Women and Depression – Echo-ing with Hope

Yesterday I participated in a panel discussion at a one-day conference called "Conversations on Depression." 

It was the first major initiative of a new Ministry of Health and Long-Term Care agency called Echo – Improving Women's Health in Ontario.

Echo was introduced in August 2007 – and is so new, it's website is still under construction, but when it's up, I'll let you know. You'll want to know.

It's priorities are mental health and addictions, sexual and reproductive health and chronic illnesses. 

Ultimately, Echo's mandate is to promote equity and improved health for women in Ontario, collaboratively. Women will be listened to and heard, at the grassroots levels of their communities and, in the health system, through research and policy changes.

In other words, Echo is giving women's health needs long overdue attention and when it comes to our needs, our emotional and/or mental health needs especially are desperate for help.

Echo's Mission and Values are "to improve the health and well-being of all Ontario women and to reduce health inequities – Equity, Diversity, Inclusiveness."

Our "Conversations" were a real eye-opener. Very hopeful. But these are early days. 

Echo is partnering with the Canadian Institutes of Health Research-Institute for Gender and Health and front-line workers from agencies, hospitals and community mental health centres across the province to gather information about women's mental health issues and in this case, depression.

Depression is singularly the most prevalent and pervasive emotional health problem women experience. 

It is perceived as an "illness" with symptoms. But it can also be a soul-destroying symptom in itself of other very serious, complex, deep-seated personal and societal problems and challenges. It's tough to talk about depression. It's misunderstood. Often it doesn't look or sound or feel like what the word "depression" suggests. 

It's frightening. Steeped in negative stereotypes, prejudices and discrimination. 

By far, the biggest barrier to gaining help with our emotional and/or mental health needs, is that we, women, and men, find it so difficult to face our emotional pain and talk about it. Not only is it painful to process, it's complicated by deeply-rooted fears about how our words and our feelings and our problems will be received. The real repercussions – like being ostracized or isolated or abandoned or losing our jobs and our security. Our connections to the people we depend on and love.

About 40 community leaders attended this day of "Conversations" yesterday – a rich culturally, ethnically and racially diverse demographic cross-section of the population – rural and urban. Almost all women and a couple of men. Dozen of others watched and engaged in the discussion via an internet web-based interface.

I wish I could have stayed for the whole afternoon. What struck me most about this event was the focus on interactivity. This was a dialogue on many levels – personal and public. Every word spoken was heard, recorded and I sensed, taken seriously. How far it will go, remains to be seen. 

Over lunch, there were a few introductory remarks and a brief PowerPoint presentation by Echo CEO Pat Campbell – one savvy lady with years of senior administrative healthcare experience in urban and rural Ontario hospitals, including Sunnybrook. 

Campbell is also a superb "active and empathetic" listener. Initially, when I called her to decline her invitation to be a panellist – after all, I have never experienced clinical depression – she managed to let me talk myself into presenting on my perspectives on Mental Health Recovery. Not a popular perspective.

Panelists' presentations were short – 10 minutes. Here are their very brief thumbnails. All are heavy-hitters. Highly qualified professionals with stellar credentials. Extremely knowledgeable and dedicated in their respective fields. 

• Natalia Diaz-Granados, an epidemiologist with the University Health Network Women's Health Program presented a thorough 2006 literature review covering all the quantitative research on women and depression in Ontario – lots of statistics but very telling. 

• Notisha Massaquoi, the executive director of Toronto's Women's Health in Women's Hands Community Health Centre, discussed both the high incidence and the causes of depression in the racially diverse, predominantly black women her agency serves – the vast majority are victims sexual assault and/or domestic violence and are living way below the poverty line.

• Denise Cole, a health policy advisor and strategic planner at StrategyCorp with 25 years of experience working on public policy at all levels of government, discussed how change happens and why everyone must play a part in this process. She "suffers with depression," she stated, stressing that "suffer" is the appropriate word in her case. 

