A decade of progress in mental health care, but not for those who need it most
When I was in graduate school in the early 2000s training to become a psychologist, a new wave of approaches was gaining momentum in the field: mindfulness-based Interventions. With mindfulness, clients and group participants received Buddhist-inspired wisdom and meditation practice to help them let go of harmful thoughts and worries and attend to the present moment with an open and non-judgmental attitude.
I developed an expertise in these approaches during my postdoctoral fellowship in the United States and came back to Montreal on a mission to lead this paradigm shift in my community. The Mindspace Clinic was founded under these circumstances, exactly a decade ago. One of the first things I did to launch my practice was pin posters on telephone poles and poster boards in NDG, promoting my mindfulness groups.
It was a stretch to fill out that first group. In fact, I had to call in a couple of favours from friends. But it wasn’t long before we were filling groups every month. I soon came to realize that the demand for our services reflected a hunger in my community for connection, compassion and the possibility of a better way of being.
I have seen a number of important changes in the mental health field in the last 10 years. We’ve seen the stigma that once buried many people’s suffering in shame and secrecy cast aside by a recognition of the ubiquity of mental health problems. As practitioners, we’ve worked hard to support our community, contribute to de-stigmatization and improve accessibility.
But there is much more to be done to ensure that our interventions are effective, and diverse communities are adequately served. The need has never been more acute than right now, as we wrestle with a mental health crisis exacerbated by the global pandemic.
The need has never been more acute, as we wrestle with a mental health crisis exacerbated by a global pandemic.
Today, therapists are increasingly sensitive to the prevalence of trauma and how it underlies and sustains so many symptoms we treat. Similarly, many of us recognize that we have much work to do to attune our sensitivities to diversity, equity and inclusion.
Our psychotherapy sessions and mindfulness groups are disproportionately populated by white, middle-class people with health insurance. In some cases the reasons for this are obvious: public system psychology clinics have wait lists of up to 24 months while private clinics are staffed by therapists with many years of training who are trying to make a living. This limits access to their services.
In other cases, the reasons are more subtle and systemic. Psychotherapy is a western construct with its own cultural history. The leaders in the field have primarily been white men trying to address white people’s problems and train white students.
Because psychological safety is an essential ingredient in psychotherapy, it is incumbent upon all therapists to deepen their sensitivity to the experience of clients who have felt marginalized by their traumas, race, cultural background or socio-economic status. It is also essential that clinic owners, educators and policymakers find ways to make services more financially accessible and support the training of non-white therapists.
In retrospect, it’s not surprising that the waiting list has been part of my experience at every stage of my career (other than my telephone pole marketing days). Throughout Montreal, new patients must wait weeks to months to get an appointment with a competent therapist or tap connections to circumvent the wait list.
How do you explain a seemingly endless supply of people who need support for their emotional pain? Is it the alienation inherent in the individualistic, capitalist values of western industrialized societies? Or the proliferation of technology that disconnects us from each other and the present moment?
After seeing literally hundreds of clients and growing our organization to three clinics with more than 40 practitioners in just 10 years, I believe part of the answer lies in the nature of emotional healing. While there are dozens of approaches to delivering psychotherapy, they all share one essential ingredient: the therapeutic relationship. The research clearly shows that positive outcomes in therapy depend on a therapist’s capacity to be attuned, responsive and non-judgmental.
In other words, clients need to feel cared for. Loved. Humans are fundamentally social beings. Our emotions have been shaped by evolution to communicate our needs to others. And so healing, whether it’s achieved through changing our thought patterns or transforming emotions, can only unfold in the container of a loving relationship. So people on psychology clinic waiting lists are really lining up for love. Why is love in so much demand these days? Why is it sold in 50-minute sessions by regulated professionals? Why do those who need these services the most receive them the least? These are important questions that we truly need to face if we want to heal and be well as a society.