Ontario Inclusion Learning Network - Mental Health, Diversity and Equity

A Report of the January 16, 2008 Learning Exchange

One in five people in Ontario will experience mental illness at some point in their lives. But statistics such as this do not reveal the complex ways in which poverty; violence, racism, homophobia, sexism and other factors complicate each individual’s experience of mental illness. They also do nothing to address the limitations of the kinds of healing that are available and accessible to persons living with a mental illness.

In January 2008, the Ontario Inclusion Learning Network (OILN) coordinated a Learning
Exchange which brought together 45 community workers, citizens, students and community activists to share ideas and discuss issues relating to Diversity and Mental Health. The following questions were addressed in this session:

• How do changing definitions of mental health serve to include or exclude specific communities?
• How are mental health institutions grappling with the challenges of diversity and inclusion?
• How are particular communities working to challenge discomfort and taboos around mental health concerns?
• What do therapists, psychiatrists, and other providers of mental health care need to learn in order to provide inclusive care to diverse populations?

Three panelists were invited to represent three different aspects of the Mental Health system; large institutions, community based organizations and individual therapists. The panel speakers were:

• Kwasi Kafele, Corporate Director of Diversity at the Centre for Addictions and
Mental Health (CAMH);
• Martha Ocampo, co-director of the community advocacy organization Across
Boundaries; and
• Farzana Doctor, an independent therapist, educator and writer.

While all three panelists spoke from their specific positioning, it was illuminating to see how their own lived histories of activism and on-going community engagement informed their analyses of the challenges involved in making mental health care truly inclusive.

Although CAMH has instituted a Diversity office and is actively implementing its Diversity
policy, Kwasi Kafele suggested that such measures only speak to one aspect of the issue.

“Why is it”, he asked, and “that most schizophrenia wards include so many black men?”
Kafele emphasized the historic and systemic ways in which the diagnosis and labeling of
mental illness has operated as a mode of social control. “What we need to ask”, he urged, “is why so many young men of colour suffer from a ‘death of hope’ that ends in this kind of ‘spiritual suicide...Without situating the contemporary struggles of marginalized and racialized communities within a larger historical framework, we will fail to understand what specific measures need to be undertaken”.

Kafele also pointed out that unlike most developed nations; Canada does not have a National Mental Health Strategy or Policy which would integrate mental health within a larger framework that includes related issues such as poverty, immigration, homelessness, racism and violence.

Kafele urged all institutions to make knowledge and understanding of diversity and inclusion central to their daily practices, so that tenure, promotions and other rewards to staff members would depend on their genuine commitment towards increasing the accessibility and relevance of health care to all communities.

Martha Ocampo is the founder and co-director of the innovative community-based mental
health organization Across Boundaries, which provides services to and advocates on behalf of marginalized and racialized communities. Drawing on her broad history of activism in the Philippines and Canada and her work in various sectors, including theatre,

Ocampo pointed out that Across Boundaries works on a model of holistic care which views all aspects of one`s life to be important to maintaining mental health. Rooted in principles of anti-oppression and anti-racism, Across Boundaries has developed innovative and creative ways to reach out to communities that have traditionally been marginalized by mainstream mental health services. Across Boundaries uses alternative holistic therapies, such as ayurveda and acupuncture, as well as performance and visual art, to heal the body, mind and spirit.

Ocampo stated that while many organizations claim to want to improve their diversity and
inclusion practices, they fail to go about it in ways that truly respond to the specific needs of such communities. She stressed the importance of organizations performing regular needs assessments. “What do these communities really need?” she asked. “How has the population changed? What new wars or political traumas may affect their sense of safety?”

She provided examples of how Across Boundaries has set up unusual yet highly popular programs for their clients such as a “Current Events” group where participants are free to discuss politics and media, thus helping them to share ideas, develop networks, and social skills.

Across Boundaries has set up satellite offices in non-traditional spaces, such as community centres and the Jane-Finch Mall, to ensure that marginalized communities have direct access to their services and programs. Across Boundaries also hires outreach workers from the community in which they work and are therefore cognizant of the local issues and concerns.

Based on her work with Across Boundaries, Martha Ocampo suggested that partnerships are a vital way for mainstream organizations to connect with marginalized communities, but she warned that such partnerships need to be built with sensitivity and care so that the less powerful or privileged partner is not ‘gobbled up’ by the other. Ocampo also stressed that advertising events and programs in multi-lingual community media is another key factor in reaching out to communities that may not normally have access to information on mental health.

Farzana Doctor is known for her work as a trainer on LGBTTIQ issues in therapy and
provided a quick overview of the histories of stigma and taboo around sexuality that continue to be embedded in therapeutic terminology.

Farzana Doctor presented a thoughtful analysis of her own development as a therapist and educator. Her training at Carleton University provided her with a structural feminist
approach to therapy. However, it was her experiences in the workplace that encouraged her to develop an integrated anti-oppression framework for her own practice.

Doctor suggested that the dominant model in therapy continues to be that of the “clinician as expert” which positions the client as “damaged” and in need of “treatment”. She asserted that such models of care create false dichotomies of behaviour which are then marked as “normal” or “abnormal”. Thus distress or grief, which may be perfectly normal responses to oppressive social structures, are seen to be “abnormal” and the person who suffers this is often misinterpreted and pathologized by a mental health care system that does not draw connections between social structures and their impacts on individuals and communities.

Doctor also called for a constant critical reflection on the part of the therapist. She suggested that therapists need to acknowledge that they are not as different from their clients as they may like to imagine and, as human beings, suffer distress, loss and grief and need to understand how their own pain is reflected in their therapeutic practice. In understanding their own fluctuating place within the models of mental health care, therapists would develop a greater depth of understanding of the therapeutic process and understand their own power and privilege within it.

She pointed out that it was only through the efforts of gay, lesbian and bisexual activists in the past few decades, and now, through the work of transgender activists, that standard terms stigmatizing sexuality and gender identity have been challenged. Proper training of therapists should, according to Doctor, enable them to understand structural and systemic ways in which the oppression of individuals and communities affects mental health and how “illness” is described, framed and treated.

Following the panel presentation, participants shared their experiences and raised additional issues that they had encountered. Many of the questions asked focused on ways of integrating what they had learned in the session into their own work. This Learning Exchange highlighted some important issues relating to diversity and mental health services and stimulated discussion on ways to be more understanding and inclusive, at a personal, professional and institutional level.

OILN is a network of provincial organizations which promote inclusion and share information about programs, tools and resources relating to inclusion. For more information about OILN and its activities please view their website at www.oiln.ca.