On mental-health care for the working class, Canada is failing – and Canadians are being failed

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Lori Fox is the author of the forthcoming book This Has Always Been a War: The Radicalization of a Working Class Queer.

When you go to a doctor, you expect, quite reasonably, you’ll end up feeling better, not worse.

You also assume – again, quite reasonably – any medication you are given will help, not actively harm you.

That’s what I assumed when in October, 2021, I went to the emergency room of Whitehorse General Hospital, walked up to the front desk and told the admitting nurse if someone didn’t help me, I was afraid I’d hurt myself.

When I finally saw a doctor, I explained I was there out of sheer desperation: I was a working-class person with post-traumatic stress disorder (PTSD) and no benefits, unable to access therapy, and of late my symptoms had become so unbearable I was having thoughts of suicide.

I left the ER with a prescription for bupropion, an antidepressant better known as Wellbutrin. I was warned there might be side effects, such as stomach upsets and increased anxiety (a side effect of many antidepressants) but told this should taper off. No one mentioned the less common but potentially dangerous side effects the drug could have.

I did not assume that, in the weeks to come, the medication would slowly but surely poison me, worsening my condition to the point of complete nervous breakdown, causing me to visit the hospital multiple times without effective treatment – or relief.

I didn’t want to take the pills. I had been trying for years to get therapy I could afford, without any success, and now I was sick – very sick – and getting sicker. So, I took the pills. I didn’t feel like I had any other options left.

Because as a working-class person, I didn’t.

And if you’re a working-class person seeking mental-health care, you probably don’t either.

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That I’m a working-class person – one very critical of blatant class inequality – is not a secret. Neither is my having PTSD: I’ve written openly about it and other issues surrounding class and mental health for a number of publications, and I’ve just finished writing a book, some of which deals with very traumatic incidents. I believe it’s important to talk openly, and with vulnerability, about mental health.

Shortly after turning in my first draft in August, 2021, the symptoms of my PTSD – anxiety, depression, hypervigilance, nightmares, insomnia, panic attacks – flared dramatically, including flashbacks and increasingly severe and prolonged episodes of disassociation. I was triggered more often: a man yelling, fireworks, even the sound of a plate breaking could flip a switch that turned me from energetic, happy-go-lucky Lori Fox into a shaking, frantic shadow.

Long before it got to this point, I had been trying to get treatment but always ran into the same issues: The free services available in my community lacked both the time and expertise to address the severity of my illness.

Likewise, in Yukon, where I live, the wait to see a psychiatrist if you couldn’t pay for a private clinic (and even then) was laughable; a friend who also suffers from complex mental-health issues once referred to getting an appointment with one as “winning the crazy-person lottery.”

My counsellor at Canadian Mental Health Association (this was a limited session, talk-therapy arrangement meant for short-term mental-health emergencies) and I agreed I needed long-term, consistent care, preferably from someone who was queer- and trans-informed and specialized in PTSD.

We kept looking. I was on wait-list after wait-list. I got worse and worse. Which is how I wound up in the emergency room that October.

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Statistically speaking, you or someone you know – a family member, a friend, a lover, a co-worker – is struggling with their mental health right now; the Centre for Addiction and Mental Health (CAMH) found around one in five Canadians reported “high levels of mental distress” in 2021.

Frankly, if living through two-plus years of a continuing global pandemic – while also contending with climate change and a geopolitical upheaval that threatens to go nuclear – hasn’t left you at least a little anxious and depressed, you should probably be paying closer attention.

Unfortunately, if you’re having mental-health problems, you might have a hard time getting care; a 2019 report by Statistics Canada found about 5.3 million Canadians needed help with their mental health in 2018, with about half reporting their needs only “partially met” and 1.1 million with needs “fully unmet.”

The CAMH says our mental-health care system was “already under extreme duress before the pandemic began.” These unmet needs have only since increased.

Largely at fault is our two-tiered mental-health care system. Wealthy people get better care, faster, through private services. A 2019 Statscan study found the inability to pay for mental-health care was among the most common reasons for not getting it. The average cost of a single psychotherapy session in Toronto is $125 to $175, or about eight to 11.5 hours of labour at minimum wage. Working-class people (which about 40 per cent of Canadians identify as) are left to piece together help from a hodgepodge of not-for-profit services. Moreover, free services often have months-long wait-lists and provide a limited number of sessions. They often also allow for less control over the kind of care you receive, reducing the likelihood of it being culturally appropriate – something especially important for racialized and/or queer people.

We are failing at providing an essential component of health for working-class people, with potentially serious implications for their economic and social success – to say nothing of happiness. We are also being failed.

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Wellbutrin is a commonly prescribed atypical antidepressant; in 2019 alone, doctors wrote more than 25 million prescriptions for Wellbutrin in the United States.

The drug is generally considered to be “well tolerated,” meaning it works well, with tolerable or minimum side effects, for a lot of people.

I was not one of those people. Whatever Wellbutrin did to my brain, my brain did not like it.

At two weeks on the medication, I developed severe anxiety, memory blips and mood swings. I cried all the time.

