Podcasts about social planning

On this episode of Below the Radar, our host Am Johal speaks with Michael Clague, a community developer who has spent decades connecting underserved people to much-needed supports and programming. They begin by discussing Michael's early service work as a UBC student, and move into conversation about the BC labour movement, community arts programming, and Michael's new book, titled So, How Have I Been Doing At Being Who I Am?: At 82, A Life In Progress. Full episode details: https://www.sfu.ca/vancity-office-community-engagement/below-the-radar-podcast/episodes/212-michael-clague.html Read the transcript: https://www.sfu.ca/vancity-office-community-engagement/below-the-radar-podcast/transcripts/212-michael-clague.html Resources: Michael's book, So, How Have I Been Doing at Being Who I Am?: https://bcbooklook.com/a-life-in-progress/ Carnegie Community Centre: https://vancouver.ca/parks-recreation-culture/carnegie-community-centre.aspx Britannia Community Centre: https://vancouver.ca/parks-recreation-culture/britannia-community-services-centre.aspx Social Planning and Research Council (SPARC): ​​https://www.sparc.bc.ca/ The Solidarity Movement in BC: https://www.communitystories.ca/v2/solidarity-bc-protest_solidarite-protestation-cb/ VANDU: https://vandureplace.wordpress.com/ Bio: Michael Clague is a former director of the Carnegie Community Centre and Britannia Community Centre, and a former board member of the Fraser Basin Council. He has participated in multiple community and social planning committees, including the Social Planning and Research Council (SPARC) and the Downtown Eastside Local Area Planning Process Committee. He was awarded the Order of Canada for community service in 2008, and he is the author of So, How Have I Been Doing At Being Who I Am?: At 82, A Life In Progress. Cite this episode: Chicago Style Johal, Am. “Reflecting on a Life in Community Development.” Below the Radar, SFU's Vancity Office of Community Engagement. Podcast audio, May 2, 2023. https://www.sfu.ca/vancity-office-community-engagement/below-the-radar-podcast/episodes/212-michael-clague.html.

Grief isn't something that you can fix.In this episode, I am joined by Aly Bird, a coach and workshop leader with a BA from Carleton University and an MSc in Social Planning from the University of Toronto. Aly is the author of Grief Ally - a book that guides people in helping their loved ones cope with death, loss, and grief. She also is a member of the Canadian Counselling and Psychotherapy Association and the Bereavement Ontario Network. Throughout this episode, Aly shares her experience with grief and what inspired her to write a book. She also shares her thoughts on why people are hesitant to approach people who are going through grief. Additionally, she shares the importance of allowing bereaved people to bring their loss forward.Listen to episode 110 of Grief and Happiness to hear how Aly helps people comfort those coping with death, loss, and grief! In This Episode, You Will Learn:Aly's experience with grief (00:36)Aly shares why people take a step back from a grieving person (03:13)The impact of allowing bereaved people to bring their loss forward (14:39)Aly shares a lesson from her book (19:20)Resources:Book - Grief Ally: Helping People You Love Cope with Death, Loss, and GriefConnect with AlyInstagramFacebookWebsiteLet's Connect:WebsiteLinkedInFacebookInstagramTwitterPinterestThe Grief and Happiness AllianceBook: Emily Thiroux Threatt - Loving and Living Your Way Through Grief Hosted on Acast. See acast.com/privacy for more information.

It's time to talk about the most misunderstood word in the Tiktok lexicon :( gatekeeping! Hannah and Maia dive into the history of the word, its sinister origins and the way it now bursts out of our mouths every time someone doesn't give us what we want, the moment we want it. Join us and extra special guest Rayne as we digress about the death of subcultures, the Supreme™ brick, the bouncer at Berghain, and the ever-overlooked qu∊∊f community! Support us on Patreon and get juicy bonus content! https://www.patreon.com/rehashpodcast Intro and outro song produced by our talented friend Ian Mills: https://linktr.ee/ianmillsmusic SOURCES: Sirena Bergman, “The internet really hates 'gatekeeping,' social media's new go-to insult. The truth is you're probably a gatekeeper, too.” Insider (2022). Kurt Lewin, “Frontiers in Group Dynamics: Channels of Group Life; Social Planning and Action Research” Human Relations, Vol. 1 (2) (1947). Pamela J. Shoemaker, Gatekeeping Theory, Taylor & Francis (2009). Courtney Young, “What Does “Gatekeeping” Mean On TikTok? The Viral Term, Explained.” Bustle (2022).

"Give the person that you love the permission, the empowerment, and the respect for the emotional experience that they are having because of their loss." We are thrilled to welcome Aly Bird to the show. Aly's work focuses on supporting folks in their bereavement and all of the knowledge, expertise, and insight she has gained on this topic has come through her own profound grief experience. In addition to sharing her story and the origins of her book Grief Ally, Courtney and Aly discuss the practical ways one can support a loved one through grief. They get a bit philosophical and discuss the failings of Western conceptualizations around grief and loss and the ways this results in further isolation for those experiencing grief. They explore the Kubler-Ross Five Stages of Grief model and Aly shares her insights about the emotions tied to grief. Aly offers alternatives to the phrase "Let me know what you need", explains the differences between intuitive versus instrumental grief, and highlights the multiple layers of the grief experience. While this may sound, at first, like a tough topic, Aly's lighthearted and straight forward manner bring a surprising amount of levity and humor to this discussion! About our guest: Since her husband's untimely death, Aly Bird has poured her heart into helping those who feel helpless during an unexpected crisis. Her extensive study of grief psychology and culture, combined with her own devastating first-hand knowledge, led her to create a roadmap for the courageous and dedicated individuals who are willing to show up for the people they love with unconditional love, empowerment, and reverence. A speaker and workshop leader, Aly shows a clear path to those who have the courage to take on the vital role of being a grief ally. Recognizing that there must be a change the way our culture handles grief, Aly is committed to building a support and educational network not only for the ones who have experienced an earth-shattering loss, but the people who are often overlooked: the griever's loved ones and trusted support system. Aiding in her mission, Aly is currently pursuing a graduate degree in counselling psychology, and a career in grief therapy. Aly Bird is a coach and author with a BA from Carleton University and MSc in Social Planning from the University of Toronto. She is a member of Canadian Counselling and Psychotherapy Association and the Bereavement Ontario Network. Keeping her life in balance, Aly is passionate about taking long walks with her dog, creating art, and singing at the top of her lungs every time she has the chance. Learn more at www.alybird.com. Or find her on social media @thealybird. Please feel free to contact the show at courtney@shineandsoar.com and don't forget to rate, review, and subscribe on your podcast app of choice! --- Send in a voice message: https://podcasters.spotify.com/pod/show/pragmaticalchemy/message Support this podcast: https://podcasters.spotify.com/pod/show/pragmaticalchemy/support

The Hamilton Today Podcast with Scott Thompson: Vancouver got hit with snow last night. How were they affected, and what is the scene today? The Canadian Space Agency, through the Canadian CubeSat Project, is providing professors in post-secondary institutions with an opportunity to engage their students in a real space mission. Prince William's godmother, who also served as the late Queen Elizabeth's lady-in-waiting, has stepped down after she made racist and “unacceptable” comments to a Black guest at Buckingham Palace. Former President Trump's tax troubles carry on. We get the Ontario perspective on the the Liberal government's new dental care benefit for children, which is now open for applications to get help for their children's dental costs. We look at housing in Ontario, and the municipal concerns in addition to how this is effecting the coveted Greenbelt. Premier Danielle Smith's new Sovereignty Within A United Canada act would give her cabinet new powers to rewrite provincial laws without passing legislation to do so. She is trying to reassure Albertans that it has nothing to do with leaving the country. A new report from Hamilton's Social Planning and Research Council shows that young people most affected by Hamilton's volatile rental market, and suggests that more rent-control regulations in Hamilton are needed to mitigate the housing crisis in our city. We talk about it all here on Hamilton Today! Guests: Kristi Gordon, Senior Meteorologist on Global B.C., Global News, CKNW and AM730 Traffic Tony Pellerin, Manager in Space Science and Technology, Canadian Space Agency Elissa Freeman, PR and Pop Culture Expert Reggie Cecchini, Washington Correspondent for Global News Dr. Lisa Bentley, President of the Ontario Dental Association Mike Collins-Williams, CEO, West End Home Builders Association Peter Graefe, Professor of Political Science with McMaster University Sara Mayo, Social Planner (Geographic Information Systems) with the Social Planning and Research Council of Hamilton Scott Radley, Host of The Scott Radley Show, and Columnist with your Hamilton Spectator Host – Scott Thompson Content Producer – William Erskine Technical/Podcast Producer - Ben Straughan News Anchors – Dave Woodard & Diana Weeks Want to keep up with what happened in Hamilton Today? Subscribe to the podcast! https://megaphone.link/CORU8835115919

Shauna Sylvester is the former Executive Director of the SFU Morris J. Wosk Centre for Dialogue and is moving on to be the Executive Director of the Urban Sustainability Directors' Network. Shauna has also been involved in various organizations, such as the Social Planning and Research Council of B.C., the Institute for Media, Policy and Civil Society, Canada's World, among others. This episode explores the impacts and changes made through these organizations, as well as how Shauna developed an interest for promoting community dialogue. Am and Shauna also discuss Shauna's concerns with Canada's changing place in the world, her focus on getting cities to 100% renewable energy, and her 2018 mayoral run in the City of Vancouver. Full episode details: https://www.sfu.ca/vancity-office-community-engagement/below-the-radar-podcast/episodes/175-shauna-sylvester.html Read the transcript: https://www.sfu.ca/vancity-office-community-engagement/below-the-radar-podcast/transcripts/175-shauna-sylvester.html Resources: — The SFU Morris J. Wosk Centre for Dialogue: https://www.sfu.ca/dialogue.html — The Social Planning and Research Council of B.C. (SPARC BC): https://www.sparc.bc.ca/ — Institute for Media, Policy and Civil Society (IMPACS): https://reliefweb.int/organization/impacs — Cuso International: https://cusointernational.org/ — Canada World Youth: https://canadaworldyouth.org/ — CIVICUS World Assembly: https://www.civicus.org/worldassembly/ — Imagine Canada: https://www.imaginecanada.ca/en — Kumi Naidoo: https://www.greenpeace.org/usa/bios/kumi-naidoo/ — Canada's World: https://www.sfu.ca/dialogue/programs/international-relations/canadas-world.html — COP26: https://www.un.org/en/climatechange/cop26 — Fossil of the Year Award: https://www.cbc.ca/news/canada/canada-tagged-as-fossil-of-the-year-1.827062 — Carbon Talks: https://carbontalks.wordpress.com/about/ — Renewable Cities: https://www.renewablecities.ca/about-renewable-cities — SFU Public Square: https://www.sfu.ca/publicsquare/about.html — Renovictions: https://www2.gov.bc.ca/gov/content/housing-tenancy/residential-tenancies/ending-a-tenancy/renovictions — Semester in Dialogue: https://www.sfu.ca/dialogue/semester/ — Ecotrust Canada: https://ecotrust.ca/ — The Circle on Philanthropy and Aboriginal Peoples in Canada (The Circle): https://www.the-circle.ca/how-we-work.html — Urban Sustainability Directors Network: https://www.usdn.org/about.html Cite this episode: Chicago Style Johal, Am. “From Dialogue to Action — with Shauna Sylvester,” Below the Radar, SFU's Vancity Office of Community Engagement. Podcast audio, June 7, 2022. https://www.sfu.ca/vancity-office-community-engagement/below-the-radar-podcast/episodes/175-shauna-sylvester.html.

SUMMARY HEADS UP producer Jo de Vries shares her personal story of healing from acute anxiety attacks that started when she was 12 years old. Now in her sixties, and after 20 years of taking two psychotrophic medications, she is in the process of healing with the help of two medical professionals. Family physician/psychotherapist Dr. Warren Bell guides her along a path of discovery to unearth her disorder's root causes, while pharmacist Sahil Ahuja advises her on how to safely taper off medication. In this compelling episode, they dig into how Jo's experiences can inform and inspire others, and explore arguments made by acclaimed journalist and author Johann Hari in Lost Connections, the book that kick-started Jo's empowering encounter with herself and the outside world. TAKEAWAYS This podcast showcases: Personal stories of healing from anxiety and depression Progressive education for pharmacists The role of personalized care and holistic healing from mental health challenges Primary considerations for deciding whether to take medication for depression/anxiety Potential side effects of some medications for depression/anxiety Potential side effects of, and recommendations for, tapering off those medications Role of psychotherapy and other treatments for depression/anxiety Role of trauma and chronic stress in depression/anxiety Benefits of feeling, identifying, processing, and learning from both positive and negative emotions Impacts of COVID on people's willingness to talk about mental health challenges Johann Hari's personal story of depression and arguments for science-based alternatives he subsequently laid out in Lost Connections: Uncovering the Real Causes of Depression & the Unexpected Solutions Using science to debunk the myth that chemical imbalance is responsible for anxiety/depression, and that medication is the only solution Disconnection (the nine causes of anxiety/depression) Reconnection (a different kind of antidepressant) Role of culture in sharing about, and healing from, anxiety/depression Role of livable communities that support the social determinants of mental health in preventing anxiety/depression SPONSOR   RESOURCES Antidepressants Going off Antidepressants Bounceback Patient Health Questionnaire Depression: Resource Guide for Patients   GUESTS  Sahil Ahuja, PharmD Sahil Ahuja is a licensed pharmacist practising at Two Nice Guys Pharmacy in Kelowna, BC. In this setting he provides patient-centered care that starts with listening to the person in front of him. In collaboration with that patient's health care team, Sahil provides a range of services including patient education, medication recommendations, and prescriptions. While completing his Doctor of Pharmacy degree at UBC, Sahil encountered mental health struggles of his own. Having made it through those difficult times, he believes the best way to reduce any remaining stigma around mental health is by openly sharing his own experiences. Professionally, Sahil's current focus is on the Toxic Drug Crisis and ensuring patients experiencing substance-use disorders have reliable and non-judgemental access to medication. These efforts have helped Two Nice Guys' Pharmacy earn recognition as Unsung Heroes in the community. In his personal life, he is prioritizing trying new hobbies and experiences (e.g., skydiving) to continuously expand his comfort zone. Dr. Warren Bell Dr. Warren Bell has been a general practitioner for more than 40 years. For decades he has advocated for peace, social development, the environment, and the anti-nuclear movement, as well as the integration of healing modalities of all kinds. He is past founding president of Canadian Association of Physicians for the Environment, past president of International Physicians for the Prevention of Nuclear War Canada and the Association of Complementary and Integrative Physicians of BC, past president of medical staff at the Shuswap Lake General Hospital, and current president of Wetland Alliance: The Ecological Response (WA:TER). He has written several peer-reviewed clinical pieces and for online publications such as the Vancouver Observer and National Observer. Warren received a College of Family Physicians of Canada Environmental Health Award and the Queen's Medal for Canada's 125th Anniversary in 1992.  Email: cppbell@web.ca Facebook: https://www.facebook.com/warren.bell.714 HOST Jo de Vries is a community education and engagement specialist with more 30 years of experience helping local governments in British Columbia connect with their citizens about important sustainability issues. In 2006, she established the Fresh Outlook Foundation (FOF) to “inspire community conversations for sustainable change.” FOF's highly acclaimed events include Building SustainABLE Communities conferences, Reel Change SustainAbility Film Fest, Eco-Blast Kids' Camps, CommUnity Innovation Lab, Breakfast of Champions, and Women 4 SustainAbility. FOF's newest ventures are the HEADS UP! Community Mental Health Summit and HEADS UP! Community Mental Health Podcast. Website: Fresh Outlook Foundation Phone: 250-300-8797   PLAY IT FORWARD The move toward optimal mental health becomes possible as more people learn about the challenges, successes, and opportunities. To that end, please share this podcast with anyone who has an interest or stake in the future of mental health and wellness. FOLLOW US For more information about the Fresh Outlook Foundation (FOF) and our programs and events, visit our website, sign up for our newsletter, and like us on Facebook and Twitter.   HELP US As a charity, FOF relies on support from grants, sponsors, and donors to continue its valuable work. If you benefited from the podcast, please help fund future episodes by making a one-time or monthly donation. Sahil Ahuga and Dr. Warren Bell Interview Transcript You can download a pdf of the transcript here. The entire transcript is also found below: RICK  0:10 Welcome to the Heads Up Community Mental Health podcast. Join our host Jo de Vries with the Fresh Outlook Foundation, as she combines science with storytelling to explore a variety of mental health issues with people from all walks of life. Stay tuned. JO  0:32 Hey, Jo here. Thanks for joining me and my two special guests as we delve into my own story of healing from anxiety attacks that started when I was 12 years old. Now 67, and after multiple rounds of medication, the latest one lasting almost 20 years, I'm in the process of seeking freedom from fear and anxiety with help from two medical professionals. The first is Dr. Warren Bell, a GP who also practices psychotherapy in Salmon Arm, BC. He's guiding me along a path of discovery to find the root causes of my disorder. Hi, Warren. Warren  1:12 Hi, Jo, I'm delighted to be here. And I just like to say that the fact that you are sharing your story in this public way is an act of courage on the one hand, but it's also something that I think will lead to many other people who listen to this podcast, understanding your dilemma and the trials you've been through, and also be grateful for the fact that you have shared this very personal voyage that you've been on. JO  1:41 The other vital member of my team is pharmacist Sahil Ahuja, who's advising me on how to safely taper off two medications. Welcome Sahil. SAHIL  1:52 Hi Jo. Thank you for having me. Likewise, very grateful to have this opportunity, and appreciative that you're willing to share your story. We talk a lot about decreasing stigma around these concerns. I think this will be beneficial to a lot of people. JO  2:07 I can't tell you how grateful I am to have you both on my side and here today for the podcast. Two things before we get started. First, a big thank you to our sponsors for this episode, the Social Planning and Research Council of BC, Emil Anderson Construction, WorkSafeBC and AECOM Engineering. And second, please note that I'm sharing my story for informational purposes only. This is very important. If you're experiencing mental health challenges or want to taper off medication, please seek advice from your doctor and/or mental health professional. Okay, so imagine you're lying down tied to a railway track. You start to feel vibrations in the ties and a hum on the rails that can mean only one thing, a coming train. As it rounds the corner, you hear the whistle scream warning you to jump or else, but you can't. As the scenario unfolds, your breathing shallows while your heart rate spikes. You feel increasingly weak, dizzy, sweaty, and/or nauseated. You quickly move from feeling agitated to being terrified you'll die, and then maybe even wishing you would so the overwhelming physical and emotional sensations would stop. After what could be minutes or hours, the train roars over you, the danger seemingly past, but in its place comes the fear of what will happen next time you're tied to a track, or more likely must give a speech, or take an exam, or feel uncomfortable, insecure, or unworthy. That's anxiety's gift that keeps on giving. The continual fear of fear itself. My panic attacks started when I entered puberty when my hormones raged for the first time. My second bout was triggered again by a hormonal imbalance after the birth of my first daughter. That time it was more serious and involved depression as well. To make a long story short, I started thinking, what if I hurt my daughter and then spiraled into terror so visceral, I couldn't be alone for fear I'd go crazy and do the unthinkable. I was trapped in a vicious cycle. Feeling depressed made me more anxious and feeling anxious worsened the depression. My father who was a doctor said I was experiencing postpartum depression and prescribed an antidepressant. I also saw a psychiatrist who said that with the medication, I would recover. That's how it was done in 1983. No mention of lifestyle changes, counseling, or other potential treatments. The pills worked, so I took them until after my second daughter was born, too afraid to again face postpartum symptoms. When life settled down and my marriage and career seemed stable, I weaned off the medication and managed well for a number of years. My next experience with paralyzing fear came at the end of my first marriage, emotions were high, my anxiety levels were higher. Again, I was prescribed medication, this time by my GP. I did get counseling, but unfortunately, the counselor decided my husband was a jerk, and that I'd be better off without him. So I concluded the anxiety was situational, and didn't see the need for further counseling to get to its root causes. Fast forward to the beginning of my second marriage. I'm feeling good and decided to taper off medication again, which was fine until I accepted a job that turned into the worst experience of my working life. Eighteen months later, just after I resigned, I descended into what can only be described as hell on Earth. I lived in the emotional storm of an acute, unending, anxiety attack for three days. I couldn't think, I couldn't eat or drink without vomiting. I couldn't be alone for fear I would die. And at times, I wished I would because I didn't think I could stand another minute. I was prescribed three medications in large doses. A benzodiazepine for sleep, an antidepressant, and an antipsychotic, which is sometimes used to treat anxiety and depression when just the antidepressant isn't enough. Well, I don't regret taking the medications as they dulled the anxiety and lifted the depression to manageable levels. They did make me look and feel somewhat like a zombie for a number of months. With that first stage of recovery under my belt, I started thinking again about tapering off my medications. Like many other people who take them, I thought I was weak and wanted to prove to myself that I wasn't. First, I tapered off the sleeping pill. Then I significantly reduced the antipsychotic but decided to stay on the same dose of antidepressant, and there I sat for almost 20 years. In the early years, I tried a few times to wean off the antidepressant, but always experienced low-level anxiety and other minor side effects such as disturbing dreams. Mainly though, I was still afraid of being afraid, not wanting to look inside to find what was hiding there. Fast forward again to a little more than a year ago when I was 65. I must have been ready for a change of perspective, because a transformational book came across my desk while I was researching a Heads Up podcast about depression. It's called Lost Connections, Uncovering the Real Causes of Depression, and the Unexpected Solutions. It's by John Hari, an award-winning journalist and best selling author who has an experience of depression that he weaves throughout his book. Hari's book made me look at my situation differently through a lens of evidence-based findings, on the effectiveness of medication for depression and/or anxiety. And it made me question the medical system's long-standing pharmaceutical approach to symptom management, and the crutch it had perhaps become for me. So with input from Warren and Sahil, I developed a plan for tapering off the medications. I felt ready given that my life is now vastly different than it was 20 years ago, and that I'm truly invested in optimizing my physical, mental, emotional, and spiritual health. The three of us agreed that tapering off should be done very slowly. Given that I'd been on hefty doses for almost two decades. And because I'd had side effects when I last tried to cut down. You'll learn more about this from Warren and Sahil a little later. Starting last spring, I cut my antipsychotic medication over several months by almost 90 percent. It surprised me that I experienced no anxiety during that time, and it thrilled me that I felt increasingly more energetic and alive as the doses dropped. I delayed tapering down from the antidepressant until this spring, given that winter can be a challenging time for me. In April, I reduced the dose of my antidepressant a small amount. As with previous tapering attempts, I felt stirrings of anxiety and had vivid, sometimes disturbing dreams. But I persisted and that past. A week or so ago, I tapered down again, and I'll stay on that dose for a month or so before deciding whether to cut down further. That's slower tapering than people typically do. But I'm fine with that. Most importantly, Warren, Sahil, and I agreed that I needed to be realistic about my ability to taper off completely. I've accepted that and we'll take this process one day at a time, watching for symptoms that might be too much for me. I realized I may have to take medication for the rest of my life. And I have no shame or guilt around that. Nor should you if you're on medication that improves your mental health and quality of life. My journey of finding freedom from fear and anxiety has led me to new places, both within myself and in the world around me. I've embraced proven science while being embraced by compassionate care. I now have feelings that are big, and raw, and real, and so welcome now that I understand they're to be revered, not feared. As Eleanor Roosevelt recommended, I also try to do one thing every day that scares me. Today, it's being vulnerable by sharing my story, which I hope will inspire you to get the help you need. If you're struggling, start by making an appointment with your doctor and/or a mental health professional. And please check out the resources in the Show Notes page on our website at freshoutlookfoundation.org/podcasts. Time now to bring in the experts who can add some meat to the bones of my story, and John Hari's book. Let's start with you Sahil. I found you at Two Nice Guys Pharmacy in Kelowna, BC. Great name by the way. My daughter recommended this because of your amazing, personalized service. We met, and you agreed to help me taper off the medications. You also promised to read Hari's book and then share your insights on this podcast. Let's start by you telling us your story, and why you find such meaning in helping people along their healing journeys. SAHIL  12:31 I'm glad that you've had a good experience. I've never had someone ask me to read a book and be on their podcast. So, it was a neat experience for me as well. My story, the part that's kind of relevant to the mental health conversation here, is that in undergrad I was in sciences and living at home in Kelowna, going to UBCO. And everything was good. But when I was accepted into pharmacy school, and I had to move to Vancouver and go into this Doctor of Pharmacy Professional program, that's where things started to unravel a little bit, I would say. When I moved away, it was great. I was living with one of my friends. But in those first couple of months of being away from home and being in a new program and in a new city, I started to feel a lot of discomfort. I remember times when I was studying, and I couldn't focus anymore on the slides in front of me, and I would have to go lie down. Eventually, I got to the point of having a conversation with my doctor, and we realized that I was having panic attacks, which was very foreign to me. And the identity that I had for myself of being this high achieving person who just is able to do anything and everything, and to have that, quote unquote, what I felt as a setback was tough to process. And I wasn't able to really get a handle on the anxiety in those first few months, then kind of depression was becoming a part of that as well. And they are sometimes related but also very distinct things, and I felt the distinctions there. I eventually started on medications, and I found them to be very helpful. I remember in those first few months of being on fluoxetine that I felt that if everyone was taking this medication, that there would be less crime in the world, everyone be happier. It was amazing. But as in the book, I had a similar experience as the author where that effect faded, and then we would increase the dose I would feel well, and the effect would fade. And that cycle continued whether with new medications or new doses for a few years. And then near the end of pharmacy school, I was getting tired of it. And I tapered myself off the medications and it took probably a year after that for me to feel like okay, I'm actually through this phase of anxiety and depression. It was interesting for me because I subscribed very heavily to the chemical imbalance narrative, in part because I had everything else going for me in life. I had amazing support systems in my family and friends. Even though I had left my family, they were still very supportive. And I had friends there. I had a great career ahead of me with meaningful work. It didn't make sense to me. And that was one of the most frustrating parts of like, why am I feeling this way. So, the chemical imbalance narrative really helped, to be like hey, it is out of your control, but kind of working through it and getting through it. I think it was the purposelessness that really got me and meaning to life that got me, and I found it in social connections, I found it in really savoring the moments that I have with friends. Meaningful conversations like this one, when you're 40 minutes into a cup of coffee with someone, I find so much meaning and joy in those moments, and I soak in that joy. And I would say it's still a work in progress. And not every day is a great day. But I definitely have much more joy in my life. I have more good days than bad days, and the bad days aren't as bad anymore. JO  16:00 Thank you so much for being vulnerable and laying that out for us. And I agree your story too will help other people. How has your experience impacted in a positive way your ability to help your clients who are experiencing mental health challenges? SAHIL  16:17 I think my experience gives me an insight into what the human in front of me is experiencing. I understand how difficult it is to even get to the point of standing at the pharmacy counter. There are so many pieces in between one of just recognizing and understanding what's happening that took me a bit of time, then being willing to address that concern and eventually talking to a physician or whichever healthcare provider getting to the point of like, okay, I have this prescription in my hand, am I going to go fill it? Okay, I go drop it off at the pharmacy counter, am I gonna go back? There's so many points there, where things could fall off or the mind could change. So when that person is in front of me, I have a sense of like, okay, it was not easy to get here. And I want to make sure that I can hopefully make it a bit easier moving forward. JO  17:13 Sahil, before meeting you, my interactions with pharmacists had been what I call clinical, which I guess is fair. But the training you received is changing that. Tell us more. SAHIL  17:26 I graduated in 2019 from UBCs PharmD program, and it is very patient-centered care. We are not just looking at the condition and throwing a medication at it. We're looking at the human that's in front of us and saying okay, this condition is part of what's going on. But let's look at everything else that's going on. And as a pharmacist, our training, the first thing we even think about is, is a medication even necessary, is it even the best treatment? For example, in school, we were being assessed when we were counseling a medication to a patient. We had to give three or four non-medication ways, non-drug measures to help address any particular concern, whether its mental health related or blood pressure or cholesterol. Those non-pharm measures or non-drug measures are very important, and the first line of therapy, frankly, in the majority of conditions. If those don't work, then we look at medication. JO  18:22 When you say patient-centered or personalized care, what does that mean? SAHIL  18:28 It's about assessing what's important to them and what their values are, depending on whether they're in school, what their age is, what their priorities are. It can help us guide the antidepressant we choose, for example, because depending on their side effect profiles, some side effects, for example weight gain, may be acceptable to some and not acceptable to others. So that's where the personalized approach comes in of, okay, let me learn about this person, what's important to them. And then we can make more informed decisions together and give them the appropriate information. JO  19:02 When you speak to your clients first about taking antidepressants, what do you tell them? SAHIL  19:07 Sometimes the majority of the times the benefits aren't immediate. And that's really frustrating when you're living through anxiety and depression. You're feeling unwell in all these ways to hear that, hey, I'm gonna have to stick through this for another 246 weeks before I really feel better. So that's one thing, it is a bit of a process. And also, the first one may not be the right one. We have a lot of options. We have a lot of medications that work in different ways that have different side effect profiles. So we can hopefully over time find the right one. And the things that probably do work more immediately are those non-drug measures, whether it's starting to look at CBT, and there's a lot of free CBT resources out there, whether it's from Anxiety Canada or MindHealthBC? Maybe the first line of therapy is being more mindful about hanging out with your friends, which is really difficult to do when you're living through it. But if there's a way that you can go for that cup of coffee and feel a little bit better, or go for that walk in nature and feel that sense of calm, those things might be more immediately soothing, and that will give the medication some time to kick in. JO  20:18 What about the primary potential side effects? SAHIL  20:24 There's a whole host of things depending on the medication that you take. So to say main potential side effects is a little bit tricky. And everything's in context as well. So I always hesitate from saying things broadly. But I will say some of the big things to watch out for is that, especially in younger patients, there is an increased risk of self-harm. And that's something that is top of mind for me. So when I am talking to my patients I, especially younger patients, I'd like to mention this is something that we've got to watch out for. There's regular things like nausea, and dizziness, and all of these things that usually, we can help mitigate or get better as the weeks go on. Certain ones might have a higher risk of sexual dysfunction, for example, others have very limited risk of that. Some have a little bit of risk of weight gain, and others are less. Some cause trouble sleeping, some help more with sleeping. That's why the personalization part is really important. If I have a patient who has insomnia with depression, then we want something that causes drowsiness, depending on if that's what they want. If we have somebody that they are unable to get out of bed at all, they're sleeping 12 plus hours a day or whatever, and I was on that side I would sleep all day long, we want something that might have energized them a little bit more, a little bit more activating. Side effects are also tricky term because sometimes that effect is something we want to happen. So it's very personalized and patient specific. JO  21:51 What about side effects associated with tapering off, and your tips for minimizing these? SAHIL  21:58 What I've seen in my short career so far practicing for a couple years is we really want to take it slow; we want to go over weeks or months. And that will help minimize the withdrawal symptoms. So it can be some of the things that patients experienced in the beginning, maybe some dizziness, or the strange one to me that I wouldn't think about is flu like symptoms. People can actually feel unwell in that way. There can be some irritability, appetite affects, sleep changes. You might even feel that irritability or depression coming back, but sometimes it's temporary, right? It's just the body getting used to not having the medication. And it's not necessarily that the depression is actually coming back. The other one that I hear patients talk about sometimes even if they miss a dose or two, is brains zaps or just that abnormal sensation there. These are the things to look out for. And if they're happening, this is how we can manage it or just even knowing that something can happen, helps mitigate the surprise of when it happens and makes it less scary in that way. JO  22:59 Thanks Sahil. That's great info and will really help me by the way, which brings us to our next guest, Dr. Warren Bell and his decades-long practice of combining medical and pharmaceutical knowledge with psychotherapy and downhome compassion. Just building on what Sahil was explaining to us, what do you see in the way of side effects or symptoms of people tapering off of these medications? Warren  23:29 The principle that Sahil referred to, which is to do it slowly, is probably more important than any other principle with respect to withdrawing or tapering off medication of this nature, psychotropic drugs. People experience a variety of symptoms when they start to reduce medication, including symptoms that are very similar to the ones that they experienced before they began to take them. These are withdrawal symptoms, but they seem to be very similar to what they experienced prior to starting medication. And as a consequence, there's a sense that maybe their condition that led to them taking medication has recurred. But it's actually a withdrawal process. And the best way to deal with it is to do it very slowly. I've had people who were withdrawn off medication in six weeks by one of my psychiatric colleagues, experience a terrible withdrawal pattern. And when I was involved with repeating it, because they cut back on the medication, we changed it from a six-week withdrawal to a two year withdrawal, and it was effortless. JO  24:36 I'd like to build on Sahil's insights about patient-centered care. You and I have talked about your practice of getting to know people in the round, versus using only biomedical measures for treatment. Why don't you share your story of integrating treatment modalities and how it's helped your patients with mental health challenges? Warren  25:00 My background prior to medicine was not pure sciences. My background was actually, believe it or not, music and creative writing. So I had a sort of artsy kind of perspective on life. So when I came to medicine, it was with a very different perspective from many of my fellow students. I understood science, but it wasn't the only thing that I had studied. As I went through medical school, I found the narrow approach on biomedical matters and physical health issues, to be challenging, because I was only too aware of my own psychological responses. So early on in my training program, one of my preceptors, who was the head of psychiatry at McGill, noticed that I had a bit of an aptitude for exploring the psychological experiences that people were having. And that led to learning about different kinds of approach to therapeutic interventions in that area. And I eventually fastened on a procedure, or a process, or an approach called short-term anxiety provoking psychotherapy, which at the time, short-term meant 12 to 15 visits as opposed to two years of weekly visits that psychoanalysis was focused around. So it was shorter term, but it was still longer term than what is commonly done with psychiatrists these days. And after I had graduated, I worked in a psychiatric outpatient clinic for a year, and I also engaged in palliative care. Much of it is intensely psychologically oriented. When I came back to BC and began practicing in the small town of Salmon Arm, I just felt the need for a variety of reasons to explore other modalities. And I embarked on what amounted to a 20- 25-year process of learning about every kind of therapeutic opportunity that there is ranging from physical interventions like manual therapies, massage, cranial-sacral therapy, chiropractic, and of course physiotherapy, one of the standards, and osteopathy, and then also mind approaches. Sahil mentioned CBT, which is a fairly formulaic form of psychological intervention, but it's been used and has been validated as having some value. But then there's other things like yoga and meditation and mindfulness. And side-by-side with them was the process that I was bringing into my practice, which is insight-oriented therapy, where you spend a long time asking challenging questions and essentially, having patient hear themselves say things that they haven't said before, and understanding things inside their own consciousness that are new, and developing insights. That way, it's not a system where I give people advice. It's a system where I probe, and their responses end up being their therapy. And I've done it now for over 45 years. So it's been a central part of what I do, because once you explore people's minds, you find out what they are like, as you said, in the round. You find out more of the totality of their life experiences, not just the disease, or the condition, or the injury that they present with. So it inevitably makes you think holistically when you approach anybody. JO  28:42 During my psychotherapy sessions, we talk about many things including the mental health impacts of my upbringing, my Type A personality, my perfectionism, and so on. But my biggest takeaway was the realization that I bottled up what I thought were negative emotions for decades, only acknowledging and sharing the positive side of myself. Warren, you along with Brene Brown taught me to sit with my not so nice feelings, to really feel them, and then to identify them, process them, and maybe most importantly, learn from them. I'll give you a simple example of that. About six months ago, I was cleaning out my kitchen cupboards, and I came across a set of china that I had inherited when my Mom passed away. And it brought back wonderful memories of Easter dinners, and Thanksgiving and Christmas dinners and us all around the tables. And my mom loved those occasions. She loved her crystal, she loved her china, and her cutlery, and everything was set so beautifully, and she was so proud. And I decided that I really didn't have room for this china anymore. So I called my sister and I said, you have a lot more room, would you like this china? And she said, sure. I went downstairs, got some boxes, brought them up, and I started packing away this china. And I started feeling increasingly more sad, to the point where I started crying, which is really unusual for me because I'm not a crier. And I just felt worse and worse and worse. And so I went and lay down. And I started thinking about the china and what it meant to me and came to the conclusion that I didn't want to give it away. I really needed to keep this as a connection to my mother. So I packed up the china and I put it in this very special place, and decided that I'm going to use it on occasion, even if it's not a special occasion. So that, for me, was a cathartic experience of feeling something, identifying what it is, processing it, and then responding in a way that met my emotional needs. It has really played a remarkable role in my healing. I've said all that to ask this question. Warren, in the patients you've seen over the years who are experiencing anxiety or depression, what role do you see unprocessed negative emotions playing? Warren  31:34 They play a central role, because they embody things that are unresolved in one's own life experience. There is a social pressure on all of us to hold back expression of any kind of negativity. If you meet somebody in the street and they say, hi how are you, you don't say, well actually I'm having a really bad day, and let me tell you about it. Partly because we know that the chance of them stopping and paying attention to those remarks will be very limited, they might be frightened away. But also, it seems like exposing ourselves to having other people see the vulnerability in us. And so it's quite natural, at a social level in many social situations to suppress the expression of negative feelings, fear, anger, frustration, terror, all experiences which we define as negative. What they are, of course, is responses of our central nervous system to things that are troubling to us, that disrupt our lives, or that appear to threaten our security. When you do that, and those experiences come to the surface, as you described in the story about your mother's china, you often will experience an emotional reaction that takes you by surprise. And if it's the wrong kind of setting, for example, there's a bunch of people looking at you and you're on stage, and you happen to open your mother's china there, you would be under intense emotional pressure internally, to not start to weep on stage. Now, if it was a psychotherapeutic group therapy session, you wouldn't have that same feeling. But if you're on stage, and it's a public performance, you would feel horrified at the fact that you were losing emotional grip on yourself. So setting has a lot to do with it. And often in our early years, we have settings where we are discouraged from expressing our true reactions to things. A parent who tried to be helpful says, "Don't make so much noise in this room, keep quiet." You don't know why they want you to do it, but they tell you to do it. And you want to make a big noise, you feel full of exuberant energy, and you can't do it. And so you learn to put those feelings and that expression away. And then you get into a situation where you start to cheer at a sports event and suddenly you are feeling giddy, you feeling strange and kind of uncomfortable, and maybe a little anxious, like I'm being too exuberant. I'm expressing my feelings too vigorously. So what the negative emotions that are suppressed or unprocessed do is they influence a lot of our day-to-day behavior. But much of that behavior as an experience is of feeling anxious, or in this case that you just described, you feel sad, but they are highly legitimate emotional responses that are present in us when we're first born. And so to suppress them tends to be kind of unhealthy. It's not so much that you express them anywhere. You find out where it's appropriate to express them as you grow older, but you don't get rid of them. That's the key I think. SAHIL  34:38 I'm going to jump in here just to add a little bit more of my story and how I think processing those emotions helped out. When I originally had my symptoms, I felt defective in a sense. It's interesting how you would never think that of somebody else but when it's yourself, there's more harsh judgment, something that I have worked through thankfully. But I went on a self-improvement binge. And in doing so, I think developed a little bit more EQ, emotional intelligence, and self-awareness. With that self-awareness, I noticed and was actually able to see those negative emotions, sit with them, and process them in ways that you two have mentioned. So I think it's extremely important to get to that point where you can recognize and deal with what's happening. JO  35:23 What about the role of chronic stress and depression and anxiety? Warren  35:29 Chronic stress is usually the result of a habit. We live by habits, our lives are guided by habits, habits are shorthand ways of dealing with events that occur over and over again in our lives, and that we have to develop a sort of patterned response to. If there are patterned responses to all or most expressions of a certain part of our own inner world that is valuable and important to us, then it produces a chronic state of feeling anxious, depressed, or just out of sorts. Because we're putting aside a part of ourselves on a day-to-day basis. And the habit of putting that part of ourselves aside, has been so firmly entrenched in our vocabulary, our emotional vocabulary, that we never think about it when somebody says, are you scared, you say, oh no, even though we could be terrified, because we don't allow ourselves to think that we're terrified. Because if we thought we were terrified, we'd start to act like we were terrified. And that would produce the kind of reaction Sahil was just describing, doing things that you feel uncomfortable, that make you look more vulnerable. But in fact, as we become more integrated, our personalities become more integrated, and the different parts of ourselves get to know each other better, then stress levels tend to go down markedly. That's one of the reasons why insight-oriented psychotherapy can be so useful, because at the end of the road, you have an understanding of why you get agitated in certain situations, and not in others. SAHIL  37:04 So just to add to that chronic stress piece, it was stressful to be in a new city and learning how to fend for myself in that way. And the pace of professional school is very different from undergrad. It's hard to keep afloat in those settings sometimes. So I do think that chronic, ongoing feeling of drowning and rat race sometimes, I felt that even in my career, I think that does add to the situation. JO  37:30 For personal reasons, I'm interested in the link between genetics and anxiety and depression, as there's a history of those in my family. My dad experienced anxiety and depression. My paternal grandfather was hospitalized because of mental health challenges. And my maternal grandmother took her life by suicide when my mom was just eight years old. I also wonder about the impact of trauma and have tried to unearth the traumatic event in my past that might have triggered my challenges. Warren what can you tell us about that? Warren  38:06 Trauma is something that depends very much on the context in which a particular behavior occurs. And the trauma is not always explosive, violent, and deeply disruptive. Sometimes trauma can be the lack of a response to a certain behavior on our part as children. The adverse childhood experience body of research is often shortened to ACE, A C E, began in 1988. But it's research that really explores something that's deeply rooted in human experience. And that is that if things go really bad when you're young and vulnerable, then it can shape your response to the future quite dramatically. If somebody has a father who's an alcoholic, the father may never be violent or aggressive or invasive into that child's life, but they may be absent, they may be sort of non-existent, the parenting role could be almost completely removed because of a preoccupation with the state of consumption of alcohol. Sometimes parents are away a lot, they're absent. So trauma takes different forms. I think it's generally recognized that an accumulation of extremely disruptive events, things like a parent going to jail, things like the death of a parent, things like physical, mental, social, and sexual abuse. All of these really invasive, intensely disruptive forms of trauma clearly shake, sometimes shatter the sense of personality, self-esteem, self-trust, trust in others, and that can have impacts throughout a person's life. There's quite strong evidence that if you accumulate a certain number of traumatic experiences in your early years, it will have a permanent effect on your development as a human being. That said, you mentioned the genetic component of mental distress and mental difficulties. There is some degree of that, but with most genetic components, they offer about five, maybe 10 percent of the reason why things happen. What you may have genetically is a tendency, but not necessarily a condition. And so you might be more susceptible to certain kinds of inputs. But it's not that you're going to go ahead and behave in a certain way because of your genes overwhelming your judgment. JO  40:49 Warren, you've been doing this for decades. Have the levels of anxiety and depression increased over the last 10 or 20 years? Warren  40:59 My observation would be that certain kinds of anxieties have increased. And certain kinds of social and environmental, and I mean environmental in the broadest sense of the term, pressures and disruptions have come into the lives of many, many people around the world. On the broad scale, there is widespread anxiety, and particularly among young people, children ages, say six to 15. Anxiety about their future, on a planet that is increasingly degraded by human activity and the presence of so many of us on the planet. That's a genuine anxiety. And there have been surveys. The BBC did one recently that showed in every country, they analyzed children's responses, they found this kind of anxiety underlying their daily lives. They don't go around talking about it all the time, but if you ask them how they feel, they're very explicit and describe quite disabling, sometimes senses of anxiety. One of my colleagues who works in an emergency room here, had three young people over a period of some months who had all come to the emergency room because they were either feeling suicidal, or they had made a suicidal attempt, because they were so depressed about the future of human society. They felt that there was no hope for us. And I think the heat dome and the fires during the summer really intensified those anxieties. There are also other stressors like the enormous disparity between the very well to do and the very underprivileged and financially insecure. So I think there are increased levels of depression and anxiety about those kinds of things. But to be honest, the primary things that bring on anxiety and depression are personal factors, elements, and events, and experiences within a person's own life. That's where those kinds of experiences take place. And I would say, there's probably in this part of the world, more of that going on in communities, and neighborhoods, and individuals to some extent than there are in many other parts of the world where connection and interaction and a sense of community are much more strongly developed. But I would say these broad disruptive impacts are being felt by people all over the world. JO  43:25 Sahil, what's your observation about mental health over the last couple of years since COVID? I have heard that statistically, mental health has declined over that period. But I've also heard very promising statistics about how many people have taken this as an opportunity, like yourself, to build themselves in a positive way. SAHIL  43:54 It's hard for me to assess the exact statistics on what's happening. But what I do feel confident saying is, it's a conversation that more people are willing to have. It's something that became a societal level conversation during COVID lockdowns on how are you actually feeling. I think it prompted a lot of self-reflection in individuals. So maybe that's why we're seeing both improvements, because people are seeing things that they can work on, and maybe more conversations on people not feeling well because you're actually recognizing what's happening. And not just burying it with the busyness of life. JO  44:32 A big chunk of Hari's book outlines his research findings about the effectiveness of pharmaceutical solutions for depression and/or anxiety. He also questions the long-held belief that brain chemistry changes are the primary causes of those disorders. Sahil, what do you think about the book and Hari's arguments? SAHIL  45:00 So I mentioned my story, I did very much subscribe to the chemical imbalance narrative. And I do think there is still some truth to be had there. I think it's good to have a conversation around that on, okay, maybe that's part of the scenario, but maybe not the whole scenario. And there are things that we can work on. I did really enjoy the book. I enjoyed the breakdown of all these connections, and frankly, then all of the solutions that can help chip away at it. I don't know if I bought all the arguments in their entirety. But I think there is enough in that book to reflect on and learn from. Warren  45:38 The book was interesting for me, because I was familiar with a lot of the research that he explores. From a journalist point of view, he went and interviewed the people who had done, for example, the meta-analysis of antidepressants with the SSRI, selective serotonin reuptake inhibitor category. I was familiar with the fact that the full meta-analysis, which was done by obtaining all the studies that have been done on these drugs, rather than the ones that have been published at the time the drugs first came out. It was possible to do say, a dozen studies, find four that said what you want them to say, and then the other eight said things you didn't want them to say. In other words, they were not so positive about the drugs in question and their therapeutic benefits. And never publish those eight and only publish the four that you like. So what the researchers on that particular meta analysis did, they went and got all the studies. They nagged the Food and Drug Administration, so they finally gave them the actual raw data from those studies. And when that happened, it showed that the evidence used to promote many of the psychotropic drugs was quite skewed. It was quite directed towards a marketing end rather than a therapeutic end. And that's nothing new. Nobody should be surprised. The nature of the corporation and most large pharmaceutical companies or corporations, is to deal with the shareholders expectation of profit. And that's the sine qua non, the other part of it is of importance, but it's not the central issue. What I liked about the book was that I was hearing some of the sort of personal trajectories, the narratives of the people who did the research and why they did it, and what they felt about the research when they had done it. And that was adding another sort of personal element to stories that I had heard, written up in clinical journals. I particularly appreciated the fact that Hari was very open about his own struggles, which I think is important. It makes it clear that say an investigative journalist or a public figure, is not somebody who sprang out of the earth fully formed. They are like everybody else, in a process of evolving, and changing, and coming to new understanding about something that they might have thought they understood very well, for sometimes a very long time. So that was helpful for me. And then some of the individual stories about changes that took place in people's lives, I found quite illuminating, and quite heartening, as well. JO  48:20 What were your favorite stories and why? SAHIL  48:23 One of my favorite parts is right at the beginning, when the author talks about the initial experience with the medications which paralleled mine, of there was a benefit, it would fade, there was a benefit, and it would fade. And specifically, there was this part where the author felt compelled to evangelize about the medications. And I felt that as well. I was singing the praises because I had felt so down and so unwell. The correction of that, or the fixing of that, however, I felt in that moment was so significant to me, that I felt that everyone should consider whether or not they need these medications. So that point of relatability from the beginning, stuck with me and probably added to the authenticity of the book for me, or added to the reliability of the author's narrative throughout. Warren  49:15 The story that captured my imagination the most was the story he told about arriving in Berlin, he's originally German so this was kind of like coming home and coming across a small community of people rejected on all sides by society. Some of them were immigrants from other countries that didn't speak English, or German, or other as a first language. Some were people who had been disabled. Some were people with sexual orientation that was not accepted in German society. And somehow, they just didn't feel comfortable in the value system of the society they we're living in. All of them had been kind of isolated from society as a whole but also from one another. And then an elderly immigrant woman decided to just sit out in public and be visible, because she was having trouble with attaining some goals in her life, from the government. And around her coalesced a whole new community that formed, and was established, and strengthened, and sustained by the energy that each of these marginalized individuals brought to the broader nature of their gathering of people. It wasn't just a heartwarming story, it was an analysis of how community is established. You reach out, you find commonality, you ignore the superficial differences, you look for the deeper values that you share. And then when you do that, you gain an enormous sense of personal and shared satisfaction. And I think if there was any way to give an example of how to enhance mental health, I would say that story to me stood out very much so. SAHIL  51:03 I agree. Not only was it heartwarming, I found it to be so empowering. In those most dire of circumstances, they were able to come together. And that sense of community that they built was inspiring and empowering on any time you find yourself in dire straits, you can build that community that will help you through it. Warren  51:22 And I would compare that to say, a very wealthy suburb in a large urban setting where all the houses are grand, the trees are beautiful, and the neighbors don't always know each other. And they're often sort of in competition to have the nicest lawn, or the biggest swimming pool, or whatever. And sometimes, not always, but sometimes, just very wrapped up in material values. And then at some point in time realizing that what they really want is a sense of relationship with others. JO  51:58 Much of the book focuses on what Hari feels are the nine major causes of depression and anxiety, including trauma and genetics. He describes them as disconnection from other people, or meaningful values and work and from status and respect. He also talks about us being disconnected from nature, and from a hopeful and secure future, which are inextricably linked. He goes on to talk about solutions, or what he calls different kinds of antidepressants. And we don't have time to talk about all of these, but I would like to dig a little deeper into what I believe is the most important message in the book. And that's the vital role social connection plays in mental health at all scales, individuals, families, workplaces, and communities. So first of all, Sahil being of Indian descent, your experience with social connection is much different than ours in the Western world. Tell us about that, and how it played out in your life. SAHIL  53:07 My parents are from India, moved here kind of in their 20s. Typical immigrant story, came with very little, have kind of worked their way up the social ladder. I'm born and raised in Canada. Being Canadian is my primary identity. And then I so happen to have this background. And with that background, I think comes a greater sense of family and importance on family. The social connection that I have with my parents and with my sister, that family household connection is so central to my existence. Leaving that when I left Kelowna to go to Vancouver for pharmacy school, that definitely had a role of being further from my greatest support system. And there was never a sense that I would be abandoned. When I look at more Western culture of kids moving out at 18, it seems such a difficult way of life. I don't know if I would have been able to get to where I'm at in life, if that was the culture that I came from, or if that was the situation I was in. So that value on a family and supporting each other, this mindset of my parents support me until I'm self-sufficient, and then eventually, the responsibility becomes mine to take care of them. So we're always being taken care of and supported in that way. There's no sense of time out in the world by myself. Warren  54:33 The Indian culture is, in some ways, far more mature than the kind of hybrid culture that we have in this part of the world. And many, many other cultures really have maintained a sense of community and family. There's no question I've observed in many, many situations how having sometimes just one healthy relationship can mean the difference between somebody being really distressed almost all the time, and feeling a sense of relief and security. Maybe I can recite a story that was told to me by two prominent members of Indigenous community here. They talked about the fact that everything that happened in Indigenous community was for the community. And as a result, everything you did was to make sure the community survived. So if food was scarce, and hunters brought back a deer or something like that, or there was some kind of plant that they could harvest, it would be shared equally among the community. And even if somebody was a hunter and needed more energy, then others would make sure that the hunter had a little bit extra. We certainly don't think of the communitarian values that underlie our behavior all that much. We're doing a better job now, but we've got a long way to go. And I think we can learn a lot from the Indigenous experience. JO  55:59 Sahil, you have one foot in Canadian culture, the other in Indian culture. Tell us what you've learned about your Indian culture that would help us build more mentally healthy communities here. SAHIL  56:12 It's hard for me to speak for all of South Asian culture. Even just India is a country of a billion people, and there's a lot of nuances. But what I can say from my personal experience is, I'm lucky to have a good family dynamic. And that's taken work. It's taking conversations, it's taken establishing and respecting boundaries. So I think the takeaway for me is put time and effort into cultivating the relationships, maintaining the relationships, because that is kind of the foundation of everything else. If you have those, you can work through a lot of the other difficulties that life throws at you. JO  56:55 Warren, you and I have talked a lot about the importance of livable communities that are designed and built to foster social connection. Dig deeper into that for us. Warren  57:08 Absolutely, and with considerable enthusiasm. How you construct a community, how you actually build the infrastructure in a community has an enormous impact on the ability for people to connect with one another. I remember an article in Scientific American that showed a small English village before the advent of the automobile. And the road was narrow, and the paths on the side of it, what we might call the sidewalk was large. And there were people all over the sidewalk, and very few vehicles, and most of them were horse drawn in the roadway. After the advent of motor vehicles, and a few decades gone by, the roadway had expanded, the sidewalk had shrunk. And the vehicles on the road clearly overwhelmed any walking activities that took place, and the sidewalk was really just a kind of a narrow front in front of stores and other kinds of buildings. And the structure there did not facilitate people crossing the road to talk to one another. So when we do that kind of change in a town, even a small English village, without realizing it, we've disrupted social patterns and a sense of social connection. The changes that we've introduced with what they call concrete jungles, downtown areas where every surface has been built. And the only place you can actually meet somebody is by going in a door into a building and typically presenting something about yourself. Either it's you want a hotel room, or you want to buy something. But the interactions that are just the casual interactions are very hard to come by. I live in a small town. I've been here for 45, 43 years, and I walk down the street and it's a social event. I meet people every few feet practically, who I know and have a few words with. So I think how you construct a community has an enormous impact. Walking trails, park benches, park spaces where people can just hang out and be sociable. All of those things and many others make a huge difference in terms of facilitating social connection. SAHIL  59:17 This theme of the environment, and how ever you define it keeps coming up and is really important. And I think that starts even in your bedroom. What do you have there, and what is that promoting in your life? All the way to, yes, the greater community and the planet. And something that I've been reflecting on more recently is cultivating as much as I can, the environment that's going to bring the behaviors out of me or create the mindset in me that I'm wanting. JO  59:45 I've been a public outreach and engagement consultant to local governments in BC for 30 years. And I'm thrilled to say that things are definitely getting better at the community scale. When I started in the early 90s, municipalities didn't have sustainability plans or programs, climate action plans or programs, and very few were thinking about the social and cultural considerations of community well-being. I'm thrilled to say that there have been dramatic changes in these areas. Communities of all sizes across Canada are working with residents to plan and mobilize efforts to enhance and integrate social, cultural, environmental, and economic well-being. Warren  1:00:32 Joanne, that is such an important thing that people who are in governance systems can do to make communities what they have the potential to be, which is hubs for people interacting at multiple different levels and in multiple different ways. And in almost all of them positive. And there are many ways you structure both the physical structures and the social structures. The way support systems are given to people or not given to people can make a huge difference in the way their lives work out. And I think that is a critical element that all leaders and communities can play and make a huge difference. JO  1:01:13 Warren, I know you're also passionate about the social determinants of mental health, and how they impact people's well-being. These include things like housing, employment, education, physical environment, security, and financial stability, to name just a few. Knowing that you promote universal, basic income at every opportunity as a way to optimize these factors, tell us more and why it would improve mental health across the board. Warren  1:01:45 There's two pieces of evidence around mental health and what a universal basic income does to that part of our lives. The empirical evidence is that every experiment that has been done in this area has shown a massive uptick in positive emotional state in the people receiving the universal basic income in whatever form it occurred. There was an experiment done in Dauphin, Manitoba in the 70s and early 80s. And one of the universal findings there was everybody felt so much better about their life. There was an experiment done in Ontario for about three years before it was shut down by a new government. And it showed exactly the same thing, something like 87 percent of people had this enormous uplift in their state of mind, because they felt cared for. They felt nurtured by the community at large. It wasn't that they were given this cheque and they just went off and spent it. They looked at the cheque and they said, "This is all the other people who live in this community, contributing a few cents to my financial security." And that was a very powerful thing. The other piece of evidence is drawn from human health. And if you look at physical health outcomes in countries where there's more income equality, and what a universal basic income does is it puts a floor under which nobody will sink. The evidence from many different countries in the world shows that human health at the physical level improves very significantly. Countries with greater financial disparities between the wealthy and the financially underprivileged. Every study shows that people use hospitals less often, they go to doctors, less often, they suffer from chronic illness less often. So I think it's very hard to argue against universal basic income. SAHIL  1:03:39 I think on a broader scale, it's a great idea. We want everyone in society to be taken care of, to be fed, to be housed. The social determinants of health are something recently learned in school. Income inequality is such a predictor of health along with education and the other determinants. We talk about medications a lot, but these basic foundational societal concerns, if these can be addressed, then were working on prevention rather than treatment, and I think that's a great approach. I am probably not as well educated on the economic consequences of these policies and decisions, but definitely something I'm curious about and want to learn more about, because the promise, I think, is there. JO  1:04:30 This has been an informative and inspiring journey with you both personally and as a producer of this podcast. Thank you from the bottom of my heart, for sharing your stories and your incredible insights and passions. So let's close with a question for each of you. Warren, you've been doing this a long time. What are you seeing in treatment modalities and health care now that gives you hope for the future? Warren  1:04:59 I've been reflecting on this quite a bit recently because I'm veering towards retirement, and it makes you think about what is the nature of healthcare and your role in it. And what is the system itself doing, which I've been observing for nearly five decades overall. One of the big changes is that the information that is now available to people is far more abundant than it once was. At one point, you could only get information about health from either a specific healthcare practitioner or from somebody who was selling you a product. Abundant and accurate information about human health, in all its aspects and every aspect that we've talked about today, it's now available online. Now, there are of course, sources of information that are entirely questionable and distorted. But much of the information is really eye opening for many people. And that's taking the emphasis off just say going to the doctor or going to see another health professional, and sort of democratizing access to information, which I think is a really important step. And I think that's revolutionizing how healthcare happens. JO  1:06:19 Sahil giving your lived experience of depression and anxiety, your expertise as a progressive pharmacist, and what you've learned from Hari's book, how do you see the future for the one in five Canadians who have or will have depression and or anxiety? SAHIL  1:06:37 I see a hopeful future. I think it starts with that first step of that self-awareness and identification of what's happening before it's becoming too severe. Trying out all the non-medication measures, some mentioned in Hari's book, and some we've mentioned throughout the podcast, and then having your health care team in place if you're needing it to work on from the psychotherapy aspect or

