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By Giri Puligandla, Executive Director, Canadian Mental Health Association – Edmonton Region

The Canadian Mental Health Association – Edmonton Region and United Way of the Alberta Capital Region are co-leading the development of a new community mental health strategy for Edmonton in partnership with the City of Edmonton. The strategy will involve a broad range of informants to guide a deep analysis of the current state and design a blueprint for a future system of community care for mental health and interrelated issues. A new governance structure will be established with people with lived experience and other affected community members in the lead. This structure will steward implementation of the strategy while ensuring accountability of service providers and funders to turn the blueprint into a reality.   

People are confused and frustrated trying to get mental health supports in the community. 

We hear the same stories today from people struggling to get help for their mental health struggles that we have heard for decades. People still do not know where to start the process or what the right thing to do is in a crisis. Many of the ideas that come to mind – like calling 911, going to the hospital, talking to a doctor, or seeing a psychologist – are hit-and-miss at best, harmful at worst, and are too often cause for people to stop trying. For example, some doctors may not adequately understand mental health issues, emergency personnel may not respond appropriately, and hospitals may be too backlogged. Even if by luck or privilege some initial help is received, getting to the next step may take someone right back to square one. A report by the Health Quality Council of Alberta (HQCA, 2020) examining family experiences seeking care for children and youth, captured this snakes-and-ladders view of mental health services: 

“It is an absolute nightmare, because you just finish with one service, and you’ve gone through this whole rigmarole. It’s taken months . . . and then you have to start all over again, because there’s no connect between the two services.” (HQCA, 2020, p. 11) 

When someone is dealing with the weight of crisis or worry, the last thing anyone needs is a confusing and uncertain array of options, let alone getting an inappropriate response or being dropped from one service to the next. What people need is a clear view of their next steps and a reliable pathway that makes it easy to access support for the first time and get more or less support as needed afterwards.  

There is no coordinated system for community-based supports to address mental health, addiction, or related issues. 

So why don’t we already have this in place? It is certainly not due to lack of investment or strategic planning: over the years, there have been many strategies, initiatives, and plans accompanied by significant funding to address known gaps and increase services in community. However, these investments are usually not rolled out in a systematic way – there are many funders that each make their own resourcing decisions, and the organizations that receive the funding typically deliver these services on their own. Any coordination among funders or service providers is sporadic or limited. Most funding for key services is usually time-limited and constrained to less than the full amount needed to deliver the service reliably and sustainably. As evident in a Canadian Mental Health Association report (CMHA, 2022) on how the pandemic impacted community mental health organizations across Canada, our problems in Edmonton seem to resonate with other communities nationally: 

“It’s these little pockets of money that are never enough to actually provide the service that is expected…you’re reporting on it, and then you’re starting the next round of proposals again because the year is up. And it’s very challenging to retain the quality employees in these programs when you can never promise them stability and it’s really difficult to be strategic in your work and to make plans when you’re year to year…” (CMHA, 2022, p. 17) 

What has become evident from talking to many community leaders is that as much as we like to think we have a “mental health system”, there is no system to speak of. A system implies intentional design and thoughtfulness about interconnections among its parts. We couldn’t randomize the way services are distributed throughout the community any better if we meant to do it.  

What complicates matters further is that the top-down view of governments, funders, and organizations shape issues through specific policies, initiatives, and programs, artificially disconnecting them (and services and resources) from the way they are experienced by people and communities. This historical pattern of institutional responses has produced a series of initiatives that focus narrowly on one segmented issue after another, layering new resources in communities but in a disorganized way. The irony is that the interconnections are painfully visible from the vantage point of lived experience: people who are struggling with mental health, addiction, suicide, violence, trauma, or social disorder are usually experiencing them as a combination of causes and effects, often compounding and exacerbating each other. Despite the interconnections plainly visible from the vantage point of lived experience, the historical pattern of institutional responses has produced a series of initiatives that focus narrowly on one segmented issue after another. Fortunately, the City of Edmonton’s Community Safety and Well Being Strategy (CSWB, 2022) and the Alberta Mental Health and Addictions Advisory Council’s Alberta Model of Wellness (AMHAAC, 2022) represent approaches that address intersections among this constellation of issues.  

Previous strategies have not put enough weight on community perspectives and lived experience. 

