Illustration by Anson Chan
Zahari Kaminski ran past the woman, standing alone on the bridge, lost in her own thoughts. But as soon as he passed, he stopped. Something was felt. When he ran back, the young woman was standing too close to the edge, looking to the side, obviously in trouble.
“Can I help?” he asked. “I’m not leaving. I care for you.” She was inconsolable, but as they continued to talk, she pulled away from the railing. Another passerby called 911 and they waited with her until the ambulance arrived.
Just a month earlier, Dr. Kaminski, a molecular biologist, has undergone a suicide first aid course called ASIST. He is researching suicide prevention at Royal, a psychiatric hospital in Ottawa. Although he did not work directly with patients, he wanted to know what to do if he ever encountered a suicide attempt. Training started on the bridge that day.
“They tell you to be yourself, to be human,” he says when asked what he remembers most from the course. Don’t stop talking. Do not give up. “Just be there and try to do your best.
A caring person who does his best to empathize at the right time – this is the most valuable resource in mental health care.
Yet, two years after the pandemic, with growing anxiety and depression, Canada’s mental health system is facing a serious crisis: more people need care and a declining number of overcrowded clinicians to treat them.
Psychiatrists in the country were aging rapidly even before COVID-19 arrived on the scene; in 2019, half of all psychiatrists were over 55 years old. The rate of burnout is increasing among those working in the field of mental health. Psychologists and social workers are leaving the besieged public system for lucrative private practice.
To fill in some of the gaps, the programs that enable the laity are being expanded. More and more research is showing that with the right training, ordinary citizens – neighbors, carers, community mentors, even the local barber – can improve outcomes for teenagers and adults struggling with mental health problems. The programs provide care in a variety of ways, including brief social contacts, basic conversational therapy, and first aid for mental health in a crisis situation. Some examples, such as the training Dr. Kaminski received, aim to build skills among the general population; other programs train people for specific roles in their community, both as volunteers and paid non-professionals. They have been found to act as early interventions to provide a wider safety net for people with complex mental illness or to provide additional support in particularly vulnerable times, such as when patients return home after a hospital stay.
These programs do not replace specialized care – and are not designed for that. But lay education benefits from two significant discoveries in mental health research: people do better in therapy when it happens to someone they trust, and they recover faster when they have the support of their community.
Sometimes, says Denise Waligora, a training and first aid specialist at the Mental Health Commission of Canada, people just need someone to “sit in the dark with them.”
However, non-professionals are not just cheap second-level help to repair a damaged system, says Srividia Ayer, a psychologist and associate professor at McGill University. These programs, Dr. Ayer says, often provide the kind of agile, holistic, mass care that too often lacked a system focused on hospitals and empowerment. “If we rethink a system in which many people play roles, we will have a much better system.
This approach has worked for more than a decade in lower-income countries, in places where doctors and psychologists are scarce resources, but there are many examples in richer nations. Disaster lines are answered by lay people with training, working in support of peers and groups using shared experiences to heal. Increasingly, mental health applications and online programs are maintained by trained trainers, as virtual self-help works better even with a brief check by people.
In the Netherlands, young volunteers are trained to offer empathetic calls at convocation centers. A U.S. program that uses trusted adults to support teenagers who have attempted suicide has been found to reduce deaths more than a control group more than a decade later. England has developed a national public psychotherapy program to train psychology students to provide evidence-based therapy for people with mild symptoms of depression and anxiety. A pilot project in California trained Hispanic members of the Latin American community – some with less than a high school education – to conduct eight weeks of group therapy; An article published last year found that “health promoters” significantly reduced participants’ symptoms of depression and anxiety.
Local communities already have a long history of supporting well-being through elders and guardians of knowledge. Dr. Ayer is part of a program in Ulukhaktok, NWT that continues this tradition by training community members in mental health first aid and suicide intervention to provide care for young people.
Another approach, known as “care contacts” – often adopted informally by community groups when personal meetings stopped during the pandemic – has shown success in combating loneliness and improving outcomes after a stay in a psychiatric hospital or an emergency room visit. In Texas, for example, university students made weekly “sun calls” to isolated seniors for a month after receiving a short active listening seminar; A study published in JAMA Psychiatry last year found that compared to a control group of elderly people in Texas who received calls, they showed improvements in mental health as well as reduced loneliness. In Hamilton, early results from a small pilot who used phone calls from non-clinical volunteers to keep in touch with patients after suicide-related hospitalizations found fewer emergency room visits and readmission among the intervention team; pending ethical approval, the study will be expanded this year.
Research shows that peer advocates – people who have first-hand experience with mental illness – are a cost-effective resource in mental health care and are increasingly used in hospitals and community clinics. But first-hand experience with mental illness is not a requirement for many of these programs. The idea is to build capacity within groups that share similar life stories, to strengthen the skills of leaders and mentors who are already trusted in communities. In cities in the United States, for example, a program called the Confess Project has trained black barbers to advocate for mental health with their clients by actively listening and reducing the stigma around receiving help.
As the pandemic highlighted, there are challenging inequalities in Canada’s health care system. Racial Canadians often wait longer for mental health care and face language and cultural barriers. Training lay people in underserved populations or diverse neighborhoods helps build health resources and knowledge of the places where patients actually live and work.
Mental health is not just medical care; it is affected by family circumstances, unemployment, poverty and racism – problems that often need a flexible, comprehensive solution, beyond diagnosis and prescription, and often require the integration of mental health support into other services. In Edmonton, for example, multicultural health professionals who counsel immigrant and refugee families who are oriented toward health care, schools, and family services have also been trained in basic techniques of therapy with trauma-aware conversations and care. when people may need a referral to more formal treatment.
Firefighter Steve Jones of Burlington, Ontario, has been trained to provide first aid for mental health.JP Moczulski / The Globe and Mail
Proponents of non-specialized programs also support wider benefits: Train more people to be confident caregivers and we can build more compassionate communities.
It often starts with a conversation in a safe space, says Steve Jones, acting platoon commander at the Burlington Fire Service in Ontario. Years ago, during an evening shift when he was still a captain, Mr. Jones confessed to his crew gathered around the kitchen table in their fire department. He had just returned from a mental health training course at work, he told them, and realized he was struggling and had to practice self-care. how did they do
One by one, the men volunteered their stories. One said he missed work because his daughter was dealing with anxiety. Another explained why he always checked his phone during shifts: his wife was severely depressed and he was worried that one day he might get a call that she was hurt. A third firefighter called. He was the lazy man no one wanted to work with, who never got up from his chair. A few weeks ago, this crew member had driven his car to the top of a bridge with a suicide note already written. His colleagues at the kitchen table were the only people he had told.
Two hours later, they were still talking. Six years later, the Mental Health Workplace Course, developed by the Canadian Mental Health Commission, was offered to the entire Fire Department, including family and spouses. Since then, the program has expanded into a partnership support program.
As more people went through the training, Mr Jones said, they developed a common language to talk about mental health, both for themselves and if they saw warning signs in colleagues. “There is a delayed search so we can just talk about these things. For example, it is good to say that I can barely walk on water and know that you are not alone.
Mental health first aid programs, another example of training for non-specialists, are designed to teach people how to respond to panic …
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