SUMMARY Senior's mental health is affected by social threats such as stigma, ageism, and racism, and impacted by individual circumstances such as isolation, loneliness, poverty, poor physical health, lack of independence, and abuse. In Part 2 of this podcast, Marjorie Horne (seniors' advocate and founder of CareSmart Seniors Consulting), Naomi Mison (caregiver and founder of Discuss Dementia), and Dr. Anna Wisniewska (geriatric psychiatrist) shed light on these contributing factors and the complex choices seniors are often faced with ─ separation vs. connection, resignation vs. resilience, and invisibility vs. legacy. They also talk about the role of spirituality in seniors' mental health, and the healthcare changes needed to make healthcare systems and cultures more integrated, personalized, and compassionate for seniors. TAKEAWAYS This Part 2 podcast will help you understand: Prevalence and impacts of macrosocial (or society-wide) influences such as stigma, ageism, and racism Prevalence and impacts of personal circumstances such as isolation, loneliness, poverty, elder neglect and abuse, poor physical health and/or chronic pain, and lack of independence People who embrace aging vs. those who resent aging and resist change Impact of seniors' attitudes and behaviours on mental health Life-affirming choices seniors can make (separation vs. connection, resignation vs. resilience, invisibility vs. legacy) The role of spirituality in seniors' mental health Mental Health Commission of Canada's 2019 Guidelines for Comprehensive Mental Health Services for Older Adults in Canada Vital values for adequate care (recovery based, accessible, comprehensive, evidence-based) Mental health promotion and illness prevention Cultures of compassion within the healthcare system SPONSOR   RESOURCES World Health Organization Canadian Coalition for Seniors' Mental Health Mental Health Commission of Canada Active Aging Canada Alzheimer Society CanAge Canadian Association for Retired Persons (CARP) Canadian Centre on Substance Use and Addiction Canadian Frailty Network Canadian Mental Health Association Canadian Suicide Prevention Network Deprescribing Network Elder Abuse Prevention Ontario National Institute for Care of the Elderly (NICE) Seniors First British Columbia The Centre for Addiction and Mental Health Caregivers Alberta Carers Canada Caregivers Nova Scotia Canadian Hospice Palliative Care Association Families for Addiction Recovery: FAR Canada Family Caregivers of British Columbia Canadian Research Centres on Aging   GUESTS  Marjorie Horne, Dipl. T. Nursing Marjorie Horne was 16 when she knew that the way we see and treat elders had to change. Her journey involved training as a registered nurse, becoming the Executive Director of the Central Okanagan Hospice Society, working in management in seniors housing and, finally, starting her own business, CareSmart Seniors Consulting Inc. She is also a Conscious Aging Facilitator and a Certified Professional Consultant on Aging. As an entrepreneur, Marjorie's goal was to bring a holistic, ‘Circle of Care' approach to supporting seniors and their families through the many transitions encountered in the third chapter of life. Her community endeavors of creating and hosting her own radio show, Engaging in Aging, every Sunday morning on AM1150, writing a bi-weekly column, facilitating workshops on Conscious Aging, and speaking at local events, are all driven by the desire to be part of a new paradigm where we reimagine later life with courage, resilience, passion, and purpose. Phone: 250-863-9577 Email: resources@caresmart.ca Website: www.caresmart.ca Facebook: https://www.facebook.com/caresmartseniorsconsulting Twitter: https://twitter.com/caresmartsenior Linkedin: https://www.linkedin.com/in/marjorie-horne-46bb8937/ Naomi Mison, BA Naomi Mison is a public speaker, vocal advocate, and a champion of change. She has spent the last four years bravely sharing her journey as she cares for her mother who was diagnosed with frontotemporal dementia, when Naomi was just 22 years old. She has spoken publicly through the Alzheimer Society of Canada National Anti-Stigma Campaign, CBC's Out in the Open podcast, Globe and Mail, Embrace Aging Okanagan, Pecha Kucha, and many more. Naomi volunteers with the Alzheimer Society of BC's Leadership Group of Caregivers, is on the planning committee for IG Wealth Management Walk for Alzheimer's, and for the Seniors Outreach and Resource Centre. Naomi holds a Bachelor of Arts in Political Science and English, and a Diploma in Public Relations.  Phone: 780-885-3956 Email: mailto:naomi@discussdementia.com Facebook: https://www.facebook.com/nam956 Twitter: https://twitter.com/NaomiMison Linkedin: https://www.linkedin.com/in/naomimison/ Dr. Anna Wisniewska, MD, FRCPC Anna Wisniewska completed her undergraduate medical training at the University of British Columbia and her postgraduate training in psychiatry at the University of Calgary. Her clinical career has always focused on the care of the elderly and their families. Dr. Wisniewska is currently a consulting geriatric psychiatrist at the Kelowna General Hospital and the Kelowna Mental Health Centre. She also works in her private practice in Kelowna and is a sub-investigator with Medical Arts Research.  Her passion for her work and compassion for her patients were inspired early on by her very close relationship with her grandparents, and maintained by the many wonderful patients, families, and colleagues met along the professional path. Email: DrAWisniewska@gmail.com HOST Jo de Vries is a community education and engagement specialist with 30 years of experience helping local governments in British Columbia connect with their citizens about important sustainability issues. In 2006, she established the Fresh Outlook Foundation (FOF) to “inspire community conversations for sustainable change.” FOF's highly acclaimed events include Building SustainABLE Communities conferences, Reel Change SustainAbility Film Fest, Eco-Blast Kids' Camps, CommUnity Innovation Lab, Breakfast of Champions, and Women 4 SustainAbility. FOF's newest ventures are the HEADS UP! Community Mental Health Summit and HEADS UP! Community Mental Health Podcast. Website: Fresh Outlook Foundation Phone: 250-300-8797   PLAY IT FORWARD The move toward optimal mental health becomes possible as more people learn about the challenges, successes, and opportunities. To that end, please share this podcast with anyone who has an interest or stake in the future of mental health and wellness. FOLLOW US For more information about the Fresh Outlook Foundation (FOF) and our programs and events, visit our website, sign up for our newsletter, and like us on Facebook and Twitter.   HELP US As a charity, FOF relies on support from grants, sponsors, and donors to continue its valuable work. If you benefited from the podcast, please help fund future episodes by making a one-time or monthly donation. Marjorie Horne, Naomi Mison, Anna Wisniewska Interview Transcript You can download a pdf of the transcript here. The entire transcript is also found below: RICK  0:10 Welcome to the HEADS UP Community Mental Health podcast. Join our host Jo de Vries with the Fresh Outlook Foundation, as she combines science with storytelling to explore a variety of mental health issues with people from all walks of life. Stay tuned. Joanne  0:32 Hey, Jo here again with Dr. Ania Wisniewska, Marjorie Horne, and Naomi Mison, as we continue this vital conversation about seniors' mental health. We'll dive deep into the social influences and individual circumstances that impact seniors' well-being, the personal choices they can make to extend and enrich their lives, and the systemic changes needed to optimize the aging experience through prevention, personalized care, and integrated mental health care. NAOMI  1:03 Thanks for having us back. MARJORIE  1:05 We had so much fun the first time we wanted to do it again. ANIA  1:08 Thank you, Jo. And nice to be doing this again with you beautiful ladies and of course with Rick. JO  1:14 To start, can each of you share a little about your work as seniors' mental health care professionals and caregivers for the listeners who didn't hear Part 1? Ania, let's start with you. ANIA  1:26 I am a geriatric psychiatrist working in Kelowna. My work focuses on the care of seniors. I work at the Kelowna General Hospital, caring for patients with mental illness, and I also provide support to the Kelowna Mental Health Center to the seniors' mental health program. I also am involved in a small way in a local drug study program that looks at novel medications for the treatment of Alzheimer's disease. I also spend quite a bit of time in my private practice where I see patients for assessments, and also for follow up long term. I guess I should also add, I'm also involved in teaching at the University of British Columbia. I am involved in teaching medical students as well as residents, which is a wonderful and enriching experience. Joanne  2:13 Marjorie. MARJORIE  2:14 I was trained as a registered nurse and then did a number of things over the course of my career. And I then went back to my first love, which was working with seniors. And that's where I started in my nursing career and worked for about 10 years in seniors housing within the elder care environment. I just saw during that time, sort of a gray area that didn't seem to be addressed as far as all the different transitions that both the older clients I was dealing with and their families, were going through all of these transitions and a lot of emotions come up. We're talking about grief and loss. So I almost felt compelled to start my own business, which I've been running for 10 years now, to try to bring a holistic approach where we really look at the physical dimensions of aging and also the emotional aspects of change and the grief and loss that many people are dealing with. JO  3:16 And Naomi. NAOMI  3:16 I have been a caregiver to my mom, who was diagnosed with early onset dementia, for over 13 years. On the 10th anniversary of caregiving, I decided I really wanted to use my voice to advocate for systemic change. So I reached out to the Alzheimer's Society of Canada and became a media spokesperson, public spokesperson for them. I'm currently involved with the leadership group of caregivers for the Alzheimer's Society of BC. So that's really rewarding being with other caregivers. In my professional life, I'm in marketing and communication, so I'm just trying to utilize my skill set. And really again, advocate for that systemic change in the area around older adults. JO  4:03 Thank you for all the great work you're doing, it's just incredible. In Part 1 of this in-depth look at seniors' mental health, Rick introduced us to macrosocial or society wide influences that seniors face. Things like stigma, ageism, systemic racism, and inequality. I'd like to touch on a few of those today starting with stigma. We won't go into detail about mental health stigma, as there's an entire episode on the topic on our website at freshoutlookfoundation.org. But for the purposes of this conversation, let's say stigma begins with negative stereotyping or the labeling of perceived differences between groups. In this case between the young and old. This separation often leaves seniors feeling diminished, devalued, and fearful due to the negative attitudes our youth focused culture holds toward them. Which means that sometimes people with mental health challenges don't get the help they need for fear of being discriminated against. I want to know how each of you see stigma through the eyes of the seniors you serve. ANIA  5:21 Stigma is so so essential to consider. And obviously podcasts that you have done would speak to that quite a bit. But I think in terms of a story, I guess would be kind of a general one. For some of my patients, they are quite reluctant to share their illness, or the diagnosis, or what they're going through with family or friends, for the fear of being rejected or stigmatized. And I also see sometimes how caregivers will sometimes minimize what's going on at home for the fear of, again, being stigmatized. So they will minimize the symptoms or cover up the symptoms with family or with friends, because they are afraid of what people may think or say. And it's really quite heartbreaking because it can lead to, in the cases of the say caregivers, a delay in getting the help that the patient actually needs. MARJORIE  6:11 Many times, if when I'm talking to groups of seniors and asking them about some of the emotional things that they may be going through, they just sort of look back at me and stare at me and I just wait and I wait. What is it do you think within you, that doesn't permit you to share what might be going on? They all look at each other, and one person always puts their hand up and they said, well, it's partly about my pride. And then they all look at each other and nod that there's some sense of, if I'm losing my memory, or if I'm feeling depressed, or if I've had a fall, I'm not going to tell anybody about it. Because this will show weakness. And then this may mean that my family feel I can't handle things. When one person expresses it in a group, then they all of a sudden all open up and begin to just again share what they're feeling about that. NAOMI  7:09 I also saw a lot of that sort of real concern around loss of independence, when I was working within the clinical research space. I was talking to hundreds, if not thousands of older adults and trying to encourage them to come for cognitive assessments, even if they weren't demonstrating any signs that just to get a baseline. The most prevalent answer I would hear was that I don't want to come in because if I have an issue, then you're going to take away my license, and I'm not going to be able to be independent anymore. Joanne  7:43 Can each of you share one thing you think we could do generally to reduce the mental health stigma seniors face? MARJORIE  7:51 We need to listen more. I see this a lot when working with seniors and their families. If we can listen and less be trying to advise. I'd see this often in adult children that they have their own fears coming into play that really interrupts the process of an older senior being able to talk about how they are feeling. ANIA  8:15 Sometimes it's education about having realistic expectations. What is a realistic expectation? What isn't? What is it that we could actually improve? What could we not? What's worth taking a risk? And for me, those discussions are typically focusing on quality of life. What are things that are important to your loved one, based on what you know about them? To me, it comes down to the quality of life. NAOMI  8:39 I work in communications and marketing. And so I really do believe that words matter. And the language that we use every day can be one area that we can focus on in the here and now. Oh, I'm just feeling crazy, or that person's senile, or they've totally lost their marbles, these different terms of phrase that we have in our everyday vernacular. And it's definitely only strengthening those stereotypes. So I really would love to see some really thoughtful discussions and considerations around language and really being intentional to dispel some of those prevalent stereotypes and increase overall understanding. Joanne  9:24 So let's talk about ageism next, which in simple terms is discrimination based on a person's age. In its Changing Directions, Changing Lives report, the Mental Health Commission of Canada noted that, "Older people have sometimes been viewed as simply a burden to society. Not only do the stereotypical views discount the contributions seniors have made throughout their lives, but they also underestimate their ongoing contribution to our communities and social life in general."  Ania, what are your observations around ageism? ANIA  10:05 What I would start off with is that there is definitely a cultural variation in terms of how aging is perceived. So in some cultures, the elderly are much more revered or put on a pedestal and seen as a source of wisdom, and matriarchs or patriarchs of the family. In our more westernized cultures, we tend to sort of focus a little bit more on the individual. We're less likely to have intergenerational living arrangements, maybe that's a good thing, sometimes. But it does make a difference. Just to give you an example, my much younger cousin who was born in Canada, and did not grow up with his grandparents. When he went back to Poland to visit his very elderly grandparents, he was terrified of them. And it's interesting, it's not anything they did or said. It was just the appearance of a much older person. And I found that so fascinating to kind of see a young child react that way to people who obviously adored and loved him. But initially, he was just scared because he wasn't accustomed to seeing a much older person. So we do need more of that sort of sense of intergenerational living. And I'm not exaggerating, there's situations where we have patients literally dropped off at emergency, because the family wants to go on a holiday, and they don't have a caregiver for the elderly mother or father. I'm not exaggerating this, this does happen. And it's obviously heartbreaking. But it's beyond comprehension that that can happen. And it does happen in Canada. So I do think that intergenerational connections is really important. JO  11:37 So what's one vital step we could take to tackle ageism? NAOMI  11:42 Sharing those stories and putting a face to a name or putting a story to a subject matter, I think is vitally important. And just really increasing awareness and prevalence of people living, no matter the age but really as an older adult, their best lives. I often find, we don't hear enough of those stories. And so I think that would be one way to really start tackling this subject matter. MARJORIE  12:12 I started to write a column in the newspaper about eight years ago. And at first, I was trying to be very professional. And while I was looking after my mom, sort of 24 hours a day, and then I finally went, oh, I'm just going to tell people what's happening. What I'm going through my own aging journey and also my Mom's was really like. And what fascinated me was that I started to receive so many calls and emails from people. And they all were saying the same thing that they had all these concerns about their own aging life, but they just didn't know how to talk about it. So we all need to talk about it together. ANIA  12:51 The only other thing I would add is, it's also leading by example in our professional lives, but also as people in our lives, our families or friends, focusing on the positives. One thing that gives me a little bit of hope is a lot of trends in our society, particularly kind of Western society have been driven by the baby boomers, because they are such a large demographic group. And because I look after patients who are by definition ill, or experiencing health difficulties, and we kind of tend to sort of see a very narrow section of the senior population. And yet many seniors are living healthy, fulfilling lives. And I'm, again, hoping that we're seeing the baby boomers come through that stage of life that will actually help improve that dialogue and improve the perceptions on the education as well. JO  13:37 The final societal influence I'd like to discuss is systemic racism. And again, with all of the podcasts on the summits that I've been producing, systemic racism comes up over and over and over again. So I'd like to know from each of you, how does racism appear in your corner of the mental health care world? Ania? ANIA  14:05 The one population of patients we've heard about is Aboriginal patients, who are really struggling with the systemic racism that exists within the healthcare system. But interestingly, there is also the fact that I think that we are having those discussions and being more honest and more open about how it is impacting patients. I'm hopeful for systemic change as well, and improvement in access to care and just the day-to-day care that we provide to patients. I'm not saying that we're there or even close. Taking the first step in improving the significant problem is developing that awareness and being honest and accepting of how much of a problem it is, and what it is that hopefully we can do to improve. MARJORIE  14:49 I don't see a lot of that just within the work environments that I'm in. I do see it sometimes coming up within independent living sites. Sometimes I will hear maybe a comment or I just sense when I'm being within a group, that there is some racial bias going on. And it's always very hurtful. And if I'm able to, I sometimes try to talk to that person that is initiating that. But that's really within my environment of working in elder care, it is quite limited that I do see it. I just think COVID has really brought so much more to the forefront for all of us, to be thinking about the inclusiveness of how much work there is still to be done. I noticed myself I'm just personally thinking about it a lot more. JO  15:41 Any ways you think we can minimize the impacts of racism on senior's mental health and the care they receive? NAOMI  15:49 One way is really developing culturally responsive, safe, accessible services that really meets mental health needs of a diverse population. Right now, I think what we have is not sufficient enough. And there's a lot that can be done to identify and decrease these disparities in rates of illness and outcomes. Joanne  16:18 Before moving on to talk about how a senior's circumstances can impact his or her mental health and well-being, I'd like to thank our sponsors, the Social Planning and Research Council of BC, Emil Anderson Construction, WorkSafeBC, and AECOM Engineering. These amazing folks fuel our drive toward improved mental health literacy throughout Canada and beyond. And we couldn't be more grateful. JO  16:47 Let's talk about isolation and loneliness and their increasing impacts on seniors, especially since COVID. These words are often used interchangeably, but they mean very different things. Isolation is a physical state. For example, we've been isolated due to pandemic restrictions. Loneliness, on the other hand, is an emotional state, meaning that some of us are feeling lonely because of the isolation. Seniors who are isolated may not be lonely, and lonely ones may not be isolated. So Ania, how do isolation and loneliness play into the mental health challenges faced by seniors? And what are the most common causes? ANIA  17:32 One of the things that I think has become much more obvious over the course of the last year and a half during the pandemic, of course, is that sense of physical isolation that was, of course, a result of the pandemic and trying to protect everyone in the community from COVID. And it certainly has exacerbated that in many ways. And I think one of the things we don't always think about is the impact not just on the patients themselves, but also on the supports and isolation from the support of their caregivers. In terms of loneliness, the recent pandemic has, I think, exacerbated that for some of our patients, leading to increased sense of loneliness. And that of course, can lead to increased depression, anxiety, as well as a sense of hopelessness. Other outcomes that can contribute to isolation and then also loneliness are declining physical health, that may lead to difficulties with mobility. Therefore, a patient becoming more shut in in their home because of inability to get out. Some physical difficulties may lead to loss of ability to drive again, increasing that sense of isolation, and then possibly leading to sense of loneliness as well. Unfortunately, as we age there's a greater chance that those who we feel connected to will become ill and pass on. There may also be other factors like physical frailty that I mentioned earlier, and loss of sensory abilities. For example, vision or hearing, that can also lead to isolation. Many of my patients will struggle with hearing loss are especially affected in kind of larger group settings, where there's a lot of sources of auditory stimulation, and they find it very difficult to take in conversations. So even though they may seem not to be isolated, they may not be able to enjoy or partake in conversation as much, because they are having trouble hearing. And then of course, sometimes we see things like family estrangement that can happen and that again, can lead to a sense of loneliness and isolation. Joanne  19:29 What do you recommend to help people become less isolated and more connected? ANIA  19:34 I think some of it is to try to look for strengths that we have, and also to make adjustments. For example, if interacting socially in a larger setting or a larger physical space, which can cause echo and other kinds of troubles when you have hearing aids, maybe plan for having a get together with one or two people in a smaller setting, where there won't be as many issues related to you hearing. Sometimes some of my patients and families, we discuss the idea of relocation. Some patients move, say to the Okanagan for the obvious benefits during retirement. But some of my patients, as they age and become frailer and develop more complex medical difficulties, find it difficult to be away from family. To some patients, I do encourage them to consider relocating to be closer to their support network. Sometimes living on your own can lead to a sense of that isolation. And then from that loneliness and consideration of alternative housing options like supportive housing, may also be a good idea that allows for increased socialization and interactions with others. And sometimes it's just a matter of being brave and taking some risks and putting yourself out there to find others. There are a lot of different resources available. Senior centers are wonderful resources to connect with others. The Society for Learning and Retirement is also an amazing resource for seniors, that can provide a lot of stimulation and opportunities for social connections with like-minded seniors. Joanne  21:04 Naomi, what are you seeing as you care for your Mom? NAOMI  21:08 I certainly believe that there has been an increase of loneliness, especially at the beginning of the pandemic when the doors were shuttered to all caregivers, and other forms of social engagement. I do think part of the issue in terms of long-term care is even the design of the physical space. For example, in my mom's home, there are three wings that are long hallways, with rooms adorning each side. And there's limited interaction, unless you're on that wing or going for mealtimes, which again has been changed in response to COVID. So for the majority of the day, other than a meal time, you would be spending alone in your room. Joanne  21:55 Another circumstance that some seniors face is poverty. And the outcomes can be things like poor nutrition, inadequate housing, or lack of transportation, just to name a few. And these will certainly all impact seniors' mental health. Ania, can you tell us about the psychology of poverty? ANIA  22:16 When we consider the impact of poverty on individuals, we can think of it in different ways. People can become more, sort of, ashamed of their circumstances, afraid to reach out for help, and focus on the basics and trying to get by from day-to-day. Poverty can then result in increased, kind of, physical as well as mental disorders, and can also decrease cognitive functioning just because of chronic stress. Joanne  22:46 So how can we start turning this around? ANIA  22:49 I think there are certainly increasing initiatives to look at decreasing poverty in our society in general. Seniors are certainly an affected group as well. Obviously, affordable housing is a big one, particularly in Canada, given the astronomical prices of housing. And that's not just for purchasing real estate, but also rental. For seniors who do not own their own properties, improving access to coverage for medications. Some medications are still out of pocket expenses that are not even covered by PharmaCare. And they can be extremely expensive. And some of my patients are not able to afford those medications, limiting the options for them. There has obviously been a lot of discussion in Canada and other countries looking at the concept of minimum income, and whether or not that would be something that will be of benefit. There's obviously differing opinions on that whether it's something worth considering as well. And also the role of families and how they are involved in supporting seniors, in terms of helping them with some of their financial concerns, I think would also be important to consider. Joanne  23:52 Marjorie, what have you learned about the impact of poverty on seniors' mental health? And again, how can we turn this around? MARJORIE  24:00 There's quite an issue with so many people as their aging, and particularly if they don't have the security of a good financial portfolio. There's a lot of fear that revolves around that. But also seniors have a great sense of pride. And it does limit them, I think, in reaching out to gain the support that maybe even is available. They don't know where to go, they don't know where to look. The generation of my parents, that's very much there that they don't want to be a burden to anyone else, even in their family or on society. They're proud and they've worked hard. Joanne  24:41 Naomi, what have you learned about the impacts of poverty on mental health, both in your caregiving and advocacy work? NAOMI  24:49 So what I am seeing, a lot of it tends to be this catch-22, where poor mental health leads to lower income and then vice-versa, lower income results in poor mental health. So I believe when you're navigating this both from a caregiving side and advocating, you really do need a lot of resilience to navigate, because you are met with a lot of obstacles along the way. And that really takes a toll on you. And when you're already worried about putting food on the table, paying your rent, it's really hard to steel yourself to fight the good fight on a daily basis. So, I'm seeing that people are just exhausted. They simply, especially from a caregiving perspective, as we had discussed that the supports that once were available to people, whether it's adult day support, or respite care, are not available in the same way. So the different areas that you may have had an opportunity to have a break or reprieve aren't really available. That compounds the stress to the point that you're often left just burnt out. Joanne  25:59 Let's move on to the conditions of trauma and elder neglect and abuse. Ania, what kinds of trauma follow people into their senior years. And how did they effect those seniors' capacity to live full and rewarding lives. ANIA  26:17 Trauma is obviously a complex issue. And it's generally kind of considered an emotional reaction to something that's quite distressing or stressful. And of course, those types of events can take place at any given point. Traumatic experiences can include exposure to combat or war. Of course natural disasters can also be very traumatizing. Accidents, be it a motor vehicle accident, or as seniors age, unfortunately, there is a high risk for falling. There are also experiences that can happen in terms of abuse, that includes both physical, emotional, and sexual abuse. And those experiences can take place in adulthood, but also in childhood. And of course, that can lead to some difficulties later on. Various studies that look at the experience of trauma and seniors will estimate that between 70 to 90% of seniors have experienced trauma in their lives, which is obviously not surprising given the average age of a senior in Canada. Now, in terms of looking at how trauma can impact a senior, I think a lot of it depends on how that trauma is experienced and processed over time. The way we experience trauma is sort of, I guess, in a way filtered through our sort of life experience, our personality, and also the circumstances. So for example, if we experienced something traumatizing, but we have tremendous support from family or friends, our reaction to it may be a bit more muted, versus if you are not supported or isolated, and may be much more difficult to cope with the trauma. But there's also, of course, concerns about delayed reactions and also chronic post traumatic stress disorder, which we will see in seniors as well. JO  27:15 What kinds of successes do you see in the treatment of seniors with trauma related mental health challenges? ANIA  28:07 Some of it actually starts off with maybe even looking at prevention, particularly when you look at seniors who are at risk for falling. So, looking at prevention to try to diminish the risk of trauma, being more in tune with what may be happening for them at home in terms of monitoring for any concerns related to abuse or neglect. Another thing that can happen in terms of prevention is even staying in hospital can be traumatizing, particularly for patients who are in the ICU. So looking at strategies in the ICU to decrease the experience of trauma in that environment. So prevention is one piece. And then of course, if a traumatic experience happens, counseling can be quite effective. And that can include more supportive grief counseling, cognitive behavioral therapy, and other modalities of counseling. Some seniors do better with one-on-one counseling related to their trauma, and others will benefit from either group therapy or a support group. That sense of connection with other people who may have experienced trauma or similar traumatic experiences, can be really empowering and also normalizing for patients. And sometimes we do need to resort to medications. Patients who have severe post traumatic stress disorder can be quite affected by it, and post traumatic stress disorder can be associated with other psychiatric illnesses such as depression. So sometimes medications are also an important tool that can improve the quality of life for a patient who has a history of trauma. Joanne  29:32 Naomi, what have you learned in your caregiving and advocacy work about how to respond if you think a senior is being neglected or abused? NAOMI  29:42 If you are aware that a senior is being neglected or abused, you should seek out provincial or territorial resources on elder abuse. They will depend on the location, but really reporting what you're seeing. If it's a staff member, reporting that to a higher level, or if it's a family member, any means that you can just bring it to someone's attention is a first step. And if you're not comfortable doing that within a home setting, then seeking out government bodies to help support or guide, I think, would be the best first approach. Joanne  30:15 Next, I want to talk about the mindset us seniors have, the choices we make, and the behaviors we adopt that can help us live long, fulfilling lives. Now, bear with me, I'm thinking there might be an aging spectrum here. On the one end, could be people who embrace the aging process and choose to be responsible for aging, while on the other end, there could be those who resent aging and resist change. What's likely for most of us is that we inhabit the middle ground between positive and negative circumstances, attitudes, and behaviors. So honestly, does that make any sense? Ania? ANIA  30:59 Definitely, I think the way you have summarized it focuses on not just some of the responsibilities you mentioned, but the sense that it is an individual experience. So the mindset is very much a personal experience that can be shaped by the person's individual personality, but also their life experiences and sense of support from their community or families. It also I think, comes from a sense of purpose, and acceptance of changes. So I think if we look at all these factors, certainly we have to consider every individual in terms of their own life experiences, and their approach to how they want to lead their lives. And yes, I agree, I think we all need to take personal responsibility for our health and well-being. We talked in the earlier podcast about factors that can increase our risk of having various medical or psychiatric conditions later on in life. That may be, for example, smoking or dietary choices. So those are some of the things that we need to think about when we want to think about responsibility for aging well, is that sense we are looking at prevention as well. That's a complex decision for sure. JO  32:08 Marjorie? MARJORIE  32:09 I work a lot with people around change in many different capacities during workshops and webinars. Because I find that as so many people as they're getting older, they are afraid to step out of their comfort zone. And it's not that they're particularly happy in their comfort zone. But I do feel that as we're getting older, sometimes we lose a bit of sense of courage to move into the unknown. And I really do feel we need to support each other with that. And I'd see the benefit of doing that within some of these wisdom workshops that I've done for the last five or six years. And there's such a broad spectrum of why do people resist change. But if you help educate them, change has a lot to do with how we have dealt with losses and grief in our life, and Ania spoke of trauma. And of course, many people have had trauma in their lives that they haven't yet healed. And so coming together and sharing that vulnerability of perhaps exploring why people resist change, and bringing some of these components forward around loss around that, it's okay to make mistakes, and to embrace imperfection. Because I think older people somehow thinks, well, I should know how to do that, or I should be able to handle that. They're a little bit more afraid of looking foolish. And so when we just bring that out on the table and talk about it, and then people hear other people sharing that they feel that way, I think it helps people to move forward with a greater awareness of how to go about change. Joanne  33:55 Naomi, what are your thoughts on what I call the aging spectrum? NAOMI  34:00 I think that makes a lot of sense. I do find aging well takes concerted effort. And sometimes people might not be ready to put that effort forward, or like you pointed out, resistance to change, which I think is quite interesting considering the age-old adage, there's only one constant in life and that's change. I believe inhabiting that middle ground really is the key to aging with grace, as no extreme really works. I'm not there in that older adults state at the moment, but I can imagine that it would be difficult when you physically cannot do the things that maybe you once did. But accepting that things change and finding maybe new activities, new hobbies really will allow you to discover things about yourself and learn new skills that you didn't even know you had. I think living life to the fullest in whatever ability you are at like physically, cognitively really will ease potential burdens. And again, to speak to what we were talking about that stress and poverty, the more you focus on the aging side of things, the more it will stress you out. And that's going to cause some other unintended consequences. I really do believe embracing what's happening in your life is the best step forward. Joanne  35:26 So let's see how this might play out in real life. We talked earlier about isolation and the huge role it plays in defining seniors' mental health, and therefore their life expectations and experiences. What if isolation and/or loneliness were choices for some seniors? And what if they chose human connection instead? Ania? ANIA  35:53 I think it is important to recognize that we're all very different in terms of our personalities. Folks who are more introverted will tend to feel a little bit more comfortable in a world that's a bit smaller and has less going on. So I think there may be an element of choice, for some people to be maybe perceived as being more isolated or more separated. And yet, it is something that they feel quite content with. So I think that will be something that is important to keep in mind that we can't expect everyone to fit into the same expected behavior. We need to ask, is this something that you're content with? Is it something that makes you happy? But I think if there is an element of choice, we also sometimes need to accept that some people just feel more content. When I see that sometimes play out in my offices, where I have a senior who is more introverted, who actually does like staying at home all day and reading a book, and maybe their family member would like to see their mother or father be a little bit more active or socialize more. And it can actually lead to some degree of conflict between the caregiver and my patient where the patient is trying to say, I'm actually happy living like this. And the families sometimes struggle with accepting that. So I think we do need to consider those personal preferences. But if there is that desire for increased connection, then I think we need to look at options for people, and as I said, we've discussed those already. Joanne  37:19 Naomi? NAOMI  37:20 In my caregiving scenario, I think in the beginning, I really tried to get my Mom to do the things that I thought she might want to do or would like to do, or that I wanted her to do. And like Ania said, some people would rather just read a book, and she is one of those people. Over time, I have learned to just cultivate that. If that's what she enjoys doing, then I want to do it. But to harness that connection, as well as respecting what somebody enjoys spending their time doing, I brought forward the idea to the long-term care home. What about a book club, or coming up with some creative ways so that you're still cultivating that hobby, but also bringing in an engagement piece as well? And I think the pandemic, one positive thing that has come out of that is that we're really getting creative about connecting, whether it's Zoom, or telemedicine, or these different ways that weren't available to us or we weren't exploring, suddenly seems more possible. One thing I have also learned is that sometimes it doesn't even take words to have that kind of human connection. I know sometimes when I'll visit my mom, she'll be in a mood that day, and she's not really up for talking, and she doesn't want to listen to me rattle on about whatever else I'd be asking or talking to her about. So sometimes I just sit there with her and hold her hand. And there are no words, and that can speak volumes. So I think really living to what the other person that you're caring for, if that is the situation, and cultivating things that they enjoy will make both of you the most fulfilled, has the most possibility of success. JO  39:14 And Marjorie. MARJORIE  39:15 Music is a wonderful thing to use. And there's a wonderful documentary on Netflix, if anybody wants to watch it, called Alive Inside. And it's all about the aspect of music and that we retain the memories and the joy of music that we heard between 14 and 21. And you can find that if you play some songs for that person that maybe is disconnected from that time period, this look, they suddenly open their eyes and they begin to just open into their emotions again, and a beautiful, beautiful connection is formed that way. NAOMI  39:55 I have also seen that film and it is so touching. And I've seen it in my Mom's home as well, that people that don't really speak, almost mute to some extent, you put them in front of a piano, and then suddenly they're playing Beethoven. Or somebody comes in and plays some music, and they're singing along, and otherwise they're not conversing, they're not making those kinds of eye contact. So I agree, coming up with some different approaches can make a world of difference. Joanne  40:24 The next contrast we'll examine is one between resignation and resilience, which are both frames of mind. I know that many seniors experience challenges beyond their control and prevent them from living full lives. But I also know from experience that some of us give in to the challenges of aging. Marjorie, I know you embrace an approach called conscious eldering. Tell us about that, and how it can help build resilience. MARJORIE  40:54 I really came to myself when I just had turned 60. And I felt, boy, how am I going to approach this next chapter of my life? One great book is by Richard Lewis. And he talks about the stages where we have to really look at our past. And it's a letting go, that this is where we are at, this is the stage. And what have all those experiences come together to make us who we are, and that we may have had difficulties, we may have made mistakes, but it's an accepting process, and sometimes not a process of forgiveness, as well. And then it is about adapting to the stage of life. And that yes, physical challenges do happen. We are facing a death at the end of this stage of our life, and what are our fears about that, and exploring that? It's also called gerotranscendence. And it's really where we are looking at perhaps our tendency to resist change as well. Because this time of life is really about wanting to have an experience of more grace in our lives. And I define grace as being aware that everything that happens to us sometimes does happen for a reason, and that the spiritual component of it is that we are taking care of. And so it speaks a bit to developing trust, in even a bigger way as we're coming through this stage of our life, and allowing ourselves to let go of what was and be fully present with where we're at, as we go on each step of our journey. And it's very, very powerful in bringing, I think, a different awareness of what are the golden aspects of this time of life, which often do include all of these challenges that we've never faced before. And it takes a change in your mindset, I think, to form this type of acceptance. And also a trust that there is something bigger that is there, supporting us as we come through this stage of our journey is very, very valuable to look at. And I think it makes us feel where we can also find new passions and new ways of expressing who we truly are, that might have gotten buried over the second half of our life and gives us this chance to explore some of those aspects of ourselves. And that don't come out in whatever way feels right for each individual person. Joanne  43:34 Naomi, can you help us understand aging in place, and the infrastructure we need to help seniors stay resilient? I know this is important to you. NAOMI  43:45 There are different definitions of aging in place. But basically what it is, is meaning that you have access to services, and health, and social supports. You need to live safely and independently, whether in your home or your community for as long as you wish, or are able in terms of physical infrastructure. Aging in place would accommodate the different levels of aging. So in a physical space, there'll be a section for independent living, then maybe some supported living, long-term care, and then palliative care. And that would be all in one place so that you could graduate to the different levels without having to have so much disruption of moving to a new location, which I have seen firsthand can cause some regression cognitively, when they have to make that kind of move. Just from my experience with my Mom, and as I previously spoke about, part of the actual design of the homes at the moment, really don't foster the ability to age in place. Just to give you an example, my mom was about 53, 54 when she entered the home, and a lot of the people that were there were either palliative or in their later stages. So kind of placing her in an area where she's not with other people in a similar condition, I think can cause decline. And I had seen that as well. So I really believe looking at infrastructure when it comes to residential care is so important. And there's a lot of countries that are ahead of us, including the Netherlands. There's a home called the Hogawick. This is basically the leading model for aging. And that is a dementia village specifically, but just really allowing the space for people to live their best life in whatever stage they're at in their journey. Joanne  45:47 Ania, from your professional perspective, what does resilience look like for seniors? ANIA  45:53 Resilience is probably one of the most important factors that I consider when I see my patients and consider treatment options. And resilience, I guess, in a brief way could be summarized as an innate ability to adapt to either change, and/or stressful situations. It is something that offers a sense of perspective, and also an opportunity for growth. And that's definitely something that I try to tap into when I do talk to my patients. Some of them may have lost that sense of resilience or have a hard time accessing it. So some of our conversations were really focused on looking at previous life experiences when they were able to deal with situations that were quite difficult. And sort of we talked about how they were able to get through it, what helped them, and try to apply some of those strategies to their current circumstances. So it's definitely something that is quite important in terms of the work that I do with my patients. Joanne  46:55 Knowing that some seniors can make choices, what is one vital step they can take to move from resignation to resilience? ANIA  47:04 When I think of resilience and making those choices, resilience is actually something that can be learned or developed if one applies themselves. So even folks who may perceive themselves over the course of their life as maybe less resilient, can be encouraged through ongoing support to become more resilient. That resilience can also be fostered by a sense of close relationships. And we've talked about that quite a bit during our podcast today and also the last time. It can also be improved by a sense of physical and mental well-being. And I think the other thing that I look at also is a sense of purpose, because I think having a sense of purpose allows someone to feel more confident. And we talked about loss of confidence and how that can impact seniors as well. And then I think the last thing I would mention in terms of making choices and looking at resilience is also that there will be some changes that are inevitable, and that's part of our good outlook. And accepting those changes is also important in terms of our well-being, because if we dwell on the changes that are inevitable, we kind of get stuck and we can't move forward and look into the future. JO  48:09 Marjorie. MARJORIE  48:10 Well, I was just reading Brene Brown, of course, has written many books and studied resilience. And she had a quote that says, "Joy collected over time fuels resilience, ensuring we'll have reservoirs of emotional strength when hard things do happen." And so sometimes people that have become resigned and sort of stuck, they're not feeling a lot of joy. They're not looking for, or exploring inside themselves. What does bring me joy? And sometimes we, I think, have to sit with that for a while and have some enquiry of ourselves. Do I want more joy in my life? Because you can't make people do things. They have to have some desire within them to have more joy or to extend themselves again, out to people. Just what Naomi was saying about giving, I think that's an important part. Whenever I feel stuck, I think okay, I need to go and give somewhere because it moves me out of that space. But people have to have desire to move from resignation to resilience. I've watched both my sister and her husband have gone through enormous challenges. And I remember when he had a massive stroke at the age of 61. And it is through love, it was the love that was all around him with his family that fueled that desire for him to say, and his mantra was what Churchill said was, if it's to be it's up to me. Joanne  49:44 Let's now look at invisibility versus legacy, which I must admit interests me now that I'm a young senior. So Marjorie, can you tell us what you think are seniors ongoing contributions? MARJORIE  49:57 A lot of people as their ageing feel like they are a burden. And so how do we help them to engage. And I think the intergenerational component is so important, because I've just turned 70 and I do find that people in their 30s do recognize the wisdom that I have gained over all the experiences that I've gone through in my life. I think it takes some courage to feel that, gee, my ideas are of value, I do have wisdom. And so that's an inward place that we each have to come as we're getting older, to let go of even what society perhaps feels in some ways about aging. For us as boomers, as we're moving into this time of our life, it's to discover what do I have to express? Where can I express that and how? And that does maybe take an engagement in a certain way that not everybody wants to do, but many of us do. Many of us do want to still be contributing. And so it takes a confidence to not listen to what other people may be telling you, "Oh, you shouldn't start that business. Or you shouldn't go and do that. What are you doing that for?" If it feels right for you, then find the courage to do it. That's where I think we're going to have healthier aging lives without as much chronic disease. And we're going to have more joyful aging lives even amid very difficult challenges that do come. ANIA  51:41 I would think of it as sort of a gradual process and trying to help them gain a sense of perspective, and a sense of pride in what it is that they have accomplished. I think it also helps to involve family members to try to help the patient gain that sense of perspective. So they do feel more valued and more appreciated, rather than invisible. And also consider some of the cultural differences that may impact the perception of a legacy. Because of course, there will be some cultural differences in terms of how contributions, either past or present, of seniors are perceived by their families or their communities. Joanne  52:23 Naomi, does your Mom or did she ever talk about her legacy and how it would be affected because of her illness? NAOMI  52:31 We didn't have an opportunity to have those conversations. Joanne  52:35 Does that make you think about your own legacy? NAOMI  52:38 Absolutely. Her dementia diagnosis, and it's inevitable conclusion has made me more cognizant of what time I have and how precious time is. And I know that I really want to leave my stamp or something that can live on beyond me, especially considering what I have facing me as a child of somebody living with early onset. There is a 50/50 likelihood that you would potentially be diagnosed with the disease, plus as a woman that Alzheimer's disease is often more prevalent. That's kind of ever present in my life. So if that is where life goes, I really want to in the time that I have now try to make a change that outlives me. Joanne  53:26 Before we touch on the mental health care system. I'd like to talk about the role of spirituality in seniors' mental health. Ania, are you aware of any research that demonstrates a link between senior spiritual beliefs and their mental wellness? ANIA  53:42 There is research that does reveal that there is a correlation between a heightened sense of spiritual connection and a sense of psychological well-being, for example, a sense of comfort, of peace, and more hopeful view of the world. Joanne  54:00 And do you see this in your patients? ANIA  54:03 Yes, it's sort of interesting because we think of spirituality particularly in the context of maybe more religious spirituality, as something that is generally beneficial. But surprisingly, there are circumstances where religious beliefs especially can present some challenges. For example, my patients who suffer from more severe depression, sometimes will have a greater sense of guilt or failing God, that can actually exacerbate their depression. Having said this, one of the protective factors that we see when it comes to suicide is a sense of faith and connection, spiritual connection, and quite often when I asked my patients who do feel like life is not worth living, or they have thoughts of suicide, and yet they are not acting on them. One of the more common answers I get is it's the faith that keeps them going. Joanne  54:57 Lastly, I'd like to touch on seniors' mental healthcare in our overall health care system? Can each of you share briefly what you think are the greatest challenges that seniors face within those systems? Ania. ANIA  55:13 That could be probably a podcast of its own. What I would like to see the most and I struggle with the most is the recognition or early detection of mental illness. Sometimes we end up meeting with patients where they've had symptoms for quite a long time. And one cannot help but wonder what if we had recognized it earlier? What if we had treated it earlier? Would it have led to that same degree of disability, loss of quality of life, or a burden on the caregivers? But I think in general, what the system will require to improve upon is a more continuous and more integrated system of care, including our acute care system and also our community. For example, we now have a Minister for Mental Health and Addictions, which I'm hoping is a sign that there is going to be greater importance paid to the treatment of mental illness amongst our community, including our seniors. But again, I think that early recognition, prevention, and also developing a more cohesive, more seamless system would be essential. JO  56:20 Marjorie. MARJORIE  56:20 A more family centered approach, if that's possible, so that everyone within the family is understanding what are the components of that mental health issue. And how can they deal with it themselves? And also, how can they support that person? I think that's an education component and an inclusiveness that perhaps needs to improve. And especially as far as seniors in the older senior population, the accessibility and availability has to change somewhat, because so many of them aren't that comfortable with computers. JO  56:21 Naomi. MARJORIE  56:21 Access to services in a timely manner, super important. Just to give you an example, we were looking for support for my Mom at the beginning of the journey. So we reached out to our GP, who had recommended or referred her to a neurologist, but it was over a year to get an appointment. And like Ania said, there could be a decline. And you wonder what could have happened if they had that timely response. NAOMI  57:27 Trying to get a dementia diagnosis, very, very difficult. There's not one test that you can get, it's a battery of tests, and the services are often siloed. And they don't always talk to each other. So as the caregiver or the person trying to get the best care for their loved one, we're really left trying to navigate all these systems that don't always make sense and are at times in contravention with one another. I would love a coordinated clear pathway of how to navigate the system, because I find that that is a lot of my time is spent just doing that. Joanne  58:08 For our listeners who are interested in more information about needed change to our seniors' mental health care system, you can find the Mental Health Commission of Canada's 2019 Guidelines for Comprehensive Mental Health Services. For older adults in Canada, you can visit the Commission's website at mentalhealthcommission.ca. We're on the homestretch now, and I can't believe how much ground we've covered. As a senior with mental health challenges, I thank you all from the bottom of my heart for sharing such great stories and helpful information. So let's bring this all to a finer point. Ania, if you could share the most important thing you've learned about seniors' mental health with other medical professionals, what would that be? ANIA  59:06 I would look at hopefulness as the most important thing that I have learned. Basically, it's that sense that there is hope that there is possibility for improvement. And that we should always strive towards the goal of improving not only that sense of well-being but also quality of life, and the well-being of the caregivers. Because often, the sense of improvement is tied into the relationship between the patient and the caregiver. So I think hope is the most important thing I have learned. Joanne  59:38 Ania, thanks so much for sharing your incredible insights. It's been a pleasure getting to know you and your work, and I'm really so grateful for people like you who use your talents and passions to serve a demographic that's often overwhelmed and overlooked. ANIA  59:56 Thank you again Jo, for taking on this really important topic. Joanne  1:00:00 Marjorie, if you could say one thing to seniors about the opportunities available to them at this time of life, what would that be? MARJORIE  1:00:09 I'm a lifelong learner. And I know many people say that to me that that's what they want to do as well. And that I think creates a sense of hope that this stage of life is wonderful in so many ways. Joanne  1:00:23 Thanks for joining us, Marjorie. Your broad understanding of the issues has helped us build a robust argument for improving seniors' mental health care. And I wish you loads of love and fulfillment in your golden years. MARJORIE  1:00:37 Thank you. I'm really trying to take that saying, 'the golden years' and really find where there are those nuggets of gold, even despite challenges that we go through and the resilience that we're cultivating as well. JO  1:00:50 And Naomi, what do you envision for the future of caregiving for seniors with mental health challenges? NAOMI  1:00:57 What I envision is really having somebody to accompany you through this journey of caregiving, that understands how to navigate these different health care systems and will help guide you along a defined path. I also see for the future of caregiving, increased access to respite care and at home care, and of course, an outlet for advocacy to make these systemic changes. Joanne  1:01:24 Naomi, your devotion to caregiving in general and your mother's care in particular, is truly inspiring. On your Discuss Dementia website, you asked the question, who will speak if I don't. I suggest that because you speak, many will listen, and positive change will follow. So keep up the great work. So that's a wrap for Part 2 of this podcast on seniors' mental health. So much great information. To connect with Ania, Marjorie, or Naomi visit freshoutlookfoundation.org and look for Seniors Mental Health under Podcasts. There you'll find their contact info, bios, a list of resources, and the podcast transcript. Another big thank you to our sponsors for this episode, the Social Planning and Research Council of BC, Emil Anderson Construction, WorkSafeBC and AECOM Engineering. And thanks to you as well for hanging out with us. You are very much appreciated. Please visit our website to sign up for our monthly e-newsletter, which will alert you to new episodes of the podcast and for podcast information as it drops. Follow us on Facebook at FreshOutlookFoundation and Twitter at FreshOutlook. In closing, be well and let's connect again soon. Episode Reviews

