One in five Canadians experience mental-health or addiction problems. By age 40, the statistic shrinks to one in two Canadians who have, or have had, such an impairment.
But the question of how best to conquer the particular challenges of mental-health care is one that Canadians are still grappling with. Whether it's about improving access to care or destigmatizing stereotypes, Canadians have been working to improve the lives of people living with a mental-health issue.
To celebrate these acts of leadership, The Centre for Addiction and Mental Health, partnering with The Globe and Mail, held a campaign to honour change makers in the field. Nominations were open to everyone. More than 3,700 names were submitted and, this fall, 150 Canadians were chosen as honourees. These recipients include officials and everyday individuals.
Here are four of their stories.
Job: Chairman & chief executive officer, Arctic UAV Inc.
For Kirt Ejesiak, there's a deep connection between an individual's mental health and the health of a community.
He has been advocating for more mental-health services in Northern Canada since his time as a former Iqaluit council member and deputy mayor.
"Having grown up in the North, you see it every day, the challenges people are having. It is really hard to imagine unless you're there," he said, explaining that the lack of housing, education and opportunities in the North negatively impacts the population's mental health.
"People are stuck and they can't see how to get out of there. That's why there's a huge crisis," he said.
Mr. Ejesiak says one way to improve mental health in the area is by encouraging young people to finish school. Through Arctic UAV, a startup offering aerial imagery services through drones, Mr. Ejesiak and his team recruit recent graduates into their business.
"I've come to realize knowledge is power. This is part of this idea of, 'Let's give people the knowledge and the power so they can make good decisions.' If we can give people better information, it improves the lives of the community," he said.
He said providing meaningful opportunities for young people – allowing them to do the things they want to do – is the biggest factor in improving their mental health.
Mr. Ejesiak has also worked to help the overall prosperity of communities in the North. His past projects include building prefabricated homes, in part because he believes there is a link between homelessness and mental illness in the North. Mr. Ejesiak said the idea to use prefab housing was to demonstrate there's a more accessible way to address housing needs in Northern communities.
"There's an underlying tension because many people up north don't aspire to own homes," he said. "They just want a safe place to go to sleep."
Since 2009, Mr. Ejesiak has been involved in developing an independent Northern university, one that would be relevant to the Arctic and Inuit. He said young people need to try new things that can lead to success and help others.
"We think it's critical to have young people openly debate some of the challenges in our communities. It all comes back to empowering people," he said.
Mr. Ejesiak says his professional journey is really a personal one. "Coming up with something that could improve not only my family, but give others an opportunity to follow in my footsteps, that's really my goal," he said.
Dr. David Gardner
Job: Professor of psychiatry and pharmacy at Dalhousie University in Halifax
Distance is one of the biggest barriers to accessing mental-health care, even in a smaller province such as Nova Scotia.
"The [mental-health] difficulties in Nova Scotia are not different from those in Ontario and elsewhere in the country," Dr. David Gardner said.
Dr. Gardner is a professor at Dalhousie University and co-developed the Bloom Program with Dr. Andrea Murphy. The program provides mental-health care to Nova Scotians through their local pharmacies.
Once enrolled in the program, a person who takes medication for a mental illness gets more time with their pharmacist "leading to more comprehensive evaluation and management of their medication and health issues," Dr. Gardner said. The initiative also promotes more communication between the patient, their pharmacist and their doctor.
In addition, pharmacists in the program also work to help educate their patients about how best to navigate the sometimes complex mental-health care system, including how to get access to services that may be available in their communities.
Since pharmacies are present within five kilometres or fewer of the vast majority of the Canadian population, the program provides unparalleled access to care, Dr. Gardner said.
"Several people who have participated in the Bloom Program did not have a regular physician or had lost touch with their physician," he said. "In some cases, pharmacists were successful in helping the patient to reconnect with their physician and in other cases they worked closely with the patient to ensure that their treatments were able to continue in the absence of a regular prescriber."
The project was developed after years of discussions and research by Dr. Gardner and Dr. Murphy.
"A major influence on me over many years has come from the many discussions I have had with people at mental-health and addictions support groups," he said. "Through those experiences, I have learned much about the day-to-day challenges people face in getting the care they need and the health outcomes they deserve."
At the end of 2016, the program was green-lit by the Nova Scotia government and has received more funding. The federal government has also expressed interest in the program after former health minister Jane Philpott was briefed about it in early 2017.