At 2½ weeks, I had fits of mania and intrusive thoughts I knew to be untrue: My friends all secretly hated me, my publisher was going to drop me, my partner would be better off if I was dead.

At three weeks, I experienced frequent dissociation and suicidal thoughts.

At night, driving to my partner’s place, the urge to slam on the accelerator and crash my car into a telephone pole was overwhelming. To stop myself, I sang If Ever I Would Leave You, loudly, the entire 20-minute drive.

It was so bad, but I pretended it wasn’t. I wanted – needed – the pills to work.

At four weeks, the hallucinations started, along with tremors and heart palpitations. I called my doctor. He was on vacation. They gave me a resident.

She told me to immediately halve my dose and then stop entirely after a few days. I asked what would happen if I stopped entirely before then. Nothing, she said. She was wrong.

I barely remember what happened after that. I felt awful, so I stopped taking the medication entirely. I went into withdrawal. Those days are a blur, but I know I behaved in erratic, uncharacteristic ways.

And then it got so, so much worse.

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In the month of December, I was taken to Whitehorse General Hospital for psychiatric distress four times.

The first time, I took myself. I paced and paced and paced the triage room, crying and clawing at myself, begging the nurses to make the anxiety stop. I was not admitted, only dosed with Ativan as needed and held in a triage room with no books, no television, no one to talk to – for more than 14 hours. When I finally saw a psychiatrist, he diagnosed me as having an adverse reaction to the medication and informed me I was in for a few very crappy weeks as it worked its way out of my system. He referred me to himself for future treatment – I’d won the “crazy person lottery” – and released me.

Less than 12 hours later, I was back. I’d tried to kill myself.

A friend took me to the hospital. I’d cut myself so badly that I needed stitches. I don’t remember this, but I do remember a yawning, dark hole of despair so deep it was a physical pain, and that I begged the nurses, with earnest desperation, to “euthanize” me.

My friend left me at the hospital, assuming I’d be admitted. I was not. Instead, I was given a lecture by a male doctor about how I needed to change my negative thinking “spiral.” I was then released with a taxi chit, disoriented, still drugged, without further care.

I had no keys, no wallet and no cellphone. Inside my winter boots, I wasn’t wearing socks. My jeans were dark with blood. They told no one I had been discharged. Somehow, I made it home.

Eight hours later, I was back, this time with a police escort, called in when horrified friends discovered I was home again, alone. I wept and wept, unable to comprehend what was happening.

Once again, I was released without being admitted to psychiatric care.

After that, my friends gave up on the hospital. For the next several weeks, I was on suicide watch. I wavered between knowing where I was and who was with me and wild, dark, unspeakable flashbacks, delusions and suicidal thinking. I lay in bed for days at a time or else was so manic I couldn’t be still, pacing and crying. Sometimes I hurt myself.

Through all this, I tried to keep working. If I stopped working, I wouldn’t make rent.

It was useless, though. I missed deadlines. I was unable to read or write. My notes from this time, normally meticulous, are gibberish.

This is what it means to be working class – to have no choice but to work, even when working is impossible.

How big are Canada’s regional gaps in mental health care?

Half of Canadians have too few local psychiatrists, or none at all, and access depends a lot on where you live. A Globe and Mail analysis examines where the problem areas are.

The fourth and final time I was taken to hospital in December, it was by force. I was arrested under Yukon’s Mental Health Act.

People die or are hurt all the time when police handle incidents involving mental health; often, police lack the necessary training that would encourage empathy and an awareness of their role in the community – including why some people are very justifiably terrified of them – which would allow them to be safely useful in these situations. This is especially true when people of colour are involved, as we saw on Feb. 19, when Calgary police killed Latjor Tuel, a Black man suffering a PTSD-related mental-health episode.

I’ve been thinking about Mr. Tuel a lot as I write this, and about what else might have happened if I were not a white person.

I don’t entirely understand what happened to me that night. It was a few days after Christmas, and what professional supports I’d had in place were closed to me until the new year; in the meantime, I was still deeply chemically unbalanced, my brain struggling to come back from the bad reaction to the Wellbutrin even as it worked to accommodate new medications.

I had a severe dissociative episode – a psychotic break.

I am told I started a fire in a barbecue in the yard and was burning things, wild and raving. I am told when the police came, I became even more unhinged, shouting that I wanted to die and demanding they shoot me.

I don’t remember any of this, only fear and a pain in my chest and the overwhelming compulsion that, somehow, any way possible, I needed that pain to stop.

I am told I was brandishing a stick and that I took a step toward the officers.

They shot me with a rubber bullet. I took it in the inner thigh. That I do remember – with perfect clarity.

I was hit. I fell. Two men – the officers – were on top of me, handcuffing me. It had snowed. The snow was very deep. They were hurting me. I was very afraid. They kept forcing my face down into the snow. I couldn’t breathe and I kept trying to come up, but there was no air and they kept thrusting me down again.

