An expert panel explores the links between mental illness and poverty

With as many as one in five Canadians suffering from a mental health disorder at some point in their lives – that’s approximately 4.5 million people, carrying a cost of nearly $50 billion annually to the country’s economy – the subject of mental health is always a timely one. WE magazine sat down with three Edmonton-area mental health experts for their take on the links between mental illness and poverty, and mental health among seniors and families. They also offered tips on how to best spur that conversation, including broaching the topic with loved ones.

Bernice Sewell is a registered social worker who, for the past 14 years, has worked at SAGE (Seniors Association of Greater Edmonton) as director of operations. In this role she manages 11 frontline programs aimed at meeting the needs of the senior population including the Seniors Safe Housing program. Bernice was instrumental in the development of both the Seniors Safe House program and the Seniors’ Abuse Helpline.

Jodie Mandick is supervisor of help lines at The Support Network. For the past three years she has trained and supervised crisis workers, volunteers and practicum students. She is a certified information and referral specialist with the Alliance of Information and Referral Systems Canada, and a certified crisis worker with the American Association of Suicidology.

Mary Stewart is a community investment specialist at United Way and has worked with children and families for 25 years, primarily in early childhood development and parental support. She recently returned to Alberta after working in B.C., in early intervention. She holds a masters in early childhood education, with a focus on families with children who have disabilities or developmental delay.

Poverty can also trigger and worsen mental health issues, particularly when it comes up suddenly as a result of a loss, like divorce or the death of a loved one.

– Jodie Mandick, supervisor, The Support Network

Q. How do you see mental health affecting the people you work with?

Bernice: There are many things that impact the mental well-being of seniors. This is the time of their lives that they are encountering many losses, including a loss of independence, loss of loved ones, loss of their home and the loss of their driver’s license. Statistics tell us that the highest rate of suicide in Canada is among men over the age of 80 (31 out of every 100,000 people).

We also hear from seniors that they are reluctant to seek help because they are from a generation where you were thought of as crazy if you had a mental illness of any sort, and that you were going to be locked in a padded cell.

In addition, there is also the ageist view that depression is something that happens when you get old, therefore it goes untreated. For this reason, mental illness also plays a role in seniors becoming more isolated.

Jodie: Specific mental health concerns are the main issue for approximately 14 per cent of Distress Line calls this year – this can range from issues like depression and anxiety to bipolar disorder or schizophrenia. A full 34 per cent of our calls are related to mental health in some capacity. Some of our callers are living with mental health issues, and others are concerned friends and family members, looking for help to support someone living with a mental health concern.

We know that one in five people will be diagnosed with a mental health condition at some point in their lives, and so many more are affected through the process of caregiving and support. The most common issues for callers experiencing mental health concerns is isolation related to lack of support services, stigma surrounding mental health and challenges with poverty and meeting basic needs.

Symptoms can vary with each type of mental illness and each individual. Some common symptoms to watch for are confused thoughts, delusions or hallucinations, extreme fears or anxiety that seems out of proportion to circumstances or events, extreme mood swings between depression and mania (sometimes with overly reckless behaviour), disruption to usual sleep patterns and talk or thoughts of suicide. While some of these symptoms are uncomfortable or frightening to talk about, it is important to connect with family, friends and professionals that can provide support.

Mary: At United Way, I work under the education pillar, and I have worked with families with young children who have disabilities or developmental delays. In our education pillar, we focus on the child, especially within the family context.

When I look at mental health it’s through a broad lens. We try to impact parent-child interactions. If you have a parent who is dealing with a mental health issue, it affects their ability to respond to their child, and you can also have a child who has some mental health issues, which affects their ability to interact with their world and the people around them.

My background is infant mental health, which looks at that parent-child relationship from birth, and the attachment process for parent and child. Mental health affects life-long experiences, starting with that first parent-child interaction. It includes things like the ability of a child to self-soothe, to transition from one activity to the next. Some of the information from the Alberta Family Wellness Initiative talks about the “serve and return” of a relationship, and the executive functioning for children – all of that is set within those early relationships.