• Nazilla Khanlou, York University chair of Women's Mental Health Research moderated and took extensive notes during our presentations.

At the heart of this event were the Questions and Answers from the audience and online participants. Then, more intimate "Conversations" at each table and an on-line survey everyone was asked to complete. 

This was an information gathering event. I was asked to send in several questions based on my presentation. Where should research focus? I'm still thinking about that. 

I was very impressed with the spirit of this conference. At the beginning, it was very official. Too formal. But after the panel, the tone of the conversation began to change and open up. 

One of the most moving moments was when Denise Cole admitted openly and courageously that she was abused sexually and incestuously throughout her adolescence and that her depression stems from those constant assaults and a family who still cannot empathize or support her. No wonder she suffers.

How many women can speak so openly and publicly about the devastating causes of their depression? Notisha stressed that close to 80% of the women who use the services of her feminist community health care centre are sexually assaulted. Raped. 

You have no idea how many women I know who have disclosed to me that they were sexually assaulted. Date raped. Tormented by incest as young girls. It's rampant. 

Yet, Denise is also in Recovery. She is a prime example of so many of us who are out there, working and living meaningful and productive lives. She's active in the community and, ironically, among many other boards she's served, currently she's vice-chair of the Seneca College Board of Governors.

How many people speak up about their recovery journeys? They travel alone, or with the support of their therapists and their close circle of friends and family.

There's huge great Catch-22 in all of this. In our culture, emotional trauma and mental illnesses are blurred. Where does one stop and the other start? They are more than a collection of symptoms. And there's no effective quick fix. Certainly, not a pill. Drugs are only tools and there are many tools available, but how many are accessible?

I learned that with a doctor's prescription Mindful Meditation classes are covered by OHIP. What else is covered by OHIP?

Still you have to see a doctor to get a prescription. That, in itself, creates another real and challenging Catch-22. 

To receive Ontario Health Insurance Coverage for an emotional health issue, you need a medical or psychiatric diagnosis. Yet, once you have it, too often you internalize it. Unconsciously. You see yourself differently. Why? Because of what the invariably ingrained negative stereotypes of having a "mental illness" may mean to you. Those stereotypes need to change and are changing, but so slowly. 

Yet, as I stressed yesterday, "we're all 'next to normal'." 

There was also an insidious "them and us" mentality that crept into the language of yesterday's conversations at times. Denise bravely erased it when she spoke out. But some other participants did not.

I urge Echo to keep a careful eye this tendency. 

I stressed in my presentation that depression is a "human" issue, not only a "health" issue. In order to effect change in public policy, we need change in public perceptions. All of us have to own our emotional and mental health issues. Openly and honestly. They belong to all of us. Either indirectly or directly. I learned that lesson from seeing the Tony Award-winning Broadway musical "Next to Normal" last week in New York.

So, that means to me that a fourth value must be added to the Echo Mission – Empowerment.

In order to heal, we must make peace with ourselves and accept ourselves, emotionally and mentally, as we endeavour to change public policies and perceptions for everyone. Especially girls and women, whose voices are not heard often enough. 

The healthcare system has traditionally been a patriarchal system. Psychiatry has been notoriously male-dominated. Governments are male-dominated, too.

Education is the key. Doctors need to be educated. They're not gods. They must learn to be healers and to look at us as whole human beings. How else can we be truly healthy?

They need our help. Healing is a two-way process. How can anyone help you if you don't tell them where and how it hurts.

We must keep that in mind. Language is imperative in this process. Echo is all about partnership and collaboration.

And hope.

Comments

[Francesca]

Echo's gain of Pat Campbell is our loss! She headed up our hospital system here in Grey Bruce.

This an amazing step forward in recognizing the complex nature of women's health.

[©lark Kennedy]

Ah women to women....haven't you had this sort of connection since time began? What I mean is... don't women already take care of their own? Whether it be nurses, those informal bathroom stall chats or the bond of feminism itself?