The CSWB commits to a “a deliberate and concerted effort to put community at the centre” (CSWB, 2022, p. 3). The Alberta Model of Wellness elevates the importance of feeding individual experience into system (re)design: 

“The experiences of individuals with lived and living experience of recovery, as well as their families, peers, allies and/or networks, are invaluable in informing the design and implementation of effective recovery-oriented care. Experiences should be inclusive of vulnerable and historically excluded groups.” (AMHAAC, 2022, p. 20) 

What will make this new mental health strategy different – and more impactful – is that it will turn the usual power structure upside down: people with lived experience and community members will have the most influence in designing the future system of community care. This is a sharp contrast to the government, institutional, and service provision lenses that typically dominate the definition of both problems and solutions, with minimal involvement of the people who live them. The end result will be a system blueprint designed by community members that embodies how they experience the breadth of mental health and related issues and offers clear, predictable pathways to get support when, how, where, and from whom it makes the most logical sense through their healing journey and lifespan. 

While the strategy is being built, the community-led governance structure will be established to bring it to fruition and guide its implementation. This will similarly blaze a new trail for Edmonton, giving direction-setting and decision-making authority to end-users and community members as the new system gets built. Change management will be critical to enabling the governance structure to lead strategy implementation because it depends on repositioning service provider organizations, institutions, funders, and governments as accountable to and in service of its direction. 

Fundamentally, if we don’t fix the current situation and do it in the right way, the mental health and related issues that are visibly escalating in our city will have deep and long-lasting consequences on our families, communities, and economy. While we should have designed the system people needed a long time ago, sometimes adversity opens doors for thinking and action that can produce real transformation. That’s the hope, and why so many of us believe we can finally make it happen now. 

Note: This is an excerpt from our December 2022 Community Matters, you can read the full publication here

Did You Enjoy this Article? Please provide feedback here: Microsoft Forms 

References: 

Alberta Mental Health and Addictions Advisory Council (2022). Toward an Alberta Model of Wellness: Recommendations from the Alberta Mental Health and Addictions Advisory Council. Government of Alberta. Retrieved from https://open.alberta.ca/publications/toward-an-alberta-model-of-wellness.  

Canadian Mental Health Association National Office (2022). Running on Empty: How Community Mental Health Organizations Have Fared on the Frontlines of the Pandemic. Retrieved from https://cmha.ca/brochure/running-on-empty-report/.  

City of Edmonton (2022). Community Safety and Well Being Strategy. Retrieved from https://www.edmonton.ca/city_government/initiatives_innovation/community-safety-well-being-strategy.  

Health Quality Council of Alberta (2020). Parent and Guardian Experiences with Mental Health Services for Children and Youth. Retrieved from https://hqca.ca/mentalhealth.  

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Losing a loved one to suicide is difficult but having the support of others can be a source of strength. The Canadian Mental Health Association provides services for those who need suicide bereavement support. Services are provided at no cost and are available to adults who have lost someone they know to suicide. The program covers 3 modules over 12 weeks, is group focused and is offered on a virtual platform. To learn more about the program click here.   

Two participants of the program have courageously shared their experiences with loss, grief and mental wellness. They both wanted readers to know if you have experienced suicide loss, you are not alone. 

Tyla Tong 

Our family lost  Shahean Aboud to suicide on 18 March 2021. He was a charismatic, full of life and laughter kind of guy who loved dogs and his family. He worked in the oil field…. long hours…. making way too much money and in the end succumbed to his addictions. First cocaine and meth and then onto more serious drugs where he then died by taking his own life. After spending over a decade with him I had to come to the realization that the man I married was no longer the same man that stood before me plagued with drugs and addiction. 

We were together for 15 years and suffered the loss of our beloved pet in 2014. I don’t think that he had the coping skills to deal with grief because grief isn’t something we talked about in our marriage or with our families. It just didn’t come up. He fell to drugs as a coping mechanism and even more so when things started to unravel from the addiction.  

I happened to find this program [Life After Suicide Loss] one evening. I was watching a TV show called a Million Little Things and they made reference to the Canadian Mental Health Association. At that moment I grabbed my phone and started to research; I wonder if there’s something here that could provide some level of support as I went through the grieving process. I had never even heard of the Canadian Mental Health Association [CMHA]. Much like Shahean I had never really struggled in that facet, so I never had a need to research it. Luckily, I found the Life After Suicide Loss and Bereavement group. It took an immense amount of courage to reach out, but I did. I sent an e-mail, and I thought maybe someone would respond, maybe they won’t, but at this point, I knew I was struggling with grief and loss and needed some support.  

They responded to me within a day, and they provided me with pamphlets, a book about suicide, and commonly asked questions surrounding suicide. The CMHA member who replied back to me was kind and compassionate and provided more avenues of support than I ever could have imagined.   

