Mental Health Stigma

Question 1

How many Canadian experience mental illness? And suicide?

Answer 1

-1 in 5 Canadians will experience a mental illness
-Over 4000 Canadians die by suicide every year
-Leading cause of disability in Canada
-Estimated economic burden is $51 billion per year

Question 2

What are the 3 major areas of disparities in mental health?

Answer 2

-Income/SES
-Sex/Gender
-Race/Ethnicity

Question 3

What are the disparities in mental health when looking at income/SES?

Answer 3

-People with < $19K annual income were 4.3x more at risk of having a diagnosable mental disorder vs. people with > $70K income (Caron et al., 2012)

Question 4

What are the disparities in mental health when looking at sex/gender?

Answer 4

-LGBTQ+ (vs. cis-gendered and heterosexual individuals) report poorer mental health (PHAC 2018)

Question 5

What are the disparities in mental health when looking at race/ethnicity?

Answer 5

-Indigenous peoples (vs. non-Indigenous people) report poorer mental health (PHAC
2018) (also seen during pandemic)
-Average wait times for mental health care for Black Caribbean-Canadians was 16 months vs. 7 months for White Canadians (however white & POC had similar rates of poor mental health during social distancing)

Question 6

What is the public expenditure on mental health in Canada?

Answer 6

• ~7% of health care budget in Canada is spent on mental health
  -Lowest proportion of funds among G7 nations
  (9% is recommended as a national strategy)
  *Canada does not have a publicly funded psychotherapy program

Question 7

What are the different kinds of mental health care providers?

Answer 7

-holding a PhD or PsyD: Clinical Psychologist; Counseling Psychologist; School Psychologist
-holding a medical degree (can prescribe meds): Psychiatrist
-holding a psychotherapist permit: Social Worker; Marriage/Family Therapist; Psychiatric Nurse; Guidance Counsellor; Occupational Therapist
-others: Community Health Worker; Family Doctors/GPs

Question 8

How many mental health providers do we have in Canada?

Answer 8

-4000 psychiatrists
- ~20,000 psychologists and psychological associates
- 11,000 nurses specialize in mental health
*Half of all Canadian licensed psychologists are in Quebec (2/3 work in private sector)

Question 9

Who can provide psychotherapy in Quebec?

Answer 9

-Psychologists
-Psychiatrists
-Psychotherapists

Question 10

Where is mental health care delivered?

Answer 10

-healthcare (historically mental health care delivered in hospitals, now reserved for complex care)
-specialty mental health
-social services
-education

Question 11

What are the top 3 mental health providers in Canada?

Answer 11

-GPs (80% of Canadians rely on family doctor for mental healthcare needs)
-social workers
-nurses

Question 12

How does jail relate to mental heath?

Answer 12

-there are more people with mental illnesses in jail than in psych wards
-symptoms worsen while in jail because of improper treatment

Question 13

Are people receiving mental health care?

Answer 13

-fully met: 56.20%
-partially met: 22.40%
-unmet: 21.40%
-Lowest income bracket more likely to report unmet or partially met needs
-No regular health care provider more likely to report unmet or partially met needs

Question 14

What are the barriers to receiving mental health care?

Answer 14

-Stereotypes and stigma
-Misconceptions & mental health literacy
-Shortage of mental health providers
-Lack of knowledge for where to go for help
-Availability of services
-Long wait times (half of Canadians waited 1 month; 1 in 10 waited for >4 months)
-Financial costs & affordable health care
-Transportation
-Culture and language

Question 15

What are 3 components of stigma?

Answer 15

-Stereotype - belief (socially agreed upon ideas of individuals with mental illness)
-Prejudice - evaluation (accepting the negative beliefs)
-Discrimination - behaviours (engaging in negative behaviours towards others)

Question 16

What are the forms of stigma?

Answer 16

-Self-stigma: individuals internalize negative beliefs regarding their group
-Social-stigma (or public stigma): societal negative belief about a group
-Structural-stigma: rules, policies, procedures, practices that restrict the rights and opportunities of group

Question 17

What are the harmful effects of Self & Social Stigma?

Answer 17

-Reduced hope
-Lower self-esteem
-Increased psychiatric symptoms
-Social isolation
-Lower treatment seeking
-Fewer opportunities for work, school, or social activities or trouble finding housing

Question 18

What are the harmful effects of Structural Stigma?

Answer 18

-Limit access to care: inequitable distribution of resources (underfunding); undertreatment or denial of services (diagnostic overshadowing; triage prioritize physical health over mental health); fragmented, non-coordinated care
-Lower quality of care: negative attitudes among providers; adverse healthcare interactions; overuse of coercive practices (e.g., involuntary hospitalizations)

Question 19

What are the strategies to reduce Self & Social Stigma?

Answer 19

-Improve mental health literacy
-Counter myths
-Be aware and examine your own attitudes & behaviors
-Choose your words carefully – words matter
-Take a holistic approach
-Offer support, show compassion
-Talk openly about mental health
-Have meaningful contact with individuals with lived experience

Question 20

What are the strategies to reduce Structural Stigma?

Answer 20

-Change attitudes and practices of health care providers
-Strengthen integration and coordination of care (integrated or co-located care, task-shifting, shared information systems)
-Advocate for parity for mental health
-Expand access to evidence-based treatments
-Foster inclusion and participation of people with lived experiences

Question 21

What are the most common mental health treatments used in Canada?

Answer 21

-only 28% of people who are being treated are receiving therapy
-the majority (56%) are taking medications

Question 22

Are evidence-based treatments used in Quebec & Canada?

Answer 22

-Drapeau (2019): Limited use of evidence-based tools, assessments, and treatments in Quebec
-Beaulieu et al (2020): Almost half of psychotherapy workshops advertised by Ordre de Psychologues du Quebec (OPQ) were not supported by research
-Welch et al (2022): Words “evidence-based” occurred 0-4x in half of provincial and territorial psychological association website

Question 23

What is the research to practice gap?

Answer 23

-Gap in transferring or translating research into practice
-On average, it takes 17 years to move evidence into practice (Morris et al 2011)
*basic research –> efficacy research –> effectiveness research –> routine clinical practice??

Question 24

How do we address the research to practice gap?

Answer 24

-Improve research dissemination
-Engage stakeholders in research-practice partnerships *
-Implementation science
-Rethink research designs & study implementation
*basic research –> efficacy research –> effectiveness research –> implementation science –> clinical practice (we want a cycle)