I was put in a car and taken to a room with a single plastic chair and an old gym mat – what passes, bleakly, as a holding room for distressed psychiatric patients at Whitehorse General Hospital. I didn’t understand what was happening or why I was there. I was furious. I was in pain. The rubber bullet had left a raw, gruesome wound that bled through my pants.

It was only when I was sedated that I was able to grasp where I was, that I had been arrested. Then there was only the misery and horror of it. I sobbed and said over and over that I wanted to die.

I was kept in that bare room on the gym mat until the morning, when I was briefly transferred upstairs and – for the first time ever – admitted for psychiatric care.

I saw a psychiatrist. She was appalled at my wound. She was appalled at my chart, at how many times I had been brought in and released. She was appalled when I told her I had been trying to access treatment and therapy for five years – and now, here I was, arrested.

I began to cry. I felt as if I would never stop crying.

I was released that afternoon.

I can’t tell you if, legally or morally, the way the RCMP handled the incident was correct or just, any more than I can tell you what was happening in my brain and body that night, beyond that I was very, very ill.

I can tell you, though, that the rubber bullet made a bruise at the impact site all the way down my thigh to my knee, and that the wound scabbed over so deeply that when it fell off I saw white gobs of subcutaneous fat. I can tell you that, four months later, it still hasn’t fully healed, remaining as a red scar and a knot of hard, painfully raised flesh. I can tell you that being shot by a rubber bullet when you’re having a mental-health crisis rooted in trauma is a trauma in and of itself.

I can tell you, too, that being shot by a rubber bullet feels like being struck with a sound that has acquired force, and that the sound itself is the sound of power being wielded against you.

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When we talk about public mental health – about why we do not have affordable, accessible mental-health care for everyone – we often talk about cost. So let’s do that. Let’s talk about cost.

To the greater public over all, mental-health issues in Canada are estimated to cost our economy $51-billion a year – not only in health care but in lost productivity and quality of life. If one in five Canadians are currently experiencing mental-health issues, we can estimate around 7.6 million Canadians need care, be it therapy, medication or a combination thereof. In Ontario alone, mental-health care is underfunded by about $1.5-billion.

In 2018, Prime Minister Justin Trudeau bought the much-contested Trans Mountain Pipeline for $4.5-billion – enough money to buy 36 million hours of therapy at $125 an hour, or 4.6 therapy sessions for each of the one in five Canadians who might need it.

In my home territory of Yukon, the federal and territorial governments have pledged $360-million to build a mining access road; meanwhile, rural communities continue to experience long-documented mental-health staffing shortages. In Toronto – where wait times for community mental-health services reached 684 days in 2020 – the police budget for 2022 is $1.1-billion.

The money is there – we just aren’t spending it on mental-health services for the people who need it.

Those numbers – while damning – say nothing, however, of what this failure of services costs a person.

For me, it meant a major mental-health crisis that robbed me of months of my life and from which I’m still recovering. It’s affected my physical health; I’ve lost weight, and my asthma, a chronic condition, is worse than ever before. I still don’t have access to consistent, affordable therapy to address my PTSD, although I do have a psychiatrist; this has meant medications that actually help my condition but for which I struggle to pay. I’ve lost income through dropped or delayed projects, and I’ve had to take a break from pursuing my MFA. It has caused me legal problems – a charge of mischief, laid two weeks after my arrest under the Mental Health Act, for reasons I don’t entirely understand – which causes me additional anxiety, shame and distress.

Among my deepest regrets and losses during this crisis was the end of my relationship. My favourite person in the world – the best and kindest person I’ve ever met – is no longer in my life.

Above all, this has cost me hope. I don’t know if I believe I will ever have a fully normal, healthy, recovered life. I don’t know if I can afford it.

It wouldn’t be enough for me, though, to wake up in the morning and find that – tah-dah! – I magically had all the mental-health care access in the world and my medications covered and all my problems solved. It wouldn’t be enough because I can see the ball as it lays: I’m working class and visibly non-binary, but I’m also white, university-educated and an advocate for social justice in my community – no one else is more willing and able to advocate for themselves than me, the Yukon’s foremost mouthy queer. If I can’t get the care I need, there are so many other people who don’t stand a chance in hell.

The thought fills me with fury. That fury is the only thing that gets me out of bed in the morning.

Throughout this personal crisis, my friends – my incredible, unmatched, impossibly patient friends, who brought me Chinese food and watched bad television with me, who walked my dog and held my hand and loved me and loved me and loved me, even when I was too sick to love myself – paid the price of my care where the health care system would not.

I’m so humbled to feel so loved and supported by my own. It is for these friends and this community that I chose to survive.

The thing about having a serious mental-health episode is that it can leave you with a sense of terrible shame, horror and regret at this thing that is both of you and not of you, separate but not apart. You fear you’ve disgraced yourself so completely, you are no longer worthy of happiness and love.

This disgrace though, is not ours. That we have this two-tiered system is a disgrace. The way we treat people who cannot afford to pay for private care is a disgrace. What happened to me – what is happening to other people, even as I write this – is a disgrace.

We – you, I, everyone – deserve appropriate, safe, affordable mental-health care. We all deserve health and happiness, regardless of class.

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