This week on rabble radio, journalist Wayne MacPhail interviews Deirdre Pike, of the Hamilton Alliance for Tiny Shelters. Hamilton has found itself in the middle of a housing and homelessness crisis. The Hamilton Alliance for Tiny Shelters, or HATS, is a new project inspired by Kitchener's ‘A Better Tent City,' to serve as a temporary solution to the housing crisis in Hamilton by providing small homes for people in need.  In 2020, the City of Hamilton released a report which set a framework on ending chronic homelessness by 2025. But this goal can't be achieved without concrete plans and real community action. That's where HATS comes in.  Pike is a senior social planner at the Social Planning and Research Council of Hamilton. Pike speaks with Wayne MacPhail about the challenges the project has faced so far. They discuss what the community has to say about the project, and what services will be available to people who will occupy these cabin community living spaces. “The way things are moving, we're not sure if 2025 is going to be a goal that's met in terms of ‘the end of homelessness,'” Pike says. “If it is, then that should mean small communities like this [The Hamilton Alliance for Tiny Shelters] are temporary and would fold up. But in the meantime, we're making sure that people don't live like this next winter … This is really an opportunity to have people live with some dignity and, probably for the first time in many years, an experience that this is their own place.”  If you like the show please consider subscribing on Apple Podcasts, Spotify, or wherever you find your podcasts. And please, rate, review, share rabble radio with your friends — it takes two seconds to support independent media like rabble. Follow us on social media across channels @rabbleca. Or, if you have feedback for the show, get in touch anytime at editor@rabble.ca. Photo by: Nathan Dumlao on Unsplash

SUMMARY In Part 2 of this podcast on Schizophrenia, we're joined again by Katrina Tinman (peer support worker with lived experience of schizophrenia), Chris Summerville (CEO of the Canadian Schizophrenia Society), and Dr. Phil Tibbo (clinical/research psychiatrist who specializes in psychosis-related illnesses). They dig deep into emerging holistic recovery approaches that integrate biological, psychological, social, vocational, and spiritual supports. They also explore stigma, impacts of COVID-19, needed changes to public policy and the mental healthcare system, and the world of schizophrenia 20-30 years from now. TAKEAWAYS This Part 2 podcast will help you understand: Emerging diagnostic practices and medications Integrated healing that incorporates biological, psychological, social, vocational, and spiritual recovery supports Benefits of meditation/mindfulness and positive lifestyle choices Benefits of creative therapies that use art, music, drama, and writing Advances in personalized/precision medicine Advances in technology and the Internet to support recovery Effects of COVID-19 Stigma's impact on recovery Challenges for families of people with schizophrenia What medical professionals need to know about schizophrenia What public policy changes would support recovery Why changes should be made to the mental healthcare system What the world of schizophrenia could look like in the future SPONSORS RESOURCES RECOVERY: Research Into Recovery Recovery Model of Mental Illness: A Complementary Approach to Psychiatric Care A National Framework for Recovery in Mental Health Recovery-oriented Practice − An Implementation Toolkit PEER SUPPORT: Peer Support  The Future is Peer Support Using Peer Support in Developing Empowering Mental Health Services MENTAL HEALTH STIGMA: Fighting Stigma and Discrimination Is Fighting for Mental Health Stigma and Discrimination Addressing Stigma Five Ways to End Mental Health Stigma SCHIZOPHRENIA: Hope and Recovery Schizophrenia Treatment and Self-help   GUESTS  Katrina Tinman Katrina Tinman is a peer support worker for Peer Connections Manitoba, formerly the Manitoba Schizophrenia Society, and is located at the Mental Health Crisis Response Centre in Winnipeg, Manitoba. Katrina is currently working toward formal peer support worker certification with Peer Support Canada, though she already has peer support certification through the Ontario Peer Development Initiative. Katrina received a university education in journalism and political science in 1998, from North Dakota State University in Fargo, North Dakota. Since then, she's had a wide range of life experiences from working in the professional arena, extensive travel, motorcycle riding, alpine skiing, and SCUBA diving, to homelessness and mental illness. Regardless of some negative life experiences, Katrina's greatest achievement was a sense of fearlessness that carried her through along with hope for the future. Now she's able, through her peer support work, to use her life's insights to help others in their recovery from crisis and mental illness. Email: k.tinman@peerconnectionsmb.ca Website: www.peerconnectionsmb.ca  Facebook: www.facebook.com/katrina.tinman.5 Twitter: https://twitter.com/tinman_katrina Linkedin: www.linkedin.com/in/katrinatinman Chris Summerville, BA, MDiv, M.Miss, D.Min, LLD (Honorary) Chris Summerville is from a family with mental health challenges (father and brother with bi-polar disorder, a brother with schizophrenia, siblings living with depression, and two suicides). He has also received mental health care himself, which has informed and inspired his work as CEO of the Schizophrenia Society of Canada since 2007. Chris has been involved with the schizophrenia-recovery movement for nearly 30 years, having served on the boards of the Mental Health Commission of Canada, Mood Disorders Society of Canada, National Network for Mental Health, and Psychosocial Rehabilitation Canada. Chris earned a doctorate from Dallas Theological Seminary, is a certified psychosocial rehabilitation recovery practitioner (CPRRP), and received an honorary Doctor of Laws from Brandon University in 2014. He is a regional, provincial, and national leader and advocate for a transformed, person-centered, recovery-oriented mental healthcare system, and believes mental health concerns should be addressed using integrated bio-psycho-social-spiritual-vocational approaches.  Email: Chris@schizophrenia.ca Website: www.schizophrenia.ca Facebook: https://www.facebook.com/SchizophreniaSocietyCanada Twitter: https://twitter.com/SchizophreniaCa LinkedIn: https://www.linkedin.com/company/schizophrenia-society-of-canada Phil Tibbo, MD, FRCPC Phil Tibbo was named the first Dr. Paul Janssen Chair in Psychotic Disorders, an endowed research chair, at Dalhousie University in Halifax, Nova Scotia, Canada. He is a professor in the Department of Psychiatry with a cross-appointment in psychology at Dalhousie University, and an adjunct professor in the Department of Psychiatry at the University of Alberta. He is also director of the Nova Scotia Early Psychosis Program (NSEPP) and co-director of the Nova Scotia Psychosis Research Unit (NSPRU). Dr. Tibbo is funded by local and national peer reviewed funding agencies and well published in leading journals. His publications are primarily around schizophrenia, and his current foci of study include individuals at the early phase of, and individuals at risk for, a psychotic illness. Dr. Tibbo's areas of research include application of in vivo brain neuroimaging techniques, to study psychosis as well as research interests in co-morbidities in schizophrenia, psychosis genetics, addictions and psychosis, stigma and burden, pathways to care, education, and non-pharmacological treatment options. Dr. Tibbo is president of the Canadian Consortium for Early Intervention in Psychosis (CCEIP), helping to advance early intervention care at the national level. He is a recipient (2015) of the Michael Smith Award from the Schizophrenia Society of Canada for research and leadership in schizophrenia, recipient of the Canadian Alliance on Mental Illness and Mental Health's Champion of Mental Health Research/Clinician award in 2017 and, most recently, recipient of the 2018 Regional Prix d'excellence – Specialist of the Year – Region 5 by the Royal College of Physicians and Surgeons of Canada. Email: phil.tibbo@nshealth.ca LinkedIn: https://www.linkedin.com/in/phil-tibbo-62170b18/ HOST Jo de Vries is a community education and engagement specialist with 30 years of experience helping local governments in British Columbia connect with their citizens about important sustainability issues. In 2006, she established the Fresh Outlook Foundation (FOF) to “inspire community conversations for sustainable change.” FOF's highly acclaimed events include Building SustainABLE Communities conferences, Reel Change SustainAbility Film Fest, Eco-Blast Kids' Camps, CommUnity Innovation Lab, Breakfast of Champions, and Women 4 SustainAbility. FOF's newest ventures are the HEADS UP! Community Mental Health Summit and HEADS UP! Community Mental Health Podcast. Website: Fresh Outlook Foundation Phone: 250-300-8797   PLAY IT FORWARD The move toward optimal mental health becomes possible as more people learn about the challenges, successes, and opportunities. To that end, please share this podcast with anyone who has an interest or stake in the future of mental health and wellness. FOLLOW US For more information about the Fresh Outlook Foundation (FOF) and our programs and events, visit our website, sign up for our newsletter, and like us on Facebook and Twitter.   HELP US As a charity, FOF relies on support from grants, sponsors, and donors to continue its valuable work. If you benefited from the podcast, please help fund future episodes by making a one-time or monthly donation. Katrina Tinman, Chris Summerville, Phil Tibbo Interview Transcript You can download a pdf of the transcript here. The entire transcript is also found below: RICK  0:10 Welcome to the HEADS UP Community Mental Health podcast. Join our host Jo de Vries with the Fresh Outlook Foundation, as she combines science with storytelling to explore a variety of mental health issues with people from all walks of life. Stay tuned. JO  0:32 Hey, Jo here. Thanks for joining me again with my three incredible guests as we continue our conversation about schizophrenia, this time focusing on integrated recovery support, emerging science, and advancing technology. We'll also touch on the stigma faced by people with the illness, and gaps in the current mental health care system. But before we dig back in, a big shout out to our amazing sponsors, the Social Planning and Research Council of BC, Emil Anderson Construction, WorkSafe BC, and AECOM Engineering Canada. We celebrate them as their continued support is fueling our passion for improving mental health literacy. Again, my three guests are Katrina Tinman, a peer support worker with Peer Connections Manitoba, Chris Summerville, Executive Director of the Schizophrenia Society of Canada, and Dr. Phil Tibbo, a Canadian psychiatrist who studies, treats, and advocates for people with psychosis and schizophrenia. In Part 1 of this podcast, we heard personal stories and learned about signs of the illness, myths, and recovery movements. Dr. Phil Tibbo also talked about past diagnostic practices. To start this episode, we'll connect with Phil again about diagnostic practices today, and what research is telling us about them. PHIL  2:06 It's a big area of research. And I think I mentioned earlier, we're still not at a point where we can do a blood test similar to other medical illnesses, and from that result in a diagnosis. So there's still a lot of work going on here, and especially at early phases of illness as well. And so a lot of the research is looking at multimodal or multifaceted approaches to diagnosis, that can include not only from interview and behavioral, looking at symptoms, but as well as what we call the biological markers, biological indices, which can be some of the neuroimaging research. Some very exciting work going on even EEG type of research within brainwaves, but as well as in genetics too. The one difficulty with schizophrenia, and again, different from some other medical illnesses where it's a single gene, and something wrong with that gene causes a medical illness. We know that's not the case for psychosis and schizophrenia. And often what it's called is an illness with multiple genes of small effect. Research is active in here, but really that focus is to really help us to identify early. But it'll probably be, like I say, multifaceted or a multimodal sort of approach to diagnosis. I wish I can kind of drop in in 20 30 years time and see what the approach is going to be. I think we're going to see a difference from how we're approaching things now to what it will be in the future, which is of course, the way that it should be. I mean, we're doing things differently than what we were doing 20 30 years ago as well. JO  3:38 Let's now hone in on current treatment strategies that focus on integrating biological, psychological, social, and vocational support, as well as psychosocial rehabilitation. And we're gonna break that down, so don't worry about all those big terms. Starting with biological support, Phil from what I understand, biological or brain-related effects are still best treated with anti-psychotic medications, which ideally, are only one part of an overall treatment plan. Is that what you're seeing? PHIL  4:17 Yes, you still have to consider that schizophrenia is a brain illness which needs to be treated, and medication can be a cornerstone of that treatment. But as a result of the illness, there are other things that may be needed when we were looking at other non-biological therapies. Definitely have psychotic medications are a cornerstone. Now that said, the amount of medication or the length that somebody is on a medication really depends on the individual and really what their needs are as well. Because I have individuals that I see that may need medications for actually a fairly short period of time, and they've been doing well with no medications at this point. It really is kind of individual, but yet yes from biological standpoint, the anti-psychotic medications are a cornerstone treatment. JO  5:04 Kat and Chris, in your personal experience and as shared by your peers, what are the pros and cons of anti-psychotic medication? And are people's responses changing over time as the medications change? KATRINA  5:21 It gets to symptoms versus side effects. As I went through the process of finding what medication would work, it was a journey that lasted about 10 years. And I'd ran the gamut of, well, three I can remember Lexapro, Risperdal, and Zyprexa. But nothing really fit. Remember the description of the spectrum, and trying to find where things fit. And for me, it wasn't until 2013 when I ended up fortunate enough to have a doctor to work with me at length, to find the right medication that would actually be the best fit for me, in communication with me. And it turned out it was one of those that hadn't even been invented until right around that timeframe. Abilify turned out to be the right one for me. CHRIS  6:15 Well, certainly, antipsychotics and antidepressants can address the symptoms of psychosis and mood disorders and minimize them. But as one of our former chiefs of psychiatry here in Manitoba said, "If only the medications did everything that we hoped that they would do." Unfortunately, as Katrina stated, there can be significant side effects. And there are many side effects that we don't have time to go into. But the two that I would mention most pronounced are cardiovascular illnesses and metabolic illnesses. And that's one reason why many people don't want to take the medications or discontinue after a while, because of that fear. JO  6:57 Phil, what advances are being made to make these medications more accessible and effective with fewer side effects? PHIL  7:05 There's a lot of research and development going into newer medications. And I think we always have to be careful in our discussion around this. Because while there may be cardiovascular, may be metabolic side effects, it's not a given. Significant number of individuals that I see that do not have any side effects with their medications. That's with our open and honest discussions. But we have to be mindful of when that can occur, and just be able to catch it early. I know we'll talk about stigma, but there is a stigma about medication that has resulted and it's probably from the older medication. The research and development these days, the focus is on developing an effective medication with little to no side effects. With a better understanding of the illness, with better understanding of brain receptors, there's more targeted, more focused research on the development of these types of medications. I have to agree that there was a period of time where there's a lot of sort of what I call 'me to' medications being developed, very similar to ones that are already out there. But what we're seeing now is just that more focused, more targeted development. JO  8:14 Phil, what about options for people who might forget to take their medications, or choose not to take them for whatever reason? PHIL  8:21 We've had, I'll use the term LAI's, long-acting injectable medication. We've had them for a while. But for similar reasons Katrina and Chris mentioned, you know, they've kind of fell out of favor because of their side effect profile. But recent developments have allowed us to have newer medications in that particular format with much fewer side effects. People can just be on a once-a-month injection medication, or once every three months. And there's product and development for other medications for once every two months. I have this conversation with individuals that I see. It allows them to focus on their recovery, because they don't have to remember to take their medication. And I think that's an important piece. What some of young adults tell me is that they have to take a pill every day that just reminds them that they have an illness. But if they just need to come into the clinic once a month, or every three months for an injection, that helps them focus on their recovery as well. JO  9:18 And Phil, while doing research for this episode, I came across information about using cannabis to treat psychosis. Is that legitimate? PHIL  9:27 No. First of all, a couple of points around that. When we talk about cannabis, keep in mind if we're talking about just overall cannabis plant, there's over 100 active compounds within that. The two most common compounds people hear about, of course, are THC and CBD. And we know that THC is actually more of the risk factor with respect to psychosis development, and poor outcomes after the development of psychosis. There have been some studies trying to look at CBD, cannabidiol, and its potential role within a psychosis, but honestly, there's not a lot. And we just recently published a position statement for the Canadian Psychiatric Association as well as a systematic review and meta-analysis, examining this literature and looking at randomized, controlled trials of different cannabis or cannabinoid products. There's actually only six studies in schizophrenia where they've looked at cannabinoid products, really not much effect. I'm not being negative about it. But just highlighting that we do need a lot more research into this area. And we have to be very clear on what sort of cannabinoid product that we're talking about. JO  10:39 Let's talk about another piece of the recovery puzzle, which is psychological support. Psychological or mental and emotional effects associated with schizophrenia can include depression, anxiety, substance-use, suicidal ideation, and others. These often respond well to treatments such as cognitive behavior therapy, and other emerging approaches such as reality therapy and cognitive remediation. Phil, how do these work? And how can they be integrated with biological solutions? PHIL  11:16 Well first of all, our approach is integrated. We look at, say, medication plus as well as the psychotherapy and psychosocial treatments as well. Having more tools in our toolkit to be able to address the illness. We will have some people who will definitely benefit from cognitive behavioral therapy for psychosis. And that really allows an individual to learn how to adapt, and respond, and develop strategies to work with their symptoms, for example, so that an individual is not as stressed by their symptoms or able to manage them so that they can do what they want to do, basically, in their day-to-day lives. There's a number of different strategies and therapies along these lines. Some are more similar to each other than not. We have a sort of service and commitment therapy as well, ACT, plus as you mentioned, CBT. But they're really there to help augment that individual's experience with their symptoms, or for example, with comorbid symptoms as well, such as depression and anxiety. JO  12:17 So Chris and Kat, are your peers ever hesitant to add these therapies to their recovery plans? KATRINA  12:25 I know I wasn't. In talking with peers, we usually do touch on some of these possibilities. And there's usually enthusiasm at the idea. Oh yeah, I heard of that, or along those lines where they are willing to engage. CHRIS  12:43 I don't think there would be a hesitancy in general, if people were aware of what their various therapies are. There are many what I call, talk therapies that we can utilize today. Some have been mentioned, cognitive remediation, cognitive behavioral therapy, dialectical behavioral therapy, and acceptance commitment therapy, and family therapy. People in general, I think, have a fear of going into therapy because someone's going to try to fix me, and I have to expose them to, and I have to reveal all of my problematic thinking or what have you. So, I think the goal of these therapies have to be clearer for the patient or the client, and that is helping one to manage difficulty in the area of cognition and their thinking, helping them in their executive skills, helping them to improve their communication skills and relationships. So, the therapy has to be explained to people that it will be more than a supplement to the medication, where the medication is not able to address certain issues. Talk therapies have been demonstrated to promote the recovery process. JO  13:47 What are the biggest barriers to people not receiving the psychological support they need? CHRIS  13:53 Well number one, here in Canada, psychological support services are not covered by our health care system unless you're a patient in the hospital. But once you're out in the community, you have to shell it out of your own pocket, and most people can't afford psychological support therapies. And also, the lack of awareness about the role that trauma can play in psychosis and recovery. A lot of people don't know about that. And many service providers may not actually be trained in trauma informed care, due to the lack of trauma informed services. So all those things that I've just mentioned, can be great barriers to people receiving the appropriate psychological supports that they need. PHIL  14:32 I'll have to step in and agree with that. Access and availability is a big thing. The other thing to consider as a barrier. Families talk to me about this kind of at the beginning, when is psychotherapy going to start? And sometimes the barrier, of course, is the illness itself and that person to be able to engage and work within some of these therapies, they have to get to a certain cognitive level to be able to do that. And that's where sometimes we have to wait a little bit of time until we get some better control on some of those symptoms, so that people are then able to engage in some of the psychosocial and talk therapies that would be helpful. JO  15:08 What about creative therapies that use art, music, drama, and writing? KATRINA  15:14 Those, speaking from a person of lived experience and pure perspective, can be very, very useful for meditations and journaling, because really it helps somebody walk through and process thoughts, feelings, and experiences. And I personally think that can be very valuable, as it's really helped me in many ways. PHIL  15:40 I'd have to agree. We've been researching areas of this as well, and we published on this too in a number of different formats and looking at mindfulness-based support groups for families looking at self compassion, and mindfulness, in relation to depression and anxiety. And interestingly too, we've even published on claymation art therapy in our youth and young adult population and the benefits of that. One person may do well with claymation art therapy, and another person not interested at all. So, it helps to be able to investigate and to know that these types of therapies and creative therapies can be helpful. JO  16:14 In your stories and insights, I'm hearing that social support is also vital for people recovering from schizophrenia, this being available through peer support, self-help programs, and family education and support. Chris, what are the biggest barriers to people receiving the social support they need? CHRIS  16:35 Society in general and the media as well, they tend to think that it's just all about medication. You wouldn't believe how many times I've been asked this question through the over 1500 media interviews that I've done, in which I will be asked, "well, how do we make sure these people stay on their medication?" As if medication was the cure all? Again, education is needed that, quote, the treatment of mental illness, and particularly schizophrenia that we're talking about today, is very holistic, so a holistic approach. And that means, what do we do to help people when they're in the community, back at home, back in the community? What kinds of social supports do they need? Whether it's peer support, support groups, whether it's accommodations in pursuing education, accommodation and getting a job, adequate housing, decent income, all those factors. As a society, I think we get it with most other illnesses. These kinds of questions didn't come up when my wife was experiencing breast cancer. There was pure support, there was family engagement, there was family education. There was not just attempts but helping her to connect with various community agencies. One of the things that perhaps gets in the way, which we'll talk about later, is that this profound stigma and prejudice towards people who have a mental illness that live in our community, that affects our policies, that affects our funding. It's a great misconception out there that to address mental illnesses is just a matter of the medical. But as we've listened to Dr. Tibbo and Katrina, they've articulated well that psychological, social, the communal aspects involved in recovery are equally important. JO  18:35 Kat, can you share a story of how important social support is? KATRINA  18:40 The way I'll share it is actually to state that sometimes we hear feedback as peer support workers from our peers, as we're going through the process and discussing with them where they're at and where they're going, and what they're working on, and what they're trying to accomplish. And one of my peers sent back the message, for instance, that I made them feel comfortable, and that I connected with her, that I was nurturing, and calming, and helped that peer make their own decisions that were right for them. And that's, I think, an important piece, that connection to the recovery process and that non-aloneness. And I think that is something that peer support is demonstrating. What we're doing right now at the Mental Health Crisis Response Center is a pilot program. The feedback that we're getting is huge, phenomenal to positive that, yes, this is worth it. JO  19:41 I know you're researching the effectiveness of non-pharmaceutical treatment options like therapy and peer support. What have you learned so far? PHIL  19:52 Well, I think the high-level approach to this question is really important. And that we need to continue with our research in looking at non-pharmaceutical options, and the different types of therapy and peer support. Specifically finding out what we can use, what has the best effect, will be important for the population that we work with as well. We have researched peer support and we have found, yes definitely, it is needed and people, as Katrina mentioned, do benefit from it in many varieties of ways. JO  20:21 Chris as a recovery practitioner, you're very familiar with psychosocial rehabilitation, which I've learned among other things, includes case management, advocacy, structured living residences, and rehab centers, for example. Tell us more about that. And what are the biggest barriers to people receiving the rehabilitation they do need? CHRIS  20:46 We have here in Canada, what's called Psychosocial Rehabilitation Canada, an organization that promotes psychosocial rehabilitation of all mental health service providers. So it's not just limited, let's say, to social workers or mental health workers. So let me just define it. First of all, psychosocial rehabilitation, also sometimes called psychiatric rehabilitation, it promotes personal recovery, successful community integration, the satisfactory quality of life for persons who have a mental health problem or mental illness. Psychosocial rehabilitation services and supports, they're what we call collaborative, person directed, individualized, and we believe they're essential element of human service prospective. And so the goal of psychiatric rehabilitation, or psychosocial rehabilitation is focused on helping individuals develop skills, and access the resources needed to increase their capacity to be successful and satisfied, in what we would call living, working, learning, and social environments of their choice. And so you need a wide continuum of services and supports. The approaches, they are evidence based. And they are promising practices in key life domains of, let's say, employment, education, leisure, wellness, and basic living skills. And family involvement, family peer support, individual peer support are very important aspects of psychosocial rehabilitation. JO  22:18 Chris, what needs to be in place for this to happen? CHRIS  22:22 Truly integrated comprehensive mental health services in which the various sectors are endorsing and creating relationships with each other. So whether that's psychiatrists, social worker, a mental health worker, spiritual health care director. The team of support around the patient, they're not in competition with each other. They are to be working as a team when they have their meetings, and hopefully, with the patient there, listening to the patient. Again, that's that question. What do you feel would help you? What do you feel you need at this point? And as well as offering, what I want to say as wisdom through listening, offering a wisdom back to the patient in helping them to find the various supports and services in and outside of the hospital, that can promote the recovery experience. JO  23:15 Let's expand upon that and look at vocational rehabilitation, and or training that prepares people with schizophrenia for work that best meets their individual wants and needs. Chris, can you tell us more about that? CHRIS  23:31 So let me just tell you a story to illustrate this point about vocational training. This individual's true-life story who had schizophrenia and he had gone through four mental health workers. Well, what happened with the fourth mental health worker? Began to listen to the individual because he was always very persistent with his mental health workers, that he wanted to be an astronaut. They would just dismiss that, "There's no way you can do that, because you have schizophrenia." Well, the fourth mental health worker began to listen to him and ask him, let's just assume that his name is Joe, and said, "Joe, why would you like to be an astronaut?" And he had seen the first moon landing and other things, and he was very enchanted that he wanted to be an astronaut. So, she asked him then in the course of not just in one conversation, but as they developed their relationship. "Well Joe, what do you think would help you to be able to reach that goal?" And they talked about that, and perhaps hygiene could be a problem. Of course, they began to focus on education. "And so what school do you think there might be, and where would you like to go to school to learn more about this?" And so she encouraged him. "Well, why don't you try for one course?" And he took the course and guess what happened? He failed. But that's not the end of the story. She continued to encourage him about other options, and again, a true-life story. He eventually found work and began to work in a space aeronautics museum, welcoming guests and introducing them to the museum. So did he fulfill his goal and his dream? Yes, but it had to be adjusted. But she didn't give up hope on him in terms of his vocational desire. JO  25:06 What a great story. In my research, I continually came upon the term personalized medicine. Phil, what is personalized medicine? And how could it revolutionize diagnosis and treatment strategies for schizophrenia? PHIL  25:24 Personalized medicine, and sometimes people refer to it as precision medicine as well. So sometimes you hear those terms interchangeably. And really what it is, is the tailoring of the medical treatment to the individual, to the individual characteristics of each patient. It does rely on research, it does rely on an understanding of a person's own unique, molecular, and genetic profile as well, and how that can influence treatment. If you think about a personalized medicine, it is really what's going to be appropriate, what's going to work for you specifically based on who you are, both biologically and otherwise. And really, this sort of came out of the advent of trying to figure out from a genetic perspective, how can we use an individual's unique genetic makeup to guide treatment decision? We're not quite there yet, in that respect, but it allowed us to be able to step back, though, and still think about, okay, what is appropriate for this person that's sitting in front of me. And I think that's a little bit more of a holistic approach to our treatment, and that is truly personalized. Now, if we get to that stage where we can do a cheek swab, get a genetic makeup, and then say, okay, this particular treatment, either medication or otherwise, this is specific to you and will work the best. Obviously, that's a great outcome. Are we there yet? No. But research is going in that direction. JO  26:46 One topic I didn't come across in my research is the role of lifestyle choices in recovery. Healthy habits, like getting enough sleep, eating well, and exercising regularly. Kat, how important have lifestyle choices been in your recovery? And do you teach life skills as part of your work with peers? KATRINA  27:09 Lifestyle choices are very important in my recovery. It's something I pay very close attention to. As far as teaching life skills, we do workshops that do some form of teaching, but teaching as an agenda. It's more of an exploration type discussion. JO  27:30 Phil, what do you see in your research and hear from your patients about the importance of lifestyle choices? PHIL  27:36 Research obviously has shown that it's very important, these lifestyle choices. What are lifestyle choices? These could be anything from smoking, cannabis use, to sedentary lifestyle, activity, diet, a number of different choices. We know that individually each of those, and accumulatively each of those can have an effect on outcomes. And the research is pretty solid with respect to that. And so a lot of our focus, so once we get to some of the early sort of phases is, okay really, how can we improve lifestyle, what kind of healthy choices we can help people with lived experience make. We do things, we have a project where we got some funding currently from our Mental Health Foundation, where we're trying to target our rural population. So we got Fitbits. So that allows us to measure and monitor some things along the lines of sleep and steps and exercise. But to be able to send that to their clinicians and to be able to have those discussions, that's sort of great talking points about lifestyle. CHRIS  28:36 Let me combine that question about lifestyle choices and the previous one about personal medicine. Personal medicine, in terms of consumer movement or people who live with mental illnesses, it was really first introduced in early 2003 as a result of qualitative research conducted by Dr. Patricia Deegan. Now, Patricia Deegan is a psychologist, PhD, has lived experience of schizophrenia and experience of recovery. And so personal medicine along with what Dr. Tibbo said, is also about what we do that's medicinal for us in managing, let's say, my depression. What are those lifestyle choices that I know helped me in terms of managing all the stress associated with living with a mental illness? And stress can lead to relapse, we know. So it's not necessarily something prescribed by a doctor or nurse. It comes from within, and it's finding that right balance of what to do and what we take in our pathway to recovery. So that can be mindfulness, can be spirituality, it can be running and exercise. Those things that you know help you to manage your illness in terms of stress management, increasing your resiliency, and your mental health as well, because people with a mental illness can have positive mental health. We know that. And so that word as Patricia Deegan has written about it, personalized medicine has to do with those things that we know that are uniquely medicinal for us, and helping us move forward in our recovery. JO  30:16 Thanks Chris, great comments. Phil, is there any science to support the role of practices such as meditation in recovery? PHIL  30:26 Yes, there is research on this. It's not necessarily for everyone. But for people who can do mindfulness-based practices and meditation, it definitely has been shown to be quite helpful in a number of different ways. I don't say for individuals with lived experience, but we published actually on mindfulness-based techniques for family members, and definitely see the benefits within that group as well. JO  30:50 Advancing technology is another thing I'm hearing a lot about for diagnostic and treatment purposes. Phil, from your perspective and in your practice, can you bring us up to speed on that? PHIL  31:02 Our advances of technology, we're trying to utilize those as best as we can, as quickly as we can as well. And also moving from research to clinical applications, of course, is really quite important. Kind of alluded to this a little bit earlier. We have had advances in the various brain imaging techniques to help us with diagnosis. And there's a lot of different types of brain imaging techniques that are focused either on brain structure, but as well as brain function, and of course, the different parts of the brain, white matter and gray matter. And then other types of diagnostic technologies are there, treatments as well, such as rTMS. There's a lot of this that's happening. And I don't want to minimize that there's a lot of research that have gone into the development and use of smartphone apps as well, and their utility within helping people move forward with their lives and on their treatment to recovery goals. JO  31:56 Chris, what about that technology for social support services? CHRIS  32:01 Well, there are two things that COVID has surfaced for us. Number one has placed mental health definitely on the radar. Ninety-eight percent of Canadians are more concerned about the impact of mental health. Secondly, the use of virtual technology, and that will not go away after the pandemic. In fact, about a year and a half ago, I had my first FaceTime experience with my GP. I never thought that would happen. So use of Zoom and other technology to offer peer support individually, to offer support groups. Many of the schizophrenia societies across Canada are doing education with family members through virtual technology. So that's not going to go away after the pandemic. It is all in a state of development. I think Dr. Tibbo, when he and I've had discussions on this, we have to look at safety, confidentiality issues, privacy, and having good standards. And then, are the various apps that have been developed and ought to be developed, are they evidence based and effective? So I'm excited about where virtual technology can lead us, especially for people who live outside of urban areas. But the great challenge is that many people with mental illnesses, especially if they're on income security, they don't have access to internet, they can't afford a laptop or an iPhone. JO  33:24 Kat, how willing are your peers to take advantage of advancing technologies? KATRINA  33:30 It's hard to conjecture, because every peer is different. As Chris pointed out, even the ability of some might be limited. But from what I'm hearing as we compare notes, peers and I, now hey I have that app, this app that works really good for me. It comes up. So I think, for the most part, it's very favorable in that direction. JO  33:53 Chris mentioned COVID-19, and just a very quick question. Phil, how has COVID affected your patients with schizophrenia? PHIL  34:03 Keep in mind that for my particular patients that I see, it's mainly youth and young adults, and actually the resilience there is really quite high. And the adaptation to virtual technologies, such as Zoom and having meetings along those lines, they're actually fairly quick to adapt to. However, what is also interesting is that a lot of the youth and young adults that I see actually didn't want to have their meetings via Zoom. They'd rather be in person. So we've tried our best to work with that. We obviously want to make sure that nobody is going to have relapse or have any ill effects because of COVID. I think we did a pretty good job of pivoting and shifting service delivery and care to accommodate that. COVID-19 overall in the general population, there's a lot of research that has gone into that and we have seen an increase in, for example, substance use in this population. We've also studied acute care admissions to the inpatient units, and I've seen a shift during the height of COVID in states of emergency declarations, where the substances have played a role, a more significant role in admissions than they did before, as well as in a little bit older age group than what we would normally see in a non-COVID year. JO  35:15 Chris, what are you seeing with your peers and their families as a result of COVID? CHRIS  35:22 Each of my workdays, two to three hours now, have been devoted to taking phone calls and answering emails since the pandemic began, by individuals and family members who are looking for additional help. There is evidence that people with schizophrenia are more likely to develop the illness resulting from COVID-19, as opposed to the general population. I think fundamentally, what some recent reports have indicated is that it's become somewhat harder for people with pre-existing mental illnesses to consistently get not only psychiatric care, but also primary health care. JO  36:02 Kat has the pandemic been difficult for you? KATRINA  36:07 It's been challenging in ways for myself and for my peers. For instance, some describe that it slammed them when they were in healthy spaces. It actually slammed them right back into illness because it looked the same. Now, we were isolating, so they were isolated, again, or still. And that just took them back into it. Just as one example alone. For me, I have to admit riding buses to commute to and from work is a challenge because of what I see. And it causes me a little stress. The people that pull their masks down on the bus when they're supposed to have it up, and stuff like that. But for the most part, I think it's, we're just all hanging in there. JO  36:57 Before moving on to talk about stigma, I'd like to thank our major sponsors again, the Social Planning and Research Council of BC, Emil Anderson Construction, WorkSafeBC, and AECOM Engineering Canada. As a registered charity, we rely on support from sponsorships, grants, and donations. If you'd like to support our HEADS UP programming, please visit freshoutlookfoundation.org/donations. As I say on every podcast, you can't have a conversation about mental health, without talking about stigma. Phil, how does stigma affect people you've researched and treated biologically and psychologically? PHIL  37:40 Stigma can be a huge part of the illness. There are a number of elements to stigma as well. And I'm sure Chris and Katrina will elaborate on these as well, and some we've already alluded to as well within our discussion. Because stigma can affect people's entry into care. And that because of the stigma around the illness, or stigma actually even towards mental health, either themselves or even within their family members as well, can actually affect their pathways to care. And we've done some research on that and have been able to show that. And then when somebody is in care too, and we do have to work with what we sometimes call self stigma, people's perceptions and ideas of what a diagnosis of schizophrenia means and what it can mean. And so there's those elements as well. And of course, we're trying to be the best advocates that we can for patients and our families. And that's where we try to work with the stigma in other areas around society towards the illness, towards mental health, of course, in general. Being those advocates and supports towards vocational or educational pursuits as well. We've definitely gotten a lot better with respect to that over the last number of years, but there still exists some of that stigma out there. JO  38:54 Kat, how would you describe stigma from the perspective of a person with schizophrenia? KATRINA  38:59 I would describe it as a belittlement. And a discreditation is a way of writing somebody off to make them not count. It's even, now how many times do you see it on TV used in a court of law, theoretically, to discredit somebody so much that that witness doesn't even count. It's a write off, and that's not fair. JO  39:21 Chris, what about the impacts of social and vocational stigma on the people you're advocating for? CHRIS  39:28 Well, first of all, we need to understand that all stigmas are built on the same formula. And that is misconceptions and myths, plus lack of education multiplied by fear, results in prejudice, and none of us are immune from prejudice. We all as a human experience. And what we need to do is to be able to look at our attitudes, confront them, and be willing to grow up, to change. Because there is societal stigma, and then when an individual with a mental illness internalizes society's stigma, we call that self stigma. So they think, well, I must have a broken brain and I'm not deserving. And then there's structural stigma in terms of laws, and policies, and practices that result in unfair treatment of people with a mental illness. Now, what does it all result in? It's not just about hurt feelings. Stigma results in a reluctance to seek out treatment. It delays treatment, it increases morbidity and mortality, it results in social rejection, avoidance, and isolation. It results in worse psychological well-being for individuals living with a mental illness. There's poor understanding amongst friends and families. Stigma can lead to harassment, violence, and bullying, poor quality of life, increased socio-economic burden. That's above and beyond the shame and the self doubt that the individual may face. That is perhaps our greatest enemy in promoting comprehensive mental health services and recovery oriented mental health services. That's why we have to advocate as Martin Luther King did, as other leaders and various other movements did, to claim our voice and to identify injustices where they are, and what impedes our being able to see people with mental illnesses as our brothers and sisters, our neighbor, and the fact that we should love one another as we love ourselves. JO  41:33 Kat, you and Chris have both experienced the mental health care system. Just wondering what you've seen, as far as stigma goes within that system. CHRIS  41:43 Well, the Mental Health Commission did a study a number of years ago amongst mental health service providers, and it found that stigma is alive and well within our mental health system, and those who provide psychiatric supports and services. So that might be surprising to people. None of us are immune to stigma, it has to be addressed. And whether you're a doctor, a psychiatrist, a police officer, a correctional guard in one of our prisons, people have to receive supportive education, which helps them to identify their attitudes, which leads to actions of discrimination, or improper behavior, or working with clients, patients, prisoners, etc. So this is a huge issue. JO  42:36 So we're on the homestretch. Now, given what you've learned over the years, what would you say to give hope to people who are early in their recovery journeys? CHRIS  42:48 What I would say is, I want you to meet Katrina. Katrina has lived experience of psychosis. But she also has found ways to move forward and live beyond the limitations of mental illness. She's a peer support worker. And so Katrina, through her lived experience, she will listen. And she will give you realistic hope. Because the hope for recovery is possible. I know this is a difficult time for you right now. And the next couple of years, it may seem like you're not coming out of this deep, dark hole. So what I'm saying here is that I think introducing patients to a peer support worker as soon as possible, can help with the depression and the forlornness that a person may be experiencing by receiving a diagnosis of psychosis or schizophrenia. We need to be realistic, but also, we need to communicate hope that things can get better. And the person who can communicate that the best is a peer support worker who's been down that road and knows what helps and hinders recovery. JO  43:53 Kat, what have you learned about hope? KATRINA  43:56 I've learned that it is the most wondrous and beautiful thing in existence to have hope, and that life without hope, isn't life at all. JO  44:06 Chris, what would you say to family members who are confused, fearful, and frustrated? CHRIS  44:13 I would say that it's normal. It's very normal to be confused, and frustrated, and fearful, and to feel shame. It's normal. And that is not your fault. But that help is available. We know more than we've ever known before about schizophrenia, psychosis, treatment modalities, what helps in the recovery process. And so I would encourage the family who's new at all of this, that there are individuals known as family navigators, or family peer support workers, and that there's family education. There are support groups because the family is in recovery too. The individual with schizophrenia or psychosis, they're not the only one in recovery. But the family is also on a recovery journey, in terms of dealing with their stigma. Dealing with their fears and their frustration, learning communication skills with their loved one who has a mental illness, and that there's hope for the entire family. And things can get better, but not minimizing the barriers and the frustrations that are there. JO  45:17 Phil, what would you say to medical and mental health professionals to help them better understand schizophrenia, and to respond more compassionately? PHIL  45:26 A lot of it is that storytelling, and a lot of what we're doing here tonight too, as well, and just appreciate that a diagnosis of schizophrenia is not necessarily a negative diagnosis, and that people can have great outcomes. And its outcomes based on the individual and what they perceive that their own personal sense of well-being and psychological well-being. And so appreciating and having them appreciate the various outcomes that can exist within schizophrenia and psychosis. So it really comes down to still a lot of that education, that's important. It's not necessarily education, for example, from me from the medical community. It's also education for family members. It's education from people with lived experience, as well. And these are very important stories for the medical community to hear. JO  46:08 How would you pitch the need for wholesale change in mental health care to the people making those policy and funding decisions, Chris? CHRIS  46:18 Well, in terms of policymakers and politicians, I think that we not only point out to them, and most the time they know this already, that our current mental health system is not adequate. And it fails many people. And that most people struggling with a mental health problem or mental illness, are not getting the kinds of supports and services that we've talked about on this podcast today. But then I would move forward, promoting transformation of the mental health system through the recovery philosophy. Australia, New Zealand, Scotland, England, has moved towards recovery oriented mental health services. In fact, the fastest growing occupation in the mental health system in England is that of peer support workers, embedding peer support workers in the mental health system, which can help transform the mental health system. We have to educate those who make policy, in politicians. And we have to get to administrators and hospitals and other domains, and not just write recovery into policies, but develop toolkits to help practitioners to move towards a recovery environment. We have to be patient, but we have to be persistent. And we have to be consistent in our advocacy. And we have to speak with one voice. The best advocacy is collaborative advocacy. Unfortunately, there is still much debate within the mental health community about the medical model versus the recovery philosophy. But we have to persist, we have to be determined we can overcome. PHIL  47:57 So it's a great question. And I guess I kind of go back to some of a little bit what I mentioned earlier, it shouldn't be me doing this pitch for wholesale change. And sometimes I really think it needs to come from those individuals who are living it, both the individuals with lived experience, and their family members. And oftentimes, our major changes in either service delivery, or funding, or policy have come because of the advocacy of family and individuals with lived experience as well. We can be there in the medical community to help support, and give that research, and give the data, and look at cost analysis. But the pitch needs to be unified with all the important stakeholders. JO  48:38 And what would you say to those of us who may not know enough about schizophrenia, but who are willing to explore our ignorance and our conscious and or unconscious biases? CHRIS  48:50 Well, it's all about contact-based education. So what I would say to a person is get to know someone, get to know that relative who has schizophrenia, and get to know that neighbour who is experiencing psychosis the same way I had to do when I was a racist in the deep south. In the first part of my life, as a child, as a teenager and young adult, I had to confront my racism. And the way I did that was by moving out of my supposed circle of safety. And that was getting to know people different from me, people of colour. Eating with them, praying with them, interacting, listening to their hopes and dreams. And then you see a person. So we have to do the same thing in terms of going beyond our comfort zones, to learning the truth about the reality of people who live with psychosis or any mental illness. JO  49:44 Kat, any comments? KATRINA  49:46 To those who are willing to explore, you'll find a whole new world because you'll rediscover people that were there the whole time. JO  49:56 What I've discovered is a whole new world of potential. So, not only for people with schizophrenia, but for collaborative change. CHRIS  50:06 Exactly. You mentioned a wonderful word, their potential. In fact, that is the mission of the Schizophrenia Society of Canada. Build a Canada, where people living with psychosis and schizophrenia achieve their potential. And that's what recovery is all about. JO  50:26 So in closing, I have just one more question for each of you. Given what you've learned, personally and professionally, and what we're collectively learning through research and advancing technology, how do you envision the world of schizophrenia changing over the next 20 or 30 years? Kat, let's start with you. KATRINA  50:48 That there won't be the fear of the illness to stop people from finding out if they need help, how to do it. That there won't be this belittlement that can lead to the self stigma, which feels horrible. That there will be treatments that encompass the wholeness of who you are, working together in greater capacity than where we're at now. We have made some progress, but we're not there yet. JO  51:23 Chris, your vision? CHRIS  51:24 We will live in a society in which no one is left behind. Not because they have schizophrenia or psychosis. That stigma will basically be a thing of the past, and it will not be our big albatross. That in fact, that treatments will go beyond anti-psychotics and won't even have to use antipsychotics. And that the recovery philosophy will be fully ingrained within our mental health system. That's what I hope for. PHIL  51:56 I think we'll have a better understanding of the illness and understanding, for example, from the biological underpinnings of the illness. That will in itself help us to understand the best treatments for schizophrenia. So I think we'll see some advancement there within the biological treatments, but as well as the psychosocial or psychotherapy type of treatments, as well. And I think really what we're seeing as well, is just that better understanding and appreciation. I think in 20 or 30 years, we'll see some of the stigma being reduced as well. I think what will continue to happen is that understanding of illness, and it's really getting back to that early intervention piece. And people understanding that if things aren't really quite right, they should get it checked out. And I do make that analogy when I do some public speaking about skin cancer, and that we've had enough education at this point to realize, okay, if we have a funny looking mole, we should get it checked out. May not be anything, but it may be something that needs a little bit more attention. Hopefully, we will be in 20 or 30 years with mental health and wellness as well, is that enough education there to say, okay, if things aren't really quite right, then we should get it checked out. Again, maybe nothing, but it may be something that needs attention. The earlier that attention is there and the treatment than the better the outcomes. JO  53:10 Thanks so much to all of you for your profound insights, ideas, and passions for making the world a much better place for people with schizophrenia, their families and friends, their employers, and society at large. Phil, I so admire and applaud your attention to the ever-changing details of diagnosis, and both pharmaceutical and non-pharmaceutical treatment options. Your boundless curiosity will certainly make schizophrenia less mysterious, and perhaps one day even curable or preventable. PHIL  53:46 Thank you so much for that. And importantly, as these venues, these educational opportunities, these podcasts, are really going to help us to those eventual goals as well. Thank you very much for this opportunity. JO  53:58 Kat and Chris, your willingness to be vulnerable so that others might be helped, is truly inspiring. And I'm sure will help to inform and transform the evolving conversation around social support and advocacy. KATRINA  54:14 It's a pleasure to help. I know, if I would have had peer support years ago, things would have been different. And that's why I'm working so hard to be a peer support worker is to make that difference. JO  54:31 Chris? CHRIS  54:31 I hope that the listeners of this podcast will be inspired and motivated to take a different approach to seeing people who have a mental illness. And here's the statement, ask not what illness a person has, ask what person the illness has. See a person, not an illness. JO  54:53 Thank you both. This is one of the most robust and powerful discussions I've had. The three of you, what you bring to the conversation individually is astounding, but how well you blended your experiences and insights is really truly remarkable. This has been a wonderful, wonderful experience for me. That's a wrap on Part 2 of our podcast on schizophrenia. Be sure to catch Part 1, which focuses on stories, signs, myths, and recovery philosophy. Huge thanks again to our guests for sharing their amazing minds and spirits. To connect with Kat, Chris, or Phil, check out the episode show notes at freshoutlookfoundation.org/podcasts where you'll find contact info, complete bios, and a transcript. I'd appreciate you leaving a review as well. I'm also grateful for all you listeners and hope this information inspires and mobilizes you along the rapidly changing road to recovery. If you haven't already signed up for monthly HEADS UP e-blasts about new episodes, please visit freshoutlookfoundation.org. And for ongoing information, follow us on Facebook at FreshOutlookFoundation and Twitter at FreshOutlook. In closing, be healthy and let's connect again soon. Episode Reviews

