Zachary Kaminski jogged past the woman standing alone on the bridge, lost in thought. But as soon as he passed, he stopped. He felt something. When he ran back, the young woman was standing very close to the edge, looking to the side, visibly upset. “Can I help?” asked. “I’m not leaving. I care about you.” She was inconsolable, but as they continued to talk, she walked away from the railing. Another passerby called 911 and they waited with her until the ambulance arrived. Just a month earlier, Dr. Kaminsky, a molecular biologist, had attended a suicide first aid course called ASIST. He is investigating suicide prevention at Royal, a psychiatric hospital in Ottawa. Although he does not work directly with patients, he wanted to know what to do if faced with a suicide attempt. That day on the bridge, training began. “They tell you to be yourself, to be human,” he says when asked what he remembers most about the lesson. Do not stop talking. Do not give up. “Just be there and try to do your best.” A person who takes care to do the best he can at the right time – this is the most valuable resource in mental health care. However, two years after the pandemic, with stress and depression on the rise, Canada’s mental health system is facing a serious crisis: more people are in need of care and the supply of overworked clinicians for their treatment is shrinking. The country’s psychiatrists were aging rapidly even before COVID-19 arrived on the scene. in 2019, half the psychiatrists were over 55 years old. Exhaustion rates are rising among mental health workers. Psychologists and social workers abandon a besieged public system for lucrative private practice. To fill some of the gaps, programs are being expanded to empower the people. An increasing body of research shows that with the right education, regular citizens – neighbors, carers, community counselors, and even the local barber – can improve outcomes for adolescents and adults with mental health problems. The programs provide care in a wide variety of ways, including short social contacts, basic speech therapy, and mental health first aid in a crisis. Some examples, such as the training received by Dr. Kaminsky, aim to develop skills in the general population. other programs train individuals for specific roles in their community, both as volunteers and as paid non-specialists. They have been found to act as early interventions, provide a wider safety net for people with complex mental illnesses, or provide additional support in particularly vulnerable times, such as when patients return home after a hospital stay. These programs are not a substitute for specialist care – and they are not intended. But educating the general public leverages two important findings in mental health research: People are better at healing when it happens to someone they trust and recover faster when they have the support of their community. “Sometimes people just need someone to ‘sit in the dark with,’” says Denise Waligora, a specialist in first aid training and delivery to the Canadian Mental Health Commission. However, grassroots workers are not just cheap, second-rate help in repairing a broken system, says Srividya Iyer, a psychologist and associate professor at McGill University. These programs, says Dr. Iyer, often provide the kind of agile, holistic, on-the-go care that often lacks a system focused on hospitals and credentials. “If we envision a system where many people play roles again, we would have a much better system.” This approach has worked for more than a decade in lower-income countries, in places where doctors and psychologists are a limited resource, but there are many examples in richer nations. Risk lines are answered by educated people, peer support staff and groups using shared experiences to heal. Increasingly, mental health applications and online programs are being supported by trained coaches, as virtual self-help works best even with a brief human check-in. In the Netherlands, young volunteers have been trained to deliver empathetic conversations in reception centers. An American program that used trusted adults to support teens who had attempted suicide was found to reduce the number of deaths, compared to a control group, more than a decade later. England has designed a national public psychotherapy program around undergraduate psychology training to provide evidence-based treatment for people with mild symptoms of depression and anxiety. A pilot program in California trained Hispanic members of a Latino community – some with less than high school education – to offer eight weeks of group therapy. A study published last year found that “health promoters” significantly reduced the symptoms of depression and anxiety in participants. Indigenous communities already have a long history of supporting prosperity through the elderly and the knowledgeable. Dr. Iyer is part of a program in Ulukhaktok, NWT, that continues this tradition by educating community members in mental health first aid and suicide intervention to provide care for young people. Another approach, known as “care contacts” – often unofficially adopted by community groups when face-to-face meetings stopped during a pandemic – has shown success in combating loneliness and improving outcomes after a stay in a psychiatric hospital or urgent. In Texas, for example, college students made weekly “sunshine calls” to isolated seniors for a month after receiving a short active listening lab. A study published in JAMA Psychiatry last year found that compared with a control group, Texas seniors who received calls showed improvements in mental health as well as reduced loneliness. In Hamilton, the first results of a small pilot who used phone calls from non-clinical volunteers to stay in touch with patients after suicide-related hospitalization found that there were fewer emergency visits and re-admissions among the intervention team. Pending ethical approval, the study will be scaled up this year. Research shows that peer support workers – people who have first-hand experience with a mental illness – are a cost-effective source of mental health care and are increasingly being used in hospitals and community clinics. But first-hand experience with a mental illness is not necessary for many of these programs. The idea is to build capacity in groups that share similar life stories, to enhance the skills of leaders and mentors who already have confidence in the communities. In cities across the United States, for example, a program called the Confess Project has trained black barbers to be mental health advocates with their clients by actively listening and reducing the stigma surrounding getting help. As the pandemic pointed out, there are provocative inequalities in Canada’s healthcare system. Tribal Canadians often wait longer for mental health care and face language and cultural barriers. Educating people in underprivileged populations or different neighborhoods helps to create resources and knowledge of health care in the areas where patients live and work. Mental health is not just about medical care. is affected by family conditions, unemployment, poverty and racism – problems that often need a flexible, comprehensive solution, beyond diagnosis and prescription, and often require the integration of mental health support into other services. In Edmonton, for example, multicultural health workers advising immigrant and refugee families navigating health care, schools, and family services are also trained in basic trauma-based speech and care techniques and recognize when people they may need referral to a more formal treatment. Firefighter Steve Jones of Burlington, OD, is being trained to provide mental health first aid. JP Moczulski / The Globe and Mail Supporters of non-specialist programs also support broader benefits: Train more people to be confident caregivers and we can build more compassionate communities. Often it starts with a conversation in a safe place, says Steve Jones, acting squad leader at the Burlington Fire Department in Ontario. Years ago, during an evening shift when he was still a captain, Mr. Jones confessed to his crew gathered around the kitchen table at their fire station. As soon as he returned from a mental health training seminar at work, he told them, and he realized that he was struggling and had to practice taking care of himself. How were they doing? One by one, the men volunteered their stories. One said he was absent from work because his daughter was suffering from anxiety. Another explained why he always checked his phone in shifts: His wife was severely depressed and worried that she might call one day that she would hurt herself. A third firefighter spoke. This was the lazy guy no one wanted to work with, who never got up from his chair. A few weeks ago, this crew member had driven his car to the top of a bridge, with a suicide note already written. His colleagues at the kitchen table were the only people he had ever spoken to. Two hours later, they were still talking. In the six years since then, a workplace mental health course, Working Mind, developed by the Mental Health Commission of Canada, has been offered to the entire fire department, including family and spouses. Since then, the program has been extended to a peer support program. As more people attended the training, says Jones, they developed a common language to talk about mental health, both for themselves and if they saw warning signs in their colleagues. “It simply came to our notice then. “Well, it’s okay to say I’re barely pressing water and know you’re not alone.” Mental health first aid programs, another example of popular education, are designed to teach people how to respond to a panic …