I'm about to engage in some stereotypes here, but mental illness amongst women seems more accepted. Is it the generations of study of post-partum and PMS? See, women can always be portrayed as artists, mystics, eccentrics or gardeners while men afflicted by the demons of mental health are pushed aside as unemployable addicts, loons and soup-kitchen patrons.

Since the government really does seem intent on moving forward with new mental health initiatives, I'd like to see more concentration on breaking down the more entrenched barriers amongst men. In our patriarchal society, it's a shame that progress, corporatism and those who craft the glass ceilings continue to stigmatize the men who suffer from so-called breaks in reality or shifts in understanding.

Women have their sewing circles, their cooking groups, book clubs, their YWCA classes and thankfully now this ECHO program. Remind me again what it is us men have other than a system of constant reminders that unless you're a good Dad with middle class income, mutual funds, a convertible and eyes on a cottage, you are considered unacceptable to the mainstream.

We're suffering too ladies.

[Sandy Naiman]

©larke,

Your comment proves that stereotyping abounds.

Today's women do everything. Yesterday's women did, too.

Sewing circles? Cooking groups? Book clubs? YWCA classes? Excuse me, but what century are you living in?

Perhaps you should keep in mind that women traditionally are wise enough to seek help far more often than men. Statistics have proven that for years.

Quite frankly, I am not going to spend a great deal of time responding to your comment because I have other things to do, but the last time I looked, the majority of elected officials in this country were men.

Elected officials make and change policy. Elected officials should be listening. Policy change based on quantitative and qualitative research is what Echo is all about. In part, and I just scratched the surface. I'll be back to Echo again, trust me.

Women's voices are not heard enough. Echo will listen. And work for effective change. It's long overdue.

If you wish to change the current system, get active and go for it. Join a group. Or better still, start one. You can do whatever you want, but complaining and whining won't change anything.

Action will!

All the best,
sln

[Sonia]

Hello Clark & Sandy,

The "Old Boys' Club" has covered many aspects of society, imposing the images you so aptly describe. If you ascribe to these self-imposed constraints on reality, then it is up to you to learn more about other perspectives. Preparing an "attack" on Echo is part of the self-imposed self-righteous attitude from which men have suffered since the Industrial Revolution.

If your concerns for men are sincere, then showing support for small steps forward for women will help men. Attending one-day conferences and workshops, answering surveys, visiting the local mental health centres will help. Women have been speaking for centuries. Men are just beginning.

If your concerns for men are sincere, then use the Yellow Pages (or Canada411.ca) to find organisations that do address these issues with men, for men, by men.

Coming from northern Ontario, and having spent the last 2 yrs in Toronto area, let me tell you this: women of this region are much better treated by the medical profession than women of the North. The respect with which I have been greeted, treated, and diagnosed in the last two years are in stark contrast with the dismissal, rejection, and blunt ways I had been treated up north. I speak of dentists, lab technicians (Nuclear, ex-ray, ultra-sound) and medical personnel (scrub nurses, reception staff and doctors).

I continue to prepare myself for a negative reaction that just does not come. It seems the message has gone across in this region that women deserve to be respected when addressing self-care and wellness issues.

I hope Echo will reach outside the GTA and southeastern Ontario to address all women of Ontario.

Sonia

[Carolyn]

What I think is most sad about comments criticizing a womens program is that I believe in "our" community, any effort of a group to help or support men is applauded by women. Whether we are a patriarchy or not, any group to help anyone is a good thing. People with mental illness are marginalized, male, female etc. A group program, with a good focus helps us all in the long run. I can't imagine why anyone would begrudge a program aimed to help improve care, which naturally would improve the care for men.

Women in the country are more likely to live in poverty,and be paid less for equal work. Just a reminder because our egalitarian society likes to "forget" information like that because it doesn't fit in with our image of our society.

In our movement we should support any effort to improve the quality of life for people with mental health diagnosis, even if that group does not directly include us.