I started the online Grief and Bereavement group with an interview by one of the facilitators to make sure that I was a good fit. It’s really not about them judging you, it’s about making sure you understand what the program has to offer and then deciding if it’s right for you or not. I completed the interview which took about an hour and included one other person who was also considering joining the group. At the end of the call those people at that moment became my people, they were so understanding, compassionate, and empathetic. In my very first session, I showed up and introduced myself and you could tell that everyone was a bit uncomfortable, you’re the most vulnerable, you are going to be in a chat room full of strangers. The program is so well laid out and so well-articulated that within probably 20 minutes I was convinced this was the place where my healing journey would begin. It’s a guideline that you don’t talk about the specifics of how someone passed away. It’s to ensure that triggers are avoided but the discussions are around feeling, emotions, and coping strategies for moving back into life after suicide.   

CMHA lays the program out in three different modules so you can pick and choose what you want to learn about or what you’re ready to learn about. Some of it you’re not ready to hear and they always preface the discussion with ‘this is what we’re talking about if this is hard for you don’t have to. Beliefs and Values were where my group started, and we eased into heavier topics from there. You don’t have to say anything, just be present and open to healing.  

It’s a very well put together program, very well thought out and articulated in the delivery. They have a second phase of the program once you complete your three modules; you have the option of a virtual drop in every second Thursday. Regardless of if you are planning on attending or not, if you’re on the list they’ll send you the link so you can choose to just drop in. Some people aren’t there yet, and I am one of those individuals. What the program taught me though was that it’s okay to progress or recess at your own rate. Grief is not linear, and it is not easy moving through the emotions. 

Some people need to check in and sit with their grief regularly and they still need to be acknowledged for where they’re at in their journey. I think that’s a really important piece because CMHA is acknowledging that you’re not better in three months but are still there to support you and provide you options for moving through the process.  

The program is concrete and consistent, which is what I needed when everything else in my life had changed forever. I know for me consistency came on Wednesday nights where I could get through the whole week and not fall apart knowing there was space for me on Wednesday nights to meet with my group and deal with my grief. You know at the end of the meeting you’re going to hang up the phone and you’re going to feel pretty terrible because regardless of how kind the people are, you just ripped a band-aid off a wound that is so incredibly deep.  

The CMHA have thought of everything. You give them an emergency contact before you can participate. They tell you if you have to leave the group for more than 10 minutes, they will call to personally check in and make sure that you are okay. The facilitators really work to provide a safe space for everyone.  

The Grief and Bereavement program doesn’t just give you tools but it provides you with this platform to continue on in your life. I feel like this program really taught us how to implement techniques, like how to really sit down and know if you’re in a good space, to know what it feels like to feel safe.  I never would have imagined that these random strangers would be people that to this day, a year and a half later, I still call when I feel like my grief is something I cannot handle alone. The program helps you establish relationships with people who are going through the very same things as you.  

The connections are truly what drives this program. For me, it was almost like a little bit of guilt every week. I didn’t want to miss a session because I knew ultimately it would help me heal but on the other hand, I didn’t want to do it at all, you’re never fully prepared for the emotions that come up.  

I thought losing my partner to drugs and addiction, the collapse of our marriage, and the loss of my lifelong best friend was the worst possible thing that could have happened until that day when I received the call. I didn’t realize that suicide was so different than other types of loss until weeks later when I came out of the haze of the crisis. The dynamic changes between your family and your friends, how people look at you, how they talk to you, what people say to you, the shame and the guilt and the question of “could I have done more” is always lingering.  

We don’t talk about grief; we don’t read articles about it, it’s easier to pretend it doesn’t happen.  But the truth is we’re all going to have to go through it. I still struggle with grief and the loss of the life I thought I was going to have. I struggle with the idea of addiction and all that surrounds it. Everything you know fundamentally and have grown your life on is completely gone.  

One message I would like to leave people with is know that there’s hope. Losing a loved one to suicide is one of life’s most painful experiences, but you’re not alone. There are people that can connect and understand you in this space that you’re in and help you move through the complexity of grief. 

Lorella Balombem 

Graeme Eigner was lost to suicide on December 25, 2019. Graeme was a welder, the kindest, most caring person who would do anything for anyone. He had a potty mouth and was often misunderstood by people.   

Graeme and I were together for 10 years. We got engaged, bought a house together and planned a destination wedding. He passed away five months before the wedding day. I made a promise to myself and him that I’m always going to talk about mental health and suicide. Not a lot of people do because of the stigma. They don’t talk about mental health and the effects it has and how it can ultimately end someone’s life. I lost Graeme to suicide on Christmas Day of 2019. It happened in our home, and I found him. I have had to deal with my own trauma plus my grief, because it was compounded. I don’t even know if there’s a word to describe the feeling. 

Two weeks after I lost Graeme, I was still in my fog of grief. Heavy, heavy grief. I knew that I needed some help. I knew that if I didn’t seek help for myself in the early stages that I possibly wouldn’t be here. I decided to reach out to support through work at Alberta Health Services (AHS).  

