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Jesse Bigelow's schizophrenia symptoms started when he was 19. Today, at age 33, he is a peer counsellor and helps others deal with their mental health problems. (Peter Power/Peter Power/The Globe and Mail)
Jesse Bigelow's schizophrenia symptoms started when he was 19. Today, at age 33, he is a peer counsellor and helps others deal with their mental health problems. (Peter Power/Peter Power/The Globe and Mail)

State of Mind Part 4: Peer counselling

Who better to guide the 'walking wounded' than someone who's been there? Add to ...

That isolation not only prevents employees from getting help until their symptoms become severe, it also leads to lower productivity and higher absenteeism, to say nothing of the stress on their families.

As well as legitimizing their role, training and certifying peer-support workers is designed to address concerns about the impact they may have.

Are they still struggling with their own recovery? Or will they try to exert undue influence on patients' clinical regimens, for example trying to persuade them to stop taking their medication, which is an especially divisive issue in the mental-health community.

But Col. Genier remains confident: “A good peer worker under the model we're developing is someone who is on the fence, who sees both sides.”

Certification would screen prospects to ensure that they are in recovery or managing their illness, as well as set clear guidelines about their role, create a national training standard and define a code of conduct.

The best tactic is to lead by example

When Jesse Bigelow was first diagnosed, there was no peer support for his age group – he got by with the support of friends and family – and he agrees with the idea of certifying people who do what he does.

“I was thrust into peer support without knowing exactly my role,” he says, but experience has taught him that “it's mostly being a role model.”

In fact, “sometimes the most meaningful thing” he can offer is that “people will see me and see how well I am doing.”

THE GOOD LIFE?

Statistics show that moving to Canada makes people sick. What's the cure? Focus on prevention, the experts say

Researchers call it the “healthy immigrant effect.” Newcomers to Canada arrive fit as a fiddle, having been carefully screened by Canadian officials to make certain of it. (Refugees, of course, are a different story.)

But within five years, their rates of mental illness rise to match those of their Canadian-born neighbours. After that, the rates get worse.

There are differences within communities – suicide rates, for instance, decline over time among Chinese Canadians but rise among those from South Asia – but, generally, it appears that life in Canada makes immigrants sick.

“We get all these bright people and we are not keeping them well,” says psychiatrist Kwame McKenzie, who is director of health equity for the Toronto-based Centre for Addiction and Mental Health.

“Why would Citizenship and Immigration spend huge amounts of money so that we have fit, university graduates with $10,000 in their pockets coming to this country, only to let them get ill in five years because health care hasn't done the prevention job? It doesn't make sense.”

For minority communities in Canada, improving mental health has tended to focus on access to care – bringing in interpreters, helping doctors become more culturally sensitive, breaking down the stigma within small communities.

But an anti-stigma campaign that works in one cultural community may mean little to another, and the reasons why people don't seek help are sometimes misunderstood.

When Ontario researchers asked 250 immigrant women what would prevent them from seeking help at a hospital for a mental-health problem, they figured they knew what would top the list: language.

Instead, 70 per cent of the respondents pointed out that, while they didn't expect to been seen by a doctor who shared their cultural background, they were reluctant to go to a hospital where everyone on the staff seemed to be white.

Even as peer support expands, the workers tend to be middle-aged, native-born Canadians – it can be hard to find recruits in minority communities.

Dr. McKenzie suggests a different approach: keep mental health from worsening in the first place. (A strategy, incidentally, that experts advocate for the entire country.)

If we know mental illness is more prevalent among certain communities, he argues, prevention is the least costly approach.

“The question is whether health is an expenditure or an investment,” he says.

“What can we do to prevent people from getting chronic illness that costs a lot of money – we have to deploy ourselves upstream.”

That also means a hard look at why the mental health of immigrants – people resilient and ambitious enough to have make the journey in the first place – crumbles. Dr. McKenzie points to the hurdles they face: higher rates of poverty, unemployment (or underemployment) and housing problems plus a lack of social support.

Addressing these social and economic realities is a key step, but so, he says, is promoting positive mental health – providing culturally sensitive services and community-based programs, ensuring that patients have interpreters when they visit family doctors, who can focus on prevention, and specifically teaching positive mental health in schools.

Prevention has to be in place. Wait five years, and Canadian society has already lost.



Erin Anderssen is a Globe and Mail feature writer.

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