SUMMARY Schizophrenia affects about 80 million people from all countries, cultures, ages, abilities, and genders. This two-part podcast explores their widespread challenges, and the hope and healing opportunities available to them and their families via integrated bio-psycho-social-spiritual-vocational therapies. In Part 1, Katrina Tinman (peer support worker with lived experience), Chris Summerville (CEO of the Canadian Schizophrenia Society), and Dr. Phil Tibbo (clinical/research psychiatrist specializing in psychosis-related illnesses) share personal stories, recount history, summarize signs and stages, bust myths, introduce recovery philosophy, and argue for recovery-focused healthcare. TAKEAWAYS This Part 1 podcast will help you understand: First-hand experience of schizophrenia and ongoing recovery Sibling experience with schizophrenia in pre-recovery era Current global and Canadian Schizophrenia statistics Definitions and differences between psychosis and schizophrenia Signs, stages, and the “schizophrenia spectrum” Psychological and physical conditions that can co-occur with schizophrenia History of diagnosis and treatment of schizophrenia Relationships with loved ones, friends, peers, and patients with schizophrenia Recovery philosophy and language and its evolution over time Recovery movement supported by government policies, programs, and funding SPONSOR The Social Planning & Research Council of British Columbia (SPARC BC) is a leader in applied social research, social policy analysis, and community development approaches to social justice. The SPARC team supports the council's 16,000 members, and works with communities to build a just and healthy society for all. THANK YOU for supporting the HEADS UP! Community Mental Health Summit and the HEADS UP! Community Mental Health Podcast.   RESOURCES RECOVERY: Research Into Recovery Recovery Model of Mental Illness: A Complementary Approach to Psychiatric Care A National Framework for Recovery in Mental Health Recovery-oriented Practice − An Implementation Toolkit PEER SUPPORT: Peer Support  The Future is Peer Support Using Peer Support in Developing Empowering Mental Health Services MENTAL HEALTH STIGMA: Fighting Stigma and Discrimination Is Fighting for Mental Health Stigma and Discrimination Addressing Stigma Five Ways to End Mental Health Stigma SCHIZOPHRENIA: Hope and Recovery Schizophrenia Treatment and Self-help   GUESTS  Katrina Tinman Katrina Tinman is a peer support worker for Peer Connections Manitoba, formerly the Manitoba Schizophrenia Society, and is located at the Mental Health Crisis Response Centre in Winnipeg, Manitoba. Katrina is currently working toward formal peer support worker certification with Peer Support Canada, though she already has peer support certification through the Ontario Peer Development Initiative. Katrina received a university education in journalism and political science in 1998, from North Dakota State University in Fargo, North Dakota. Since then, she's had a wide range of life experiences from working in the professional arena, extensive travel, motorcycle riding, alpine skiing, and SCUBA diving, to homelessness and mental illness. Regardless of some negative life experiences, Katrina's greatest achievement was a sense of fearlessness that carried her through along with hope for the future. Now she's able, through her peer support work, to use her life's insights to help others in their recovery from crisis and mental illness. Email: k.tinman@peerconnectionsmb.ca Website: www.peerconnectionsmb.ca  Facebook: www.facebook.com/katrina.tinman.5 Twitter: https://twitter.com/tinman_katrina Linkedin: www.linkedin.com/in/katrinatinman Chris Summerville, BA, MDiv, M.Miss, D.Min, LLD (Honorary) Chris Summerville is from a family with mental health challenges (father and brother with bi-polar disorder, a brother with schizophrenia, siblings living with depression, and two suicides). He has also received mental health care himself, which has informed and inspired his work as CEO of the Schizophrenia Society of Canada since 2007. Chris has been involved with the schizophrenia-recovery movement for nearly 30 years, having served on the boards of the Mental Health Commission of Canada, Mood Disorders Society of Canada, National Network for Mental Health, and Psychosocial Rehabilitation Canada. Chris earned a doctorate from Dallas Theological Seminary, is a certified psychosocial rehabilitation recovery practitioner (CPRRP), and received an honorary Doctor of Laws from Brandon University in 2014. He is a regional, provincial, and national leader and advocate for a transformed, person-centered, recovery-oriented mental healthcare system, and believes mental health concerns should be addressed using integrated bio-psycho-social-spiritual-vocational approaches.  Email: Chris@schizophrenia.ca Website: www.schizophrenia.ca Facebook: https://www.facebook.com/SchizophreniaSocietyCanada Twitter: https://twitter.com/SchizophreniaCa LinkedIn: https://www.linkedin.com/company/schizophrenia-society-of-canada Phil Tibbo, MD, FRCPC Phil Tibbo was named the first Dr. Paul Janssen Chair in Psychotic Disorders, an endowed research chair, at Dalhousie University in Halifax, Nova Scotia, Canada. He is a professor in the Department of Psychiatry with a cross-appointment in psychology at Dalhousie University, and an adjunct professor in the Department of Psychiatry at the University of Alberta. He is also director of the Nova Scotia Early Psychosis Program (NSEPP) and co-director of the Nova Scotia Psychosis Research Unit (NSPRU). Dr. Tibbo is funded by local and national peer reviewed funding agencies and well published in leading journals. His publications are primarily around schizophrenia, and his current foci of study include individuals at the early phase of, and individuals at risk for, a psychotic illness. Dr. Tibbo's areas of research include application of in vivo brain neuroimaging techniques, to study psychosis as well as research interests in co-morbidities in schizophrenia, psychosis genetics, addictions and psychosis, stigma and burden, pathways to care, education, and non-pharmacological treatment options. Dr. Tibbo is president of the Canadian Consortium for Early Intervention in Psychosis (CCEIP), helping to advance early intervention care at the national level. He is a recipient (2015) of the Michael Smith Award from the Schizophrenia Society of Canada for research and leadership in schizophrenia, recipient of the Canadian Alliance on Mental Illness and Mental Health's Champion of Mental Health Research/Clinician award in 2017 and, most recently, recipient of the 2018 Regional Prix d'excellence – Specialist of the Year – Region 5 by the Royal College of Physicians and Surgeons of Canada. Email: phil.tibbo@nshealth.ca LinkedIn: https://www.linkedin.com/in/phil-tibbo-62170b18/ HOST Jo de Vries is a community education and engagement specialist with 30 years of experience helping local governments in British Columbia connect with their citizens about important sustainability issues. In 2006, she established the Fresh Outlook Foundation (FOF) to “inspire community conversations for sustainable change.” FOF's highly acclaimed events include Building SustainABLE Communities conferences, Reel Change SustainAbility Film Fest, Eco-Blast Kids' Camps, CommUnity Innovation Lab, Breakfast of Champions, and Women 4 SustainAbility. FOF's newest ventures are the HEADS UP! Community Mental Health Summit and HEADS UP! Community Mental Health Podcast. Website: Fresh Outlook Foundation Phone: 250-300-8797   PLAY IT FORWARD The move toward optimal mental health becomes possible as more people learn about the challenges, successes, and opportunities. To that end, please share this podcast with anyone who has an interest or stake in the future of mental health and wellness. FOLLOW US For more information about the Fresh Outlook Foundation (FOF) and our programs and events, visit our website, sign up for our newsletter, and like us on Facebook and Twitter.   HELP US As a charity, FOF relies on support from grants, sponsors, and donors to continue its valuable work. If you benefited from the podcast, please help fund future episodes by making a one-time or monthly donation. Katrina Tinman, Chris Summerville, Phil Tibbo Interview Transcript You can download a pdf of the transcript here. The entire transcript is also found below: RICK  0:10 Welcome to the HEADS UP Community Mental Health podcast. Join our host Jo de Vries with the Fresh Outlook Foundation, as she combines science with storytelling to explore a variety of mental health issues with people from all walks of life. Stay tuned. JO  0:32 Hey, Jo here. Thanks for joining me and my three guests as we learn about schizophrenia, perhaps the most misunderstood and stigmatized of all mental illnesses. In this two-part podcast brought to you by the Social Planning and Research Council of BC, we'll explore the challenges experienced by people with schizophrenia, and the proven opportunities for healing available to them. We'll hear from three remarkable people who are devoting their lives to the cause. First, a woman with decades of lived experience, who is now helping others along their own recovery journeys. Then, the executive director of the Canadian Schizophrenia Society, will share his personal and professional observations about recovery, and needed systemic change. And finally, a clinical and research psychiatrist will share past, present, and emerging diagnostic and treatment strategies, along with his thoughts about recovery philosophy. But before that, let's connect with Rick our researcher to learn the basics. RICK  1:37 First off schizophrenia is not a single distinct illness, but instead a psychiatric diagnosis with various symptoms found on the schizophrenia spectrum. There is no single lab test or brain scan for schizophrenia. Doctors will explore symptoms on the spectrum if there are no medical conditions, mental illness, or substance-use issues that could be causing signs of the illness. JO  2:04 What symptoms are doctors looking for to confirm a diagnosis of schizophrenia? RICK  2:10 Symptoms are classed as positive, negative, or cognitive. Positive, or psychotic symptoms include hallucinations and delusions. These occur when a person loses touch with reality and must be present for a diagnosis. Negative symptoms indicate lost capacity, such as social or occupational dysfunction, or a lack of hygiene, expressiveness, or motivation. Cognitive symptoms affect thinking processes, and can impair concentration, memory, judgment, and decision-making skills. JO  2:49 Who's most affected by schizophrenia? RICK  2:51 Symptoms are typically first recognized in the late teens and early 20's. While boys are 40 percent more likely than girls to be diagnosed, girls are more likely to be diagnosed at an older age. JO  3:06 Do we know what causes schizophrenia? RICK  3:08 While potential causes are still unknown, experts agree that several vulnerabilities can set the stage including genetics, prenatal infection or birth complications, abnormal brain structure, chemistry, trauma, cognitive impairment, and environmental stressors. JO  3:29 Last question Rick, how widespread is the illness? RICK  3:33 People from all geographies, races, cultures, abilities, genders, and socio-economic groups have the illness. About one percent of the world's population is affected. That's about 80 million people worldwide, or about 380,000 in Canada. JO  3:52 Thanks Rick, it's certainly a big problem with serious implications for individuals, families, workplaces, communities, and certainly our mental health care systems. For more information, you can visit the Canadian Schizophrenia Society at schizophrenia.ca. I can't wait to dig in deeper with our guests, the first of whom is Katrina Tinman, a peer support worker at the Mental Health Crisis Response Center with Peer Connections Manitoba. Welcome Kat, and thanks so much for joining us. KATRINA  4:29 Thanks for having me. It's a pleasure to be here. JO  4:32 Later, we'll explore the stigma and discrimination faced by people with schizophrenia. But for now, I'd like to share my own story of stereotyping. Until I met Kat and her colleague Tracy Kosowan, I'd never spoken to anyone with the illness. My only experience was seeing people in my community who I knew were affected. Some walked fast, their faces expressionless with eyes focused straight ahead. Others talk to themselves. One fellow always carried a stack of books, while another always wore headphones and the same dirty clothes. That was the extent of my understanding about the illness. Then I learned about Kat's life and read a speech Tracy wrote. My first thought was just how difficult their journeys have been, and how amazingly resilient they both are. I don't know that I would have been so able or determined to recover if I'd been in their shoes. Mostly though, I was struck by the fact that they're just like me, women with mental health challenges who've learned to manage their conditions, their work, their lives, and their dreams in meaningful and productive ways. So Kat, let's open with your incredible story. Where's the best place to start? KATRINA  5:49 You know, it took a few twists and turns. It started though, as just an average kid, growing up middle class, Can-American in my case because I'm a dual citizen. That was the one unique thing about me. I'm a dual citizen of Canada in the United States. And as I progressed through schooling, I did very well, even was one of who's who in American high school students, as I was studying high school in the United States. Attended University of Fargo, North Dakota and graduated in 1998 with a degree in journalism and political science. That took me to about the age of 25. And that's when things started to change. Now not really right away, because I met, married, and fell in love with somebody, not necessarily in that order, and became a sales and marketing director for a pool set company actually making pools accessible for elderly and disabled. I traveled, skied, rode motorcycles, camped, played Texas hold'em poker, and even scuba dove. I was living the life, as my cousin once said, and never expected what was coming my way. But there were a few things that didn't pan out. And a few things that were kind of negative. By 2003, I started to experience symptoms that others noticed. I'd say it this way, because I never recognized or realized myself that I was getting sick in any regard. I just knew people were telling me, "oh there's something wrong" and, "might be a mood disorder." Though they were never certain back then what was going on in my head. In ways, neither was I. It's a very sneaky thing at first. I just didn't see it. And I should have realized the potential. But that's hindsight because my mother actually had illness before I did. What got me though, was mental illness, it's not a genetic absolute, and that I always knew. So I didn't get how I had it, and didn't see the absolute and I wasn't seeing it myself. I went through my many experiences from 2003 'til present, and actually define I had two different journeys of recovery. The first one concluding coming to a climax point in 2009, where I had reached a point of going from being examined and not really recognizing, realizing it, and starting to get it, I guess, that in 2009, the doctors actually said, "well, you can go off medications, your insight is strong enough, you're aware." A lot of things changed for me in 2009. I divorced my now ex-husband, and I no longer was employed. And that presented a lot of stress. And I ended up not recognizing or realizing it again, because I still was at the point of not acknowledging illness. I actually thought it was just because my marriage turned out to be a bad one. Discreditation of me, I thought it was just trying to write me off, make me not count, make my voice not heard, and things of that nature. In 2009, those stressors really served to trigger me. And it was retrospectively, I can say it now, at the time I couldn't, I didn't think it was me. But in 2009 in July, I was starting to really get sick and go on that journey. And because, at the time, I was so immersed in my divorce and some of the other things of trying to find a job in an economy that actually was taking a massive hit in 2008 and 2009, I still didn't see it. And I actually moved myself from Fargo, North Dakota where I was residing to Tucson, Arizona in search of a job. Even that decision might have been a sign of my illness at play in a way and I just continued straight downward in a long, slow spiral. By 2010, my economic assistance, unemployment, had run out and I was no longer able to maintain housing. It just collapsed more and more and the illness did reveal. But it's retrospect that shows me that at the time, I didn't really realize. That's one of the things about the illness. It's like this betrayal from the inside out. You can't believe what's inside. By 2010, I basically went back to Fargo, North Dakota with assistance from somebody. But things were still getting worse and worse and worse. My decision making was horrible. It really was. Even my choices in partners were based in unreal things in ways. And I still, up until that point, didn't see it. By 2011, I actually left Fargo and came back to Winnipeg, where I was born, and just tried to survive, still not getting it. By 2013, though, I was actually already at the point of homeless because that was from 2011, through on again off again in very assorted ways, and in hospital. Somebody actually cared enough to look at me and say, "No, there's something here." And it started to sink in. But not until about 2012, 2013. I went that long a time. Not getting, not seeing, not wanting to either. There was one particular instance, a former roommate saw me on the street. I converse with him briefly and he right away said, "Are you okay? Are you sure you're okay?" There was an instance where I'm trying to take a moment to feel human in the midst of homelessness. I went into a dress shop to try on a dress. And it did hit in the back of my brain as I looked in the mirror at myself and saw what I had become, which really was not good. I had shrunk from being a size 14 and 2009ish to being a size six by end of 2009, down to by 2012 when I was homeless, I was shrinking down to zero. It was like I was shrinking away to nothingness. Now, that's a lot to take in. But there was still hope. And that's what actually got me. There were a few instances over time of help that came my way. And I think I started to recognize that. And, it's not easy saying it but I ended up in hospital involuntarily. But it was because somebody cared enough to call. And there was enough evidence of it. It wasn't because of the want to harm self or others that wasn't present. But the detriment to self was really there. For all of it. I never had suicidal ideation. But there was definitely enough evidence of illness present. I was having hallucinations. I was having delusions. My cognitive impairment was definitely present. It was all of it. And once again, it took a lot out of me because when I was a kid, I was nothing like that. I made it all the way through university, attaining exceptionality in grades, and doing well and juggling multiple jobs to get her done. In conjunction with financial aid, I was able to work for a decade actually being a sales and marketing director. But in that journey of recovery there was some semblance of support system, while I was married. Now the hard part was that marriage end and that transition. My parents, they had actually reached a point where they were no longer together, and they were both at retirement age. And they didn't have a way to support me and give me that help. And I was residing in an area that didn't have much social structure for agencies to help. And I moved to another area that really didn't have anything that I could find easily. But in the midst of it all, I wasn't looking because I wasn't seeing that I was sick. And it wasn't until 2013, that really, it came about in a hospital. I was actually walked through some of the questions, now what are the berms? And it was something that I realized, oh no, you're asking me that when the berms were something, and that moment I realized were something unreal. And to this day, I wish I could thank those doctors. Just saying in those moments, you can say they saved me. There's so much more that I could encapsulate between 2003 to 2013. Because one of my stories includes hitchhiking across two countries, lost. Still kind of survived, but I was truly lost. The education was wasted. Those four and a half years I spent obtaining a degree with two areas of focus, that was out of the window. When I was released from hospital in 2013, I did finally have network, I had a social worker, a mental health worker. And at discharge, it was first a question where to get housing. I took what was available, which was actually the Winnipeg Hotel, which was a dive hotel. Only had one incident there that was unpleasant, and ended up there for a year, and then was able to get into housing. And that was beginning of 2014. That same timeframe, the social worker, after engaging me for a while and trying to pick my life back up from being at that bottom point, he actually had this broad sheet of information about some of the agencies that Winnipeg had. And it was at that point, I kind of reached a juncture of where do I go. Because at that point, I finally had a diagnosis. What originally started in 2003 as just well, mood disorder, we don't really know what's going on, mood disorder, we'll just call it that. Because it's a mood disorder, we know that it had evolved. And by 2013, it was schizoaffective disorder, which is the traits of schizophrenia and the traits of a mood disorder, in my case bipolar. That still kind of left this trick of where to go, because the agencies that I found were very illness specific. But I found the Manitoba Schizophrenia Society, and Chris Summerville actually. I actually first met, though, a woman named Karen who worked for the organization. And she kind of introduced me to what it stood for and what it was about and what help might be. I started using that opportunity. Something had shifted in myself in 2013 and 2012 end point, where after going through all of it, which included the self stigma even, I turned around on myself and re-embraced myself and said, "Well, I'm still human, I'm still me. And okay, so there's this illness point, but it can be dealt with just like mom dealt with diabetes." And I was able to turn things around and started going to the Schizophrenia Society, and then falling for it in a way of deciding, well, this might be a good place to volunteer, and pay back all that I had acquired through social structure and help in other regard. And I progressed and stayed a volunteer until the beginning of 2015 and was at that moment able to become an employee. Now 2014 is when I was able to move into housing, that was actual housing. It took a year, though, for things to really flush out where I could look for a job again. And yes, in 2015, the Manitoba Schizophrenia Society offered me that opportunity. JO  19:21 Thank you for sharing Kat. Your incredibly compelling story is the reason that we do this podcast. I'm so blown away by your resilience. Can you tell me where you think that comes from? KATRINA  19:35 I really think it comes from my parents and how they raised me. I don't know beyond that, something else inside me, my faith and hope that I found the beauty that still surrounded me that I could still see. A psychologist in my early recovery journey, once spoke with me and the psychiatrist both, about how the truth is still in people. And there's still all those parts of reality there. It's just kind of piecing it back together again. JO  20:09 So how do you support yourself, or what do you tell yourself, during your most challenging moments? KATRINA  20:16 I remind myself that I've already done so much. I take a look at all that I have done and realized, not many could. Because I look around and there's so many who are there, and are not doing it, and are not getting out of it, and are still in their places and spaces that are more difficult for new people venturing into those spaces. I actually am now at this point where I'm turned around so much toward it, to facing it, that it's a deep core value. And that's the peer support part of me that I am now doing, and that work to reach back out and help others, and that feeds me. JO  21:08 How did your schizoaffective disorder impact the relationships you had, and now have with your family, friends, and colleagues? KATRINA  21:18 It's an interesting situation in many regards, because it depends on so many factors for each one. In the instance of family, it was intense conversation and misunderstandings. At one juncture in my journey, I was in Tucson, Arizona with my dad's sister and her husband, my aunt and uncle. And I was really raging leo. I kept turning off the swamp cooler for their air-conditioned Tucson, Arizona home. And that is actually the worst thing you can do for a swamp cooler. And they couldn't understand that it was actually part of my delusion. And I couldn't understand their point of view, because I was in the midst of my delusion. And so, we had various different, difficult situations and conversations to the juncture that they said at that point, I couldn't stay with them, I had to go to my Dad. Now this was actually at a point in time when I was homeless. And on that hitchhike, I was in the States at that point in time as was my Dad was moving to Denver. The short story is I didn't connect with him. I ended up back in Winnipeg in a longer term. But there's other relationship issues, the interactions between significant others and myself. Those are always charged with it, with a fear that can impact me now, how is this person going to react to me, and respect me, and treat me. I've had situations where there wasn't the proper treatment, where I was actually healthy and accused of being mentally ill for being in an argument with a person, when they were themselves being out-of-line and inappropriate. A big day before a big event of my life, where one would have thought they would have been more supportive. And yeah, we are arguing and that came out of them instead. That uncomfortable, "Why are you mentally ill?" I've had situations of being assaulted, and the illness being used as an excuse. I've had situations of, my current partner might be a keeper. Because I have had situations because my medication doesn't cover all my symptoms perfectly. And I've had medications, well we're worse. This one is actually really good. But it doesn't cover everything. And once in a while something pokes through. And this partner, he's actually been on his own journey and understands in a different way, how things can happen, and illness can happen. And he embraces me in a different way. So now, I'm possibly in a positive situation. JO  24:21 How much of your story do you share with peers or the people you work with? And why do you think sharing your lived experience is helpful in their recovery? KATRINA  24:31 I try to share what is most applicable to their story and situation. Because ultimately, the sharing is supposed to be relevant for that peer as they're going through their process and conversation. Oversharing is not what it's about. It's part of my training actually, to look for that fact and to be aware of that potential. Because the peer is the ultimate focus of the interaction. It's appropriate for sharing in creating connectivity between myself and the peer and being able to share with them that feeling that they're not alone. And that reinforcement that they can do it, and that validation that they might be lacking. So, it really depends on the situation. Sometimes there is very little sharing. Sometimes there's more. JO  25:24 As mentioned earlier, the Schizophrenia Society of Canada is a great source for information, inspiration, and mobilization. I now have the pleasure of introducing Chris Summerville, the society's Executive Director since 2007, who has amazing insights that reflect personal and professional experiences with schizophrenia over 50 years. Chris earned a doctorate from the Dallas Theological Society, is a certified Psychosocial Rehabilitation recovery practitioner, and an adjunct professor at Brandon University in Manitoba. So glad to have you here, Chris. CHRIS  26:06 Thank you so much, and what a pleasure to be joined with Katrina and Dr. Tibbo in making this podcast. JO  26:13 We're so happy to have you here Chris. We'll dig into your perspectives as a recovery practitioner and society leader slash advocate a little later. But first, please tell us about your family's experiences with mental health challenges in general, and schizophrenia in particular. And when did your focus on schizophrenia change from being personal to professional? CHRIS  26:40 Well, as you've heard Katrina's story, it's definitely not just an individual experience, but it is indeed a family experience. I mean, the family is involved in all the trauma, and the burden, and the suffering, and dealing with the complexity of having a mental illness. For the Summerville family, my mother, seven of her seven children had significant mental health problems. We lived in a very, what used to be called a dysfunctional home, a very unhealthy home, and that certainly did not help us in dealing with the mental health problems and the mental illnesses. My father struggled with what we would call today, bipolar disorder, along with alcoholism, addiction issues, as did a brother Dennis, who struggled with the same thing. And both of them took their lives by suicide. It was just difficult for them to continue on and had lost all hope that things could get better. Then my other brother Terry was in Vietnam, and he developed cannabis-induced psychosis, and also struggled with addictions. And both of those two brothers spent time in prison. And I myself as a teenager, I struggled with what's called today, depersonalization derealization, along with depression. And basically, it's sort of like an out-of-body experience, and you're not sure you're in reality. And it's very scary, and you feel very lost as if you're a rimless bubble on the sea of nothingness. That's a sort of an existential thought, even for a teenager as I was to be trying to figure all of this out, which I indeed was trying to figure it out. But in those days, we didn't talk about mental health, we didn't have words for it. We literally didn't have words for it. And so, it was the shame of the family that bound us, there was really no hope. Even as an adult, periodically, I would struggle with depression, along with suicidal ideation, and never, quote, attempted to take my life. But having noticed suicidal ideation and the fear of hopelessness and living the secret because you didn't talk about it, you don't talk, you don't feel, and you don't trust. And that in itself was a great bondage, so to speak. Then I pastored for 25 years, I started when I was 17, and I struggled with it. But I remember when we moved to Niagara Falls, Ontario in 1985, my wife and I, at that particular church there, I was addressing mental health issues. I was kind of an unusual pastor in terms of the fact that I would speak occasionally about my experience, and was very conscious about individuals that were part of the church that I pastored that they were struggling, not just with spiritual issues, but also with mental health issues. Unfortunately, the faith communities not really address mental health issues as they ought to. I mean, they're certainly getting better at it. But during those days, in the 1970s, 1980s, and even the 1990s, it was rare for a pastor, number one to be vulnerable, and number two, to address it in a forthright manner. As I progress with my story 22 months ago, when I'm 68 years old, I had a hospitalization. It was actually my first hospitalization. I had been struggling with depression and anxiety, and my psychiatrists had put me on a new antidepressant. And I had serious side effects, very, very serious side effects, as if I were having muscular seizures, inability to concentrate, the anxiety getting much worse. And so, I was admitted to a hospital voluntarily, but under the Mental Health Act. That was all very scary, because unfortunately, to be a patient in a psychiatric center is not pleasant. Unfortunately, many service providers treat you as a diagnosis as opposed as a person. To answer the question about moving from it from a personal or professional aspect, like I said, I did address it as a pastor. The response was very hesitant. People weren't comfortable about disclosing. And that was very sad to me. And many people would deny not because they lacked insight, but because they were ashamed. And it was embarrassing to be so vulnerable and open about it. In 1995, I made the transition from the pastoral world to the mental health world, because I wanted to work more closely, and to be a strong advocate, and to be a voice for those who are voiceless, and to see transformational change in the mental health system here in Canada. So I began with the Manitoba Schizophrenia Society in 1995, was there for 25 years. Also, during that 25 years, in 2007, I became the CEO of the Schizophrenia Society of Canada. It has been a pure joy. It has afforded me to be a leader of leaders. I often think about Martin Luther King, not that I'm in the same arena as he is, but I grew up in Birmingham, Alabama. I know what racism looks like, because I was a racist, and learned myself out of it. And also, my spirituality helped me to move towards seeing people and not labels, in color necessarily. To be able to take my lived experience, and not only bring hope and encouragement to individuals and families, but also to be able to engage, along with Katrina and Dr. Tibbo, being at the tables where decisions are made by different levels of government, and to represent the voices of those with lived experience, and in the family lived experience, and to create a better mental health system in Canada. JO  32:37 Another amazing story Chris, thank you so much. Can you tell us more about the evolution of your brother's experience with schizophrenia? CHRIS  32:47 Well remember, it was 1964 when Terry developed cannabis-induced psychosis. And the reality is if he were living today, his outcome would be better today. There was no understanding about early intervention. So, he went for years without any assistance or help. There was no access to psychiatric or psychosocial rehabilitation. So once you began to get quote, help, that help was very limited. It was basically take these medications to reduce symptoms and go home. You won't have any friends; you probably won't get married. It was a sort of a kiss of death diagnosis, so to speak. And recovery, good grief, very few people and very few service providers were even trained, let alone talked about the possibility of recovery, which we can define later. And as far as addictions, no one addressed the addictions. And we now know that they both should be seen as primary disorders in terms of a mental illness, and a substance-use problem. And then both have to be simultaneously treated because one influences the other. There was no family education. Insight into having any understanding about mental health and mental illness was zero for ourselves. And so, I'm absolutely convinced that if my brother were developing schizophrenia today, that his outcomes would be a lot better in the process. He lost his physical health, developed cirrhosis of the liver, he lost his family, he never saw his grandchildren. He was sort of ostracized by everyone. Those losses were profound. And it wasn't just because he had schizophrenia, the wall, there was a giant wall like he was on the other side of the wall, and we were on the other side. And that wall was not just the schizophrenia, it was stigma. It was self stigma. It was loss of identity. It was the lack of early intervention, psychiatric rehabilitation and recovery, mental health services, the lack of addressing the addiction, the lack of hope that created this huge wall barrier. And we basically had no way of understanding as family, how to tear that wall down, and he on the other side of that wall. I mean, Katrina is much, much, much more informed, as you've heard her story. It doesn't have to be that way today. What my brother experienced, that doesn't have to happen today. But unfortunately, it still does in areas of Canada. JO  35:31 How is your brother now? CHRIS  35:32 He is actually still living in a veteran's home, sort of a ghetto. It's a slum, which breaks my heart again. His health is reasonably good. He doesn't struggle with psychosis. He's on medication. But my aggravation and my grief is that that's all he's gotten really is medication, as opposed to all the kinds of supports, and just even a decent place to stay. And I have gone down to the state to try to help, but they know I live in Canada. And so, my advocacy efforts have always been very limited. JO  36:08 Can you tell us more about the relationship you have with your brother, and the personal insights you've gained over his five decades with this illness? CHRIS  36:18 We have a good relationship. We both have a strong sense of humor, which we got from my mother. And we utilize that in terms of maintaining our relationship. He knows that I care from my heart. And I think listening to him and being able to empathize with the emotions that he feels. You shouldn't agree with the content of the delusions or hallucinations when one has them, but one thing you can do is come alongside of the person, and affirm, and confirm, and validate the emotions that they may be feeling as a result of those delusions or hallucinations. And that's therapeutic. And in fact, it lessens the angst and the anxiety that the person is experiencing when you are able to do that. The fact to, I don't argue, I've never argued with the illness. Well no, that's not true. I had to learn not to argue with the illness, which many families do, to see him a person and affirm him in terms of his expressed desires. Another thing I learned was not to always focus on the mental illness, but to ask him questions like you would have any other person about his hopes and dreams. I think the fact that I did not abandon him, I did not isolate from him, but have attempted to maintain a relationship with him over all these years. I know he's appreciative of that. JO  37:38 Such profound insights Chris. We'll bring you in again after we hear from our next guest, Dr. Phil Tibbo, a Canadian psychiatrist who studies, treats, and advocates for people with psychosis and schizophrenia. Dr. Tibbo is also a professor of psychiatry at Dalhousie University in Halifax, Nova Scotia, and director of both the Nova Scotia Early Psychosis Program, and Early Psychosis Intervention Nova Scotia. Welcome Phil, such a treat to have you here. PHIL  38:12 Well thank you, and it's great to be here. And thank you so much for having this as a focus for a talk and a podcast. It's very important and needed as well. And, of course, I have to echo Chris' comments too earlier, when he was introduced, that it is for me truly honoring to be sharing this mic with both Chris and Katrina here today. JO  38:33 So let's start with the story of how you landed on the study, diagnosis, and treatment of schizophrenia as your psychiatric specialty. PHIL  38:43 Great question. I think I have to sort of back up a little bit with respect to that in my journey. I obviously entered into medical school, and interestingly, psychiatry was the furthest from my mind when I was in medical school. I entered medical school because I wanted to be a sports medicine physician, and all my electives were in sports medicine. But then as I did my psychiatry rotation, it sort of tweaked on me that I actually truly liked talking with the patients, seeing some improvement, seeing the resiliency that's there, as well as the struggles and challenges and what I could do to help with that. I subsequently did my rotating internship and then actually still wasn't quite sure what I wanted to do. So, I worked for one year as a family physician at the Nova Scotia Hospital, which is our provincial psychiatric hospital. And there I was responsible for the medical care of an entire unit, but as well as looking after the psychiatric needs of half of a unit as well. And interestingly my title, because I had those dual roles, the official title was whole person physician, which today still makes me smile because I realize and reflect on it, that's still my approach to the work that I do as a whole person physician. That sort of cemented for me my desire to do psychiatry. And then it was during my psychiatry residency, my specialty training, and my rotations through interactions with individuals who were living with psychosis or schizophrenia spectrum disorder, that I realized that it was something that definitely interests me, again for the same reasons, sort of appreciating what the brain can do in this development of these delusions and hallucinations. But as well as working with the individuals to, and understanding them and how these delusions, hallucinations affect them, and how it affects the family and seeing, ok what is the possibilities here? How can we work this through and get somebody back on their feet? And in some ways, the term you sometimes hear is a good fit. And that I really saw this as an area, for me, it's something that definitely interested me. I was fortunate in my last year of my specialty training to spend a fair bit of it down in Iowa, working with then the leading researcher in schizophrenia research, Dr. Nancy Andresen. And then that also cemented for me that I should be doing research in this area as well, because at that point, and still, you know, there's a lot of research that still needs to be done in many facets of schizophrenia, from understanding the illness, to treatments, and many other areas as well. And then that's what led me to my career. So, I've always been what we call a clinical researcher. So I'm a clinician, I do see patients, but I'm a researcher as well, within this area. JO  41:30 Great story and thank you for all the great work you're doing. So, when you listen to both Kat and Chris' stories, what about those stories tweaked your medical mind and touched your human heart? PHIL  41:46 Well, I like to say it touched my heart first versus my medical mind. But these are extraordinary journeys. And people that I talked to have these extraordinary journeys. And I think some of what I heard in both Chris and Kat, and that sort of leads me to the area that I work in with respect to early intervention services, is really the work that we need to do to understand this illness, so that we can identify illness early, and that we can treat early as well. Our main goal really is to optimize an individual's outcomes. If we only are able in those situations to truly identify early, treat early, and have some of the resources that we have now would have been nice to have in the 80s, and in the early 90s as well too. But yes, amazing journeys that we're able to talk about today. JO  42:36 Like to get down to a few nuts and bolts with regard to the illness. First, can you give us the Coles Notes history of schizophrenia's diagnosis, treatment, and prognosis? So really, then versus now. PHIL  42:51 I'll try not to go into a full lecture on this. And also, I like the term Coles Notes. Some of, perhaps our younger listeners, may not know what Coles Notes are, but I'm fully aware of what the Coles Notes are going to university. I think, you know, with most things with physical health, mental health, we know these illnesses have been around for quite some time. I guess most people point to the evolution of, or the start of, more modern psychiatry, the modern sort of idea of schizophrenia and psychosis really started at the beginning of the 20th century. The name that you will hear a fair bit is around at that time is Emil Kraepelin, who was a German psychiatrist. And he is really credited with truly writing about, and studying, and trying to understand what we know today as schizophrenia, and truly from a clinical perspective. And he was an individual who was able to understand or appreciate the difference between what we call today a primary psychotic disorder, and a mood disorder. And being able to write about that it's one particular symptom that is a diagnostic, but oftentimes, it's a pattern of symptoms that we have to look at. So, he coined the term dementia praecox, actually, as what we know today is schizophrenia. But then, over the years, that diagnosis has changed. Another name you'll hear is a Eugen Bleuler, who a little bit later on, sort of broadened the concept of schizophrenia. But I mentioned his name because he was actually the individual that coined the term schizophrenia, that kind of splitting of the psychic processes like emotional and intellectual. So he coined that term, but from a diagnostic standpoint, it really wasn't until perhaps the 50s when the Diagnostic and Statistical Manual, the DSM, came into being, and that really allowed the field of psychiatry to have a unified way of diagnosing schizophrenia and schizophrenia-like illnesses. And really that encapsulates criteria where if an individual presents in Canada, and an individual presents and another part of the world, if they use the DSM, then they would come up with a very similar diagnosis. And this was important, of course, within mental health because then and even today, we don't have one particular blood test that could make a diagnosis that you would get with some of our other medical illnesses as well. So, we are having to rely on a number of other different symptoms and factors to look at to diagnose. So that's how the diagnosis has moved on. And the DSM has gone through a number of different revisions. We're currently on the DSM-5 as well. But the ideas and the concepts are there to have that unified approach for diagnosis of the various illnesses. That's around diagnosis. Of course, treatment has changed over the years as well. And I always say, how surgery was done in 1910, 1920 is different from how it is done today. And we have seen that evolution in time. But just to point out that from the medication standpoint, which really was a game changer for schizophrenia and psychosis, that chlorpromazine was the first medication, and that really wasn't developed and available until the 1950s. But that was a medication that wasn't developed primarily for schizophrenia, or psychosis. It was actually developed as an adjunct medication for surgery. But the various properties and how patients were talking about how the meds sort of affected them, they decided to use it within and trial it within psychiatric and particularly psychosis population. And actually, if you read up a bit about chlorpromazine, you see sometimes the comparisons are made to antibiotics and infections and that. When chlorpromazine is used it wasn't more of sedative, but actually helped with delusions, and hallucinations. That's where we started seeing people actually being able to leave hospital. And of course, since then, that was a proposal first medication, we better understand how it works now, and as a result, sort of more targeted approach to medication development. That's the medication side of it. But of course, and something that Chris alluded to, as well, it's more than just medication too. And you see that development over the years of other types of therapies, for example, of psychotherapies. We have to have a few tools in our tool chest with respect to that interesting development. JO  47:05 We'll dig deeper into those treatment strategies in Part 2 of this podcast. But first, can you tell us about the similarities and differences between psychosis and schizophrenia? PHIL  47:17 When I do some public speaking on this, sometimes I start with a bit of an apology, because I tend to use those terms interchangeably sometimes. And I think that's more of a reflection of the work that I do within early intervention services. And oftentimes a diagnosis is not clear. And as a result, that we tend to use the word psychosis a fair bit. A psychosis itself is not a diagnosis, it's more of a set of symptoms. And schizophrenia, for example, is a diagnosis, schizoaffective disorders is the diagnosis, delusional disorder is a diagnosis. While schizophrenia is considered a psychosis, psychosis is more of a kind of a broader term and concept. JO  47:56 What happens to people during psychosis? PHIL  47:59 Well, it's very individual. There's not one particular sort of set of symptoms that can happen. But from a psychosis point of view, we often talk about grouping of symptoms. So, people can have what we call positive symptoms, which are not necessarily good symptoms. It's just that they're there, and they shouldn't be there. Those are the things like delusions, hallucinations, thought disorder. Then there's the negative symptoms as well, and those are experience or cognitions that should be there but are not. And that could be things along the lines of what we call alogia, sort of difficulty thinking, amotivation, difficulties in even just energy levels as well. A psychosis is also comprised of cognitive symptoms as well as mood symptoms too. But it's very variable for how people experience their symptoms. JO  48:45 We may not know what causes schizophrenia, but we know it has distinct stages. Can you tell us more about that? PHIL  48:53 Now that's a great question. I would say yes, we know, we defined schizophrenia now as having stages and we should be careful using the word distinct, because sometimes it's very difficult to know start and ends of particular stages within this. The different stages that you'll tend to hear first is really around, we talk about prodromal stages. Prodromal basically means by definition, one of the symptoms that are there prior to what we call frank psychotic disorders, before somebody could actually meet criteria for a diagnosis of schizophrenia. And that prodromal phase, again, can last a very short time for some people and very long for other people as well. And oftentimes there are unfortunately kind of what we call nonspecific symptoms, but as well can be psychotic-like symptoms but don't meet the criteria for delusions or hallucinations. Again, early intervention services are focused on trying to identify really what those prodromal symptoms could be, but they're recognized as something that's different from what that individual use would be. And then we do move into the next phase, which is called early phase psychosis or first episode psychosis. And really, that's the first three to five years of illness in a very critical and important time, in order for us to address the illness and again maximize outcomes. After we go through the early phase of psychosis, and there's different terminologies after that. Sometimes what you hear is either residual, or chronic. I don't particularly like the word chronic, because it has a negative connotation to it, but all really, truly what it implies is that it is somebody living with illness at that point in time. You can get into some of the more finer details of each of those, but those are more the high-level view of the various stages. JO  50:29 What conditions can occur alongside schizophrenia? PHIL  50:33 Having schizophrenia is not exclusionary for any other kind of illness. For example, for mental illness, people can have schizophrenia, but as well can also have a mood disorder, anxiety. Chris mentioned substance use as well, addictions. So, these are definitely possible and think that we from a treatment team has to be able to identify and treat if needed, as well. Oftentimes, we also have to make sure that some of those symptoms are not as a result of schizophrenia as well. Because sometimes we have to be careful making sure that we treat the schizophrenia as best we can to ensure that those other symptoms aren't there. JO  51:11 So do you have to treat each condition separately then? PHIL  51:15 You tend to yes. We want to make sure that our treatment of schizophrenia is optimized. I guess a good example of that would be if someone is having paranoid ideation, like feeling like somebody's out to get them, out to harm them in some way. Well, you expect them to be anxious. But that doesn't mean you have an anxiety disorder that's separate. So, you need to make sure that that is treated, those symptoms, and just see where the anxiety lies after that. But once the psychosis is treated, I mean, if you do have those residuals, anxiety symptoms or mood symptoms, then yes, they do need to be treated separately as well. JO  51:48 What are other potential health complications associated with schizophrenia, and how do they affect longevity? PHIL  51:56 Great question. Again, there are a number of other different health and we here we're talking about more medical health complications or comorbidities, that can happen with schizophrenia. And there's a number of factors that are associated with that too. And here, we kind of think more along the lines of cardiovascular health, for example, your cholesterol and lipids, about obesity, high blood pressure, diabetes, glucose intolerance as a result of that as well. And monitoring thyroid conditions too. And it's multifactorial, sometimes that could be a result of medications, particularly for the older medications in existence. But other times it could be as a result of the illness itself. And perhaps some of the behaviors around the illness. And unfortunately, some of the situations too, and Katrina alluded to that as well, which having an illness sometimes leads people to find themselves in, such as in homeless conditions or situations where they're not able to, for example, have the healthy meals, activity, and exercise that they need to maintain cardiovascular health. These are the things that are monitored within the treatment teams. JO  53:00 Thanks Phil, such important information. Taking a moment here to acknowledge our major HEADS UP sponsor, the Social Planning and Research Council of BC. SPARC is a trailblazer in Applied Social Research, social policy analysis, and community approaches to social justice. Thank you so much for your generous support. Let's bring Kat and Chris back into the conversation. And we'll start by having you all bust the most common myths associated with schizophrenia. Myth number one, people with schizophrenia have multiple personalities. PHIL  53:45 Well, that is indeed a myth. And I think it derives from the term schizophrenia as well, which people have misinterpreted as split or multiple personalities. But no, definitely, schizophrenia is not associated with multiple personalities. JO  54:00 Myth number two, people with schizophrenia always hear voices. Kat, what's your experience with that? KATRINA  54:08 That that's not true. It's actually a situation where not everybody who has mental illness hears voices and not everyone who hears voices has mental illness, there is a difference. PHIL  54:20 I would agree with that Kat as well. So from an individual perspective, some people can have those auditory hallucinations, those hearing the voices. And then they go away. They can be episodic, but definitely not, an always kind of condition or state. KATRINA  54:36 Yeah, I never actually heard voices. Lately, I hear music once in a while, but that's about it. JO  54:42 Myth number three, people with schizophrenia are more violent or dangerous than other people, Chris. CHRIS  54:49 Well, this is the most dominant, common, pervasive, and enduring myth around schizophrenia that the public in their opinion, they associate schizophrenia and bias together. And why is that? Well, the portrayal of people with psychosis and schizophrenia, if you look at media reporting, it historically has been very negative, focusing on violence and unfortunate criminal activity instead of addressing the complexity of schizophrenia, and high suicide rates, and media not telling us very much about the illness in general. Also, Hollywood movies, sitcoms, and even children's cartoons, how they have historically and currently do portray people in a negative way who have a mental illness, especially schizophrenia or psychosis. The reality is that people with schizophrenia are more likely to harm themselves than others. When you look at the studies, approximately 97% of people with psychosis or schizophrenia are not violent. But for those people who are violent, and there is indeed a subgroup of people who will engage with the criminal justice system and act out a violent behavior, you have to look at the factors, all the factors that are involved in that happening. And even with a major Health Canada study, some years ago, talked about the multiple factors that are involved in a person engaging in violence, who has psychosis or schizophrenia. And those factors are the following: they're not receiving effective treatment, they have a previous history of violence or a volatile behavior, they're engaging in misuse of alcohol or other street drugs, they are experiencing paranoid hallucinations and delusions, which triggers fear in the individual. It's not a simple answer, it's a complex answer, and we need to understand those multiple factors, that it's just not just the illness that's involved, when people act out and violence. JO  56:43 Myth, people with schizophrenia require long-term hospitalization, Phil. PHIL  56:49 That definitely is a myth. And I think one thing, though, we need to state out right, though, is that sometimes hospitalization is needed for various reasons. But again, it's a very individual thing. And I have people with lived experience in my practice, who have never been hospitalized, but they do have a diagnosis of schizophrenia. And I have other people that I see who, unfortunately, have had multiple admissions for various reasons. It's not an absolute, you don't require long-term hospitalization with schizophrenia. JO  57:18 People with schizophrenia can't or won't work. Kat, you're living proof that this isn't true. KATRINA  57:25 Yes, I love my job. And I love being the proof of that not being true. PHIL  57:29 Yeah, that's great said Katrina. And from an outcomes perspective, and we're focused on getting people back to school, back to work, and people do want to get back to school and back to work. That really is the goal. JO  57:42 People with schizophrenia are more likely to end up in jail, Chris. CHRIS  57:47 Well, unfortunately, 3% of inmates in prisons are estimated to have schizophrenia or other psychotic disorders, like bipolar disorder. Approximately 16% of prison inmates have major depression. But really much of this is a result of failed mental health policy. And what I mean by that is the institutionalization that occurred in the 60s and 70s, the outdated treatment laws, demanding a person become violent before the intervention. All of that has driven those who are in need of care into to the criminal justice and corrections system. So, we call that the criminalization of the mentally ill. And what they really need is to be in the public health care system where they can get help as opposed to being in a prison. That is certainly a social justice issue, for those of us who advocate for those who are living with schizophrenia and their family members. JO  58:42 Another myth, schizophrenia is caused by bad parenting. Who wants to tackle that one? KATRINA  58:49 I'll stand up for my mom. She was a good mom. My parents were excellent parents. It was other environmental triggers later in life of the traumas. And my mother had schizophrenia and schizoaffective by her final diagnosis point. PHIL  59:07 Some of it comes back from some terminology, I think, which unfortunately, in this early early 20th century. I mean a term sometimes you hear more in history than anything else is a schizophrenogenic mother. But definitely we know that it's nothing to do with bad parenting. JO  59:24 Chris, do you have a comment there, given that your mother suffered with mental health challenges, and many of your family members did as well? So, do you think that's genetics talking or the nature of your environment? CHRIS  59:38 Well certainly mothers, I think especially feel a huge amount of guilt and shame. What is it that I did that caused my child to be born with schizophrenia? But no one is born with schizophrenia. It's something that you develop later on in life. And we know that it's not completely genetic, and that's been a great revolution of understanding since the time my brother was diagnosed with psychosis in the 60s. Today, our understanding is that gene expression, how genes express themselves, it's very much influenced by environmental factors such as trauma. That can be in utero as well as a young child or in adolescence in terms of bullying. But even to this day, I think it's just one of those things, I don't want to call it natural, maybe that's the word natural, but mothers will especially feel guilt ridden. What did I do during the pregnancy? Or what did our home life have to do with it? Let me say that, if you're in an unhealthy family dynamic, that's not going to be good for anything you experience in life in terms of your health care, whether it's physical or mental. So, addressing the family environment and the home is important in terms of its own mental health and resiliency, and wellness. But to say that a parent caused the schizophrenia is not based on any kind of fact, or scientific fact. JO  1:01:11 Another common myth that people with schizophrenia will never recover, provides a perfect segueway into my next few questions, about the much-needed growing focus on recovery. In this case recovery, meaning people receive timely diagnoses, early intervention, and bio-psycho-social-vocational treatment strategies. A mouthful, I know, but we'll break it down for you after we first talk about recovery philosophy. Phil, how would you describe recovery philosophy from a psychiatric perspective? And how will that philosophy change to reflect emerging research? PHIL  1:01:54 Recovery philosophy has been evolving over time. And as much as we understand and appreciate the illness of the individual, we evolve within the recovery philosophy. I've been working in early intervention services for quite a few years, and most of the services, our clinic here has been around for 25 years. And that is definitely part of the philosophy. So not necessarily new, but at the same time it's new enough, where we still need to be able to talk about it. And really, the recovery philosophy is that appreciation that people with lived experience with psychosis, schizophrenia, can recover. And that's where we can look at then the definition of what, really what recovery is being a symptomatic recovery as well as functional recovery. And that sense of psychological well being, of course, as well. But a recovery philosophy is just more a construct in which we work within the medical system, that everybody has the potential to recover, how ever you define that. JO  1:02:58 Chris, what does recovery philosophy mean to you as an advocate and recovery practitioner? CHRIS  1:03:05 Well, we need to understand that recovery is not about a cure. And another thing is that illnesses don't recover, people do. And recovery as a concept, as a philosophy, and as a movement as it is today, has strong roots in the advocacy efforts of people with lived experience. So, we learn about the experience of recovery from the people themselves, who see it as a journey. They see it as a process, and indeed it is that. And even the Mental Health Commission of Canada, in 2006, in their landmark report and later other documents, said that recovery should be placed at the center of mental health reform. Historically, the mental health system has been about symptom reduction. And that's fair, and that's understandable. But really, the goal of our mental health system should be that of quality of life, or life satisfaction. So, recovery is made possible by our providing safe places for people to be themselves. It's built on hope. It comes from a strength perspective as opposed to a deficit perspective. It's about shared decision making. That should be our goal. The goal of mental health services should be that of promoting quality of life and promoting recovery oriented mental health services. And we still have a long ways to go in that. Recovery as a term is probably in all mental health documents and policies today. But it really hasn't filtered down into actual practice like it ought to