They sent me to a counselor, however when I met with her, I realized that I only had ten sessions, then it ends.  So, I knew that wouldn’t work for me. Ten sessions would never ever be able to help me with what I needed, but I went anyways. Two sessions in the counselor was very honest and told me that the compounded trauma and grief that I was dealing with, was beyond her scope. So, she recommended I seek other help. 

First off, it’s extremely expensive even with my coverage, it was still $150 per session. She sent me to Pilgrims Hospice Society, a nonprofit organization that deals with family grief in all different forms, for adults, kids, and the whole family. So, I went to Pilgrims Hospice, and I had my sessions with them. Their psychologists told me coming through them is great, but they believed that I would benefit way more from a group setting. She recommended me to Peris [facilitator with Life After Suicide Loss Program], sent Peris an e-mail and that’s how I became connected with the Canadian Mental Health Association.  

I went through the program with my own grief in the group setting and then after I finished that I knew within myself that I needed more. I couldn’t do short term it was not going to work for me, I knew I was going to derail at any minute, at any time. I needed that constant support. I started to go to the weekly sessions, at first, they were in person and then COVID hit. It was like, OK now what?  

The weekly program ended up being virtual after COVID started. It was so helpful because it gave me a platform to talk about what happened during the week and listen to other people. That was probably the most effective for me, just listening and learning how other people were dealing with their grief.  

I met people that were there 14 years after they lost their loved one. I think realizing that that it would be a never-ending struggle was helpful, but also it was sad. There are people that have good days, I have good days, I have good weeks and then it hits you again. So having that platform every week to listen, share or support was tremendous.  

I know what it is that CMHA is doing differently. They have such a structured program that it helped with my grieving steps, and it helped me to understand what to expect. Grieving came at any time with different emotions, it’s just all over the place. Knowing what to expect was so helpful. 

I went back to work sooner than I thought I would because I knew that I had that meeting for support. As much as my colleagues, my boss and everybody was supportive, people don’t know. They didn’t know what to say or how to say it. Or people just don’t talk about it. It was like you have to keep this secret all week about how you were feeling and then you get into this weekly session, that was your release.  

During our weekly session we all were struggling, we all had that weekly support and there wasn’t enough time for everybody to share within an hour how they were feeling. Knowing that there’s other people suffering, only someone that has been through it can understand that. Even though I’m struggling, someone else is too. 

I work shift work and I try very hard to attend my biweekly support groups because there were a few months that I stayed away, and I thought that’s OK I got this, I’m doing good. It feels good, but then something happens, and you realize you really need someone that understands. 

I can’t talk to my mom about it because my mom doesn’t understand. She and other people think and say you should get over it. It’s been almost three years and life has to go on. So, there’s that huge barrier. You can’t speak to just anyone and they will understand. That is why the support group after suicide loss is so extremely important.   

Even though I work with AHS, when I look for mental health support, I have a son that suffers with mental health challenges also, and when I look for support for him it is incredibly hard to access. The world suffers so much with mental health illnesses, resources are hard to find and they’re not affordable. Why? We have treatments for cancer, for diabetes and for hypertension. Yet, the mind is overlooked.  

We have to recognize mental health illnesses more. We must destigmatize it. We have to talk to our kids and bring support into schools because that’s where it starts. This is 2022 we have nurses going into schools to take care of kids, why can’t we have the same sort of support for mental wellness? When I hear Graeme’s family and his parents talk about the struggles he faced as a kid and how overlooked that was, it didn’t appear overnight.  We notice mental health challenges, but we brush them off and we tell our kids to suck it up. Society makes things difficult, anytime a man talks about his feelings he’s viewed as weak. He’s not allowed to feel. Graeme was one of those men. He was so ashamed of how he was feeling.  

Society as a whole needs to encourage young boys and men to talk about their feelings. Society needs to understand that mental health challenges are just like every other illness. It needs attention, it needs medication, and it needs rest. 

Note: This is an excerpt from our December 2022 Community Matters, you can read the full publication here

Did You Enjoy this Article? Please provide feedback here: Microsoft Forms 

If you or someone you know needs supports:  

Suicide Support Resources: https://edmonton.cmha.ca/brochure/suicide-bereavement-resources/ 

Visit the Canadian Mental Health Association Website for additional resources.  

If you or someone you know are in immediate danger, call 9-11.  

If you or someone you know is in distress: 

• Call the Distress Line at 780-482-HELP (4357) 

• AHS Mental Health Help Line 1-877-303-2642 
• Talk Suicide Canada 1-833-456-4566 
• Kids Help Phone-1-800-668-6868 
• Indigenous Hope Line 1-855-242-3310 
• National Trans Help Line 1-877-330-6366 

• 211 Alberta: find programs and services in your community. 

For more information on programs and resources about suicide: 

Alberta Health Services Suicide Prevention 

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