the world. She was the champion, and the movement owes her a great debt. Her efforts established this coalition and unleashed momentum. Our internal struggles and toils proved insurmountable for far too long.
But now… it has happened. We have come together. The question arises, beyond the obvious, beyond the superstructural: What exactly is occurring and why did it take so very long? The answer speaks to a reality that must be confronted lest the movement falter.
It is not as simple as mere worries about funding. It is not as simple as substantive debate about what to do next. It is something far more profound.
Stigma and reconciliation
When we talk about mental health and mental illness, things go unsaid between all of us.
So rarely do we squarely and honestly acknowledge our dead. Every year, roughly the same number of people in this country choose to kill themselves rather than endure the suffering that is the consequence of their existence in the world as those who die of breast cancer. In Newfoundland and Labrador, that is over one man, woman or child per week. While we split hairs over the finer details of the world we would like to see someday, people die all around us. That’s reality. Death. Death is happening. Homelessness is happening. Deep and profound isolation is happening. Lifelong loneliness despite appearances of overt integration is happening. Fifty billion dollars a year down the tubes of reaction is happening.
Stigma is happening. But, it may not entirely be the stigmatization you have heard of.
Stigma has two levels.
Level one is the mere failure to recognize the moral and objective validity of the problem of what we call mental illness. It’s basic: the failure to see that mental illness and mental health are objectively real problems. The failure to appreciate that resources can be deployed to help alleviate their negative impacts. The failure to understand that conditions need not define a person their entire existence. The profoundly common failure to grasp that conditions are not cookie cutter phenomena, but rather, are complex and deeply individual experiences that defy stereotypical characterizations much like race, gender and sexual orientation.
Level two is often unseen, rarely spoken of, and sometimes mistakenly rolled into level one. In a sense, level two is a mutual and reciprocal stigmatization of the mental health movement, mental health care providers and those who live with conditions who are fearful and suspicious of them.
The reality is this: Millions of people avoid the mental health system and mental health services because they fear threats to their autonomy. They fear being acted upon and controlled by those who mistakenly believe they act with their best interests at heart despite the historical swath of failure they have left behind them. They fear being paved into the road of good intentions. It does no good to react against this view as undesirable, unpleasant, irrational or something to be ignored. It will not go away on its own. It is the truth. It is a major reason why so many avoid seeking help of any sort. People choose to suffer rather than risk loss of autonomy. It is an unsurprising choice. It is a human choice.
We must compellingly demonstrate we have truly internalized the emerging norm that autonomy, choice, empowerment and respect for the individual is paramount within the mental health system.
There is only one answer to this stigma: reconciliation. We must compellingly demonstrate we have truly internalized the emerging norm that autonomy, choice, empowerment and respect for the individual is paramount within the mental health system. We must show consistently, and with great conviction, that we believe and respect the rhetoric of independence. We must ensure these notions and concepts are embedded deeply within our culture until we reach such a point that the notion of merely acting upon an individual becomes as unthinkable to the everyday person in the street as racism, sexism and all other forms of hierarchically enforced bigotry.
We cannot even begin to compellingly demonstrate these things until at a bare minimum our crumbling, 19th century health facility is replaced by something fit for modern human beings consistent with what other people in our country at large already benefit from. The project is underway. It must not be permitted to stop.
We cannot even begin to compellingly demonstrate these things until we permit people with conditions are varied as OCD, Bipolar Disorder, Schizophrenia and Autism Spectrum Conditions to frankly state how it feels for them to live in a world designed for people very different from them in their day to day experience. All must hear them. All must reflect on their words and ask themselves in the exchange who they are. All must be permitted to be. All must be given a world where they can develop to their utmost on their own terms within their own personal capacities and attributes.
If we seek a truly merciful and productive future, this is what it will look like.
Hope, belief, action
There is hope. Large swaths of professionals and occupational workers in all realms of mental health care and advocacy believe in exactly what I am describing. I know. I have spoken with them. There is a real sea change taking hold in the very heart of the system. No one wants to repeat the errors of the past. No one wants the suffering to continue. All want success stories to repeat.
Few appear to believe there is some pharmacological magic bullet. Rather, all speak of the need to properly support an individual as they adapt to the outcome of the emergence of their condition. It is understood that the life course and social supports are absolutely crucial to achieving positive outcomes. It is understood employment, education, housing, self-acceptance and cultivated personal insight are critical.
We must believe in this change, and we must be the change, to keep momentum.
We have just begun.
We must believe we can bring about this world together. We must believe we can get there.
This work begins with groups like the CC4MH, the all-party committee, a committed series of governments, a community of advocates, a community of supportive and aware professionals and a vast body of family, friends and those who have lived through mental health conditions all working together to appreciate the fundamental dignity and inherent unadjusted worth of those who struggle to adapt to the reality of their lives.
It begins when we finally realize that control and the urge to control is the antithesis of a proper mental health movement. It begins when it is realized that fear of arbitrary control is the greatest weakness of the system. Legitimacy is paramount. The effort must be truly non-partisan. It must be open to all. It is.
It continues when all people who experience any status or condition defined by cognitive difference are taught to understand that they are not truly that “different” at all, but are rather merely an expression of what it is to be human.
The Community Coalition for Mental Health lives today on belief. Its members believe. The community believes in it. It receives no funding. It is independent. It is powerful. It is uniquely situated to bring about change. The future will be a test of belief and will.
The Coalition must rise above cynicism and presumptions to demonstrate it is a permanent force sincerely dedicated to the global pursuit of addressing the mental health crisis. It cannot be a creature of the moment, or even of those who comprise it now. It must persist. It must develop itself as a democratic entity accessible to all and answerable only to the community. There is too much at stake for anything less.
The work continues as we walk together into a future where a person with schizophrenia or autism, or their families, need worry no longer about how they will survive alone in the world someday. It continues when the mere relief of this worry gives way to a true sense that great contributions can be made by those so liberated. It continues when a young person who is told they are bipolar does not feel a sinking sense of hopelessness coloured by statistics proclaiming their shortened lifespan and greater propensity to tragic endings, but rather a sense they have been given a responsibility and challenge to properly develop themselves to contribute to their people in their own unique way, knowing all the time they will receive help and support during those difficult formative years. It continues when all people who experience any status or condition defined by cognitive difference are taught to understand that they are not truly that “different” at all, but are rather merely an expression of what it is to be human.
It ends, if an ending is possible, when all people intuitively understand this. It ends when suicide no longer seems necessary or inevitable to great numbers of human beings. It ends when people realize there is a place for them in society.
There will be no Ashley Smith’s then. Nor will there be people in the halls of power who fail to see they are her despite their obvious commonality to an aware eye. The enduring reality of our community will be obvious to all. It will know no boundaries of power and station. We will all learn a little more about what it is to live and be as the broader social promise of finally confronting this issue unfolds.
This is unstoppable. It is now only a matter of time.
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