SUMMARY The over-65 age group is the fastest-growing demographic in Canada, with rates of mental illness for seniors over 70 projected to be the highest of any age group by 2041. Add to that the impacts of COVID-19, and you have a complex and costly national challenge that requires urgent attention from all sectors, in the move toward upstream seniors' mental health care. Join Marjorie Horne (seniors' advocate and founder of CareSmart Seniors Consulting), Naomi Mison (caregiver and founder of Discuss Dementia), and Dr. Anna Wisniewska (geriatric psychiatrist) in Part 1, as they share their personal stories and professional insights about the mental health challenges seniors face, and the opportunities that abound for improved care and enhanced quality of life. TAKEAWAYS This Part 1 podcast will help you understand: Current and projected statistics related to seniors' mental health and care Personal stories of caring for family members Reflections on COVID from caregivers and a geriatric psychiatrist Lessons learned from COVID to improve the mental healthcare system Common myths associated with seniors' mental health Common mental health challenges (e.g., depression/anxiety) and opportunities for care available to seniors and their families Risks of marginalized groups, experiences of men vs. women, and roles of ethnicity, genetics, ACEs (Adverse Childhood Experiences), epigenetics Common mental health challenges for seniors in residential care and their families Challenges and opportunities associated with caregiving and advocacy Transitional challenges experienced by seniors of all ages Need for intergenerational knowledge and connection Terms such as “eldering well”, “eldercare”, “death cafes”, “end-of-life doulas” SPONSOR The Social Planning & Research Council of British Columbia (SPARC BC) is a leader in applied social research, social policy analysis, and community development approaches to social justice. The SPARC team supports the council's 16,000 members, and works with communities to build a just and healthy society for all. THANK YOU for supporting the HEADS UP! Community Mental Health Summit and the HEADS UP! Community Mental Health Podcast.   RESOURCES World Health Organization Canadian Coalition for Seniors' Mental Health Mental Health Commission of Canada Active Aging Canada Alzheimer Society CanAge Canadian Association for Retired Persons (CARP) Canadian Centre on Substance Use and Addiction Canadian Frailty Network Canadian Mental Health Association Canadian Suicide Prevention Network Deprescribing Network Elder Abuse Prevention Ontario National Institute for Care of the Elderly (NICE) Seniors First British Columbia The Centre for Addiction and Mental Health Caregivers Alberta Carers Canada Caregivers Nova Scotia Canadian Hospice Palliative Care Association Families for Addiction Recovery: FAR Canada Family Caregivers of British Columbia Canadian Research Centres on Aging   GUESTS  Marjorie Horne, Dipl. T. Nursing Marjorie Horne was 16 when she knew that the way we see and treat elders had to change. Her journey involved training as a registered nurse, becoming the Executive Director of the Central Okanagan Hospice Society, working in management in seniors housing and, finally, starting her own business, CareSmart Seniors Consulting Inc. She is also a Conscious Aging Facilitator and a Certified Professional Consultant on Aging. As an entrepreneur, Marjorie's goal was to bring a holistic, ‘Circle of Care' approach to supporting seniors and their families through the many transitions encountered in the third chapter of life. Her community endeavors of creating and hosting her own radio show, Engaging in Aging, every Sunday morning on AM1150, writing a bi-weekly column, facilitating workshops on Conscious Aging, and speaking at local events, are all driven by the desire to be part of a new paradigm where we reimagine later life with courage, resilience, passion, and purpose. Phone: 250-863-9577 Email: resources@caresmart.ca Website: www.caresmart.ca Facebook: https://www.facebook.com/caresmartseniorsconsulting Twitter: https://twitter.com/caresmartsenior Linkedin: https://www.linkedin.com/in/marjorie-horne-46bb8937/ Naomi Mison, BA Naomi Mison is a public speaker, vocal advocate, and a champion of change. She has spent the last four years bravely sharing her journey as she cares for her mother who was diagnosed with frontotemporal dementia, when Naomi was just 22 years old. She has spoken publicly through the Alzheimer Society of Canada National Anti-Stigma Campaign, CBC's Out in the Open podcast, Globe and Mail, Embrace Aging Okanagan, Pecha Kucha, and many more. Naomi volunteers with the Alzheimer Society of BC's Leadership Group of Caregivers, is on the planning committee for IG Wealth Management Walk for Alzheimer's, and for the Seniors Outreach and Resource Centre. Naomi holds a Bachelor of Arts in Political Science and English, and a Diploma in Public Relations.  Phone: 780-885-3956 Email: mailto:naomi@discussdementia.com Facebook: https://www.facebook.com/nam956 Twitter: https://twitter.com/NaomiMison Linkedin: https://www.linkedin.com/in/naomimison/ Dr. Anna Wisniewska, MD, FRCPC Anna Wisniewska completed her undergraduate medical training at the University of British Columbia and her postgraduate training in psychiatry at the University of Calgary. Her clinical career has always focused on the care of the elderly and their families. Dr. Wisniewska is currently a consulting geriatric psychiatrist at the Kelowna General Hospital and the Kelowna Mental Health Centre. She also works in her private practice in Kelowna and is a sub-investigator with Medical Arts Research.  Her passion for her work and compassion for her patients were inspired early on by her very close relationship with her grandparents, and maintained by the many wonderful patients, families, and colleagues met along the professional path. Email: DrAWisniewska@gmail.com HOST Jo de Vries is a community education and engagement specialist with 30 years of experience helping local governments in British Columbia connect with their citizens about important sustainability issues. In 2006, she established the Fresh Outlook Foundation (FOF) to “inspire community conversations for sustainable change.” FOF's highly acclaimed events include Building SustainABLE Communities conferences, Reel Change SustainAbility Film Fest, Eco-Blast Kids' Camps, CommUnity Innovation Lab, Breakfast of Champions, and Women 4 SustainAbility. FOF's newest ventures are the HEADS UP! Community Mental Health Summit and HEADS UP! Community Mental Health Podcast. Website: Fresh Outlook Foundation Phone: 250-300-8797   PLAY IT FORWARD The move toward optimal mental health becomes possible as more people learn about the challenges, successes, and opportunities. To that end, please share this podcast with anyone who has an interest or stake in the future of mental health and wellness. FOLLOW US For more information about the Fresh Outlook Foundation (FOF) and our programs and events, visit our website, sign up for our newsletter, and like us on Facebook and Twitter.   HELP US As a charity, FOF relies on support from grants, sponsors, and donors to continue its valuable work. If you benefited from the podcast, please help fund future episodes by making a one-time or monthly donation. Marjorie Horne, Naomi Mison, Anna Wisniewska Interview Transcript You can download a pdf of the transcript here. The entire transcript is also found below: RICK  0:00 Welcome to the HEADS UP Community Mental Health Podcast. Join our host Jo de Vries with the Fresh Outlook Foundation, as she combines science with storytelling to explore a variety of mental health issues with people from all walks of life. Stay tuned! JO  0:05 Hey, Jo here. Thanks for joining me as we explore the complex world of seniors' mental health. In this two-part podcast, brought to you by the Social Planning and Research Council of BC, we'll study the challenges, gaps, successes, and opportunities for seniors through the eyes of a geriatric psychiatrist, a young caregiver, and a seniors' advocate and entrepreneur. But before I jump into our discussion with these amazing women, I'd like to set the stage for you. Given that the over-65 age group is the fastest-growing demographic in Canada, seniors' mental health will be an increasingly critical issue for healthcare systems, all levels of government, academic institutions, healthcare-related businesses, and nonprofits that focus on either seniors' mental health or specific mental health conditions such as mood or cognitive disorders. Taking a closer look, we see that almost seven million Canadians, or about 18% of Canada's 38 million residents, are 65 or older. The rates of mental illness for seniors over 70 are projected to be higher than for any other age group by 2041. This scenario presents serious social, cultural, and economic challenges for individuals, families, and communities in Canada and beyond. On the bright side, a Statistics Canada study showed that almost 70% of seniors consistently report having good or excellent mental health, and that they are more satisfied with their lives than those in younger age groups. More than eight in ten seniors reported they always or often have someone they can depend on to help when they really need it. On the other hand, about 20%, or almost 1.5 million Canadian seniors, experience mental health challenges caused by a range of medical conditions, social situations, lifestyle choices, cultural influences, and economic circumstances. To help us dig deeper into this vitally important topic, Rick joins me to share what he learned from a variety of research and advocacy organizations in Canada. RICK  0:30 Up to 20% of older adults, or as many as 1.4 million people, report being depressed. And 40% of seniors in long-term care homes are depressed. More than 10% of seniors, and up to 30% of those with major late-life depression, misuse alcohol. JO  0:30 What about anxiety? RICK  0:30 About 10% of seniors, or about 700,000 people, have diagnosed anxiety disorders, and seniors have the highest rate of hospitalization for those disorders. JO  3:37 What about other kinds of mental health challenges? NAOMI  3:41 More than 500,000 seniors in Canada have dementia, of which there are more than 130 types. And more than 90,000 seniors have schizophrenia or other delusional disorders. JO  3:55 What about seniors and suicide? NAOMI  4:00 More than 10% of seniors seriously thought about suicide in the last year that was studied. That's probably higher now due to COVID. The overall rate for death by suicide is about 11 per 100,000. And the rate for men 85 and older is 29 per 100,000. JO  4:20 Great info, I just hit the big 66 so your stats hit a little close to home for me. Did you find evidence of personal traits that predispose seniors to mental health challenges? NAOMI  4:35 I did. mental health conditions are often affected by innate characteristics such as gender, ethnicity, and genetics. Developmental factors such as childhood experiences and educational status also play a role. JO  4:45 How does a senior's circumstances affect his or her mental health outcomes? Mental health challenges are often intensified by factors such as poverty, poor health, loneliness, inadequate nutrition and or housing, lack of independence, and loss of loved ones. NAOMI  4:59 We'll talk about those more later on in the podcast. But for now, what about more broad-based social risk factors? JO  5:06 Society-wide, or what are sometimes called macro-social risk factors, include lack of available health resources and the impacts of negative social influences such as stigma, ageism, inequality, systemic racism, and gender bias. NAOMI  5:21 Thanks, Rick. We're going to talk about those a little later as well. When you take all of that into account, seniors' mental health is staggeringly important, and needs to be addressed at all scales. JO  5:31 To help with that I welcome our first guest, Marjorie Horne, a community seniors' advocate and entrepreneur. She has diverse experience as a registered nurse, hospice volunteer and executive, residential care services manager, columnist, broadcaster, and founder of CareSmart Seniors Consulting. As a Certified Professional consultant on aging, she uses her education and work experience to meet the transitioning needs of seniors and their families. She was also a caregiver for her elderly mother, caring for her in her own home for the last year of her mother's life. Welcome, Marjorie, and thanks so much for joining us. Oh, thanks for having me, Jo. JO 6:25 Marjorie, first, can you share the parts of your personal story that pertain to seniors' mental health. MARJORIE  6:27 My journey in seniors' care began really when I was 15 years old here in Kelowna, and I decided to go and work in what we used to call residential care, then in care homes. And that was an experience that really affected me very deeply. And it was where I really felt and was part of this sense of isolation that so many of the residents felt, and they would talk to me about their families not coming to visit. That they didn't feel that anybody really heard them. And I just, for some reason, found this just so touching, and I wanted to be there for them individually. So, when I began listening to their stories and just being really present for them... this was even in my teenage years... I began to see a light come back in their eyes that was sort of deadened when I started working there. And it really had a profound impact on me. And it led me into nursing when I graduated from high school. And I think it's what still really drives me to this day, in wanting to make things better for our older population. When I was caring for my own mom in my home, the last year of her life, it gave me a really close and real personal experience. Even though I do this professionally, it's different with your parent, and I was there for her for a good part of the day, hearing her go through her life review and reflection of her life experiences. And my mom had been diagnosed as being bipolar in her late 30s, and she had been put on a combination of quite a number of psychotropic drugs at that time, which she has stayed on for over 35 years. And of course, this really impacted me and my three sisters and our family life. And when she was 75, we actually took her off everything to have some major surgery done. And all of a sudden, I had gone to stay with her, and I saw this light come back in her eyes that had been really missing for about 35 years. So, this has had a dramatic influence on my life, around my thoughts around mental health, by living that experience for so many years. And she began to tell me once we had her off these drugs about sexual abuse that happened her life that she had never told anyone. She talked to me about some very traumatic experiences she'd gone through, that again she just hadn't shared with anyone. And it was quite heartbreaking to hear her in her early 80s tell me about a roommate that had hung herself, and my mom came home and found her. And that all of the emotion and everything around this had really been locked inside of her. As she began to verbalize this to me over sort of a ten-year period, and especially when she was coming to the end of her life, I think it affected me in a way where I really feel that just listening sometimes to our older seniors, as they're going through their aging journey is such a very important relevant thing. And the grief that my mom had held inside of her for so long, I really feel that it influences how our older adults are doing as they're getting older. JO  10:20 Thanks for sharing, Marjorie, I know that each person is unique. But given that you've worked with hundreds of seniors in transition, can you paint us a picture that reflects your observation about what that looks like? MARJORIE  10:35 I do think everybody's unique. And that's a very important thing to remember... that we don't lump people together and try to label them. I so often hear from seniors, as they're growing older, that they tell me they begin to feel invisible. They don't feel seen anymore, and they don't feel valued. Even my older sister who's had a remarkable career, earned every type of award that you can imagine and has had such a successful life. But five years after she retired, she said to me that she was beginning to feel invisible. And it shocked me, but it's an expression that people start to look at you differently as you're growing older, as the wrinkles are starting to come and maybe you're walking a little bit slower. And she was verbalizing to me how she just isn't asked for her input on things. And she was quite shocked within herself that she's beginning to feel depressed at this realization. That after everything she's been through, society really doesn't honor us as we're aging. I think you know, when you have that personal experience for somebody, you're looking at admire, and they're telling you that, you can see how across the board that I think, no matter what you've done over your life, we start to feel this way. And we find it hard, I think to reach out for support. So many people just start to turn in, I even saw this with her, separating herself more being quieter or for somebody who had been so outgoing. And so, I think this, of course, affects our physical health and our sense of joy in life tremendously. And I think I see in many, many seniors that I am involved with, it can begin sort of a downward physical cycle as well. And that becomes sort of the centre of their life talking about that. There's a lot of different things around how society views, people as they're aging that I think we need to have a shift in. JO  12:40 Marjorie, is there a flip side to the heartbreak you see? What do you see, that's heartwarming in your work? MARJORIE  12:48 I have many, many heartwarming things. I'm working with somebody who's 93 right now, and I go over and play crib with her, and I thank God she says sharp is a tack. I really have to work hard at beating her at the crib. And I see a lot of people in their late 80s and 90s that really still have a sparkle in their eye. Even people with quite severe physical handicaps. They have a mindset that they have chosen. They want to stay optimistic, they want to stay involved, they want to be sharing their wisdom. And I have many, many experiences of that. And it inspires me on my own aging journey, to remain openminded and optimistic about my future. They inspire me to keep becoming better, because there are many people out there aging that have that mindset. And I think we need to help it flourish. JO  13:49 Thanks, Marjorie, great insights. Next, I'd like to introduce our second guest, Naomi Mison, founder and CEO of Discuss Dimentia and an advocate for the Alzheimer's Society of BC, Cycling Without Age, and BrainTrust. For 13 years, since she was 22, Naomi has been caring for her mother, who was diagnosed with early onset dementia when she was only 53. Naomi, thanks for joining us and agreeing to tell your story and how it brought you to where you're at now. NAOMI  14:26 Thanks, Jo, for allowing me to share my story with you and with your listeners today. So, from a young age, my mother had lived with mental illness. But in 2006, when she was found wandering outside of a train station in her nightgown, it had surpassed a regular dealing with mental illness and moved into a different area. I got a call that she was being placed in an institution. So, I flew to the UK where she was living to bring her back to Canada. When we arrived, she was quite delusional and at risk for wandering. While her GP recognized that there was an issue, she did make a referral to her neurologist,  but the symptoms continued to progress and worsen. And my brother and I grew more desperate for answers. We took her to an emergency room, and unfortunately were chastised for bringing her there under perceived false pretenses as I mean, I don't know how much and direction you have in this regard. But I find sometimes when you're caring for somebody with mental illness, they know when to really show that they are thinking clearly and making the right decisions, when you actually need them to show the struggle that they're facing. So, after some more incidences of trying to find support, we were finally able to locate a crisis team who came and conducted an assessment on my mother's mental health. And at that time, they recognized that she was really struggling and recommended that she be hospitalized and was admitted into Alberta Hospital. So, at the time, she was initially treated for bipolar disorder, and that was about six months when they were trying different methodologies to see if they could stabilize her symptoms. But after a PET scan showed atrophy of the brain, we were given a diagnosis of Pick's Disease, what is now commonly referred to as frontotemporal dementia. And then instance, we were asked to make a life-altering decision on her behalf. And unfortunately, there was no time to really accept, grieve, or even wrap my head around her diagnosis. In that moment, my life was never the same again. Eventually, my mother's condition stabilized, but we could not provide her the level of care she needed. So, when a bed became available, we moved her into long-term care and into the home that she presently lives at today. So, after 10 years of caregiving, I decided I wanted to become a public speaker and advocate for people living with dementia and their caregivers. I want to share my story in hopes of meaning other people like me, and I want to fight on behalf of people and for people that don't have this strength, energy, or capacity. And that's what brought me here to where I am today. JO  17:29 Thank you for your candor. Naomi, it takes courage to be so vulnerable. Can you share with us the toll this multi-year commitment has taken on you personally? NAOMI  17:41 Having this level of responsibility thrust on me at such a young age was life altering, to say the least, I really lost out on the majority of my 20s and the dreams I held. For myself, I always wanted to be a world traveler. I had big grandiose dreams of going to a different country every year and working on a holiday visa. I even had an idea of possibly having a family one day, but that for me is no longer a consideration. When I received the diagnosis, I essentially became the mother to my mother. I've lost out on a chance to have those Mother's Days that you share celebrating your mother's life and contribution, brunch at my house on a Sunday, maybe sharing some bubbles together. Or even the comfort of calling her when I've had a hard day and you just need your mom. The consequences of this disease are a measurable and suffice to say, my life has never been the same. JO  18:47 Are there any silver linings to this experience? Maybe what you've learned about yourself that you can put to good use. NAOMI  18:55 I've really learned that the caregiving journey is not linear. A lot of things are learned through trials and tribulations. And this can cause a lot of stress, especially coupled with your loved one's behavioral changes... it can be trying. From that extreme difficulty, I should say, this experience has taught me how determined and resilient I truly am. From these experiences I have found my passion, even my calling. I am determined to make systemic change to honor my mom. I believe that by sharing my story, it shows vulnerability. And I hope that it will build awareness, understanding, and bridges. Most people have a connection to dementia in one way or another, and I can empathize with that struggle. But if we don't stand up and share our story, then we won't build the awareness needed to make the changes. JO  19:52 Thanks Naomi. We'll bring both you and Marjorie back in after we hear from our third guest, Dr. Anna Wizniewska, a geriatric psychiatrist with Interior Health in British Columbia, Canada. Great to have you aboard, Ania. ANIA  20:09 Thank you, Jo. It's lovely to be here with you, and Marjorie and Naomi. JO  20:14 So, given all of your medical training and all the opportunities available in medicine, what drew you to geriatric psychiatry? ANIA  20:23 Thank you for asking, Jo. It's interesting that the three of us probably reflect on our experience and where we are right now in our lives, going back to our family, and our sometimes formative years. And I think when I look back on my own decision to pursue this career, I really think started in my childhood. I was especially close to by grandparents, and especially my grandfather. And it's sort of, I think, developed a sense of affinity and closeness with seniors in general. It also offered me an opportunity because I grew up with my grandparents living next door to listen to their life stories and to be very interested in their experience. They both survived the war, my grandfather was a POW for six years... there was a lot to learn from them, and a lot to really come to understand through their experience of their lives. And then later on, once I became a teenager, my grandmother, unfortunately, developed dementia. And her dementia was particularly challenging because she had a lot of psychosis. She was quite delusional, particularly around my grandfather. And that led to a lot of distress for our whole family, understandably, but most of all, for my grandfather. And what I always found so fascinating about that relationship was, even though my grandmother would do things that are really quite awful when she was ill, my grandfather never complained. And I always felt that it was so fascinating that, in spite of the things that were happening to him, he never had a word of complaint. And as a teenager, I found it difficult to understand. Why would he be so understanding so forgiving, and seemingly so uninfected? And of course, as I got older, I think I came to understand it a lot more, I hope. And I came to understand it as basically a sense of love and a sense of devotion. And I think that's, in the end, what actually led me to this field. I always wanted to be a doctor, that wasn't something that came later in life. And I think I was always drawn to the idea of helping others and caring for other people. And when my long journey into medicine kind of came to fruition, I actually had an interest more in the opposite-end age spectrum... and that is a care of children. I was quite interested in pediatrics. And I was also very interested in psychiatry, and specifically child and adolescent psychiatry. So, when I actually got into training in psychiatry, it was with the idea of becoming a child adolescent psychiatrist... but I kind of ended up at the other end of the spectrum. That occurred primarily, I think, through the fact that I realized that child and adolescent psychiatry was not really for me for various reasons. And then being influenced by preceptors, who were really quite outstanding, and really showed me how enriching the work can be and how wonderful that work can be. And I think for me, the reason for choosing geriatric psychiatry, and staying in it for almost 20 years, and looking forward to every day that I got to work, is I really like my patients. And that includes patients who, by some standards, may be perceived as quite difficult and unreasonable because of their illness. Because I still see that humanity and the stories that they have in their lives, with our children and grandchildren. As I said, it's that sense of affinity for them, and the appreciation of the stories of their lives and the desire to understand them as people not just in the moment that they are ill or unwell, but to understand them through their whole life experience. The other part of what I love about my job, of course, is our job is challenging and it's stimulating. In geriatric psychiatry, we have to pay a lot of attention to general medical conditions, medications that our patients take. There's not a boring day when I go to work, which again, I appreciate. I know it sounds a bit selfish, but it's also wonderful to have that stimulation. And in the end, it's just extremely rewarding. Many of my patients I have known for more than ten years, and their families have known for more than ten years. I have multi-generational patients, so patients who are from the same family but from different generations, because I have been in this community for so long to see improvement in symptoms or sometimes maybe symptoms can be improved by the quality of life can. It's extremely rewarding to see my patients improved to see their families maybe feel a bit less distressed or feel a little bit more at ease. really wonderful to see. JO  25:02 Another wonderful story... thank you. We know that each senior's mental health journey is unique, but do you see patterns, say of symptoms, of experiences, of behaviors that you can weave into a composite story for us. ANIA  25:20 The one thing that I mentioned is, I sort of see myself as someone who's sort of in the trenches. And so, I typically really look at people as kind of an individual story or individual family. And yes, there can be some patterns. But I think it's important also appreciate that every experience is very, very unique. And even certain elements of the story that may be similar for one family or one patient can lead to sort of different outcomes because of the age group of my patients. My practice is sort of from late 40s to over 100, but I would say the average age my patients is into their 80s. Many of my patients have experienced or were affected by the depression in the 1930s, quite a few of them by war, during World War II, mental displacement and the trauma that came with it. So those are some of the fairly common themes that I hear from my patients and their families. Other things that tend to sort of be maybe a bit of a pattern is, of course, adjusting to the process of aging. Some patients may be a bit more concerned about some of the more superficial changes that come with aging. But for many of my patients, the adjustment to the loss of physical stamina, or occurrence of physical disability, and of course, quite often concerns about cognitive decline as well. So, I think those would be some of the parents that I see. But again, I do need to emphasize that every experience is very individual. JO  26:49 What are the most common myths about seniors' mental health? ANIA  26:53 Things that typically I hear about from either families or patients is that having some forgetfulness as we age is a definite confirmation of a diagnosis of dementia. That is, quite often what I hear from patients when I see them about cognitive decline. So, it's the sort of worry that as we age, if we started becoming a bit forgetful, that necessarily means that we have dementia, which is usually not the case. Another one is, I guess, more so perceptions from the society that as we age, we become somewhat less useful. And I think that was reflected in some of Marjorie's comments, that sense of being invisible. So that's one of the worries that my patients will describe as their concern that they may be sort of perceived as less useful or a burden on their families or societies. JO  27:41 Rick noted earlier that depression and anxiety are the most common mental health challenges experienced by seniors. Why are they so prevalent? ANIA  27:51 I think part of it comes from the fact that we're much better at recognizing their existence. I'm not sure that they were necessarily less noted before or experienced before, I think it's more that we are better, at least I'm hoping we're better, at recognizing the presence of depression or anxiety. And I think seniors are becoming a little bit more open about actually reaching out for help sometimes. And we have to keep in mind that there are very generational differences in approach to how we deal with mental illness or mental health in general. So, I think part of it is that seniors are becoming, some of them anyway, becoming a little bit more open or the idea of reaching out for help when they are unwell. There are other reasons for it, however. Patients that I look after, because of their age, are more likely to experience loss. So that could be a loss of a spouse or a partner. Unfortunately, even loss of other family members, including children, who, depending on what's going on, may have their own health concerns. So, there are a lot of losses of course, loss of friendships, those who have friends in the similar age group will unfortunately lose their friends because of the age and the risk that comes with that. There are also changes that happened physically... certain medical conditions will increase the risk of depression or anxiety. Certain medications can also cause increased depression and anxiety, and, of course, seniors are more likely to take multiple medications. But unfortunately, depression and anxiety are fairly common amongst all age groups. But as I said, I think we're just a little bit better at recognizing it in seniors and looking for it when we see patients, especially in primary care. JO  29:27 So, in that seniors age group, are the treatments for anxiety and depression different than for other age groups? ANIA  29:37 The treatments in general are essentially identical. What makes the seniors more unique, compared to say a younger adult patient, is that the treatment becomes a bit more complicated because of the fact that older patients are more likely to have other medical conditions... so some medications may be contraindicated with some medical conditions. They are also more likely to be taking more medications, and again, you have to consider interactions with other medications that you're thinking of prescribing. So, there are some differences in terms of your approach. But in terms of the actual treatments that we would prescribe, be it medications or electroconvulsive therapy, commonly known as shock treatments, or psychotherapy... the approaches can be more or less identical, except for consideration of medications, medical conditions, and things like that. JO  30:28 What's the link between seniors' mental health and healthy lifestyle choices? ANIA  30:34 Well, I'm glad you bring that up, Jo. I think we need to get a little bit better at having those discussions around lifestyle factors and choices. There is no doubt that certain lifestyle choices are detrimental to not just physical well being, but also mental well being. For example, let's say increased BMI or obesity is associated with decreased well-being. And that can lead you to say, pain, because if you are overweight, you're more likely to have joint issues, particularly in your lower extremities. Issues that relate to poor mobility, for example, that can come from it. And that could lead to isolation. And pain, of course, can also increase the risk of depression, especially. So, certainly the lifestyle choices we make a great difference, say alcohol or smoking, be another lifestyle factor that would be important to consider. So, I do think we need to get a little bit better or a lot better at promoting healthy lifestyle choices. And helping people understand that the decisions we make now will have some consequences even later on in our lives. JO  31:42 So, Marjorie, you've been watching seniors in a variety of settings for decades. What are the most common transitional challenges you've seen? And why are they so difficult? MARJORIE  31:55 Well, the third chapter of life brings around many, many changes. And when I was doing work within residential care settings and seniors living sites, I saw just such an angst developed within a family when an older adult was becoming frailer. And there was just so much stress involved. Everybody was in more reaction around whatever change was happening. And so, when I decided to start sort of a holistic model of elder care and move into running my own business, it was because all of these transitions, and there's so many aren't there... when I started, it was the older, frailer senior. And often they were having to look at making a move out of perhaps the family home or a home that they had been in for a long time. And there'd be so much disagreement that would come up within the family and different ideas about what should be done. I think we all like to hang on to our independence, and so that was one of the major transitions that I was dealing with a lot was trying to support the family, looking at the physical change or transition that might need to happen as far as their living environment. But then try to help the family to understand all the emotional aspects that were going on, from the different perspectives of the older senior. And then often the adult children, and everybody was viewing things differently. So that's one of the major things that I have been supporting people with initially, to try to help the family as a whole move through this and stay supportive of each other, and also compassionate and understanding of the loss that is occurring, because any transition we make in life, whether is moving from a position that we're in, thinking about retirement, letting go of that part of our identity, if it's a loss of a family member, spouse or child... this deep loss in a lot of ways we don't understand that any transition brings forward losses that perhaps we haven't felt or dealt with that have occurred over our lifetime. Especially the silent generation, often, they weren't given permission to feel the emotions of loss when there was something that really was needing that. And so that grief comes forward. And I think people don't understand that. And so there becomes a lot of reactionary difficulty that comes up with families. So that's one of the big transitions is actually, even though 90% of seniors when studied want to age in place in their home, that's just not always practical. And so, it kind of evolved as I was supporting families as a whole and going through that type of transition. I then began to hear more from the adult children. And this just happened organically that were beginning to consider retirement. And they seem to need a lot of support. mostly as boomers, wondering how they were going to cope with this. Who were they going to be? How are they going to see themselves? How were other people going to see them? And so that is a lot of transition I deal with now, of the sort of the journey of moving into the eldering years, and how we need to change our way of thinking about ourselves... often let go of the past, of things that we're regretting or holding on to that will continue to cause us stress if we can embrace kind of... well, I call it conscious eldering, but it's really looking at all the different aspects of aging. So, of course loss for me, as I've been working with this so intimately for 10 years in this way, is the loss that comes forward over and over and over again, and how people are afraid to be vulnerable within perhaps a grieving that hasn't been resolved. But also thinking and knowing that as we go through all these transitions in the third chapter, whether it's physically, emotionally, cognitively, or perhaps we are developing a different spiritual attitude towards life, as our death is coming closer, and I know we're going to talk about this more, but that just seems to be the majority of my work now is trying to help people to talk about that, as they're going through transition. JO  36:45 Given that we all face transitional challenges in the third chapter of our lives... and at 66 I'm already starting to feel some of those... what is 'eldering well'? I know you talk about that as a concept. And also 'elder care', can you tell us more about those. MARJORIE  37:04 I've just turned 70 myself, so I am definitely well into this whole process myself. And it's kind of an interesting journey to the aging at this point, and still involved in working. So, the things that I am trying to talk to other people about, obviously, I'm having to look at within myself, as I'm now really moving through my own eldering journey. There are so many people as they're going through these transitions in this chapter that they fight against getting older. I do a lot of teaching and workshops, and I just hear it so much. And I watched my own mom, too, because she was living with me as she was going through her last year of her life, fighting it the whole way. And I came to realize that this is really such a key aspect of how we go through this stage of our life. Do we fight it? Do we fight that even having to become a little more interdependent, that is part of this stage of life? And if we fight it, wanting to use this word, "I want my independence, I want my independence," we're actually shutting ourselves off from what I think are some of the gifts of this circle of life that we are all in. And so, I talk to people a lot about that. This stage of life is, I realize every year that passes now, you know, even between 65 and 70, is very different, the changes we're going through than in our middle years. Being present with where you're at whether you're in your 60s or 70s, your 80s, or for more and more people who are living into their 90s now, I think elder care is, to me, it's really understanding that growing older does take resilience. We have to cultivate a resilience because there's a great sense of impermanence as you're getting older. And as you see friends die suddenly, or your spouse die much sooner than what's expected, it takes resilience. And I think the more we can improve how well we elder is taking and looking at each other from a more holistic viewpoint of all the emotional changes, the physical changes, the cognitive changes, and also how do we move towards accepting that death? We are all going to go through that. JO  39:36 Well, and that's a perfect segue into my next question. When you and I were preparing for this episode, we talked about dying well, and how death cafes and end of life. doulas can help. Tell us more about that. MARJORIE  39:52 I've done a lot of palliative care and I was intimately involved with both of my parents' final year of life. My dad, when he was dying with cancer, and I left my job to take care of him. And with my mom as well, from really not dying from cancer, but dying, really from old age. I really had to look at this and explore my own fears of death, even though I thought I was more comfortable with it than some people, having gone through that with my parents so closely. I think this is another big part of, I guess, us opening more to the vulnerability that we're all going to die. And we're all going to experience more death, particularly at this stage of life. And so, understanding that it's closer as we crossover into our 60s... I think right then you start to feel... wow, gee, this came awful fast. And we know that the completion of our life comes at the end of this chapter. But can we really talk about that? Can we really face what our fears might be about that? I think it's a very important part of shifting this paradigm to embracing this stage of life, both the challenges of it... and also, as we embrace the challenges, I think we can open more to the joys that there are at this stage of life. There are many... even sitting with your parents as they're coming to their death. There are so many gifts in that, I think as we can talk about this more and be more willing to embrace the aspect of our parents coming to their death, and being with them, I just can't tell you the gifts I received from that. And then it has helped me from how I watched my parents come to their deaths, one fighting at completely and the other just surrendering to it. It showed me that I wanted to just start surrendering and letting go more at this stage of my life. JO  42:02 My mom and I were very close. She died when she was 88 and she had two requests. One was that she die at home, and that she die in my arms. And that actually unfolded that way. And I have to say that it was one of the most, if not the most meaningful, experience of my whole life. It was transformative. MARJORIE  42:26 It was for me, too. It absolutely transformed me going through at the age of 40 my dad's death and that time I spent with him. I think there's a real trend moving to end of life doulas... I have two on staff myself because I feel it's an important part. People need support with it. It is not easy to sit with somebody you love who is dying. It's hard. It's hard. It's rewarding. But I think that we are seeing more and more end-of-life doulas being educated. I talk a lot to families of how much value I got from this, and encourage and support them, and that's what end-of- life doulas do. That's important part of us moving forward to embracing death in a much healthier way. I think society is still in the dark ages around it, to be honest. JO  43:20 Naomi, let's bring you now back into the conversation. I so admire your devotion to your mother's care. I'm really interested to know what drives this devotion. NAOMI  43:33 For me really, when I was growing up, my mother was my best friend. We talked about all kinds of different things, she was very open, and created a safe space for me to share. So, we were quite close. And I'll always hold those memories at the forefront of my mind, even as her behavior changes, or her cognition declines, I just still hold those memories ever present. And so that really does inspire my devotion, as well as I know that if the roles were reversed, she would do her best to care for me. So, I feel inclined and really drawn to do the best for her. And moreover, if I don't provide the care, who will? Who is there to step up and provide that level of care? So, it's both an obligation as well as a gift. JO  44:27 One of the things we talked about while preparing for this podcast was the need for intergenerational knowledge and support related to seniors' mental health issues. As a young person who lives in that world, what do you think other young people need to know? NAOMI  44:46 There seems to be a stigma around aging, which we've touched on, and I know we will talk about later, where somehow older adults aren't always held in the same regard as youth. And that goes to show as well for dementia, where it's more of an out of sight out of mind, where we've really constructed our society around that. And I find that extremely disheartening, because I think there's exceptional knowledge to be gained from engaging older adults, as well as people living with dementia. I really think that there's immense knowledge that can be derived from building these relationships with older adults. And I'll just give you an example for myself. I know at the onset of the pandemic, I really wanted to try to make a difference, and I know there was a lot of seniors being isolated. So, I had reached out to the Seniors' Outreach and Resource Center locally and just express my interest in helping out. I was paired with a senior that was also looking for support. And basically, what I would do was to call her once a week for about a ten-minute conversation... just ask her about how her day was, what her plan was for the weekend, how she was feeling. And I couldn't believe the immense amount of gratitude I felt for my time... it was just so touching and rewarding. She had expressed how it was really helping her... I actually really felt like it was helping me, and I was really making a difference in contributing in a meaningful way. I really think to foster these intergenerational discussions is really about seeing the value that can be offered by really just engaging that conversation and engaging older adults. JO  46:40 Along that same vein, we talked about bringing young people into the conversation early, by way of what you call "courageous conversations." Tell us about that. NAOMI  46:52 I've been advocating for this for years, because realistically, aging and death is a part of life and an inevitability. Yet I find that we don't often have open and honest discussions about this topic. So, I routinely encourage people to have these courageous conversations... to really talk about those hard, often not discussed, topics so that you can have these discussions while your loved one still has all of their faculties and can express their wishes. For instance, asking a parent if they would prefer to be buried or cremated, or do they want to do-not-resuscitate order in place? If they were on a ventilator, and they were in a vegetative state, would they want to continue in that state? Or would they want to move past that? These conversations that you have, while difficult will really inform future decisions. That way, you won't have to run into the same scenario, or people will not have to run into the same scenario as I did, where I'm making a decision on behalf of someone else, rather than bringing their wishes to actualization. You'll be more grateful and thankful that you had these conversations than if you had not. JO  48:12 Tell us about other opportunities we have to help seniors mental health by bridging that generation gap. NAOMI  48:20 By bridging this intergenerational gap. It can really fight isolation and loneliness, which we know is so prevalent at the moment. And I think one way to do that is really working towards intergenerational programming. So really bringing together people from different age populations around activities that focus either on young children or older adults. And there are some examples where this is being undertaken successfully. There is a St. Joseph's Home for the Asian Hospice in Singapore, that's not really adhering to the typical nursing home. The facility includes a childcare centre that accommodates about 50 children. And at the centre of St. Joseph's courtyard is an intergenerational playground that really fosters spontaneous interactions between older adults living in the nursing home and the little ones that are being cared for at the childcare centre. And I think these creative solutions really do promote that intergenerational and community connection that's needed to combat isolation and loneliness. JO  49:30 Earlier, Rick talked about the onset and extent of seniors' mental health challenges being affected by innate personal characteristics such as age, gender, ethnicity, and genetics, and developmental factors such as childhood experiences and educational status. So, let's have a bit of a free for all here. First of all, how do risks and experiences differ between younger seniors and elderly ones? Ania, maybe you could jump in first. ANIA  50:04 I think one way that I think of it is, unfortunately, as we become older, there are some risks that increase the numbers will be risks of, say, for example, cognitive impairment or dementia. So, of course, much older seniors will have a higher risk of developing a cognitive disorder. Other factors that come in through, again, increasing frailty or other medical conditions as increased risk of falling or mobility issues. And of course, that can result in increased risk of isolation, decreased quality of life, as say, an arthritic condition advances that can cause more pain. So, that again, impacts the sense of well-being as well as a sense of decrease in quality of life, or decrease access to activities because of pain or stiffness, and things like that. So, I would say there's definitely a difference there. JO  50:53 Marjorie, what do you see? MARJORIE  50:56 We're seeing, obviously, as people are getting into their upper 80s, definitely, I see a lot more risk and with people living in their own home, and with the cognitive changes that do occur. It seems we're seeing more of the early onset types of dementia as well, which is quite shocking and worrisome. There's risk at any stage of life, because of the unexpected physical things that can happen. My brother-in-law had a massive stroke at the age of 61. And no one expected that at all to happen at that time. We may be faced with extreme physical challenges. So, it sort of runs the whole gamut, I think, between this stage of life. JO  51:40 Naomi, any comments? NAOMI  51:42 I have a unique case because my mom was diagnosed at such a young age. And I found for me personally, what I find is that in terms of accessibility, and funding for services, is quite a bit of a disparity between a younger senior and an older senior. So, I find that if you're 65 and under, and you're looking for services, it seems that the responsibility often falls to the family to cover expenses. Whereas once you pass the age of retirement and go to 65, then there's old age security, guaranteed income supplement, and so on different medical and government benefits that kick in that do assist, and the financial responsibilities not in the same way to families. I find that's what I have been seeing, and it is a concern for me as Marjorie had mentioned, with the increased prevalence of diagnosis around younger onset. JO  52:44 What are the risks for men versus women? MARJORIE  52:47 Men, in my experience, as I see them going through the transitions, particularly moving from their work positions into retirement, seem to have a higher risk of depression. Often their identity was very well defined within their work environment. Somebody that I've experienced that went through that and shared his story with me, it's quite interesting, after his wife died and he had moved into retirement, he did find himself becoming very depressed. I think men and women respond to this differently. I think women reach out much more to their women friends and tend to be able to talk about that more openly sometimes the men can. JO  53:36 Ania, what does your clinical practice show? ANIA  53:39 One of the things that I think that's what Marjorie has spoken to is the increase in depression amongst men. And I think the big thing that I always think of in terms of those differences is that men are at a much higher risk of completing suicide, in terms of senior women versus senior men. So that's always a big concern. When we do see depression or severe depression is that increased risk of suicide. In terms of women one thing is that, unfortunately, women are more likely to develop cognitive disorder or dementia type of illness. And because they live longer on average than men, they may experience more sense of isolation or loneliness because of losing a partner or losing their friends or other family members. So that can also be a concern. NAOMI  54:22 If I might interject, one thing I find that's very interesting in this regard, and I don't know if you guys have heard about this, but it's called the widowhood effect. When it comes to life expectancy, after a spouse dies, if the husband dies, her life expectancy is twelve-and-a-half years. However, if the husband is the surviving spouse, that life expectancy is about nine-and-a-half years. So, it's quite a big disparity between those two life expectancies, and I do think it has to do a lot with connection. Husbands and men often turn to their wives for that social connection, whereas, and this is a generalization, women often have friends that they seek out and are more able to discuss what's going on in their life. And so, I see this as part of the reason for this discrepancy in life expectancy. JO  55:16 What about the mental health risks for marginalized communities such as indigenous folks, or LGBTQ communities? MARJORIE  55:27 I was asked to come and just talk to a seniors' group of LGBTQ here in our community, because the person running the group felt that there's just so much pain and sadness being expressed by people who were dealing with so much negativity around, non inclusiveness of this group. Many of them felt that they didn't know where to turn as they were getting older, because there doesn't seem to be an openness, even within seniors housing, to even talk to them about it, or create a space where they feel accepted. There was just so much pain expressed in that meeting that I had with them. I did go and talk to a couple of the retirement communities hear about it, and just started trying to create a dialogue. Because I think it's just something they don't think about, that there are a large number of people in this group, and they're seeming to suffer with it. So, I think it's another area where there needs to be a lot more discussion and dialogue and creating an openness that they need to feel included, and they still have the barriers that have sort of been there for a long time for them. JO  56:46 So, Ania, what's your experience with people from marginalized communities? ANIA  56:52 I think it's definitely an important topic to discuss, as Marjorie has mentioned. One of the things that I've noticed is, as we get older, we sort of carry with us our life experiences. And looking at Indigenous elders, a number of them would have likely experienced the residential school system, and the trauma associated with that separation from family... potential for abuse. So, those are the kinds of traumas that they will carry on. We know that Indigenous folks also are at much higher risk for struggling with adequate housing or adequate supports. I know within our communities, there are more resources,  but if you look at smaller communities, that becomes a significant concern. And also, some of the difficulties they experienced within their families, because we know that Indigenous people are, unfortunately, more affected by violence and substance use. So of course, that has an impact on the elderly as well. And then in terms of LGBTQ patients... one thing that I find interesting talking with my patients who have lived these lives for so many decades, is obviously being a member of an LGBTQ [community] is much more accepted now in our society. But it wasn't always the case, and sometimes it was completely unacceptable so-called lifestyle. And so to speak to my patients about their experience, and it was like for them to eventually come out or to transition to a different gender and what I was like them in terms of the impact that had on them, personally, their families, their job opportunities, and things like that, and our younger adult life is really humbling to hear what they have had to go through and how much it's still impacting them now. So, I do agree, I think we need to pay more attention. I'm not suggesting that being a member of the LGBT group is now easy, because there are certainly challenges and struggles that continue. But I do think that for the folks in the age group of my patients, that definitely was a very different experience than it's the one that after decades can be very traumatizing for my patients. JO  58:54 Naomi, what do you see in your work? NAOMI  58:57 I really see... especially in long-term care, homes... customs, and traditions that are outside of, I guess, the norm, or what's been created around or not really being considered, let alone incorporated into programming. So, I find that when these marginalized communities, or if they do actually seek support, the supports that are available to them aren't really designed for them, and don't help in the way that they need. So, I definitely think having them play a part in the creation of programming and designing of programs is really crucial to ensure that we're accounting for those considerations, those customs, those traditions that maybe are not thought of otherwise. JO  59:49 This is amazing! I'm just so thrilled that you're all coming at this from such different perspectives. It's very robust. Ania, this is a question for you. What about the role of genetics? ANIA  1:00:02 Genetics definitely will play a role in certain aspects of our physical and mental well being. There are certain conditions that are more likely to be impacted by genetic influences. For example, early onset Alzheimer's Disease is unfortunately associated with higher risk because of genetic influences. Certain other conditions, for example depression, can also have a genetic component to it as well. And then, of course, genetics around other medical conditions that will impact the quality of life and sense of well-being of a senior can also be important. For example, breast cancer... there are some types of breast cancers that are very strongly associated with a genetic risk and can result in developing cancer in your 20s or 30s even. There's certainly a role there to be considered for patients who may have a family history of particular conditions. NAOMI  1:00:55 Genetics does play a role. I also think prevention does play a key role. But for me, as a child of someone that was diagnosed with younger onset dementia, that means I have a 50% likelihood of developing the disease. I already have genetics working against me. So realistically, I only have prevention at this point, especially given that there is no treatment or cure for dementia at this point. So, I'm taking every precaution, but that's something that is already working against me. JO  1:01:30 What does prevention look like in your particular case? NAOMI  1:01:34 Personally, staying mentally well is very important. Continuing to expand my mind, continuing to really stretch my cognitive activity, whether it's learning a new language, or doing anything outside of my comfort zone, that's really going to push me... that's another way. Really maintaining those social connections. One thing I've definitely been trying to work on because my mom was a bit of a worrier, herself. So, unfortunately, whether genetic or not, I seem to have taken on that attribute, as well. So, I've really been working to be a bit more mindful and really harness the practice of meditation, to calm the mind and really get connected and rooted. Healthy eating... some things that we know through research that have a dramatic impact on the likelihood of developing a cognitive impairment. JO  1:02:33 Marjorie, any observations? MARJORIE  1:02:36 I think this is so significant, Jo, and what Naomi is saying, because having grown up with a parent that when I was eight was diagnosed as being bipolar... and living in really an environment that is traumatic in itself because of the uncertainty that went on constantly... and the behaviors that you didn't understand as a child. And so, I think for both Naomi and myself, having experienced this with a parent... having very difficult mental health issue... there almost isn't enough support, I don't think, for the children of parents that do have mental health major concerns. Because it really plays on you just even this aspects of the genetics, because I used to often be thinking and worrying about it, because there's history genetically too with bipolar, but it creates a fear. And I think sometimes we need to be providing more support in different ways for children of parents with mental health concerns. I don't think we do enough with that, to be honest. JO  1:03:44 We touched on the risks for people from marginalized communities. What about ethnicity? Are certain racial groups more prone to specific mental health challenges? Ania, let's start with you. ANIA  1:03:59 One of the things that comes up in research, and it's not necessarily maybe an issue of ethnicity but more of immigration, is that some studies have shown that immigrants are at a higher risk of developing an illness that involves psychosis. So, that could be schizophrenia, for example. And that seems to be a factor. The thing that I think about the most in terms of my own experience within my family, or my experience as a physician... treating patients from different ethnic backgrounds... it's more really about cultural expectations that families and patients bring into the discussion. This may be around accepting of diagnoses. This may be around expectations around caregiving. In many cultures, different ethnicities, there is definitely a different approach to providing care to elders, typically in the home and typically by the family, which is a little bit different from some of the more kind of Anglo-Saxon Western nations. And also, expectations around seeking help and even accepting mental illness for what it is because of stigma... or even very practical things like challenges around language, especially for more recent immigrants that may be a challenge or senior immigrants who come to Canada who have not had an opportunity to learn English to express some of their concerns. And sometimes it's about access as well. And again, that ties in to the maybe sometimes the language concerns. So those are the kinds of things that I sort of look at, in terms of impact of maybe ethnicity or cultural differences. JO  1:05:33 Marjorie or Naomi, any comments? NAOMI  1:05:36 It's like she took the words right out of my mouth, I was going to say the exact same thing, I think cultural sensitivity about mental health. In a lot of different cultures that's not accepted to talk about, or it's not recognized in the same way. So, I wholeheart