Q. What are the links between mental health and poverty?

Bernice: Even if they don’t suffer from mental health issues, many seniors live in poverty, on $1,600 per month or less. Only 70 per cent of their medication costs are covered and only a very minimal amount of dental expenses and the cost of glasses are covered.

If someone has suffered from chronic mental illness all of their life, they might have been on Assured Income for the Severely Handicapped (AISH). So let’s fast forward to turning 65. First, seniors have to be able to understand the forms they are required to fill out. Once this is done, they receive Old Age Security, Canada Pension Plan and other seniors’ benefits. If they meet some very specific requirements, they will make slightly more than they did on AISH. However, their cost of living increases considerably from what it was on AISH, under which all of their medication, dental and eye glasses were covered. Once they turn 65, this is no longer the case.

It is also worthy to note that the shelters available in Edmonton do not meet the needs of the senior population for many reasons, the first being that they are not accessible to walkers or wheelchairs.

Jodie: We know that there’s a lot of overlap between mental health and poverty. Coping with a mental illness takes significant time and energy that may otherwise be used seeking and maintaining gainful employment and attending and successfully completing post-secondary education.

In addition to these challenges, many people with mental illness struggle to maintain housing and other basic needs. Approximately 59 per cent of Edmonton’s homeless population suffers from some form of mental health condition. Medications for these health conditions can be very expensive, making it hard to find the resources for proper food and clothing. There is also a pervasive stigma surrounding mental health issues, which exacerbates isolation and prevents people from accessing supports.

Poverty can also trigger and worsen mental health issues, particularly when it comes up suddenly as a result of a loss, like divorce or the death of a loved one. Mental health and poverty often have a cyclical relationship, where poverty perpetuates mental illness by preventing people from being able to access supports; and mental illness consumes a significant amount of time and energy, preventing people from focusing on increased financial stability.

Mary: Poverty affects children right from conception. If a parent is living in poverty they typically don’t have access to adequate nutrition, which impacts the child’s brain development in utero. Compounding that, if you’re a person living in poverty, you are facing daily stressors due to an unstable lifestyle, like “Where do I live? How will I pay my hydro bill? Where is my child’s next meal coming from?” It becomes difficult to respond to your child because you are focused on these immediate issues. The link between poverty and mental health starts right at birth and compounds from the parent’s experience and the experience of the child living in that unpredictable, possibly unsafe environment.

What we do know about brain development is that if a parent, and consequently a child, is under toxic stress, it actually becomes a toxic environment for the brain. Those neuropathways are not able to develop, so a child is not able to learn or retain information well. And for the parent, stress impacts their decision-making ability. Poverty with families is a very complex and compounding issue.

Q. How can we start the conversation about mental health with our loved ones who may be affected?

Bernice: When it comes to seniors, it’s important to help dispel the myths that surround mental illness. Ask a person who has high blood pressure or diabetes if they would seek treatment for the disease, and the answer is always “yes.”

This provides an opportunity to talk about the similarities to mental illness.

It is important to be well informed about available resources and exploring the person’s ability to access those resources. It is important to name mental illness and talk about it.

Jodie: The best thing we can do to start a conversation about mental health is to show genuine care and concern.

A major part of reducing the stigma around mental illness, and supporting people affected by it, is to address it directly with a sense of empathy. Remember that, although you may never have experienced exactly what they are going through, we have all been afraid or confused.

Allow the person to talk about what is going on, and listen without judgement. Respect and acknowledge that the issues that trigger mental health are real and valid to the person experiencing them. Help them build on the resilience that they’re already demonstrating, and encourage them to access more resources and support. It can be helpful to connect them to support services for people living with mental health conditions, like the Canadian Mental Health Association, or a crisis line such as the 24-hour Distress Line.

Mary: If it’s somebody you care about, it’s really just about starting that conversation and saying, “I am concerned about you. You are taking care of a lot – how can I support you in being responsive to your child?” Start the conversation without judgement, talk to them about what resources are available. One of the things that came up when we were having our panel discussion was recognizing that there are some diagnosable conditions, even in early childhood. Sometimes children need to be treated with medical interventions and psychotherapy.

A high percentage of our children and youth are suffering from anxiety and depression, so it’s important for us to recognize that those are conditions that need intervention, but there are also ways that we can support, parents and children.