Let me preface what I’m about to say with acknowledging my support and thanks for #BellLetsTalk. I believe that any effort to de-stigmatize mental illness is a valuable one whether it comes from corporations, academia, or activists. However, as a nurse and educator who works in mental health, I question how ready we actually are to have the tough conversations required to address mental health long-term? We can tweet and text our support for the cause, but can we really talk about the issues involved? If so, here are some of the conversations we need to have:

Mental illness isn’t primarily a middle-class issue.

Everyone’s mental well-being is important, and every person matters. However, stories told of mental illness and recovery are often as much reflective of personal privilege and opportunity as they are of personal strength. In fact, my own story of recovery from depression depends on access to resources, supports, employment benefits, and opportunity that are far from available to all. The hard truth is that people experiencing poverty are nearly twice as likely to have a mental health challenge than those who are middle-class, and over 7 times as likely as those who are wealthy. Comments like “mental illness affects us all” serve to effectively de-stigmatize mental health, while simultaneously masking the significant variances in who is impacted most by mental illness. So if we truly want to talk about mental health, we need to talk about why it’s much more of an issue for those experiencing poverty than an issue of the middle-class.

Meeting the basic needs of people experiencing mental health challenges means bigger government.

As demonstrated by the thorough and powerful reporting by Jennifer O’Brien into the substandard housing conditions faced by many with mental health challenges in London, basic needs of food and housing prove out of reach to many. With many individuals who are in the midst of a mental illness living on Ontario Works at $676/month and inadequately supported in the community, affordable housing wait lists of years, and food prices rising, mental illness is equating to hunger and homelessness. Altering this reality means a significant raise to two tax-supported government systems: affordable housing and social assistance. If we are willing to talk about mental health, then we need to also talk about an expanded social safety net and what it will cost.

The first step is to stop causing mental illness.

The root causes of mental illness are complex, interactive, and quite individual. The role of genetics is often highlighted as the idea that “mental illness is an illness like any other” is effectively de-stigmatizing. However, the role of genetics is often over-stated, with Dr. Gabor Mate teaching us that environmental factors and determinants of health play a much greater role, and even genetic predisposition is itself effected by the environment. A greater explanatory factor than genetic predisposition is the experience of trauma. Physical abuse, sexual abuse, cultural abuse, emotional abuse are primary root causes of mental illness and are perpetuated by us. In fact, half of the women reading this post will have experienced physical or sexual violence, the majority perpetuated by a male intimate partner. Therefore, if we are willing to talk about mental health, we should also be willing to stop our own acts of violence and stop perpetuating trauma. Are we ready to talk about mental health but avoiding talking about our violence against women?

(Note: If you are a woman experiencing violence in London support is available at Women’s Community House.)

Some people who commit crimes have mental health challenges.

Compassion is easy when we are not personally effected, can we maintain it when we are? It’s possible that you have or will be victim of a crime, whether it’s something minor like having change taken from your car, or major like being assaulted. It’s possible that the person who commits this crime has a mental health challenge. If this occurs, will your response to this be tempered by your compassion around mental illness, or will it be driven by the evolutionary desire for vengeance? With those facing mental health challenges incarcerated en masse, I would suggest that neither individuals nor the justice system are particularly good at considering the impact of illness on behaviours, and how we might better assist people to be well. The out-cry surrounding Vince Li getting day passes, even though not criminally responsible, shows that vengeance reigns over compassion. We avoid talking about mental illness and crime because thinking of those with mental health challenges as criminals has been a horrendous part of the stigmatization process. However, if we are willing to talk about mental health, we need to be willing to talk about how we can reform our justice system to stop having jail serve as the new asylum.

Many of us discard our own mentally ill children.

I left this one to last as it is the most personal and most painful for many, including myself (my brother’s experience of homelessness started when he was kicked out of our family home). Visiting any youth shelter, you will find a group of youth who have been driven out, kicked out, and frequently simply discarded by families. Where many have the misconception of homeless youth as “bad kids who run away”, I highlight that the lead cause of youth homelessness is the experience of violence in the home. And, the overwhelming majority of youth experiencing homelessness face a mental health challenge. Therefore, when confronted most closely with mental health challenges within our family, many of us respond poorly and reject rather than support them. If we are going to talk about mental health, then we need to talk about how we respond to those in our own family who struggle.

(Note: I want to acknowledge that so many, many of you do the very opposite. You are the rocks, the amazing supports for you loved ones through their difficult times. You are their pathway to recovery and I want to thank you…it’s not you who I’m talking about here.)

So yes, let’s talk about mental health.

For sure, we need to. Mental health is a catastrophe and a crisis. However, if the primary narrative is the cost of mental illness on our economy, and the solution is driven by workplace wellness, then I think we are missing a lot of the conversation. The issues go beyond middle-class concerns, and get to fundamental questions of how we structure our society, how we share our resources, and how we live together. Let’s have those conversations too.