SUMMARY If you're wearing a mask to hide mental health challenges, why not swap it for a superhero cape and brainpowers so strong they're sure to save the day! Sharon Blady, PhD (comic book geek, former Manitoba Minister of Health, founder of Speak Up: Mental Health Advocates) and Dr. Simon Trepel (a psychiatrist and member of Sharon's treatment team) openly talk about Sharon's multiple diagnoses, what's helping her heal, and how you, too, can embrace neurodiversity and load your mental health toolkit with superpower solutions. They also touch on the impacts of stigma and childhood trauma on mental health, the effects of COVID-19, the need for resilience, and the importance of strong doctor/patient relationships. TAKEAWAYS This podcast will help you understand: Personal experiences from a person with multiple mental illness diagnoses, and those same experiences from the vantage point of her psychiatrist An individual's experiences with post-partum depression, ADHD, OCD, Bipolar 2, and suicidal ideation Challenges and opportunities associated with multiple diagnoses Mental health “superpowers” and how they can help promote personal healing and support others Superhero Toolkit Benefits of neurodiversity (seeing that brain differences such as ADHD and autism are not deficits) Impacts of stigma (structural, public, and private) and reducing its negative effects “Resilience” from personal, professional, and community perspectives Impacts of COVID-19 on mental health Doctor/patient relationships and what makes them work   SPONSOR The Social Planning & Research Council of British Columbia (SPARC BC) is a leader in applied social research, social policy analysis, and community development approaches to social justice. The SPARC team supports the council's 16,000 members, and works with communities to build a just and healthy society for all. THANK YOU for supporting the HEADS UP! Community Mental Health Summit and the HEADS UP! Community Mental Health Podcast.   RESOURCES Speak Up: Mental Health Advocates Inc. Embrace Your Superpowers program Managing Multiple Diagnoses of Mental Illnesses The Importance of a Complete Diagnosis: Managing Multiple Mental Illnesses Neurodiversity in the Modern Workplace   GUESTS  Sharon Blady, PhD Sharon Blady is former Minister of Health and Minister of Healthy Living for the Province of Manitoba, an academic, and a comic book geek turned mental health superhero who empowers others with her fandom-based Embrace Your Superpowers program. Using her lived experience of multiple mental health and neurodiversity diagnoses, she helps others better understand and achieve improved mental health and well-being. Her diagnoses became a source of strength – Superpowers – which she harnessed and directed for personal, organizational, and community growth. Sharon's life experiences range from being a single mom on social assistance, to being responsible for a $6-billion health department budget. She is a survivor of domestic violence, cancer, and suicide, along with being a published author, entrepreneur, and public speaker. Email: sharon@speak-up.co Phone: 204-899-4731 Website: www.speak-up.co Facebook: @SpeakUpMHA Twitter: @SpeakUp_MHA & @sharonblady Linkedin: https://www.linkedin.com/in/sharon-blady/ & https://www.linkedin.com/company/speak-up-mha Simon Trepel, MD, FRCPC Simon Trepel is a child and adolescent psychiatrist with more than a decade of experience assessing and treating kids and teens. He is an Assistant Professor at the University of Manitoba, where he teaches medical students, residents, psychiatrists, pediatricians, and family doctors. Simon is also a clinical psychiatrist with the Intensive Community Reintegration Service at the Manitoba Adolescent Treatment Center. Simon is co-founder and consulting psychiatrist for the Gender Dysphoria Assessment and Action for Youth clinic, and consulting psychiatrist for the Pediatric Adolescent Satellite Clinic, where he primarily works with children and adolescents in Child and Family Services care.​ Simon has worked with Vital Statistics as well as Manitoba school divisions providing his expertise in child and adolescent gender dysphoria. He has spoken to audiences on a range of topics, including gender dysphoria, video game addiction, anxiety, attention deficit disorder, and neuroplasticity.​ Websites: https://matc.ca/ (Manitoba Adolescent Treatment Center) Email: sptrepel@gmail.com Twitter: www.twitter.com/simontrepel LinkedIn: https://www.linkedin.com/in/simon-trepel-md-619a76b8/   HOST Jo de Vries is a community education and engagement specialist with 30 years of experience helping local governments in British Columbia connect with their citizens about important sustainability issues. In 2006, she established the Fresh Outlook Foundation (FOF) to “inspire community conversations for sustainable change.” FOF's highly acclaimed events include Building SustainABLE Communities conferences, Reel Change SustainAbility Film Fest, Eco-Blast Kids' Camps, CommUnity Innovation Lab, Breakfast of Champions, and Women 4 SustainAbility. FOF's newest ventures are the HEADS UP! Community Mental Health Summit and HEADS UP! Community Mental Health Podcast. Website: Fresh Outlook Foundation Phone: 250-300-8797   PLAY IT FORWARD The move from mental health challenge to optimal restoration becomes possible as more people learn about various healing challenges, successes, and opportunities. To that end, please share this podcast with anyone who has an interest or stake in the future of mental health for individuals, families, workplaces, or communities. FOLLOW US For more information about the Fresh Outlook Foundation (FOF) and our programs and events, visit our website, sign up for our newsletter, and like us on Facebook and Twitter.   HELP US As a charity, FOF relies on support from grants, sponsors, and donors to continue its valuable work. If you benefited from the podcast, please help fund future episodes by making a one-time or monthly donation. Sharon Blady, Dr. Simon Trepel Interview Transcript You can download a pdf of the transcript here. The entire transcript is also found below: RICK  0:10 Welcome to the HEADS UP! Community Mental Health Podcast. Join our host Jo de Vries with the Fresh Outlook Foundation, as she combines science with storytelling to explore a variety of mental health issues with people from all walks of life. Stay tuned! JO  0:32 Hey, Jo here. Thanks for joining me and my two guests as we conduct a brain tour that will take you on a journey of discovery, from mental illness all the way to mental health superpowers and superheroes. This great conversation is brought to you by the Social Planning and Research Council of British Columbia. My first guest is Sharon Blady, founder of SPEAK UP: Mental Health Advocates Inc., and former Minister of Health and Minister of Healthy Living for the province of Manitoba. She knows firsthand how getting mental health or neurodiversity diagnoses means living with stereotypes and stigma associated with those labels. She also knows there's a way to reframe those stereotypes and define assets that empower us instead. Sharon's lived experience, combined with a lifelong love of comic book superheroes, successful treatment with cognitive behavioral therapy, and robust peer support, gave her the perspective and tools she needed to see her mental health challenges as assets or superpowers that she now harnesses and manages for better mental health and success. Helping us navigate Sharon's brain tour is Dr. Simon Trepel, a psychiatrist with more than a decade of experience assessing and treating kids and teens. He's an assistant professor at the University of Manitoba, where he teaches medical students, residents, psychiatrists, pediatricians, and family doctors. He's also a clinical psychiatrist with the Intensive Community Reintegration Service at the Manitoba Adolescent Treatment Centre, and co-founder and consulting psychiatrist for the Gender Dysphoria Assessment and Action for Youth Clinic. Welcome to both of you, and thank you for embarking on this journey of disclosure and discovery with me. SHARON  2:39 Thank you. It's great to be here, Jo. SIMON  2:41 Hey, Jo... yeah... thanks for having me as well. JO  2:43 I know the relationship between doctor and patient is sacred, so your willingness to help us better understand that connection is brave, and so very much appreciated. First, we're going to dive into Sharon's story, peppered with Simon's clinical perspective. I think this is going to give you a whole host of insights. Sharon, let's start with you. When we spoke to prepare for this episode, you talked about being born with quote, "different brain things," unquote. Can you tell us that story, starting with you being an energizer bunny and chronic overachiever right from the get-go? SHARON  3:27 Yes, that was my very articulate way of self-identifying, but that's how I felt as a kid... that there was just something different about me. And it wasn't just that I felt that way. I kept getting told that I was different, and not always in a good way. Sometimes I did receive positive encouragement in school and always did well. The first time my parents had to ever deal with the principal, and my being in the office, was because in grade three I had decided I wanted to drop out because I felt there was nothing more that they had to teach me because I was spending more of my time helping other students. And it all just seemed so boring. That's what would eventually get me into advanced programs and stuff like that. So, it was just that thing where I was always doing things and not intending to be one step ahead of things, but finding myself there and then kind of getting simultaneously rewarded and punished for it. So, it'd be like, yeah, there's a great grade, but then you get the side-eye from your classmates. And then I get my father. His tendency was to say that, on one hand, yes, you're my child, you're so smart. But don't think you're that smart... don't get too confident or cocky. So, there was never 100 percent security in it. It's the way I lived in terms of the university and how I was managing things. I remember a girlfriend and I… the joke was that no one would have thought of giving us mental health or neurodiversity diagnoses. More that the joke was made to zap us both in the butt with tranquilizer darts to slow us down so that everybody else could keep up. That was my childhood. JO  4:57 What were your teenage years like? SHARON  5:00 Oh, a roller coaster. I was always good in school, but I got into the IB (International Baccalaureate) program, and it was the first year that they had the IB program in school. So, I think in some respects, they weren't ready for us. We were that first class... 50 of us kids that were used to being chronic overachievers… outsiders… were all suddenly in one small school that only had a total of 350 students. I was, again, still doing well in school, but I found my own people and then went off in directions that had me going to The Rocky Horror Show and doing all of this wonderful world of exploration and finding like-minded people. That was when my second round of visits with the principals started to happen. But again, that weird place where it's like, how do you discipline the kid that's in the advanced program for doing a thing, because they're supposed to be there as a role model. And also, that thing, like the seven colors in her hair, might not actually be a disciplinary issue. It's just you've never encountered it before as a principal. So, I was all over the place. I was doing really well in school and was the very untraditional captain of the cheerleading squad where we cheered to punk rock songs like Youth Brigade. And then I was also in Junior Achievement and, in fact, was the president of the Company of the Year for all of Canada in my final year. Yeah, so again, chronic overachiever... energizer bunny. JO  6:25 What happened that triggered your first experience with mental illness? How was it treated? And how well did you respond? SHARON  6:34 It was actually a while after my first son was born. I was 25, I was a grad student, I was doing my master's degree. I had been going out with somebody that had been a classmate, but when he found out that I was pregnant, ran the heck away. Of course, he also ran the heck away, because the day I found out I was pregnant, I also found out he was cheating on me, and basically said, "Don't let the door hit your butt on the way out." So, I moved back to Manitoba from BC. I had my son, and didn't feel very well, and I couldn't figure out what it was. Because it was, "I've got this kid, I'm doing my master's degree, I've got support from my family," and then one day, I had... after feeling all of this up and down and trying to juggle everything... the overwhelming desire to drive my car off the side of a bridge. And was really the red flag, and something stopped me in the same moment that my wrist almost turned to do that. Another part of my brain went, "That's not the rational thought that you think it is, that's not going to save you or your child the way you think it is." And that's when I sought out help, and would end up with a postpartum diagnosis. And then that would go on to being diagnosed as chronically depressed, and then I spent some time on Luvox. The GP that was looking after me… I wasn't receiving any therapeutic care… I wasn't receiving any kind of counseling or supports that way… it was just medication. I was eventually on the maximum dosage, and it was making me physically ill, so I did a very unsafe thing and I went cold turkey. I was lucky to then connect with a psychotherapist that helped me and introduced me to Cognitive Behavioral Therapy. And that's where my really first positive journey happened. But I have to admit, I probably lived the first three, four years, five years of my eldest son's life in a real, foggy, ugly place. That's where the journey started. And it's led to other things and seeking out care has been intermittent and based on things like addressing being assaulted by my ex-husband. Other basic traumatic events have triggered seeking out care. And it's now working with Simon that I've really had that opportunity to go back and dig through a lot of stuff and learn more about myself. And she's like a superhero geek kind-of-way retcons my narrative in the sense that I've realized my understanding of things has changed, especially as we've dug deeper and I've learned more about my brain and what my diagnoses are, as opposed to what I thought they were, and what others had told me they were in those shorter forms of treatment and care. SIMON  9:12 That might be a nice place for me to maybe step in a little bit if you guys don't mind. Sharon's covered a lot of things simultaneously… I'm going to try to have a foot in Sharon's side and to be preferential and biased in Sharon's behalf. But, I also want to take a bit of a meta sense, as well and take a look at what Sharon has said through the lens of maybe how people with mental health challenges or superpowers are sometimes treated by the system or by their families or even by themselves. So, we backed up a little bit to the beginning when you asked Sharon about her childhood. She talked about having lots of energy and being an overachiever. And she was told that she was different, which is an ambiguous message. “Difference” doesn't let a child necessarily understand that that's good or bad. And the child is left to struggle with, "Am I special? Yes. But do I fit in? No." That is the mixed message that a "different" label gives us as children, and we struggle as well to make sense of that. And we are, simultaneously, as Sharon mentioned, rewarded for our special features, our cognitive abilities, but at the same time it isolates or sometimes distances us from other connections that we can have in social circles and with peers and things like that. So, Sharon felt ahead of others, which then makes her feel separated from others, which then makes her aware of pure jealousy. And then she mentioned this mixed message from her father to be, “Hey, you're good, but don't become arrogant.” And I think that's a big understanding of Sharon's struggle to really understand, "Am I a good person or not?" And this is ultimately what leads us to struggling with our sense of self-esteem and sense of identity. You then went on to talk about the teen years and, again, Sharon is propelled to this academic special status of IB program. But you hear her own worries about the school's ability to contain and nurture that in a good way by her own misgivings about it being, quote, "the first year the IB program is in effect." And so again, the theme is, "I'm not sure the adults can handle us... I'm not sure the adults and the systems and the parents can handle us special kids." And you hear the same thing when she talks about getting in trouble, and the rebel phase of, I think it was, pink hair, and getting into trouble despite good marks. And she remarks, "Yeah, it was really tough for the principal because he'd never encountered it before." But he had, Sharon, many times. The principal had encountered many rebellious yet academically talented kids who weren't getting clear messages at home about who they were, and letting them shape a  foundation and identity that gets stable over time, then becomes something for them to fall back on in later years. When they struggle, or even fail at things, they're able to tell themselves, "Hey, that's okay, I'm good at stuff." But when you get a mixed message for so much of your life, and so many systems, you end up falling back on yourself, and you're not sure if you're going to catch yourself. So, you start to wonder if you're able to get helped by the adult authority or systems that are supposed to be catching us. And then we move on to university degree, and we hear Sharon talk about these awful experiences with a partner, and yet she glosses over it very quickly. And you hear the avoidance in her about talking about that very traumatic rejection and separation that happened abruptly at a time when she needed help the most. And see here, there's no ability to process that trauma. And so, when she gets home, all of a sudden, she wants to drive into traffic, and she doesn't understand why. But yet it's the lack of processing that trauma that sits in the basement of our mind and the sub-cortex and waits like a monster until we are at our lowest, and then it shows and rears its ugly head and attempts to take everything from us because we don't feel like we have anything there. JO  12:47 Sharon, I know that you have had multiple diagnoses with different mental health challenges. Can you explain to us how that unfolded? SIMON  12:59 How about, “Sharon, how you doing?” Because we talked about a lot of things just now. And I think an important part of doing these type of interviews where we are laying bare our souls and our histories is that we can go too far. And we can open up too much. And I took Sharon's lead from how far she went in hers. But I think at this point, I'd like to sort of check in with all of us because we've really unloaded some very heavy things. And we don't have to act like it wasn't heavy, Sharon? Well, it's not just for sharing. It's also for our host. JO  13:29 I love this back and forth. I think it's brilliant in that we combine lived experience with a clinical perspective of that lived experience. And I think that's very, very positive. And as you mentioned, Simon, it must be positive for Sharon as well. SIMON  13:48 Exactly. And when we unload things like this, we feel exposed. When we feel exposed, really, again, the sub-cortex of our brains, our basement where our amygdala (which is our fear and emotion center) sleeps beside our hippocampus (which is our library), and that retrieves our memories. And when those two get intertwined in the dance of trauma, they end up opening up these boxes again, when we're not always ready. And so, I always make sure whenever we're talking about traumatic events that I take the lead of the patient, but then when I do the step that seems like I'm being asked to do, we stop and we take a breath, and we reregulate our nervous systems, to make sure that we're still on the same page, and it still feels safe, because therapy doesn't always feel safe, but it should always feel caring and kind and make sure that you are checking back with people. So, you're walking together. And I hope I've given you some time now, Sharon to sort of articulate what it is that you want to maybe say at this point. SHARON  14:47 Thank you for the processing time. I want to thank Simon for how he picked up on how I had said things. And so that in that time to process what I recognized was, for example, that tendency to gloss over things or to say things quickly and sort of dismiss the traumatic aspect of it. And that I've kind of conditioned myself to just telling that story, and that sometimes it has left me raw and open and vulnerable. And that I would just keep moving on not recognizing that it was effectively taking a psychological or a mental scab, and leaving it open to possibly getting infected. And so that's one of the really interesting processes. SIMON  15:31 Oh, I like that. I like that metaphor. SHARON  15:33 Well, that's what I've loved about this process, and about being able to share this today here in this manner, because I've come to realize that so many things that I had taken as normal... they were my normal, they were my habits, they were my whatever. But they weren't. And they maybe got me through the thing at the time, but that they weren't the way things had to be... they weren't a mandatory default setting… that they could be changed. And that even some of the language that I use is, again, a process or part of that, again, what I had internalized. And so that's what I always love about feedback. And the support that I get from Simon is that recognition of, oh my god, am I still using that language? Oh, really? Okay. I thought I'd made some growth here. Yes, I have made some growth, but I'm still carrying around some baggage that I didn't realize I had. I thought I dropped that emotional Samsonite back two weeks ago, but somewhere along the line, I decided to pick up the carry-on version of it after all. And, so what can I do to process that... SIMON  16:35 I hate to interrupt you, Sharon at this point, but we often talk about again, in trauma, this idea of a win-lose or black-white, or yes-no. But when we get into this idea you are doing it again, you're selling yourself short when you say, "I thought I made some growth, but if I made a single mistake, I obviously haven't." SHARON  16:47 Again, and that's what I appreciate, because it's a black and white thinking that I've normalized. So, I'm enjoying the growth. I appreciate the reminders. Jo had the question about the different diagnoses, and I have to say that, because I've been given a variety of things over time, I didn't view them necessarily as negative. Some people will look at mental health labels and neurodiversity labels as negative and other, and I found ways of reframing that, but I still found them as identifying mechanisms or filters that I would run things through. And what I've come to realize in the time that we've worked together is that while those were, I guess you'd say, things that I could use to ground and navigate with. I think it's Maya Angelou that said, "You do the best you can, and then when you learn more, you do better. Some of the diagnoses that we've talked about that I ascribed to at one point, and then realizing that they were mislabelings. I'm glad that I had them for the time that I was there to get me through the thing. It's nice to go back, and that's where I use that term about retcon and go, "Oh, that wasn't really the thing that I thought it was. And now I can adapt to it differently having a better sense." And I would have to say that the one thing that I was most surprised to sort of learn about myself, was just how much of my own mental health has been shaped by trauma of all the different things that I've been dealing with. That is not one of the ones that I would have put near the top of the list or is having had the most influence. SIMON  18:26 That's powerful, and it's because we as a society demonstrate one of the symptoms of trauma, which is avoidance. In my clinical work, and in my everyday life, we are all desperately trying to avoid talking about traumatic things. And that's the reality. JO  18:41 Simon... a question for you. A few of the diagnoses that Sharon had were ADHD, OCD, bipolar two, PTSD. Do you often have patients with multiple diagnoses like that? And if so, isn't it incredibly difficult to diagnose if a person has more than one problem? SIMON  19:05 Well, yeah, but we're not textbooks. We are complicated things. And so, there's many, many reasons why somebody may or may not have a diagnosis at a certain time, and maybe why someone might look like something at one point, but they'll change over time. So, for instance, children, children to teenagers, teenagers to adults, our brains are qualitatively changing over that time, not just in size, but in how they work. A child is not a mini adult... a child is a qualitatively different animal, so to speak. I think that's first of all. So, really, what we're learning is that the brain undergoes incredible amounts of development over our lifetime. And we know that, for instance, in ADHD, while 7% of children are born with the psychological diagnosis of ADHD, according to our latest studies, by the time you reach 18 years old, we know that only 50% of people are going to have ADHD, which is about 4% of adults. And the reasoning for that is because we know as the brain develops and matures naturally over time, if given the right supports and the right conditions, and you will naturally develop the ability to regulate yourself in unique ways as you develop more skills, have good experiences, and accomplish things, and believe in your ability to manage yourself. And we see those things. You can be diagnosed as ADHD as a child, never having been treated or medicated and end up not having ADHD as an adult just by the power of development of the human brain and neuroplasticity. But there's also other things that happen. For instance, you might learn skills that allow you to be more organized, and so you no longer meet criteria for ADHD because you've learned skills that compensate for it, the same way maybe somebody with diabetes might learn how to regulate their diets. They don't have to rely on as much insulin. So, I think we're all regulating our chemistry in different ways all the time. And lastly, we're not in Star Trek or the Jetsons yet, so we don't have the ability to scan a human brain and say, "Okay, well, now we know exactly what this is." So, if somebody comes in talking about hearing a voice or feeling delusional, or being disorganized, and it looks like something called psychosis, well, psychosis is a really a general term that can be many, many things… anything from a bonk on the head, to paranoid schizophrenia, to somebody using math for the first time, to somebody having an autoimmune disorder that's causing an inflammation of the cerebral arteries in the brain. So, there's many reasons why we present the way we do, and sometimes it's not clear in the beginning. Lastly, PTSD and trauma is a great imitator, it can look like almost anything in medicine. We talk about lupus sometimes looking like many, many, many different types of disorders from many different areas. And I feel that in psychiatry, in particular, child, adolescent and young adult psychiatry, I see that trauma looks like many things before it finally gets figured out to be what it is. JO  21:52 Sharon, how did your understanding of the diagnoses and yourself change as your treatment with Simon unfolded? SHARON  22:01 I would have to say the greatest thing was that recognition of what he just explained about PTSD. And I love his comment about the societal avoidance of trauma. Because when I think about my childhood, or the way I used to think about it in terms of or even how well I was in it, it was that… well, you know, my folks are together, I live in a nice house, I've got my brother, I've got my cousins, I've got this, I'm doing well in school. I never would have thought of things necessarily as trauma... trauma was for somebody else that lived far away, that didn't have a stable roof over their head, that lived in a warzone, that kind of thing. So, it was again, not that eight-year-olds necessarily have the clinical or academic understanding of adverse childhood experiences, so the notion of trauma didn't really enter my life until I got to things like dealing with an abusive ex, dealing as an adult recognizing what I had experienced with my father, and what he considered discipline, was, in fact, abuse, and that it was both physical and emotional, psychological, that kind of thing. But that was like, again, in retrospect. So, I understand now exactly how the labels... I go, okay, that's the thing. If that's what I've got, at least I know what I'm up against, at least I know how to deal with it. And so, the understanding that there was something actual masquerading, and that my trauma responses, I think that's the other part, was things that I thought were other things were now like, "Oh, that's a trauma response. Okay, I didn't realize that. Well, that shines a whole new light on it." So, I have to say that's the one thing is that it's given me a lot more, or an ongoing sense of self-reflection. Not that I ever figured out, I never thought that I had it all figured out, but it's encouraged me to keep a growth mindset about my own mental health and neurodiversity. And that there are things that I can always learn about myself so that I can really learn better, healthier ways of coping and adjusting and just moving through life. JO  24:08 Simon, what are you learning about Sharon's unique brain during all this? And is her response to her trauma similar to other people's responses who have experienced similar trauma? SIMON  24:23 I'll take the second part first, if that's okay. What's really fascinating to me about trauma is that every single human being that's ever existed, has experienced something traumatic, but not all of it becomes something that we call PTSD, or a fundamental change in how your brain works after that event. And that's what separates it. We can be scared, and we can struggle by something for a few days, and then our brain essentially gets back to factory settings. Or we can have a really horrific event happen and our brain can then change. And they can do two different ways. And so often people think of trauma, like somebody has been to war or has been raped, really something we think about something truly savage has happened. And that is one type of trauma. And that is the classic type of PTSD you think about. But we are now becoming very aware, our eyes have been opened to another type of trauma called complex PTSD, where it doesn't have to be savage, at least not savage through the eyes of an adult, but is savage through the eyes of a child. So, for instance, if you are a harsh parent to a child, you are a big, much larger individual. And if you scare, intimidate, or otherwise terrorize a child in the act of trying to be a parent to teach something, you are actually in some ways putting that child through a savage event, and that can be scary. And when the person that lives with you scares you, that can easily become something we call complex PTSD, and it fundamentally changes how our brain works. And so that's something that has to be recognized. And it doesn't recognize that, as Sharon said, "I didn't realize how much trauma affects me," but it's like putting a lens over your reality from childhood. And so, you start to recognize that when we see this happen in other ways, for instance, in religion, or even in more severe things like cults, for instance, where children are very young or sort of shaped in a certain way, it becomes very difficult for them to disentangle themselves from those perhaps bias messages from their childhood, or perhaps healthy messages. I'm not going to moralize on these things right now, but my point is, what we learn early affects us, and sometimes it can affect us for a very long time. So, savage or harsh, either one can create trauma. And so that's the first message. The second one is Sharon's brain is unique, but I don't know where to start, actually, like we've already mentioned lots of things. And so, I honestly think that the most unique part of her brain is simultaneously the ability to experience everything she's been through, and then be able to look at it and really allow her to renegotiate who she is, again, looking back, which is the power we all have. And so, I really am honored about and privileged to work with somebody who is so strong and doesn't know it all the time, but is so strong, they're willing to walk back and say, "Let me look at my childhood, again, with my kinder eyes, with my more neutral, healthier eyes, with eyes that aren't afraid, in the same way anymore... and let me see what was truly there. And let me look in the shadows, then find out they're not as scary. Let me look into my eyes and see that I matter all the time, not just when my Dad's in a good mood." And these kinds of things become extremely powerful moments for anybody, but in particular, people willing to risk the discomfort of therapy with somebody who's willing to go there with them, but also take care of them along the way. And that's what Sharon and I have been able to create. JO  27:56 Sharon, what have been your biggest challenges along the way?  SHARON  28:01 Wow. I'd have to say that it's been breaking belief cycles and habitual cycles that reinforce the trauma behaviors. So, whether, like I said before, it's the use of language or the comparative competitive thinking, or even recognizing, as I'm recognizing my own strength, because I have to say that there's a lot of things where I would describe the situation or thing that I'd accomplished and kind of felt that it's like, well, anybody would do that under those circumstances, and not allowing myself to recognize the specialness, of maybe something that I had done or accomplished the uniqueness of it. And whether that was academically, politically, it was just oh, this is what I had to do at the time. Or, gee, anybody in my shoes could have done it. And so, I think the biggest challenge will be in that assignment. Okay Simon... I'm curious what you have to say, cuz you're always good at reminding me when... SIMON  29:02 Well, again, when you are putting yourself in the crucible of your own personal accomplishments, you have to remember that earlier on it was compounded into you that you can't get cocky. Yes. And so, what you end up keeping with you is that what seeming like an innocuous message from your father when you brought home 105% on that math test, and he said, "You know, don't get too full of yourself because no one likes an arrogant person," and you didn't know what to do with your accomplishment. And you see how long you carry that. And so, what I challenge you to do is to put that down and say, you don't have to worry about the backhand when you do a perfect forehand. Yeah, I just made that up. But that sounds great. SHARON  29:41 Yes, it does, I agree, and that's probably the biggest challenge right there is living in those things.  SIMON  29:48 Or maybe you should not have to worry, because that's not reasonable for me to suggest that you shouldn't worry when the person there perhaps is a vulnerable narcissist and needs to extract his self-esteem from you in some way. And as a child, we are unequipped to even imagine that as possible from the gods that we sort of worship. Right? Yeah, sorry to be so powerful. I'm just in that kind of mood today... loving it! JO  30:15 Sharon, you touched on your challenges. What have been your key moments of personal growth and resilience? SHARON  30:23 Well, it has been the aha moments like those and recognizing that I'm allowed to celebrate these things. And in fact, I should be encouraged to celebrate them. And that it's okay, and that I'm not being cocky and celebrating. Yes, I was the Health Minister dammit, and I was responsible for the $6 billion budget, and I think I did it well. People are allowed to have another opinion. That's their opinion and their business, but I don't have to diminish myself anymore around those things. Earlier on in my own experience, like I said, I've learnt to get through things by reframing them. And that came from experiences with my son and finding the assets. So, I have been able to go, "Yeah, you know what, you might say I have this thing, and that makes me difficult to manage or whatever. But I've also got this other positive aspect of it." So, it was that process of the reframing, which would turn into that superpower language that I use, because being the Energizer Bunny can be very useful and productive. And being somebody that gets told that they can't sit still, and they can't focus, also means that, you know, I pulled together pretty damn good master's theses, and I connected some really interesting dots in some other places, both in my academic and political life that other people hadn't got to. And that in some respects, I was surprised that, "Why is it taking me to do this? How come nobody else thought of this, because once I got here, this seemed really obvious.?” So that reframing is health. SIMON  31:55 Or, how about one ever talks about Steve Jobs and Elan Musk never sitting still. JO  31:59 Yeah, exactly. SHARON  32:03 Yeah, well, and that's the other part of it, too, is that some of it's even been gendered, in a way.  SIMON  32:08 In a way... some of it? All of it! SHARON  32:10 Yes. Yes, I was the Chatty Cathy doll that was a know-it-all and this and that... but I'm sure boys... SIMON  32:16 No, you weren't, you were a woman with an opinion. SHARON  32:18 Yes, but that's how I was... SIMON  32:20 ... like a human being. Yeah, exactly. SHARON  32:22 But that's how I was labeled when I was growing up was that it was... SIMON  32:25 ... no, that's the microaggression. SHARON  32:27 And that's the thing that has to be unlearned, because I'm watching my granddaughter right now, who's also recently been diagnosed with ADHD. And one of the messages that came home was that we need to get her to learn to be quiet, and to behave herself in class. And I was just like, "Oh, you do not tell a young girl who has got a voice and an opinion and is able to articulate thing well... you don't put baby in a corner.” SIMON  32:55 Particularly in 2021. SHARON  32:57 Yes, exactly. SIMON  33:00 I thought we just learned these lessons.  SHARON  33:03 This was it. So, it was like, we work with her on how to focus, manage, empower, but do not make her quiet, because that would be doing to her in 2021 what was done to me in 1971. SIMON  33:17 Well, yeah, talk about a replay. JO  33:20 So, what you might be saying, Sharon, is that your granddaughter... her ADHD may be a superpower for her. SHARON  33:27 Oh, it honestly is. Like this kid, it blows my mind, honestly, sometimes the things that we'll watch her do, and then process and be able to articulate back. When they went to Drumheller, guess who came back like the little dinosaur expert, and that she was, again, connecting dots and doing things. She's now a big sister, and I think one of the things that she's also got is a sense of compassion there, where she understands her little brother in a way that while he's not even two weeks old, I mean, she wanted to sit down and read all of these books so that she could be a good big sister, and she read some bedtime stories. And I think that there's a compassion that she's acquired because she knows what it's like to be treated particular ways, to make sure that she's going to be her little brother's defender. She's going to be a good big sister. SIMON  34:21 Let's not do that to her.  SHARON  34:22 Okay, that's a good point. Let her be her. SIMON  34:25 Let's not sign her up for a job without discussing it with her first, because we've got all sorts of great plans, but John Lennon had some song about that or something. I'd like to challenge us, as well, to circle back the last two minutes and let's reframe something. What is the school telling her by saying she needs to learn to be quiet… what are we actually missing in that message? Because, if we see it as a pure criticism, we might be missing some wisdom in there that is helpful for us to think about. Because superpowers... when you discover heat vision as a child, you don't make microwave popcorn for your parents, you burn a hole in their curtains is what you do. And so, we're not talking about that... we're acting like the superpowers are easy to handle, and the person who has them knows how to wield them. But I think what we're hearing the school say is that she has something cool that makes her unique, but it also interferes at times, and we don't want that to hurt her. JO  35:25 Before digging in deeper was Sharon and Simon. I'd like to acknowledge a major HEADS UP! sponsor... the Social Planning and Research Council of British Columbia. SPARC BC is a leader in applied social research, social policy analysis, and community development approaches to social justice. The council's great team supports 16,000 members, and works with communities of all sizes to build a just and healthy society for all. Thanks yet again, to all of you great folks for your ongoing support. So, Sharon, let's circle back... we've been talking about superheroes and superpowers. And I'd like to hear the story of how that all got kicked off for you. SHARON  36:17 Well, I'm a comic book nerd. I fell in love with superheroes at about a year-and-a-half when the Spider-Man animated show came on TV, and I found myself fixed on the screen. And I just never broke away from that, and it's gone down into other different fandoms over time. So, I've got a whole bunch, I'll spare you the list, but what happened was in raising my kids, especially having two boys, we were surrounded by comic books and action figures and Marvel movies. So, it was just familiar. We had favorite characters, and this and that. And, so what happened was when my second son was born in 2003, I noticed some things about him very early on, especially once he started school, it became really obvious. He was not interested in learning to practice his writing, he would just scribble, he had a very strong auditory sense, like, go to a movie with his kid, do not ever try to debate script with him, because he will have picked it up. And he can come back, like literally with the phrasing, the cadence, the tone, that kind of thing. And that was his gift. But he was struggling in school, and he always had problems. He was told that he was daydreaming. He was having problems with reading and math. So, they would just send him home with more stuff, and he just was super frustrated. And as much as I'd asked for psychological assessments, I was told that he was too young and will get by. And they kept passing him from one grade to the next, where things just kept getting progressively harder and harder, because he didn't have the skills. And he was eight years old, and he just melted down one day and said, "Mommy, if you love me, you wouldn't send me to school anymore. Because I'm a failure, I'm broken. And I'm not going to do well there. And it's just it's not worth it." And I found myself saying to him, as he rattled off each of these different things that were wrong with him. I found the flip side. "Oh, so what you're telling me is that you think you're oversensitive to this and that, well, I see empathy there, I see caring, I see strategic thinking." And we flipped all the things and found assets. And I said, "Sweetheart, you're not broken... you're like an X-Man... you have mutant superpowers. And it's just a matter of figuring them out and figuring out how to harness them. So, we're going to do for you what Professor X does for the X-Men," and I use the example of Cyclops with laser vision. I said, "Think about Cyclops... you can blow up buildings and save his friends to do all these things and take down the bad guys, whatever. But if he doesn't put his visor down in the morning, guess who's gonna set his underwear on fire while he gets ready for school?" So, we use the example of Cyclops, and what I found myself doing at first I was like, "Oh my gosh, did I just blow smoke at my kid?" And then I realized how I had been coping and managing since that diagnosis of postpartum, and the different tools that I had been given intermittently, and what I had learned on my own... taking those tools and then researching and doing things further on my own,... was that I had been reframing, and I had been finding assets, and that actually previous to that diagnosis the thing is like the kind of thinking that I had with ADHD... well, that had been an asset. As long as I was checking off the right boxes and I was getting rewarded, that was an asset that was a spidey sense that I was hiding. And that why is it as soon as things helped out on me at a diagnosis of postpartum, that suddenly there was like, “Whoo, I've got a thing wrong with me… it's a diagnosis...  bad, broken.” And I saw that it's stigma, that kind of thing. That's what I started doing, and that's where we started really trying to Identify within our own family, what were the assets that we had. And it was things like hyperfocus, it was creativity, and that's just the language that we started using, because we also found that it was neutral. The superpower is inherently neutral... it's what's done with it. It goes to Simon's comment about burning the hole in the drapes or making the popcorn, right. It is what it is... now, am I going to be stigmatized and end up someone like Magneto, who becomes the antihero and become reactive and defensive? Or am I going to become someone that's more like a Professor X and the X-Men and use my powers for my own benefit, but also for the benefit of others. And that's where I realized that a lot of the things that I had been doing were about using those powers to help others. So that's where it came from. It was basically me trying to parent my little boy who was broken, and to help him build a toolkit until he could get proper clinical diagnosis and support. It was our way of getting through things. JO  41:06 How have you evolved that program? I know now that you're offering the toolkit, for example, to other people. Tell us about that. SHARON  41:15 I guess it's been about a decade now or so since that originally happened. I was using that language with my kids, which crept into my language at work. So, you want to see political staff, which have the minister in a meeting, use the word “superpowers.” That was on the list of words that the minister wasn't allowed to use. And also, not allowed to talk about neuroplasticity, or anything else that will get the opposition a front-page headline where they can call me quirky or a flake or something. And they tried, but it was a case of going through that and deciding that after coming out of office, and after working at another organization, that I wanted to share that, because as I encountered different people that went, "Oh my gosh, that's an interesting way of looking at it." And so, I realized, and also watching my son and other people I'd  shared it with, that it had a destigmatizing approach. I'm not a clinician, and I'm not someone that's trained as well as Simon is... I'm someone with lived experience who has trained in things like peer support, and, that for me, it's a language that I find helpful in taking these big complex ideas and making them relatable, and making them a conversation that we can have, without it being again, scary or distancing. So, I can talk about anxiety and talk about Spider-Man. And we can have conversations around Peter Parker, and Spider-Gwen, and Miles Morales, and find out that people have empathy for those characters in a way that they might not have for themselves, or someone they know what that diagnosis is. So, it creates that little bit of a safe space. I guess how I put it is I take mental health seriously, but I don't always take myself seriously. And if I can share stories and do things and introduce people to tools and perspectives, or especially introduce kids to ways of handling their emotions, because a lot of times it manifests more emotionally, where they see it as positive. I've seen the results with my son, who specifically has got some powerful reframing tools. That's what it is. And so now it's a program called Embrace Your Superpowers. And I've since encountered another fandom that I've been dived way too deep into, and I have another program based on the music of Bangtan Sonyeondan (BTS), and just published an article in a peer-reviewed journal out of Korea on the mental health messaging within their music and how they model things like CBT (Cognitive Behaviour Therapy), peer support, and some other therapies. JO  43:43 Wow, that's amazing. Simon, can you put all this into clinical/neuroscience/neurological context? SIMON  43:54 You mean, as assistant Professor S? JO  43:56 Yes. SIMON  43:59 Like that one... Sharon... Professor S? SHARON  44:00 Yes, yeah. SIMON  44:01 Pretty close... yeah... not bad. And as a psychiatrist, I didn't want to say sex because then I have to say something about my mother... it's embarrassing. So no, I really can't summarize it in some perfect way. But I can talk about Sharon's use of superheroes as a way for her to lovingly and empathically discover herself. And I think that when you think about how difficult Sharon's life is… especially early on was, maybe not so much now, which is awesome… but as a child, she didn't have a hero that was safe to look up to. And when kids don't have a hero that's safe to look up to they find them. They find them in teachers, or they find them in pop culture, or they find them in rock and roll, or they find them in fandoms. And Sharon was really lucky to be able to find such an awesome fandom that gave her such positive messages, that allowed her to start to say, "Wait a minute, different is unique." It gave her the idea that adults could be nice, that they could do things that were selfless that did not have to hurt other people. That adults could do big things and handle things. That they could be role models. That adults could be strong, and that people could look up to them and still be safe in doing so. And these are all contrary to the messages that Sharon had been experiencing in her own life. And so, this was a very much a place for her... a cocoon for her... to be able to develop safely in her own mind and her own psyche to survive how harsh childhood was with all the adults in her life that were not sending her comfortable messages. In fact, they were quite mixed, and they were quite barbed. So, I think that I would start off by just saying it's awesome to think about this way, and in Sharon, teaching other people how to have more empathy for themselves. We always work on the idea that what we do for others we're actually doing for ourselves. And so, it brings us back to the idea that Sharon is doing this, in fact, for herself, which then makes me wonder if I'm doing this for myself, and it makes me feel good to help other people. So perhaps, I'm selfishly also baked into the system here and doing some of the same things. But that's okay, because you can reach a point in your life where you can give to others without taking anything away from you. And that's the other idea about how things are not a zero-sum game, things are not black and white. In fact, we can generate kindness and love on the spot as humans, and we have this beautiful ability to do so. And that's, as well, what superheroes do... they love the human regardless of the situation, because they know the person's always trying their best. And that's one thing that I always make sure I work on with everybody... I will truly believe that everybody is trying to be as successful as possible at every moment, including when we don't want to get out of bed, we just calculate that. That's all we have that day, and that's the best we can do. And I just want to make sure Sharon continues to embrace those parts of her because they are easily the most powerful parts that really do have the ability to generate almost infinite abilities to believe in yourself. JO  47:02 Sharon, you mentioned earlier… neurodiversity, and I'm really interested to know, first of all, from you Simon, what that means, and what that means to people like myself and like Sharon, who have mental health challenges. She may not be considered, quote, "normal" unquote, from a mental health perspective, but look at who she is. Look at what she's accomplished. Look at how she's helping people. So, can you just respond to that? SIMON  47:37 Absolutely. I'll back you up a little bit. Sharon's as normal as anyone else... there's no such thing as normal. This is the lie that we've all been sold very early on in our lives, that there is something called "normal." And, by the way, that normal is also perfect. And that's also the thing we all wanted to aspire to be. But it's really a story of conformity... the language of normal or perfection is actually language of conformity. And so, the reality of it is, we are all so different. If you go into a field and look at 100 cows, but then you put 100 people in the field beside them, you look at the people, humans are really unique. I'm not suggesting cows aren't unique...  cows are pretty neat, too, but humans are exponentially more unique. And because of the freedom that we enjoy, because of our prefrontal cortex to imagine ourselves in almost any scenario we like, we're walking around with a holodeck in the front of our skull. So, we all have that. But what neurodiversity truly speaks about, it's recognizing that in the great, great ghetto blaster of Homo sapiens, the equalizer is spread uniquely throughout all of us, all of Homo sapiens is a spectrum. And so, we do cluster sometimes around some tendencies such as gender, but we're learning that not everybody experiences a “normal” quote/unquote, as we've been sold, gender. In fact, there is intersex conditions, there is agender, there is gender fluid, there is genderqueer, there is non-binary. So, there is no such thing as normal. There is just this incredible adventure called being a human being. And the only limitations we're going to put on that are the ones we put on ourselves. JO  49:16 So, Sharon, how did your understanding of neurodiversity help you to see yourself in a different light? SHARON  49:23 Well, it goes definitely to what Simon said... one of my favorites expressions around this is "normal is just a setting on a dryer." That's the only place it's a useful term. SIMON  49:34 And it doesn't always work for the clothes in the dryer either. SHARON  49:37 Exactly, exactly. It might not be the setting you need. Again, when my youngest one was finally tested and given diagnoses that said that he had discalculate dysgraphia and dyslexia, these are things that are called learning disabilities. And I'm like, no, no, no, no, no, he just learns differently, and that he learns in ways, that again, it's this idea of along a spectrum, and so it's a case of wanting to take the stigma away from it. There is all of this diversity. And that somewhere along the line, somebody came up with some sort of liberal, conformity-based normal in the supposed center, and that the rest of us were put out on the margins. And we have a disability or like with ADHD, the idea that it's a deficiency, and I'm like, “Okay, no, no, I don't have a deficiency disorder. I can hyper focus. My ability to focus is divergent, and it can be hyper focused, it's not deficient.” The term, variable attention stimulus trait is one that I've come across as an alternative. And I appreciate that one, because it's the idea that I just have greater variety in my stimulation range. It's not better or worse, that idea of positive or negative. So that's why I tend to use the term neurodiversity, where other folks would tend to use terms like a learning disability or some kind of a challenge or something, again, something that implies other or negative. It's like, no, there's this wonderful spectrum that exists. And that's what we need to understand and appreciate. And then the other thing that I've come to realize, especially, I guess you'd say, in real time with my son's experience… and then I'd say, in retrospect, with my own on this journey with Simon… has been that those of us that have that kind of a diagnosis or a label, will inevitably have some kind of traumatic or mental health issue. Because you're going to experience anxiety, you're going to be stressed out, you are going to overthink and self-judge and do all of these things. When you are being treated as other in the classroom, because you're not reading the same way, you're not writing the same way, you're not allowed to hand in a video presentation instead of an essay. And so instead, you're beating yourself up for two nights trying to get two paragraphs on a piece of paper. Whereas if you had been left to give an oral presentation, or maybe my son had a geography assignment that by God, if you'd been able to do it in Minecraft, to build this world that he created for this class, he would have knocked their socks off. But instead, it was knowing we need five paragraphs on a piece of Bristol board and a picture. And that just wasn't his thing. So that's for me, neurodiversity is about we need to challenge how we see each other, how we teach, how we work, because we're missing out. There's a lot of us that I call sort of shiny sparkling stars that, you know, you're trying to take those shiny, pointy stars, and that's what you're trying to shove into the round hole, not just a square peg. But you're trying to shave off all of my shiny pointy stars to stick me in a boring round hole. And we all lose. SIMON  52:44 And I think really the other thing we have to mention is that we need to treat education like fine dining, but instead we treat it like the drive thru. Yes. And so, if we don't talk about that, we're going to blame the teachers for everything. And it's not their fault. Schools, education has been undervalued, underfunded, and quite frankly, is not sexy or cool. Even though I think it's the best thing ever. SHARON  53:07 Yes. SIMON  53:09 We don't look at teachers as heroes, yet, they are probably one of the highest skilled and the most patient and most saint-like versions of humans that have probably existed in our society. And I'm not joking, the ratios are too high and unmanageable for teachers to spend the qualitative time to actually help kids learn in the best ways they learn. So, what they do is they bundle kids… and I know sounds like a [Bell] MTS package…but they bundle kids into packages of classrooms where the median learning style will get served the best. But what we have to start doing is recognizing there might be seven or eight unique learning styles, and then streaming our children into those enriched learning environments. So, they simultaneously get to enjoy their easy way, while working on the other seven types of learning that they're not good at. So that everybody starts understanding that there's no deficit for those people. We all have deficits, because we don't have everyone else's skills, but that's a qualitative aspect about being human. We're all capable of learning to greater or lesser degrees, but we're all capable of learning, period. And we're gonna find some ways that we do it easier across the board, which is going to work in many environments, but it's not going to work in all environments. So, the challenge for all humans is to enjoy what you got and flaunt it, and be celebrated. But at the same time, celebrate learning the other things you don't do well, and we're not going to blame the student because the school doesn't know how to approach their unique learning challenges. We're going to help fund the school, we're going to elect people that take education seriously, and we're going to start to really give our kids a fighting chance to develop self-esteem and identity and an actual career that they feel fulfilled by. JO  54:53 Simon you mentioned that we can all learn. How does neuroplasticity play into that? SIMON  55:00 Our brains have changed dramatically since the beginning of this podcast. That's how our brains are a dynamic ocean of neurons and waves that are sending electrical signals to each other all the time. Every single thought you have is like playing a single note or several chords on a keyboard at the same time. That's why people say we only use 10% of our brain, because if we used all of it at once would be like playing every key on the piano at the same time, and you would not make sense of what that was. Neurodiversity and neuroplasticity, in particular, talks about the idea that our brains are shaped by our genes that sent templates for them, but then having great amounts of potential to be shaped in dramatically unique and different ways. By our experiences, in particular, if those experiences are harsh, they can hardwire in some ways and rigidly keep that template baked into the system for sometimes decades at a time. And on the other side of the spectrum. If our young brains are nurtured… like an orchid in a garden that understands the conditions under which they will thrive the best… then the human brain doesn't seem like it has limits, and we see that in our neurodiverse populations that are allowed, because they're so separated in so many other aspects. If you have severe autism, for instance, we see human abilities that are beyond anything we could ever imagine. And that's all within the human brain. JO  56:29 You can't discuss mental health without talking about stigma. Sharon, what kinds of stigma have you experienced? Be it structural, public, personal? And if you have experienced that, how have you reduced the impacts of that in your life? SHARON  56:46 I might not have identified it as stigma as a child. But there was definitely that sense of being othered. I wouldn't have had that word. I remember when I was first given the postpartum diagnosis, and I remember the doctor asking about if there was any history of mental health issues. And then going back to my folks and being given this adamant, "NO," that there was nothing. Okay, they're very defensive. And yet, at the same time that I was given this adamant "NO," it was then followed up with my mother's explanation about how she and her two sisters all spent some time on Valium in the 70s, while six of us peasants were all young and growing up together. There's been a lot of self-medication on both sides of the family, and how those that had nothing to do with those behaviors, nothing to do with that. And there was this real sense of denial, and, How dare I ask these questions? And I still have some family members, from whom I am estranged because, How dare I talk about mental health? How dare I be the crazy person? And as I said, I had been given a diagnosis of bipolar which again, through work with Simon, realize that behaviors that were seen in there, it seemed like the thing at the time, but we're realizing those because trauma hadn't been addressed appropriately. So, my son, his father to this day still asks, and because my son lives with me predominantly, has had the gall to say... my son would come back, and this is pre-COVID, would come back from a visit. And you know, so how did your visit go? Oh, well, Dad asked, "What's it like to be raised by a bipolar mom?" And, "Am I okay?" And, "Am I safe?" And then, when I went public with my mental health, as the Minister of Health, part of the reason why I did that was because I wanted people to know that I was somebody with lived experience, I wasn't just a talking head. And it had to do with a particular situation, where we had just lost someone to suicide, and that the system failed this person, and hadn't been able to meet his needs. And as a result, we lost this wonderful artist. And that broke my heart, because I always looked at that job as if the system can't look after me and my family, then it's not good enough. And if we lost this person, I saw the situation, I guess, from both sides. I saw myself as the potential parent in that situation, and also the potential adult child who was lost. And I remember my staff, people were flipping out about how the minister cannot discuss this, because we're gonna have to deal with peop