"As a physician, she quickly recognized the important role and unmet potential of pharmacists in the care of people in their communities," Dr. Gardner said. "She asked about our ideas for how to expand this to other regions of Canada."
Dr. Gardner and Dr. Murphy have also recently launched the Headstrong project this fall. The initiative looks to raise awareness and access to care for men who are struggling with mental-health issues, including anxiety, depression, insomnia, suicide, tobacco use and problematic alcohol use.
Dr. Pushpa Kanagaratnam
Job: Clinical psychologist; PhD, C.Psych.
Through her practice, clinical psychologist Dr. Pushpa Kanagaratnam has worked with refugees and immigrants in need of support for the past 21 years.
"I've been interested in these areas of war and violence since I started as a student of psychology in Norway," she said.
"Coming as an immigrant from a war-torn country [Sri Lanka], I was well aware of issues that people were struggling with."
Dr. Kanagaratnam's PhD was on the cognitive impacts of war and political violence. During her schooling, she also wrote a thesis on child soldiers. When she came to Toronto in 2003 as an international fellow, she did a research study on the cultural effects of war trauma in the Tamil diaspora.
"War trauma in itself it doesn't seem to exist as a condition requiring treatment. But when you experience trauma within the context of migration and resettlement, it may contribute to illness," she said.
As Canada has taken in a large influx of new refugees, there needs to be a way within the mental-health-care system to work with them systematically, Dr. Kanagaratnam said.
In her years in Canada, Dr. Kanagaratnam has worked on these issues in a variety of roles, including as a family-violence councillor and as an external mental-health consultant in an international post-tsunami project in Sri Lanka. She gives presentations on issues faced by refugees, both on television and in print, as well as for legal and educational panels.
Her goal is to both educate Canadians about refugee communities and also speak with refugees themselves about integrating into Canadian mainstream society.
Recently, Dr. Kanagaratnam has been part of an independent team that worked on development of a framework for refugee mental health, which was presented at CAMH.
"You can't start developing a treatment approach or model for every community. We don't have evidenced-based research as much as we have in other areas of mental health," she said. "The solutions need to be applicable to all refugee communities."
She said the framework is meant to supplement Western-developed models of mental-health treatment that may not apply to refugee communities. By helping educate the clinician about the refugee community's perspective on topics of mental health, Dr. Kanagaratnam expresses hope they will then apply the knowledge to provide the best support possible for patients.
Dr. Perry Kendall
Job: Provincial Health Officer
Throughout his career, Dr. Perry Kendall has long championed changes to the health system that were at first considered controversial, but eventually became common practice.
"It's a passion. It's a thing I enjoy doing," he said of his work.
Dr. Kendall was a former medical health officer for the City of Toronto and the former CEO of the Addiction Research Foundation of Ontario. Among his many career highlights, he has supported the ban of smoking in public spaces, pioneered programs to avoid the spread of HIV, contributed to the development of the First Nations Health Authority and helped steer the political process that resulted in the opening Canada's first supervised injection site in Vancouver.
Today, Dr. Kendall is the B.C. Provincial Health Officer and is working on building an integrated response in health, political and public spheres to the opioid crisis. His goal is to inform the NDP and Green parties on how to proceed with the response to opioid overdoses.
"This is a very complex problem that doesn't lend itself to a simple solution," Dr. Kendall said.
The opioid crisis affects groups in Canada so differently that there is no simple solution, he added.
"There is no magic bullet for addiction. We also know that some people don't want these treatments either."
Dr. Kendall attributes the crisis in part to the pharmaceutical industry for overselling and misrepresenting the safety of opioids. According to him, when people are cut off from their relatively safe supply, they fill this gap with illegal substances, such as fentanyl, which is far stronger and deadlier than heroin and morphine.
"You only need a very small amount to come through the mail to create thousands of doses. This has completely changed the drug market," Dr. Kendall said.
One obvious answer, Dr. Kendall said, would be to provide safe drugs, such as methadone, to those who are dependent, but this treatment does not always work. There is a program in Vancouver through which roughly 100 people receive heroin as a treatment, but it is very politically controversial, he said. Expanding hydromorphone injectables, a opioid painkiller, is another option that is being looked into.
Dr. Kendall has twice announced his plans to retire, but so far has not followed through.
"There seems to be a place for me to do it and there seems to be a lot of work that's left that could still be done," he said. "I think I'm very privileged to be able to do what I do."