Are you really good at setting goals but sometimes don't do so great on the achieving end? Join master leadership coach Dr. Geneva on her 100th Ignite2Impact podcast as she shares the 4 top secrets to achieving success thru goal setting.  Award-winning executive Geneva Jones Williams (Dr. Geneva) is a speaker, author, and leadership strategist for business executives, entrepreneurs, and nonprofit leaders. She is the founder and CEO of Dr. Geneva Speaks, LLC whose mission is to educate and inspire leaders for greater impact. Dr. Geneva also serves as Director for the Live6 Alliance, a nonprofit planning and development organization to enhance Detroit’s quality of life and economic opportunity. Dr. Geneva led the United Way, founded an innovative multi-sector national partnership model, launched a new leadership development initiative for girls, and developed models of community engagement and strategic planning for nonprofits. She raised millions for community change initiatives and served as an education leader. Dr. Geneva recently was appointed to the Women’s Commission by Michigan’s governor and chairs its Visible Authentic Leadership Committee. Dr. Geneva hosts the Ignite2Impact Podcast on Apple Podcasts and iHeart Radio featuring influencers who are making a difference in business, nonprofits, government, and the arts. Her blogs inspire and educate women on aging vibrantly, everyday leadership, and philanthropy. Dr. Geneva consults with nonprofits like Detroit Future City and The Kresge Foundation. Crain’s Detroit Business cites her as one of Detroit’s most influential women, she is a Michigan Chronicle Woman of Excellence and was named the National Association of Business Women Owners (NAWBO) Top 10 Michigan Business Woman. For a significant portion of her career, Dr. Geneva was a guiding force for the United Way in the Detroit area. She was the first female president and chief executive officer of United Community Services of Metropolitan Detroit, a $15 million United Way, where she developed and led a three-year strategic plan, resulting in staff retraining and organizational reengineering to meet future challenges. Dr. Geneva also led the merger between two United Ways where she became the first female Executive Vice President and COO, overseeing $42 million annually in agency allocations. She developed the strategic planning process that transformed the agency’s fund distribution system, resulting in new outcome-based measurement systems for over 120 regional health and human services agencies. While at United Way, Geneva attended Harvard Business School and taught at the United Way of America’s Academy of Volunteerism. Dr. Geneva was tapped by foundations and city officials to launch City Connect Detroit, an innovative national model to create and leverage public-private partnerships for increased funding for community needs. Dr. Geneva led the successful strategic planning process implementation, and secured over $100 million for youth employment, education reform, access to fresh food, community development, and urban health. A frequent guest lecturer and panelist at regional, national and international conferences, Dr. Geneva served as chair of the Western Michigan University Trustee board, a member of the First Independence National Bank board, chair of several public school management companies, and vice president of the Detroit NAACP. She has been the recipient of many awards for her work, including the Bank of America’s Local Hero Award, Ford Motor Company’s Heritage Award, the Michigan Business & Professional Association’s Women and Leadership in the Workplace Award, and the National Association for Community Leadership’s Distinguished Leadership Award. Through her company, Dr. Geneva Speaks, she consults, coaches, speaks locally and nationally on strategic planning, collaboration, leadership and personal development, work-life balance, and philanthropy. Dr. Geneva won the prestigious title of Ms. Black Fit and Fine, a beauty pageant encouraging healthy lifestyles for women over 50. She’s an alumna of Morgan State University where she serves on Morgan’s Foundation board. Dr. Geneva is an alumna of the Greater Wayne County Chapter of The Links, Incorporated, and she earned a doctorate in education leadership from Wayne State University, She received her master’s degree with a concentration in Community Organization and Social Planning from the Bryn Mawr School of Social Work and Research. Recently, Dr. Geneva was honored as a Golden Soror of Alpha Kappa Alpha Sorority, Inc. She is an author, amazon.com/author/genevawilliams, and her new book, Justice on the Jersey Shore, about her father’s transformational leadership while fighting social injustice during the Civil Rights Movement, launched as an Amazon bestseller. To learn more, visit drgenevaspeaks.com

How not to bumble or botch social in 2021The only thing we can predict about social in 2021, is that it will be unpredictable. So how do you plan for uncertainty? Why should you plan? Can you plan? What does a plan look like? Join Katy Howell in this episode of Serious Social are she explores how to structure your plans and smash social in 2021.Copyright: immediate futureWebsite: http://www.immediatefuture.co.uk Social profiles: ·       YouTube: https://www.youtube.com/user/IFTubes ·       Facebook: https://www.facebook.com/ImmediateFuture/ ·       LinkedIn: https://www.linkedin.com/company/immediate-future/ ·       Twitter: https://twitter.com/iftweeter ·       Instagram: https://www.instagram.com/ifinstas/For full show notes, view our podcast page: http://immediatefuture.co.uk/podcasts/

On Episode 11 of the Adoptee Thoughts Podcast, Louise, and host, Melissa Guida-Richards discuss the unique experience as an international adoptee who grew up in an open adoption, coming out of the fog, and more. Louise's Bio:Louise Shepherd was born as “Fenny” on the island of Java, in Indonesia in 1982. At 6 months old she was adopted by a white Australian family. It was then her name was changed to Louise. The family consisted of mum, dad, two biological sons, and then Louise. Two and half years later the family adopted her sister from Seoul, South Korea.Louise grew up in Adelaide, South Australia. Louise lives on Kaurna Land. In 2009 Louise completed her Bachelors of Social Work and Social Planning. She is currently working in the Homelessness sector and has previous experience working in Child Protection. Louise feels passionate about many human rights topics, in particular the plight of Aboriginal and Torres Strait Islander Peoples. Louise is mum to one healthy and boisterous, thriving 6-year-old little boy. She enjoys going to the beach, trying different food cuisines, and spending time with friends and family. Louise also says a good afternoon nap never goes astray either. Follow Louise on Instagram!  To read more of the work by your host Melissa Guida-Richards, check out guida-richards.com, or the podcast's website adopteethoughts.com. Social:TwitterInstagramFacebook Mailing List: Subscribe Here 

Register Now for Brendan's Masterclass where he reveals the one thing that will help you stand out in a 3 second world. Reserve your seat HERE! P.S. Focus on Purpose and Passion first, and the Profits will follow. The Online Coaching Business Crash Course will show you how! Get instant access HERE while we're still giving it away for free!

A report from the Social Planning and Research Council says that low income and racialized neighbourhoods were impacted more by the pandemic. Guest: Sara Mayo, Social Planner - Geographic Information Service, Social Planning and Research Council of Hamilton

What planning must you do for the inevitable new normal? What we know is - fundamentally the pandemic is changing some big factors in society from economy to technology. We know need to be on top of that because we need to understand where our role is as brands and it's uncertain, that play out that will happen is an uncertain future, so how do you plan for uncertainty?Website: http://www.immediatefuture.co.uk Social profiles: ·       YouTube: https://www.youtube.com/user/IFTubes ·       Facebook: https://www.facebook.com/ImmediateFuture/ ·       LinkedIn: https://www.linkedin.com/company/immediate-future/ ·       Twitter: https://twitter.com/iftweeter ·       Instagram: https://www.instagram.com/ifinstas/ Welcome to the Serious Social podcast, created by the straight-talking social media experts at immediate future.How to plan your social media for tomorrow, today.   This episode was recorded live on Facebook, on Friday 3rd April 2020.  Katy - Hi, my name is Katy Howell, I'm CEO at immediate future, and welcome to our Serious Social live from our homes. Today I'm going to talk a little bit about something really important to do now right now, when we're busy, which is planning for tomorrow today. We have been frantic the last couple of weeks, we have been frantic. Nearly every marketing department has decamped somewhere else - homes and other places, and of course met with a completely changing society. But things are beginning to get into a place where we're kind of balancing out. We know what we need to do - now is the time to look up look at the mid-term and long- term in marketing, to understand what is changing now, what has changed, what will change down the line, and what will stay the same. So, I know we're spinning plates, but now is the time to plan. What we know is – fundamentally, the pandemic is changing some big factors in society from economy to technology. We know need to be on top of that because we need to understand where our role is as brands and it's uncertain, the play out that will happen is an uncertain future, so how do you plan for uncertainty? Well sixteen years ago, I decided to launch a social media agency before there was a thing called social media, and one of the things I've learned in 16 years is how to plan when you have no idea what the future holds! None! I had no idea whether or not Twitter would take, I didn't even know MySpace would disappear. I had to plan for a changeable environment, so I thought I'd help you guys, and help myself as well by thinking through what it is - what are the fundamentals we need to do right now to think for the future. Why is that important to us to do it now?For full show notes, view our podcast page: http://immediatefuture.co.uk/podcasts/

Several neighbourhoods in our city were without power yesterday. Rachel Bertone is a media spokesperson with Alectra Utilities and joins Rick to provide an update. Guest: Rachel Bertone Media Spokesperson, Alectra Utilities Police reported 400 crashes and urge caution Monday morning as storm causes chaos in GTA. Guest: Kerry Schmidt, Sergeant - Media Relations, Highway Safety Division, Ontario Provincial Police. 45% of Hamilton renters living in unaffordable housing. Which neighbourhoods have a higher number of eviction rates and renters? Guest: Sara Mayo, Social Planner - Geographic Information Service, Social Planning and Research Council of Hamilton. Recently it was decided that autonomous cars will be tested on some of Hamilton's roads. Why is the testing good for Hamilton's economy and what do we get out of it? Guest: John-Paul Danko, City of Hamilton Councillor for Ward 8. Hamilton's transit union has filed for a No Board Report with a vote of 97.6%, which will start the clock towards a strike or job action.Guest: Eric Tuck, President, ATU 107.

City council, after a very long meeting, decided to release the documents relating to the Cootes Paradise sewage spill and apologize. Guest: Laura Babcock. President, PowerGroup. The City of Hamilton is facing a rental crisis where monthly rent prices and evictions are soaring. Guest: Sara Mayo, Social Planner - Geographic Information Service, Social Planning and Research Council of Hamilton. Dale King, the accused in the shooting death of Yosif Al-Hasnawi, was found not guilty yesterday. The jury said that he had acted in self defence. Guest: Ari Goldkind, Toronto Defence Lawyer.   

This week, the Social Planning and Research Council in Hamilton and the Hamilton Roundtable for Poverty Reduction revealed the new living wage for the city which is $16.45 an hour. Guests: Tom Cooper, Director of the Hamilton Roundtable for Poverty Reduction Judy Travis, of Living Wage Hamilton Katherine Kalinowski, of Good Shepherd

This week, the Social Planning and Research Council in Hamilton and the Hamilton Roundtable for Poverty Reduction revealed the new living wage for the city which is $16.45 an hour. Guests: Tom Cooper, Director of the Hamilton Roundtable for Poverty Reduction Judy Travis, of Living Wage Hamilton Katherine Kalinowski, of Good Shepherd - Yesterday Andrea Horwath, leader of the NDP, called on thegovernment for action on overcrowding in hospitals. She referenced Juravinsky Hospital saying that it is already over capacity, at 110%. She joined Bill to discusses the issue of overcrowding and what needs to be done, as well as Premier Ford's disparaging comments about the city. Guest: Andrea Horwath, leader of the Ontario NDP - Yesterday at Queen's Park, the Premier said that the provincial NDP along with the former Liberal government “destroyed” the city of Hamilton and that the credit for our improving economy should go to MPP Donna Skelly and the Ontario government. This has not gone over well with many Hamiltonians – including hometown rockers, Arkells – which is a fairly predictable outcome. So why did the Premier say this, what will the fallout be, and can this disparaging comment be turned into an opportunity?   Guest:  Laura Babcock. President, PowerGroup

Four of the political party leaders will partake in the French debate tonight, including Trudeau. Guest: Henry Jacek. Professor of Political Science, McMaster University. A report with the Social Planning and Research council has revealed some of the upfront and unseen expenses faced by students at school. How do these costs affect low income students? Guest: Lyndsy Baillie, VP at Glendale and lead member of the steering committee that worked on the report.  Donald Trump has called the recent impeachment proceedings against him a “COUP” that was intended to take away “the God given rights” of American citizens. Is the impeachment proceedings rattling him more than the Mueller report was? He has also retweeted the words of a pastor who stated that a “Civil War like fracture” would occur if he was impeached.  Guest: Brian J. Karem. Executive Editor - Sentinel Newspapers/ WH reporter for Playboy/ Political analyst at @CNN

In this episode of The Stories Behind the Bet, Philip James discusses the National Center for Responsible Gaming’s research efforts and the significance of Responsible Gaming Week with Dr. Russell Sanna. As America embraces and normalizes gambling, it’s important to teach responsible gaming at the same caliber as safe sex or defensive driving. While awareness doesn’t usually radically change public behavior, events like Responsible Gaming Week create a much-needed dialogue for stakeholders, researchers, and industry members alike. Dr. Russell Sanna joined the National Center for Responsible Gaming in 2016. He has an extensive background in many fields; an expert resource developer, Sanna has acted as the Executive Director of the Harvard Medical School Division of Sleep Medicine, the Associate Dean for External Relations at the Harvard Design School, the Assistant Director of the Harvard Art Museums, and the Assistant Superintendent of the Solomon Mental Health Center in Lowell, MA. Dr. Sanna holds a PhD in Policy Analysis from the Heller School of Social Policy and Management at Brandeis University, a master’s degree in Social Planning from the Boston College Graduate School of Social Work, and an undergraduate degree in Sociology from the University of Wyoming. SUMMARY In this episode, the following topics are discussed: – Dr. Russell Sanna introduction – NCRG’s unbiased research – U.S. sports wagering research – The thread that connects Sanna’s careers – The importance of Responsible Gaming Week by the American Gaming Association – Normalizing gaming terminology – Green buildings and LEED – Recognizing industry efforts (MGM and GameSense) – The need for responsible gaming research – NCRG’s new fund for sports wagering research – Bird’s eye view of responsible gaming solutions – Responsible Gaming Week specifics – Self-exclusion as a responsible gaming practice – Final thoughts  NOTES The National Center for Responsible Gaming Sports wagering Responsible Gaming Week The American Gaming Association Green building/LEED NPR: “Banning Gas Is The Next Climate Push” MGM’s commitment to GameSense Self-exclusion gambling Reach out to episode guest Russell Sanna or follow the NCRG on Twitter. About No Line Media No Line Media features stories behind the bet — a look behind the scenes of gaming — as told by the people, the gamblers, the prop makers, the payment providers, the innovators, and those in the forefront of the industry. Hear from sports betting legends and leaders shaping the future. Hosted by Philip James Beere. No Line is sponsored by Play+. About Play+ Play+ is a payment platform, developed by Sightline, and used by leading brands nationwide, including Draft Kings, Fan Duel, Caesars, MGM, William Hill, Mohegan Sun, Boyd, Station Casinos, and many others. Play+ is leading the industry toward cashless and an integrated resort experience, guaranteeing a better user-experience that promotes speed, security, and ease — all from the convenience of one’s phone. Sightline is committed responsible gambling. Listen to all episodes on iTunes      

The Scott Thompson Show Podcast - This morning, the mayor woke to 20 agitators outside his home, swearing and planting signs that say “Our Mayor doesn't care about Queer People.” We play Mayor Eisenberger's interview with Bill Kelly.And then Scott speaks with Deirdre Pike about the state of the community, hours before she was appointed to the position of special advisor for a community-wide action plan to address 2SLGBTQ+ community initiatives. Hear more in the Bill Kelly Show podcast, available on Google Podcasts, Apple Podcasts, Spotify and all of the same places you find the Scott Thompson Show. Guests: Mayor Fred Eisenberger Deirdre Pike, Senior Social Planner, Social Planning and Research Council of Hamilton - Last night was the democratic debates, part two. How did they do? Guest: Reggie Cecchini, Washington Producer and Correspondent with Global News based in Washington D.C. - An Ontario court has ruled that the federal government's carbon pricing law is constitutiona. But should the federal Liberals scrap the carbon tax anyway? Guest: Aaron Wudrick, CTF Federal Director

A report from the Social Planning and Research council says that Hamilton's poverty rate has dropped by nearly a quarter over the past two decades. Guest: Sara Mayo, Social Planning & Research Council of Hamilton. Guest: Kim Martin, Social Planning & Research Council of Hamilton.

A report from the Social Planning and Research council says that Hamilton's poverty rate has dropped by nearly a quarter over the past two decades. Guest: Sara Mayo, Social Planning & Research Council of Hamilton. Guest: Kim Martin, Social Planning & Research Council of Hamilton. Wesley Urban Ministries is shutting it's day centre down in downtown Hamilton. What exactly happened to cause the closure? Gust: Andrea Buttars, Manager of Resource Wesley Urban Ministries. Hamilton's public school board says that it will no longer offer 173 courses planned for next year due to the changes in the education (class sizes, budget cuts, etc). Guest: Alex Johnstone, Trustee, Hamilton Wentworth District School Board.

The Saudi Arabia-Canada spat continues. Should Canada get itself involved in the business of other countries? Why are none of Canada's allies calling out Saudi Arabia? Guest: Stephanie Carvin, Assistant Professor of International Affairs, Carlton University - With Ontario backing out of the basic income pilot, should the federal government pick up the slack? The program costs about $50 million a year and with its short life-span, is it worth seeing it through to the end to see what data it produces? Guests: Deirdre Pike. Senior Social Planner, Social Planning and Research Council of Hamilton Alex Pierson, Host of On Point with Alex Pierson, Global News Radio - New details have been emerging over the Fredericton shooting. What's the latest? And The Taste of the Danforth festival was a mix of celebration and remembrance following last month's shooting. Guest: Ross McLean. Crime Specialist. Security expert, Former Toronto Police Officer

With Ontario backing out of the basic income pilot, should the federal governmentpick up the slack? The program costs about $50 million a year and with its short life-span, is it worth seeing it through to the end to see what data it produces? Guest: Deirdre Pike. Senior Social Planner, Social Planning and Research Council of Hamilton (Photo: Global news File)

Welcome to Grandmothers on the Move! I’m your host, Ilana Landsberg-Lewis, and today I have the great honour to speak with Malena de Montis. A participant in the Sandinista Revolution in Nicaragua that overthrew the Somoza dictatorship, and then a Director of Social Planning in the new government of Daniel Ortega. Malena left the FSLN party in 1989 to establish the Centre for Democratic Participation and Development, and as a feminist leader has written books about feminism, empowerment and popular education and power. Power, and transformative power is a theme that runs through Malena's work in Nicaragua, and extensively on the international stage, always connected to the grassroots, always thoughtful, she is a force, and a passionate advocate for peace, women's rights, and now, in a terrible moment of government tyranny, an important dissenting voice. Grandmothers – from the living room to the courtroom – making powerful contributions in every walk of life. We know them most intimately as loving caregivers, the older women in our lives with a thousand stories about their grandchildren and pictures in their purses. In this podcast, you’ll come to know even more about our Grandmothers – they are galvanized, determined and are guaranteed to get you thinking! What drives them? What are they up to? What is the potential of Grandmother power, and how is it changing the world?! Grandmothers are on the move…you don’t want to be left behind!

Sean Meager, Executive Director, Social Planning Toronto talks about Toronto getting older and more isolated.

Hamilton City Council right now is looking at a new law that would limit the number of payday loans to one in each ward, a max of 15. Is this a wise idea? Guest - Sara Mayo, Social Planning and Research Council of Hamilton

The date for the announcement of the new leader of the Ontario PC party draws nearer and we chat with one of the candidates: Christine Elliot. Guest - Christine Elliot, Ontario PC Leadership candidate Hamilton City Council right now is looking at a new law that would limit the number of payday loans to one in each ward, a max of 15. Is this a wise idea? Guest - Sarah Mayo, Social Planning and Research Council of Hamilton The fall out over allegations against Hedley continues as the band withdraws from consideration for three awards at the Junos this year. They say they plan to talk about how they've let people down and their plan of attack going forward. However, they will not be cancelling their shows. Guest - Kamil Karamali Reporter, Global News Toronto

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Photo: (Chip Somodevilla/Getty Images) The Federal government has detailed a 10 year national housing strategy which includes the introduction of a housing benefit for families. Guest: Peter Milczyn, Minister of Housing and Minister Responsible for the Poverty Reduction Strategy. Guest: Renee Wetselaar, Senior Social Planner with the Social Planning & Research Council of Hamilton.  Hamilton Mountain NDP MPP has called on the Wynne government to stop its plan to let Hamilton's new GO stations to sit empty. Guest: Monique Taylor. Hamilton NDP MPP.  The Grey Cup is fast approaching. What is the atmosphere like in the days leading up to the event? Guest: Mike LeCouteur, Global National Ottawa Correspondent. The US FCC plans to scrap the net neutrality rules put in place during Barack Obama's presidency. How will this affect the average consumer? Guest: Ryan Singel, Media and Strategy Fellow, Center for Internet and Society, Stanford Law School.

What if the key to growing a vibrant city isn’t in endless suburbs or more condo projects? What if, instead, it lay right in our backyards? Hamilton’s Emma Cubitt sees big potential in small houses lining the city’s laneways. Along with Good Shepherd Hamilton and the Social Planning and Research Council, Cubitt — a 37-year-old … Continue reading Emma Cubitt: “[I want] a community where we can all live together” →

HOT SPOT HAMILTONHamilton was chosen earlier this year to be a part of the basic income pilot project. How would a basic income help those in the city? Are we doing enough to help our poor? Guest: Deirdre Pike, Senior Social Planner, Social Planning and Research Council of Hamilton

Hot Spot Hamilton Today we are taking a look at the issue of poverty in our city. What arewe doing to assist our most vulnerable? Guest: Carol Cowan, Executive Director, Mission Services.Guest: Todd Bender, City Kidz. Guest: Tom Cooper, Social Planning and Research Council.  What issues do Hamiltonians face when it comes to low income housingand how do we get better? Guest: Renee Wetselaar, Social Planning and Research Council. Guest: Shawn MacKeigan, Director of Men's Services, Mission Services. Guest: Chad Collins, Ward 5 Councillor, City of Hamiton.

HOT SPOT HAMILTONHamilton was chosen earlier this year to be a part of the basic income pilot project. How would a basic income help those in the city? Are we doing enough to help our poor? Guest: Deirdre Pike, Senior Social Planner, Social Planning and Research Council of Hamilton(Photo: Thinkstock)

The City of Hamilton is pushing forward with a plan to implement tiny homes for the homeless and to put some of these homes down Hamilton's laneways. Guest: Renee Wetselaar, Senior Social Planner with the Social Planning & Research Council of Hamilton - The Ontario Energy Board has rejected a request from Hydro One to increase its administrative costs and to spend more capital projects. The decision comes as part of a review of the 2016 hike request from the company, which if approved, would see rates jump this year and 4.8 % by next year. Guest: Sarah Warry-Poljanski, founder of Hamiltonians Against High Hydro - According a poll conducted by Ekos Research, the federal Liberal and Conservative parties are statistically tied for support, while the NDP remain a distant third. How much of challenge does this pose for the Prime Minister and the opposition leaders? Guest: Peter Graefe, Professor of Political Science, McMaster University

Income growth in our city was the highest of Ontario's five largest metropolitan areas according to census data that was released yesterday, which included a drop in the poverty rate. The issue though? Ontario's performance has lagged far behind every other province and territory in the country. Guest: Sarah Mayo, Social Planning and Research Council of Hamilton.

Councillor Donna Skelly says she will introduce a notice of motion for an audit to look into the Waterfront Trust's finances at a GIC meeting next month. Guest: Donna Skelly, City Councilor for Ward 7. Income growth in our city was the highest of Ontario's five largest metropolitan areas according to census data that was released yesterday, which included a drop in the poverty rate. The issue though? Ontario's performance has lagged far behind every other province and territory in the country. Guest: Sarah Mayo, Social Planning and Research Council of Hamilton. The CFL and the CFL Players Association have announced that effective immediately, all practices that are fully contact will be discontinued during regular season. Next year, teams will also get an extra bye week to reduce the risk of player injury. Guest: Scott Radley. Host of “The Scott Radley Show”, Columnist for the Hamilton Spec.

Photo: (AP Photo/Tony Gutierrez) Ontario's Labour Minister is promising changes to legislation that will encourage companies to hire people full-time. This comes due to the rise in temporary, precarious work. Guest: Dierdre Pike, Senior Social Planner with Social Planning and Research Council.

Photo: (File / Global News) A meeting was held yesterday where regular business owners spoke with local MP's Filomena Tassi and Bob Bratina in regards to their concerns and feelings on the proposed federal tax changes. Guest: Bob Bratina, former Hamilton Mayor, Liberal MP for Hamilton East-Stoney Creek. Hamilton City Councilors are asking for less consulting and more in-house work on city projects. This comes after an auditor's report that focused on our city's use of outside experts. Guest: Dan McKinnon. General Manager, Public Works. Ontario's Labour Minister is promising changes to legislation that will encourage companies to hire people full-time. This comes due to the rise in temporary, precarious work. Guest: Dierdre Pike, Senior Social Planner with Social Planning and Research Council.

Are we in a crisis when it comes to low income housing? There have been people that were living on a vacant brownfield near the waterfront that have been evicted from the site. How do we solve this issue? Guest: Renee Wetselaar, Senior Social Planner with the Social Planning & Research Council of Hamilton.

The Hamilton Waterfront Trust has lost its charitable status. This is because the CRA says the work it does is not ‘exclusively charitable'. Guest: Jason Farr, City Councillor, Ward 2. Are we in a crisis when it comes to low income housing? There have been people that were living on a vacant brownfield near the waterfront that have been evicted from the site. How do we solve this issue? Guest: Renee Wetselaar, Senior Social Planner with the Social Planning & Research Council of Hamilton. Earlier this week, there was a story about how rats had invaded a Hamilton townhouse complex. Why are we seeing more of the rodents? What problems do they bring and are they difficult to get rid of?  Guest: Jim Miner, President of Action Pest Control Services Inc. 

Photo: (@HamOntFringe/Twitter) Posters for some plays that were featured as part of Hamilton's Fringe Festival were defaced over the weekend. Placed on the posters were pieces of paper with verses from the bible that attack the plays' LGBTQ and feminist messages and themes. Guest: Deirdre Pike, Senior Social Planner with Social Planning and Research Council.

Ward 15 Councillor Judi Partridge and MPP Ted McMeekin will be running in the provincial election in 2018. What made her come to this decision? Guest: Judi Partridge, Ward 15 Councillor, City of Hamilton. Posters for some plays that were featured as part of Hamilton's Fringe Festival were defaced over the weekend. Placed on the posters were pieces of paper with verses from the bible that attack the plays' LGBTQ and feminist messages and themes. Guest: Dierdre Pike, Senior Social Planner with Social Planning and Research Council. Chief's Townhall with Hamilton Police Chief Eric Girt

Photo: (U.S. Air Force photo/Airman 1st Class Daniel Brosam) A report on Ontario labour laws in Ontario was released on Tuesday, recommending 173 changes to workers' rights. What will these changes, if implemented, mean for individual employees, unions, and employers? Guest: Sarah Mayo, Social Planning and Research Council of Hamilton.

Police in Manchester say they're arrested 3 more individuals in connection with the concert bombing that killed 22 people. They are attempting to establish whether bomber Salman Abedi acted alone or whether there is the possibility of more attacks. Guest: David Videcette, a terrorism expert and author of The Theseus Paradox. Hamilton Ward 4 Councillor Sam Merulla is proposing a program in which individuals on fixed incomes with health issues that are worsened by extreme heat be provided air conditioners. These are people who would otherwise require intervention and displacement to cooling centers. The idea is already in use in New York State, where some individuals receive cooling assistance. Guest: Sam Merulla, Hamilton City Councillor, Ward 4. Due to relentless rain throughout the spring, Hamilton has been forced to dump untreated sewage into the harbor. This is an issue that varies dramatically from year to year. Guest: Dan McKinnon. Director, Hamilton Water. A report on Ontario labour laws in Ontario was released on Tuesday, recommending 173 changes to workers' rights. What will these changes, if implemented, mean for individual employees, unions, and employers? Guest: Sarah Mayo, Social Planning and Research Council of Hamilton. Guest: Lior Samfiru, Employment Lawyer at Samfiru Tumarkin LLP Barristers & Solicitors.   A new study says that the children of parents who refuse to vaccinate them face harsh treatment from others. Other children often do not sit with them, work on school projects with them or have playdates arranged. The judgement faced by the child is considered to be greater than that of the parent. Guest: Maureen Dennis, Mom of Four, Parenting Expert and Founder of Wee Welcome.ca

Manchester suffered what police are calling a terrorist attack at an Ariana Grande concert last night. The explosion at Manchester Arena killed 22 people, including children, while leaving 59 injured. The Islamic State has taken credit for the attack, though they've provided no evidence. Guest - David Harris, Insignis Strategic Group. Terrorism expert NYC Pride has invited Toronto Police officers to march in their parade this summer, in uniform. The two parades are scheduled to take place on the same week. Guest - Dierdre Pike, Senior Social Planner with Social Planning and Research Council How are Toronto Police responding to this news? Will they take up NYCPride on their offer? Guest - Mike McCormack, President of the Toronto Police Association Renegotiation of NAFTA have forced the Hamilton Chamber of Commerce, along with others such as those in Windsor-Essex and Sault Ste. Marie, to launch surveys to companies in the steel food chain to figure out who's health is contingent on the Canada-US agreement. Given how much is known about America's goals in renegotiations, how can we prepare for those changes? Guest - Huzaifa Saeed, Policy and Research Analyst with the Hamilton Chamber of Commerce.

After another marathon meeting, the LRT project's Environmental Assessment has been held off another week. Is this death by delay? What are the thoughts of some of the city councilors? Guest: Sam Merulla. City Councillor, Ward 4, City of Hamilton.  Guest: Terry Whitehead. City Councillor, Ward 8, City of Hamilton. Ontario this morning announced what actions they are taking to make housing for Ontarians more affordable. Some of those options include a 15% foreign buyers tax as well as expansion of rent control. Guest: Ted McMeekin. MPP, Ancaster-Dundas-Flamborough-Westdale, Ontario Liberal Party. Are these actions going to do anything to make housing affordable? Guest: Sara Mayo, Social Planning and Research Council of Hamilton.  Affordable housing actions continued… Guest: Vic Fedeli, Conservative MPP for Nippissing, Finance Critic.

According to Hamilton Food Share, about 80% of food bank users in the city are spending half of their household income towards rent. Guest: Dierdre Pike, Senior Social Planner with Social Planning and Research Council.

The City of Hamilton will not be pushing through a request to study about the feasibility of turning Gore Park into a protected heritage district. Guest: Jason Farr. City Councillor, Ward 2, City of Hamilton Should Hamilton be taking precautions now when it comes to the rock face along the escarpment edge? Guest: Dan McKinnon. General Manager of Public Works. Guest: Carolyn Eyles, Professor at the School of Geography & Earth Sciences. Director of Integrated Sciences Program, McMaster University. According to Hamilton Food Share, about 80% of food bank users in the city are spending half of their household income towards rent. Guest: Dierdre Pike, Senior Social Planner with Social Planning and Research Council. Guest: Joanne Santucci, Executive Director of Hamilton Food Share.

A report by the Social Planning and Research Council says that poverty is still a major issue in the lower inner city and that 1 in every 5 children are impoverished. Guest: Sara Mayo, Social Planning and Research Council of Hamilton.

Should the replacement for departing deputy chief Ken Weatherill be replaced with a civilian administrator? Guest: Lloyd Ferguson. City Councillor, Ward 12, City of Hamilton. – A report by the Social Planning and Research Council says that poverty is still a major issue in the lower inner city and that 1 in every 5 children are impoverished. Guest: Sara Mayo, Social Planning and Research Council of Hamilton. The results of Ontario's first cap-and-trade auction are expected today. This system is aimed at lower green house gas emissions. How does this entirely work? Guest: Ian Lee. Sprott School of Business. Carleton University.

A pitch will be going forward to council for adding a splash of colour to the International Village. They'd like to install a “rainbow crosswalk” to celebrate inclusiveness and celebrate the LGBTQ community. Is the rainbow cross walk a good idea?Deirdre Pike. Senior Social Planner, Social Planning and Research Council of Hamilton.

A pitch will be going forward to council for adding a splash of colour to the International Village. They'd like to install a “rainbow crosswalk” to celebrate inclusiveness and celebrate the LGBTQ community. Is the rainbow cross walk a good idea?Deirdre Pike. Senior Social Planner, Social Planning and Research Council of Hamilton. Canadian military commanders have been warned that veterans that suffer from mental illnesses are being bullied by fellow soldiers online. The fear is that due to this, it could prompt some to commit suicide. Michael Blais. President & Founder of Canadians Veterans Advocacy. The City of Hamilton is looking at resurrecting a graffiti fighting plan that would help targeted homeowners.Sam Merulla. City Councillor, Ward 4, City of Hamilton

Pride TO says it has no plans to backtrack on Tuesday's vote that would ban police participation.   Guest: Dierdre Pike, Senior Social Planner with Social Planning and Research Council.

Premier Kathleen Wynne says that there will be more hydro relief coming before the spring budget is tabulated and released. Guest: Brady Yauch, economist and executive director with the Consumer Policy Institute. With Donald Trump's administration looking to take apart NAFTA and utilizing its own resources, how should Canada proceed with Trade. Could the world's free trade nations rally against protectionism?   Guest: Ian Lee. Sprott School of Business. Carleton University. Pride TO says it has no plans to backtrack on a vote on Tuesday that would ban police participation.   Guest: Dierdre Pike,  Senior Social Planner with Social Planning and Research Council.     Guest: Savoy Williams, Brock Student, recipient of the John Holland Award in 2015.

Can laneway homes be a housing solution in Hamilton? A report going to Public Works tomorrow explores whether it is a good idea.   Guest: Renee Wetselaar, Senior Social Planner with the Social Planning & Research Council of Hamilton.

Hydro One is going to be reviewing cases of people who have been living without electricity after a Global News investigation profiled some of the families affected and disconnected.   Guest: Parker Gallant, Vice President of Wind Concerns Ontario.   Can laneway homes be a housing solution in Hamilton? A report going to Public Works tomorrow explores whether it is a good idea.   Guest: Renee Wetselaar, Senior Social Planner with the Social Planning & Research Council of Hamilton.   A study from Statistics Canada shows the precarious position young workers face today including job quality and wages.    Guest: Marvin Ryder. Business Professor, DeGroote School of Business, McMaster University.

The City of Hamilton is another step closer to solidifying its promised transgender and gender nonconforming protocol. Dierdre Pike,  Senior Social Planner with Social Planning and Research Council

Deep within the auditor general's report, it suggests that nearly all Ontarians who heart their homes with natural gas want to see the costs of cap and trade on their bills clearly. Tom Adams. Independent Energy & Environmental Consultant. Bullying ay Hamilton's public schools seems to be getting worse. The latest annual survey on the school climate shows 40.4 percent of elementary students say they've been bullied or harassed by other students. Todd White, Board Chair and Ward 5 Trustee with Hamilton Wentworth District School Board. The City of Hamilton is another step closer to solidifying its promised transgender and gender nonconforming protocol. Dierdre Pike,  Senior Social Planner with Social Planning and Research Council.

  9:05 – A juror is not supposed to speak to a journalist during a trial. During the Badgerow trial however, a juror did reach out to a Hamilton Spectator reporter.   Susan Clairmont. Columnist, Hamilton Spec. 905-520-6838. 9:35 – As prices go up and jobs decrease, Hamiltonians are moving to areas such as Brantford, St Catharines and Caledonia just to be able to afford housing. Renee Wetselaar, Senior Social Planner with the Social Planning & Research Council of Hamilton. 905-978-1718 10:05 –Toronto Mayor John Tory says that it's time for fellow “905ers” to pay up their fair share for Toronto highways. Is it? Also: is tapping private capital for infrastructure truly a good idea? Johnathan Hall, Assistant Professor in the Department of Economics at the University of Toronto

As prices go up and jobs decrease, Hamiltonians are moving to areas such as Brantford, St Catharines and Caledonia just to be able to afford housing. Renee Wetselaar, Senior Social Planner with the Social Planning & Research Council of Hamilton

On Monday, Kathleen Wynne will unveil her government's plan to help first time home buyers. What do we know so far? Guest: Tim Hudak, CEO of the Ontario Real Estate Association. Gore Park has new benches however they are impossible to lie down or sleep on due to an armrest in the middle of the bench. Advocates are wondering whether the benches are ‘defensive architecture'. How were the benches selected? Guest: Greg Tedesco, Community Developer with the Social Planning and Research Council of Hamilton. Guest: Meaghan Stewart, Landscape Architect for the City of Hamilton. An Ontario resident and Hydro One are going head to head over delivery charges during an eight month period where the property owner's power line was disconnected. What has the cottage owner gone through so far.  Guest: Kip Van Kempen, cottage owner fighting Hydro One charges.

Hamilton has seen a steep drop in the number of children in the city of the past two decades, despite a growth in population. Why aren't Millenials having kids in Hamilton?   Guest: Sara Mayo, Social Planning and Research Council of Hamilton.

Hamilton has seen a steep drop in the number of children in the city of the past two decades, despite a growth in population.   Guest: Sara Mayo, Social Planning and Research Council of Hamilton. The group Concerned Ontario Doctors has come up with an idea to get the OMA and the province back at the bargaining table and to make the deal better for doctors.   Guest: Dr. Sohail Gandhi, Concerned Ontario Doctors. Canada's border services has started a firearms campaign to remind Americans to keep the firearms at home. How prevalent are gun issues at the border? Guest: David Hyde. Security Consultant, David Hyde & Associates.   

You can’t miss this interview as Deirdre talks about her passion for social justice, why she is a Catholic Lesbian and still loves Jesus.Deirdre Pike is a Senior Social Planner with the Social Planning and Research Council (SPRC) of Hamilton with a special interest in poverty elimination, equity, and inclusion. She is co-chair of the Hamilton Positive Space Collaborative and a leader in delivering Positive Space Training.Read her article here from the Hamilton Spectator called:How Many Churches Does It Take To Marry A Catholic Lesbian. See acast.com/privacy for privacy and opt-out information.

Taboo Talk, a Christian talk show featuring Lady Charmaine Day (Pastor, Author and Christian Consultant www.ladycharmaineday.com). Taboo Talk helps individuals transform their mind, body, and spirit utilizing the principles of Jesus Christ! Guest star Jessica Ingram-Bellamy is a nationally recognized civic and social justice issues marketing executive/consultant, civic and social issues advocate, and non-profit administrator, with over seventeen-years of experience in the areas of social welfare, corporate social philanthropy, public policy, social marketing, public relations, and external and governmental affairs. She holds a bachelor’s degree in Africana Studies & Research from Cornell University (1992), and a master’s degree in Social Administration and Social Planning from Columbia University (1996). She also completed the prestigious Women’s (Political) Campaign School at Yale (2006).  

Taboo Talk, a Christian talk show featuring Lady Charmaine Day (Pastor, Author and Christian Consultant www.ladycharmaineday.com). Taboo Talk helps individuals transform their mind, body, and spirit utilizing the principles of Jesus Christ! Guest star Jessica Ingram-Bellamy is a nationally recognized civic and social justice issues marketing executive/consultant, civic and social issues advocate, and non-profit administrator, with over seventeen-years of experience in the areas of social welfare, corporate social philanthropy, public policy, social marketing, public relations, and external and governmental affairs. She holds a bachelor’s degree in Africana Studies & Research from Cornell University (1992), and a master’s degree in Social Administration and Social Planning from Columbia University (1996). She also completed the prestigious Women’s (Political) Campaign School at Yale (2006).

SUMMARY Recovery from COVID-19 provides remarkable opportunities for transition to a just and green economy that would ultimately boost universal mental health. Policy professionals Trish Hennessy (Canadian Centre for Policy Alternatives) and Arden Henley (Green Technology Education Centre) talk about transformative concepts such as ‘doughnut economics', ‘well-being budget', ‘inclusive economy', and the ‘three-sided coin'. They also explore how lessons learned about mental health during the pandemic, can guide economic reform while informing solutions to other global challenges, such as systemic racism and climate change. TAKEAWAYS This podcast will help you understand: Role of policy in economic reform that supports social, environmental, and economic well-being Link between policy and mental health Role of all levels of government in the move toward a just and green economy that fosters mental health at all scales Alternative Federal Budget (Recovery Plan 2020) Rebuilding BC: A Portfolio of Possibilities Social solutions within a green economy; environmental solutions within a just economy Challenges such as systemic racism, poverty, and inequality in a market economy vs. solutions in a just and green economy Potential for positive change using emerging concepts such as ‘doughnut economics', ‘well-being budget', ‘inclusive economy', and the ‘three-sided coin' Economic reform and the World Health Organization Sustainable Development Goals How lessons learned about mental health during the pandemic can guide economic reform while informing solutions to other global challenges such as systemic racism and climate change Upstream approach to economic reform that supports universal mental health   SPONSOR The Social Planning & Research Council of British Columbia (SPARC BC) is a leader in applied social research, social policy analysis, and community development approaches to social justice. Lorraine Copas and her great team support the council's 16,000 members, and work with communities to build a just and healthy society for all. THANK YOU for supporting the HEADS UP! Community Mental Health Summit and the HEADS UP! Community Mental Health Podcast.   RESOURCES Canadian Centre for Policy Alternatives Think Upstream Seth Klein (The Good War) The Leap Well-Being Budget Rebuilding BC The Spiritual Level: Why Greater Equality Makes Societies Stronger by Richard Wilkinson and Kate Pickett A Roadmap to a Renaissance Amsterdam City Doughnut   GUESTS  Trish Hennessy Trish Hennessy is a senior communications strategist at the Canadian Centre for Policy Alternatives (CCPA) and director of Think Upstream, a project dedicated to policy solutions that foster a healthy society and community well-being. She is focused on the social determinants of health, sustainable development goals, income inequality, decent work, and an inclusive economy. Trish was the founding director of the CCPA Ontario, a progressive think tank that focuses on provincial and municipal social justice and economic issues. She co-founded the Ontario Living Wage Network. She was the founding director of the CCPA national office's growing gap project, which began in 2006. Trish was a former newspaper journalist, originally from Saskatchewan but now lives in Toronto. She has a B.A. Sociology from Queen's University, a B.S.W. from Carleton University, and an M.A. in Sociology from OISE/University of Toronto.  Email: trish@policyalternatives.ca Website: www.thinkupstream.ca Phone: 613-563-1341 (323) Facebook:  www.facebook.com/upstreamAction Twitter: www.twitter.com/UpstreamAction Linkedin: www.linkedin.com/in/trish-hennessy-25b9395/   Arden Henley Arden Henley is founding board chair of British Columbia's Green Technology Education Centre. He is a former Vice President of City University in Canada, and one of the founders of its Masters of Counselling program. He has a BA from McMaster, an MA from Duquesne in Pittsburgh, and a Doctorate in Education Leadership from SFU. Arden is also an Honorary Doctor of Traditional Chinese Medicine. Well known for his innovative leadership style and thought-provoking presentations, Arden consulted broadly with community and government agencies, and practiced family therapy and organizational development for more than 40 years. These experiences are outlined in his book, entitled Social Architecture: Notes & Essays.  Website: www.gteccanada.ca  Email: nwpses@gmail.com  Phone: 604.317.4128 LinkedIn: https://www.linkedin.com/in/rc-arden-henley-977752122/?originalSubdomain=ca   HOST Jo de Vries is a community education and engagement specialist with 30 years of experience helping local governments in British Columbia connect with their citizens about important sustainability issues. In 2006, she established the Fresh Outlook Foundation (FOF) to “inspire community conversations for sustainable change.” FOF's highly acclaimed events include Building SustainABLE Communities conferences, Reel Change SustainAbility Film Fest, Eco-Blast Kids' Camps, CommUnity Innovation Lab, Breakfast of Champions, and Women 4 SustainAbility. FOF's newest ventures are the HEADS UP! Community Mental Health Summit and HEADS UP! Community Mental Health Podcast. Website: Fresh Outlook Foundation Phone: 250-300-8797   PLAY IT FORWARD The move toward a just and green recovery economy becomes possible as more people learn about its social, cultural, spiritual, environmental, and economic benefits. To that end, please share this podcast with anyone who has an interest or stake in the future of mental health for individuals, families, workplaces, or communities. FOLLOW US For more information about the Fresh Outlook Foundation (FOF) and our programs and events, visit our website, sign up for our newsletter, and like us on Facebook and Twitter.   HELP US As a charity, FOF relies on support from grants, sponsors, and donors to continue its valuable work. If you benefited from the podcast, please help fund future episodes by making a one-time or monthly donation. Trish Hennessy, Arden Henley Interview Transcript You can download a pdf of the transcript here. The entire transcript is also found below: RICK  0:10 Welcome to the HEADS UP! Community Mental Health Podcast. Join our host Jo de Vries with the Fresh Outlook Foundation, as she combines science with storytelling to explore a variety of mental health issues with people from all walks of life. Stay tuned! JO  0:32 Hey, Jo here! Thanks for joining me with my two guests as we explore the emerging economics of mental health, prompted by COVID-19, and how we can mobilize a just and green recovery that enhances well-being for all Canadians. But first, a huge shout out to a major podcast sponsor, the Social Planning and Research Council of British Columbia. SPARC BC is a leader in applied social research, social policy analysis, and community development approaches to social justice, and works with communities of all sizes to build, a just and healthy society for all. Thank you for supporting the HEADS UP! Community Mental Health Podcast and the HEADS UP! Community Mental Health Summit. For more info about the summit, visit us at freshoutlookfoundation.org. Our guests today are both passionate big-picture thinkers with innovative insights and ideas about the need for economic reform as we adjust to our post-pandemic reality. Trish Hennessy is director of Think Upstream, an initiative of the Canadian Center for Policy alternatives. A former journalist, Trish earned a bachelor's degree in social work, and bachelor's and master's degrees in sociology. Her work focuses on the social determinants of health, sustainable development goals, decent work and income, equality, an inclusive economy, and well-being budgeting. Welcome, Trish, it's so great to have you here. TRISH  2:09 Great to be here. JO  2:10 Before we get into the discussion about the link between mental health and economy, can you tell us a little bit about the Canadian Centre for Policy alternatives?  TRISH  2:22 Absolutely. We're an independent, nonpartisan think tank that has been advancing policy solutions to promote greater equality, social inclusion, as well as social and economic resilience and sustainability. I work out of the national office, which is based in Ottawa, and the national office is actually celebrating its 40th anniversary this year…we're one of the older think tanks. We also have offices in BC, Saskatchewan, Manitoba, Nova Scotia, and Ontario… I founded the Ontario office in 2012. Those offices focus on provincial and municipal issues, whereas the national office tends to focus on national issues. Sometimes we go into sub-national as well. JO  3:06 So how much of the work you do relates to mental health? TRISH  3:09 I think mental health and physical health are deeply intertwined, and the pathways toward improved mental and physical health include access to adequate income, to decent work, to an inclusive economy, to an economy that leaves no one behind and that protects the health and well-being of both our people and our planet. So, all of the Canadian Centre for Policy Alternative's work intersects on that front... is kind of like the hip bone's connected to the leg bone. If you leave one of those things out, you have worsening mental and physical health outcomes. So, we look at those social determinants of physical and mental health. JO  3:50 When we spoke to prepare for this podcast, you said that policy is "behind everything that shapes our world." Now, I'm sure that, as a policy wonk, you can elaborate on that. First, what is policy? And why is it important for us moving forward toward better mental health? TRISH  4:11 Year in and year out, governments at every jurisdictional level... whether it's local, provincial, or federal... make decisions and policies that affect our lives, for good and for bad. [In 2020], for example, [we saw] the federal government make a series of rapid policy decisions in the face of COVID-19 to create income security programs to try to soften the blow for the millions of workers who lost their job or their working hours due to the necessary economic lockdown in the spring [of 2020]. The government quickly realized that its previous policy for unemployed workers... the unemployment insurance system... wasn't designed for a moment of mass unemployment like we experienced at that beginning of the global pandemic. And we're still experiencing a lot of unemployment when you compare it historically. So, the federal government created CERB, the Canadian Emergency Response Benefit, and it's like a form of income guarantee for those who couldn't work at the start of the economic pause, so that we could all shelter down and give public health officials a chance to implement policies to try to get ahead of the virus, and limit the spread, and make sure that our hospitals weren't surged to beyond capacity. And that is about as dramatic an example as you can get for how governments make policies that, in this case, save millions of people's lives in Canada. And it's so important because the number-one job of any government at any jurisdictional level is to protect public well-being. And governments don't always live up to that task, but governments who succeed use wise and strategic policies to get there. JO  5:53 What types of policies affect public health in general, and mental health in particular? TRISH  5:59 Public health is like this great invisible infrastructure of experts and health care experts, whose number-one job is prevention. They promote vaccines to prevent people from getting the chicken pox or the flu. They promote safe consumption sites to prevent even more deaths in the opioid crisis that's rippled across Canada. Because we are living in the age of a global pandemic, they promote policies to protect the public. Public health officials are usually rarely visible, but now they're hugely visible. We see them on the daily news advising us to physically distance, to wear masks when we can't physically distance, to wash your hands, to protect ourselves against COVID-19. But the meat and potatoes of their work in a pandemic still kind of remains invisible. They're tracking the epidemiology of the virus, they're contact tracing, they're following up with those who are infected with COVID-19… and a lot of that isn't in front of the public eye. And yet that invisible work is what saves lives and what guides government policies to either reopen the economy or, like what's happening in Toronto where I live, to return to a modified stage two. We can't eat indoors in restaurants, the bars are closing, the gyms are closing, all to avoid swamping our hospital system, because there's a disconcerting rise in COVID cases here and in other places in Ontario, as well. And so that's public health, quietly in the background, trying to keep the wheels on the bus. JO  7:35 What about the mental health meat in all of that? TRISH  7:38 In terms of mental health policies, I think we have a long way to go to get to that preventative phase of mental health issues. Most of the policies that are in place are there to help you after you've developed a mental health issue, and even then those policies are inadequate to the task... we treat the symptoms downstream. A lot of people don't have access to mental health services. Many people can't afford them. They can't afford to go to the private market, and the public sector has not created a robust plan here. I'm actually hoping that the pandemic is the push that our governments need to invest in a national mental health plan. It's something that the federal government has promised to do in its recent throne speech. It's a long time coming. And I think with COVID-19, we're going to see a rise in mental health issues and anxieties, depression, agoraphobia for people who are going to be afraid to go out after staying sheltered for so long. And so, we're still at the baby stages of a mental health system that is more upstream in nature and that prevents things that get to the root of mental health issues. JO  8:52 I know we don't have any details, or either a firm commitment for a national mental health plan, but what might that look like to you? TRISH  9:01 A national mental health plan for me would look like what a national dental plan should look like, too, because it's in the same boat. We don't have a holistic, universal public health system right now. You can get treated if you break a bone in your arm or your leg... you can walk right into a hospital and they'll fix you up. But you can't necessarily get treated if you've got something wrong with your teeth, or if you're in emotional distress. And so, it would be a coherent, coordinated plan, where just like I can walk into my family doctor to talk about an infection that I have, I would be able to walk into a mental health facility and immediately access counseling. But that's still addressing an [existing] mental health issue. A really upstream mental health national plan would look at those social determinants of health. There's just tons of research that shows that if people have adequate access to safe and clean and affordable housing, if they have food security, if parents have access to affordable, high-quality childcare... all of these are supports that take a lot of the pressure off of a household. And they can influence the amount of mental health issues that are out there. When we think about mental health, we tend to think about what you personally can do to work through a depression or through anxiety. But it's so interrelated with everything else, like how we live, and whether we're poor, whether we're scrounging to earn next month's rent and worried about getting evicted, which many people in the middle of this pandemic are worried about. So, thinking about health in all policies, not just a mental health plan, but every federal ministry, every provincial ministry, would look across all of their departments and ask what investments would actually fuel greater mental health? And it's a holistic approach. It's big. JO  11:03 Are there any countries actually doing this kind of massive policy change and implementation of great programs like what you're discussing? TRISH  11:14 I'm really inspired these days by New Zealand. The Prime Minister of New Zealand has basically said GDP growth isn't your measure of success, because if you don't have public well-being, then it's failure. And so, in New Zealand, they're investing in well-being budgeting, and that includes investing in mental health initiatives, investing in inclusion and empowerment of indigenous communities, investing in climate change interventions, because if you don't have a healthy climate, you can't even have a healthy economy. So, she's kind of flipping the conversation where I think, for far too long and certainly in Canada, we have politicians who look at the job growth [and say] we're doing great. But the questions I asked are: Is that job growth part-time, crappy wages, where you don't even earn a living wage? Is every job that we're creating a good job that has a living wage that is not precarious, where you can actually plan for a future where you might have benefits at work in case you get sick… if you need prescription drugs? Those sort of things. That is a worldview that is counter to just looking at GDP growth and job growth. It's not asking how big is the growth, what's the percentage? It's asking about who's impacted by that? And are we lifting everyone up? JO  12:44 For each of the past 25 years, the Canadian Centre for Policy Alternatives has released an Alternative Federal Budget. These what-if exercises outline what the federal government could do differently to ensure and integrate social, environmental, and economic well-being. This year's Alternative Federal Budget is called ‘A Recovery Plan' that closes the chapter on the old normal, because it says the status quo after COVID-19 is no longer an option. "This is our chance to bend the curve of public policy toward justice, well-being, solidarity, equity, resilience, and sustainability." The plan goes on to say that economic issues can't be disconnected from everything else, and promotes a health-in-all-policies approach, "because if this pandemic has taught us anything, it's that public health is the requirement for economic health." So, Trish, in keeping with these quotes, tell us about the key principles and recommendations outlined in your recovery plan. TRISH  13:56 As we were writing that recovery plan, it wasn't lost on us that it's the 25th anniversary of the Alternative Federal Budget that we've been putting out every year that the federal government could take up to reduce income inequality, to battle climate change, etc. So, our recovery plan, it's like a weighty document… it's 200 pages long. We work with civil society organizations from across Canada, they help inform this document. So, obviously, I can't tell you everything in it because it's quite a commitment. But the key principles are we're advancing income security, and that to me is the core role of public policy. It's to ensure that those who are getting left behind by an economy that has been growing, but the benefits of economic growth have been growing disproportionately to those who are at the highest end of the income ladder, while more and more people are getting left behind. We promote income security for the unemployed, for people who can't get into the labour market, and we promote ideas of income adequacy as well. And if you look provincially, anyone on social assistance is trapped in poverty. Social assistance is hugely inadequate, and we think that has to be addressed. We look for income security and income adequacy, but we also look at four supports for households and individuals. I was just saying earlier about the social determinants of health, affordable housing, food security, and affordable, universal public childcare. All of these are key to helping people not only survive, but to thrive, and no full economic recovery is possible without these things, and especially with childcare, since right now, in the middle of this pandemic, too many women are actually stepping out of the paid labor market because of the lack of childcare. We're seeking an explicit equity-seeking agenda to address anti-black, anti-Asian, and anti-Indigenous racism and discrimination. And we know that COVID-19 has disproportionately affected these communities in terms of work, their ability to safely quarantine, and we've seen a rise in anti-Asian racist incidents during COVID-19. And there are higher incidences of COVID-19 among black communities, especially being tracked in Toronto and Montreal. So, we're taking a racial and gender equity strategy. And last but not least, we're also promoting a caring economy and a public health agenda. This includes investments in long-term care. We've seen far too many vulnerable seniors who have been impacted by COVID-19 outbreaks in long-term care facilities, as well as personal support workers who were not protected in the workplace from COVID-19. We're promoting investments in home care. We do think it's time for a universal pharmacare plan and the throne speech, once again, promises that there's one around the corner. And then the creation of a universal mental health care plan, as we've already discussed. We address climate change. We address trade issues, taxation, how we pay for it all. You name it, there's a chapter on it. JO  17:15 What's the URL if people want to get more information about the plan? TRISH  17:20 www.policyalternatives.ca. JO  17:23 For this plan to work, we'll need political and administrative buy-in from all levels of government, I assume. TRISH  17:31 Over 25 years, let me tell you, it's been a long uphill climb. We've had our victories, and particularly, it's kind of notable to me, particularly in moments of economic crisis, we've noticed governments are a little bit more ready to act on some of our recommendations. In the 2008-2009 global recession, we wrote an Alternative Federal Budget plan to get through the worst of that. Surprisingly, the Stephen Harper government implemented a number of our recommendations at that time, which kind of surprised us, but we were happy to see it happen. And then, again, now we're in the middle of a crisis, and we're seeing the federal government, now it's a Liberal government, and we're seeing them implement a number of the policies that we're advocating for, partly because what we're advocating for, it just makes sense. It's like we suddenly noticed public health, it's suddenly visible in the middle of a pandemic. Problems that need to be fixed, like employment insurance, suddenly become glaringly obvious in the middle of a pandemic, or a global economic crisis. The sad thing is, had more governments taken up these policy recommendations over the years, we would have been more prepared for all of this because it wasn't a surprise that employment insurance wasn't up to the task. We've known for more than a decade, that far too many unemployed workers didn't even qualify for employment insurance. And if they did qualify, it still isn't adequate. Because, remember, I was talking earlier about the importance of income adequacy. It's one thing to provide income benefits to Canadians, but if you're trapping them in poverty, you're actually just perpetuating cycles of poverty. And that's bad policy decision-making. So, long story short, we've had our moments. We do feel like there's greater receptivity to our just recovery plan because these are just obvious solutions. But I would just submit that they shouldn't just be obvious in the middle of a crisis or an emergency. If we'd had investments in these policies decades ago, we would be fighting a pandemic from upstream instead of downstream. JO  19:53 To talk more about the provinces' role in recovery and some options that are being explored in British Columbia, I welcome our next guest. Arden Hanley is Board Chair of the Green Technology Education Centre in BC, which has recently established the Council for the Green New Economy. With a Doctorate of Education, Arden is former vice-president of City University in Seattle. His recently published book, entitled Social Architecture: Notes and Essays, summarizes his 35 years experience as both a family therapist and organizational development consultant. Hello, Arden. And thanks for joining us. ARDEN  20:36 Hi there Joanne, and hi Trish. I'm delighted to have this opportunity to have this conversation with you both. JO  20:44 So, why don't you start by telling us what we need to know about the Green Technology Education Centre. ARDEN  20:50 GTech, as we like to call it, will celebrate its fourth year in the spring of 2021. It's a nonprofit and its mission is to inform, support, and activate communities in responding to the climate crisis. JO  21:09 You recently released a report called Rebuilding BC: A Portfolio of Possibilities. Can you summarize the principles and recommendations in that document, and how they mirror the model outlined in Kate Raworth's book, Doughnut Economics? ARDEN  21:29 Let me give you a bit of background first. At the time COVID struck, we were delivering a community-based program called the Neighborhood Environmental Education Project in conjunction with Vancouver's Association of Neighborhood Houses. And basically, the objective of the program was to deliver education at a community level. We had 14 different environmental organizations make presentations at the neighborhood houses. We also held town halls to listen to the community and where they were standing in relation to the climate crisis. Then along came COVID, and we pivoted at that point and formed the Council for a Green New Economy based on some of the thinking that Trish has already shared. It was very clear to us that when COVID was said and done, there was no way we can or should return to business as usual. What's the alternative? That was our question in terms of economic recovery. What a social justice and green environment and recovery looked like was the mission of the council. The council consisted of a core seven people of economists, environmentalists, lawyers, social workers, and we then surrounded ourselves with a circle of subject matter experts in areas ranging from building retrofits to corporate social responsibility. The report, as you know, is based on what we might call ‘doughnut economy' principles, and the doughnut economy suggests that in shaping the economy, we should consider not just how much money the society is making... what the GDP is... but we should also consider the social and mental health of the society, the education of the society. We should also consider its relationship to its environment or its ecology. So, if you picture the doughnut, then it has these three major layers, the 'social foundation', including mental health, education, and also social justice issues like income, equity, childcare, housing, and so forth. The inner layer is a social foundation. The next level is the relationship with the environment. If we destroy our environment, of course, our economy isn't going to function at all. And then finally, the outer layer is the economy. JO  24:16 So, Arden, what are the specific recommendations outlined in the report? ARDEN  24:23 First of all, the overall recommendation is to take the opportunity of reconstructing the BC economy, post-COVID, in terms of sustainable rather than extractive principles. And within that, then we make four key recommendations. First of all, to generate employment through the construction of new affordable housing, including modular construction for the homeless. And this would be done by an expanded and more effective nonprofit sector. We go on to say, number two, create jobs and reduce carbon emissions through programs that support large scale retrofitting of buildings. Interestingly, buildings are one of the major sources of carbon emissions up to 60% in cities. There's a tremendous carbon payoff from this, as well as great opportunities for employment. The third recommendation addresses our food supply by encouraging BC to secure its food supply by supporting farm employment and increasing land use. And finally, here, there's a tremendous convergence with mental health. As you know, we encourage the government to employ up to 30,000 young people as Recovery Rangers to help with BC's economic recovery. And in the report, we spell out a number of areas where youth employment could be particularly an asset, such as the restoration of environments such as wetlands, the further enhancement of walkability in cities... we identified several areas like that as employment opportunities for young people that would also result in a more green environment for us all. JO  26:26 We heard from Tricia about the federal government's role in policy change. Ideally, what is the province's role in achieving your recommendations? ARDEN  26:36 Well, as you know, the province has very many key domains, such as energy, mines and petroleum; municipal affairs; social development; and poverty reduction… all of those areas fall under the auspices of the provincial government. Provincial government does also have a lot to say about the environment and climate change strategy and has a ministry with that title. The provincial government is also responsible for forest lands and natural resources and rural development. So, all those domains, then there's tremendous steps forward that provincial governments can take to complement the broader strategy of the federal government. JO  27:23 I know that you released this report a number of months ago, and I'm just wondering where you're at with that. Are you having discussions with the provincial government? And if so, how are they unfolding? ARDEN  27:36 Jo, we've had three very productive conversations with government at the cabinet level. We've been very encouraged by their response and also by the inclusion of some of our recommendations in their first economic recovery strategy. But most importantly, we've opened channels for ongoing dialogue. The report has also been a springboard for some further definitive action on the GTech board's part, which we're very excited about. JO  28:09 I know that you've also had discussions with a number of different organizations throughout the province, what has come of those? ARDEN  28:19 In the construction of the report, we had a lot of great feedback from environmentally concerned organizations and environmental organizations. And we incorporated that in the report. But from our point of view, and it also enabled us to build on the relationships that we'd begun to establish through the Neighborhood Environmental Education Project, with a range of the many environmental organizations in BC. And through that, we also began to see a picture of not only tremendous industry and accomplishments, but also continued fragmentation, and a lack of consolidation of effort, which is really been a part of a new strategic plan that the board has been working on, in which GTech has a role in addressing this issue of fragmentation or, in more positive terms, consolidating our efforts. JO  29:20 You've mentioned numerous times that a prime focus of this is enriched employment opportunities, especially for younger people. Have you had any input from organizations like the BC Federation of Labor, for example? ARDEN  29:38 Yes, we have actually built a very positive relationship with the Fed, and we're engaged in ongoing discussions with them. Of course, they have tremendous sensitivities on behalf of their members about where employment takes place, and what government policy supports. I think what's very unique, and I think they would say that as well… that we have not taken a proselytizing stance. With the Fed, we've taken a stance that says let's find common ground, and they certainly do have environmental concerns. And they also have social justice concerns, which we share. JO  30:22 Looking again a little deeper into the employment aspect of this, I know Arden that you have been long involved in counseling and social development and those kinds of things. Why do you think these kinds of green tech opportunities will be embraced by younger potential employees? ARDEN  30:45 While there's no question that the next generations from Gen Z and on are already deeply concerned about the climate crisis. I recall vividly marching across the Cambie Street Bridge with nine- and ten-year-olds, along with parents, teachers, and people of all ages, carrying signs clearly very concerned and aware about environmental issues. There's no question that young people are aware of the climate crisis, its implications, and feel a tremendous urgency, understandably, about this issue being addressed. JO  31:27 And they're also looking to make a contribution to their communities, aren't they? ARDEN  31:32 Definitely. We have a great pilot project going right now, by the way, with Gen Z via two BC high schools, and we're doing an education project about electrified transportation, using an AI mediated application. It's so much fun, and they have so much concern, but also a really sophisticated understanding of these issues. JO  31:57 That's great. It sounds like you're doing amazing work. ARDEN  32:00 I hope that's the case... I certainly feel good about it. The other thing I wanted to mention to you is that Rebuilding BC has also inspired the GTech board of directors to take GTech in a much more definitively educational direction, with the ultimate goal of creating an educational institute in a much more formal way than it is now, including, eventually, degree granting. So, we're quite excited about that development. And I want to assure you, by the way, that as we began to design what this center will look like, that mental health, providing support through counseling and community development initiatives, in relation to mental health has a key role to play in our view. JO  32:48 Well, we'll have to have another discussion once that is all set and ready to go. ARDEN  32:53 For sure... be delighted to. JO  32:55 So, we talked about federal and provincial roles in the move toward a more sustainable economy that also supports mental health. What about the role of local governments in that transition? Arden, do you think local governments have any clout here? Or are they at the whim of senior government policies? ARDEN  33:18 Well, I think Trish was very right in saying that municipal governments, city governments, right now are really struggling. They've lost enormous tax revenue, and at the same time, have had to provide additional services. But Vancouver, for example, does have a plan. And they've put a great deal of energy and attention into it. So, I think cities can play a very important role. JO  33:43 Trish, any more thoughts on that? TRISH  33:46 I agree, they've got one hand tied behind their back, for sure, because they don't have the fiscal tools that provincial and federal government have. But also, I think sometimes local governments have more weight, and some of them think they do, because all of those downstream problems have an economy that's not sustainable in terms of income inequality and climate emergencies. Those present themselves as major problems at the doorsteps of our municipal governments and our health units. So, municipalities are on the front lines, sending word back to senior levels of government to hopefully inform policy and fiscal transfers from those governments. So, I think sometimes municipalities don't have the strength. But especially when they get together and make demands of senior levels of government, real change can happen. JO  34:39 We did a podcast about the role of local government in community mental health, and the big takeaway for me there was that it's not only important for local government to work with senior governments but also with people within their own communities. Groups like businesses, universities, colleges, schools at all levels, and particularly community groups, who not only have ideas about how things can be improved, but also they have the manpower and the passion to get these things on the ground. So, I think that's something else that's really worth noting. TRISH  35:23 Absolutely. Whether it's city council, or provincial or federal, governments cannot make policy in a vacuum. It has to be shaped by the lived experience of people on the ground.  JO  35:34 Exactly. Both of your documents… Trish, your Alternative Federal Budget recovery plan… and Arden, your Rebuilding BC document, they both outline the need for a just and green economy. Let's dig a little deeper here, starting with a just economy. Trish, how would you define that? TRISH  36:00 I talked a little bit about that earlier. And so really, to me, the core of a just economy ensures that economic growth isn't the only measure of success, because then you're leaving a lot of suffering out of that frame. A just economy operates on key principles of income, security, greater equality on all fronts... that caring economy that I talked about earlier. And it also understands that a green economy has to be embedded in the just economy, because if we can't save our planet, if the next 40 years is more trying to deal with climate emergencies, then the people in the communities who will be hardest impacted by that by climate change and those climate emergencies, will be people on the lower end of the income spectrum. We see it with every kind of crisis, and we're seeing it with COVID-19. It impacts lower income communities more… it impacts racialized communities more. So, a just economy really is focused more on like that doughnut economy that Arden was talking about. JO  37:11 Arden… additional thoughts? ARDEN  37:13 Let me start with a story. I teach a course called the Psychology of Aging. And one of the exercises I ask students to do is imagine themselves as 72 years old, and looking back over their lives, to ask questions like: What were the most significant turning points in your life journey? And are some of those ones that you would decide differently? Looking back, are there others that you're absolutely delighted with? I have them do it in triads. So, if you can picture that situation, and then following that, the class's debriefing their experience of the exercise, by the way, this exercise, speaking of social justice, has the effect of getting younger people under the ages of barrier. That's one of the intentions. In any case, we're debriefing this exercise, and suddenly, one of the students in the class, it's a graduate class, she's probably around 28, and she suddenly started sobbing. It was so powerful. And she and I talked, and what she said was, "I can't be sure that I'll be even alive when I'm 72. I don't know whether I want to get married. I don't know whether I want to have children. The future of the planet, the environment, but also the social world is so uncertain." It really broke my heart. And there you begin to see that connection between the climate crisis and mental health. It's very evident. JO  38:54 Can you give us some examples as to how a just economy would support better mental health outcomes? Trish... TRISH  39:04 Let me try to loop it in with a just economy and a green economy, and how that could foster better mental health. And just thinking about Arden's exercise... I wish everybody would go through that thought exercise and really think about the future that faces them if we continue with the status quo. There's this term called 'eco-grief'. It describes the deep sense of angst and dread that many people feel, and especially young people, when they realize that our economic activities are compromising the health of our planet. And that time is really running out quickly. And it describes the despair that many people feel over the lack of concerted government efforts to treat climate change like the emergency that it is. Arden mentioned Seth Klein, earlier in his comments, and Seth Klein has a new book called 'A Good War', and it draws on the lessons from previous war time in Canada, where governments treated things like an emergency and made incredible policy advances, and how we need to treat climate change like that emergency. And that's why it's called 'A Good War'... it's definitely a book worth reading. I think that if you address climate change, like the emergency that it is, you would be addressing some of that eco-grief that's out there. And eco-grief isn't just when you think about your future and you wonder, "Am I going to have a future, because are we going to have a healthy planet?" But eco grief is already happening to people whose communities have been ravaged by wildfires, by flooding, by other community-related emergencies. And so, dealing a plan that anticipates more of this, and supports people through these climate emergencies, would also be part of addressing eco-grief. Human beings are deeply connected with our natural environment. We live in a built environment, but we have a deep connection with that natural environment. And if that natural environment isn't doing well, we aren't either… physically or mentally. JO  41:11 Before we move on to a rather complex question. Arden, I'd love for you to just very briefly explain what a green economy is. ARDEN  41:21 I think the major criteria of the green economy is its environmental sustainability. Are we relating to our environment in a way that will result in future generations having the same abundance that we've experienced? And clearly, our current economy does not meet that key criterion. If we continue to use fossil fuels at the level that we currently use them, we will fundamentally destroy environment of the planet. So that's, to me, the first criteria. And the second is how can we relate to the environment in a way that also supports our resilience as communities, families, and individuals. And this whole idea of connection is so important. When I asked Jody Wilson-Raybould, who represents our riding [federally], and is also a colleague, what was the most important thing that Indigenous people had to say about a green economy, she talked, as Trish did earlier, about connection. We need to foster, embrace, and celebrate our connection to the natural world. JO  42:36 So, ideally, we need policies and practices at all levels of government that foster a just economy, and that support a green economy as well. Now, let's talk specifics about how those can best intersect. In your two documents, there are areas of focus that overlap. And I'd like to explore those one at a time and their impacts on mental health. Let's start with climate change. How can what we know about green technology enable not only environmental outcomes, but social sustainability as well? ARDEN  43:17 Well, I think New Zealand, Norway, Finland, are showing us a lot about how to create a healthy society. Let's take for example, how business operates. In all of those countries, government is requiring that corporations…  businesses… address environmental and social justice issues in their business planning and operations. So, that requirement is one way to bring the commercial sector of the economy on board with creating not only a more sustainable, but a more compassionate, supportive, and respectful society. JO  43:58 Trish, any comments on that integration regarding climate change? TRISH  44:03 I totally agree with Arden... I would just add one thing. There's this nascent but growing movement in Canada around inclusive economy initiatives. And here they're looking at what public anchor institutions can do in any community across Canada to foster a just economy that's inclusive, sustainable, and that is also a green economy. So, with public anchor institutions... your city council, your hospitals, your universities... these are examples of public institutions that make spending decisions every day, whether it's for procurement, they're putting out RFPs for work that has to get done. And so, with regard to procurement, they're saying, why not make your criteria for procurement social procurement criteria. Instead of just putting out an RFP, and the criteria is we're going to give the RFP to the lowest bidder... how are you the lowest bidder, well, you're  paying your employees low wages. And some government policies and spending decisions are actually reinforcing the low-wage precarious economy. If you actually make an inclusive economy, an element and a goal out of your procurement policies would be to look at RFPs from companies in our community who show a commitment to green sustainable practices, who hire and/or offer training opportunities and apprentice opportunities for people from marginalized and historically disadvantaged communities. You think of all the money that gets spent from all these public anchor institutions, and we forget the social and the sustainability question within it. So, ideally, they would intersect by saying, we're not putting out RFPs, or making contracting-out decisions based on cheap. We're making those decisions based on inclusion and resilience and sustainability. And by the way, if public anchor institutions did this, this would be good for their local economies, because they would be less dependent on these external multinational corporations [that] are only interested in your community if you're a low tax jurisdiction, if they can actually get away with a low-paying workforce so that they can extract more profits that don't stay in the community. So, an inclusive economic approach, if you're building a bridge, you would have a community benefit agreement, so that the general contractor who's building the bridge would be hiring people from the community who are on the sidelines of the labour market. They want in, but they don't have access to those opportunities. So, there's a lot more power that our public anchor institutions have, I think that they could be exercising, that we have to change the frame from cheap and low bidder, to social and sustainable. JO  47:02 Trish talked in detail about inclusive economy, and both of your reports talked about equality. Are those the same thing? TRISH  47:12 They're interconnected, for sure. I co-founded the National Income Inequality Project in 2006. Actually, since then, we've been tracking the growth of income inequality in Canada, and the storyline is the same today as it was in 2006. As we've grown the economy, the benefits of that economic growth haven't been redistributed.... that more and more, if you're well off, you're even more better off. Corporations and CEOs, the CEO pay gap compared to the average income, keeps going through the roof. So, if you actually want to attack income inequality, and protect the middle class and the working class, and eliminate poverty, then you have to change how you do your economy. And you have to make sure that the economy isn't simply extractive. That economy has to have social goals that say, we want to be a Canada that leaves no one behind, and we're one of the wealthiest countries on the planet, we actually have the resources to do it. The pandemic is forcing us to spend some resources to do some of this stuff, but it can't stop there. We can't go back to an old model because it wasn't working in the first place. JO  48:32 Arden, any comments about inclusivity or equality? ARDEN  48:37 Absolutely. Let me channel first Bernie Sanders a little bit… and looking at the example of the United States… three billionaires... Bezos, Gates, and Buffet... command as much wealth as the lower 50% or 150 million people in the US. This is income disparity. Now, let me link it directly to mental health through a book that I found so informative and fascinating, The Spiritual Level by Richard Wilkinson and Kate Pickett. And what that book does, and their subsequent research does, is report on the social and mental health impact of income disparity. It turns out that there's a very direct relationship between income disparity and a whole range of societal wellness and mental health issues, ranging from infant mortality to longevity, including teenage pregnancies and delinquency. There's just a remarkable connection. And this research was enabled, of course, because over the last 50 years, the developing countries have kept very comprehensive statistics of the social dimensions or determinants of societies. So, let's talk about taxation and banks. If we want to have a healthier society, we need to adjust the tax system so that it redistributes income much more equitably. And we also need to provide sources of funding that recognize, explicitly, wellness and sustainability. We need instruments like social banks. JO  50:24 Both of your reports also included information about affordable housing. So, Trish, starting with you, what is the link between that and both a just and green economy? TRISH  50:38 Here, I'm just gonna give you an example. The City of Medicine Hat [Alberta] became the first city in Canada to eliminate chronic homelessness. And how did they do that? They gave people housing... they gave them access to housing. And once they had access to housing, they offered other income and community support to help the homeless integrate back into the community. This is a model of how you actually look at solutions that aren't just one dimensional. Yes, the homeless need housing, but they also benefit from wraparound services so that they can get back on their feet and integrate into the community again. Unfortunately, I think too many times when we think about affordable housing, we think about it in commodified private market-sector terms. We think about affordable housing as the housing market is too expensive. Say, can we do something to lower my mortgage rate? And, [with] that focus on the private sector… can I buy my own home and afford to?" [This] pushes a lot of people out of the window... the homeless number one, but also people who will never be able to afford to carry a mortgage, people who will always be in the rental market or rental market that is squeezing more people is increasingly unaffordable, and not regulated to protect renters and tenants. I think that you have to look at all of these things in an integrated way. And not just in that commodified private sector market. What can a government do to make it easier for you to buy a house or a second home... the well off? We have to think about who's missing from this frame? JO  52:28 Arden, what about the impact of education on a just and green economy? ARDEN  52:34 Let me just say one thing about housing if I can, Jo. One of the things we recommend is the support and further development of nonprofit housing providers, which can really make a substantial difference in the availability of housing to minorities and the economically disadvantaged. The other thing… I just want to highlight what Trish was saying about once you have people housed, then you can wrap services around them much more easily than if they're on the street or moving from place to place. Education's my bias, one of the fundamental predictors of sustainability and health in a society. And there's so much that we can do with education. Let's just take the example of assuring that we're educating girls and young women. The level of education of women in the society is one of the most vibrant predictors of the society's wellness and its economic development. JO  53:36 This last one is really near and dear to my heart as a communication specialist to all levels of government with regard to public outreach and engagement. What is the link between public engagement, a just economy, and a green economy? TRISH  53:53 In researching what some communities across North America and in the UK are doing to foster an inclusive economy, I was struck by what the City of Seattle has done. They've actually set up a table where all of the representatives from frontline service workers in those most marginalized and disadvantaged communities, they have a table to inform the city policies and budget decisions. In Canada, often there'll be consultations, and there might be a brief mayor's table that's created. And you might be able to come in and weigh in at that one time, and then you're gone. This table is a permanent table. The people who are actually seeing the devastation of public policies and an economy that leaves too many behind have a permanent place influencing the city's budget and policy decision-making. And those are frontline leaders who are deeply connected in their communities and they're bringing back the information, the stories. and the recommendations from their communities. I think that's a powerful model. JO  55:06 It's very progressive. Arden? ARDEN  55:09 I was just thinking of in terms of an inclusive economy. And I'm sure that an inclusive economy contributes to the mental health of the society and its members. It's about the availability of money. And this is another strength of public banking, which is very well developed in Europe, for example, public banking is much more inclined to make money available to disadvantage groups. JO  55:38 So, you're talking about public investment, then? ARDEN  55:41 Yes, absolutely. Public banks are generally owned by government. It's an instrument that government can use to generate a more just and more fair economy. TRISH  55:54 And imagine if we had that here, and that if you were very low income and needed cash quickly, that your option wasn't solely to go to payday lenders who are charging exorbitant, I would say criminal, amounts of interest that can just keep you stuck in poverty forever. Imagine if we actually delegitimize the payday lender sector and said, there's a role for government here. ARDEN  56:22 Thanks so much for getting there, Trisha. That's where I was going to go next. Yes, let's get rid of a loan outfit. TRISH  56:29 Exactly. JO  56:30 I know you both agree that social justice, resilience, and sustainability are three sides of the same coin. So, have we already covered that? Or are there other things that you'd like to add here? Arden? ARDEN  56:45 COVID made it very clear, I think Trish was saying that earlier. The people who are suffering most, let's even say dying, or frequently are the disadvantaged members of our society. So, you can begin to see there... the sides of the coin relate to one another. Or if you look at climate change... the communities and the countries in the world who are already suffering the impact of climate change, most dramatically, are the countries who are in poverty with disintegrating societies, and so forth. We need to approach these issues from all three sides of the coin, that is including social justice and resilience along with sustainability. JO  57:30 So, that triples the complexity then of the challenges and the opportunities? ARDEN  57:36 It also amplifies the benefits of making significant progress, and any side of the coin, because it's likely to influence the other sides in a positive way. TRISH  57:48 I think it acknowledges the complexity… it acknowledges that all of these things are interconnected, that the Minister of Health doesn't just look at doctors and nurses and hospitals. If the Minister of Health really wants to promote healthy societies, that Minister of Health is working with the Minister of Education is working with the Minister of Labour, to create decent work, to create educational opportunities, skills, training, lifelong skills, an economy that keeps changing and demands more and more of us. So, it's like what I said earlier about the leg bone being connected to the hip bone. Sometimes public policy acts as though they're not connected at all. But if you acknowledge that complexity, and how interconnected all of these things are, then you're actually not putting good money after bad money, you're actually investing in solutions that can lead to a healthier, more cohesive society. And also more inclusive economies that give people hope and make them feel like they have a chance in life. And all of that is deeply interconnected with the health and vibrancy of our democracies, because I've long said that democracies can't run on autopilot... it requires a deeply engaged citizenry. And you can't do that if you're just fighting to keep a roof over your head. If you're fighting to get some kind of food, any kind of food into your home, you can't feel like you're actually engaged. You've got this other full-time job and it's trying to stay alive and keep your family going. So, acknowledging those complexities would be a very upstream approach to government policymaking. JO  59:33 How do both your organization's recommendations for a just and green economy stack up against the World Health Organization's sustainable development goals? Arden? ARDEN  59:46 We know that Rebuilding BC is fundamentally aligned with the sustainability goals of the United Nations and was something that we took into consideration and were aware of. And the amazing thing is, so many of these documents, these reports, these policy recommendations, are aligned with one another. And my hope for the future is that we'll work more closely together and have more dialogue.  TRISH  1:00:14 If we embraced well-being budgeting and inclusive economy initiatives, we would make far more progress on those Sustainable Development Goals than we're making today. As I said earlier, Canada is one of the wealthiest countries on the planet. The only thing preventing Canada from achieving those Sustainable Development Goals has been political will, at every jurisdictional level. And so, I'm hoping that if one good thing can happen from a pandemic, that will snap us out of the status quo approach, because the status quo hasn't been the option. Both of our documents that we're talking about today give us a pathway to achieving those goals. JO  1:00:53 Talking about what we've learned from the pandemic, what have you learned about each of the following? First of all, the potential for rapid policy change and financial support? Trish? TRISH  1:01:05 Everything is possible. Everything's on the table, and everything is possible. And like I said about Seth Klein, what he has to say... treat it like an emergency... and the solutions present themselves. ARDEN  1:01:16 Governments can pivot enormously quickly when they have to, and they can command more resources than they've allowed us to know. JO  1:01:27 How about the drawbacks of bipartisan politics and their impact on our ability to move toward better mental health? TRISH  1:01:37 I think we've seen less performative politics... performative, partisan jostling during the pandemic. I mean, there's still some of it, but there hasn't been a huge public appetite for that sort of thing. JO  1:01:48 Not in Canada, anyway.  TRISH  1:01:50 That's right. Watching the US news can feel very defeating some days. So, there's been more cooperation than I think we're used to seeing in recent years. And I think that you're seeing how things can work when provinces and municipalities and the federal government work in common cause. And I just want to see more of it over the long haul. JO  1:02:10 What about the role of innovation? TRISH  1:02:13 We've seen huge innovation from the public service to create federal programs to support those workers and businesses that were sidelined at the start of the pandemic. There were public servants who were writing new policy overnight, and doing very innovative work under duress, often from their homes with children under foot at the beginning of the economic lockdown. It's not just in this moment that we see it. Economist Mariana Mazzucato, she's written about the history of the public sector, and how governments have historically led the way on innovations that later get picked up by the private sector. And so, governments and the public sector often get short shrift when it comes to appreciating the power that they have to create innovative new solutions to the problems that are before us. But I actually hope that this pandemic is fostering a renewed appreciation for the role and the responsibility that governments have not only to protect the public good, but to spur the innovations required to meet that goal, to protect and support the public good. ARDEN  1:03:23 On the ground level, my local coffee shop has been so innovative in continuing to connect with, reach out, and serve the local community. And also, I think the business sector of the economy has been incredibly innovative, and shifting a great deal of their transactions, meetings, and work online to lower the risk of transmission through face-to-face encounters.  JO  1:03:52 This next one is really key to me in that the Fresh Outlook Foundation has really focused on increasing communication and collaboration. So, what have you learned about the importance of collaboration during the pandemic? That could be across geographies, governments, businesses, NGOs, academics, demographics, etc. We could go on. Trish, what's your takeaway there?  TRISH  1:04:23 This is a big one. But I'll just focus on how we have seen public health experts and epidemiologists from around the world collaborating on learning in real time about this virus, sharing that information so that other countries can be better prepared to deal with outbreaks, working collaboratively to try to develop in real time vaccines that can sometimes take decades to create. And so, I'm seeing a level of cooperation for all around the public good that is not just national in scope. You're seeing it across Canada, but you're also seeing it globally as well. And that is very heartening to me. ARDEN  1:05:08 I think the level of collaboration, level of action, and hot networks has increased quite dramatically. And it's really heartening. And it's really a lot of fun. So, let's reach out, listen, connect, learn, and then take action together. JO  1:05:28 When we talk about these revelations for rapid policy change, financial support, the role of innovation, the importance of collaboration, how can we use these revelations to best inform response to other very big societal challenges such as loneliness and systemic racism, for example? TRISH  1:05:53 I'm going to go back to Seth Klein's findings from his book, The Good War. Treat it like an emergency. Treat loneliness and depression like it's an emergency, instead of putting people on six-month waiting lists that they may or may not ever be [able to] afford or to have access to help from. Treating homelessness like an emergency. Before this pandemic, we just really became complacent, and I'm really hoping that this pandemic jolts us out of that. ARDEN  1:06:24 I think we need to work together on the fundamentals. And to me, the fundamentals are building communities and supporting families. That's the cornerstone of our society. JO  1:06:36 Given the tenure of existing free-market economic policies and practices, how can we make the break to a more just and green economy? TRISH  1:06:49 We might be reaching the tipping point with this global pandemic. It broke down supply chains. It's illustrated the power of governments to act. It's reduced many private-sector actors to businesses begging for government help, and we can't unsee that. That is something that's happening, and it's affecting how we view who acts and where the leadership needs to come from. ARDEN  1:07:12 To go back to Trish's point, I think the fundamental flaw is prioritizing material gain over the public good. And I think that we need to prioritize the public good, and all of our thinking, and especially our thinking about economies. And yes, COVID has helped us to make that transition. The great majority of people are very aware of the imperative to take care of one another during this period, to wear masks to keep appropriate distance, to limit our social contact, at the same time finding new ways to be connected with one another. JO  1:07:54 Exactly. And I hear over and over again amongst my family and friends and professional networks that people are really thinking about what really matters. And I think that's just a hugely important shift. Let's say that we do hop on that path to a more just and green economy. How long would it take before we start seeing positive impacts of that? TRISH  1:08:22 I think almost immediately… you put the inputs in, and the outputs will start presenting themselves almost immediately. It will take as long as required, but not a second more, and change can happen swiftly. ARDEN  1:08:35 I live near a very busy street called King Edward. It's an east-west thoroughfare in Vancouver, not quite as dramatic as the Gardiner Expressway in Toronto, but a very busy street. For two weeks, during the height of the pandemic, King Edward went quiet. There were occasional vehicles rather than herds of vehicles. And those vehicles were driving very slowly. There w