From the Canadian Women’s Health Network
The federal government recently announced the establishment of a Mental Health Commission (March 2007), and the plan to develop a Mental Health Strategy for Canada. This has created an important opportunity for us all to make sure that women’s and girls’ mental health issues, challenges and experiences are part of the national agenda, and that a gender lens will be used to inform the overall work of the Commission.
To this end, the Canadian Women’s Health Network (CWHN) held a national workshop in Ottawa in October 2007 to bring together researchers, community-based service providers and educators, non-governmental organizations and policy makers interested and active in gender-based and women’s mental health issues to explore the mandate of the newly formed Commission, and to establish strategies for ensuring women are not left out of the picture. The workshop was made possible with support from the Canadian Institute for Health Information (CIHI) and Carleton University.
The workshop convened by CWHN comes a full 20 years after the release of the Canadian Mental Health Association landmark report, Women and Mental Health in Canada: Strategies for Change (April 1987), and almost 15 years after a federal/provincial/territorial Working Group on Women’s Health released its report, Working Together for Women’s Mental Health: A Framework for the Development of Policies and Programs (March 1993), which includes mental health as a key focus. Participants at the workshop built on these still-relevant documents, as well as more recent research completed by the Ad-hoc Working Group on Women, Mental Health, Mental Illness and Addiction, established in 2006 by the CWHN.
This more recent Working Group was convened by CWHN to respond to a report from the Senate committee chaired by Senator Michael Kirby, Out of the Shadows at Last, which largely kept women’s mental health concerns “in the shadows.” In 2006, the Working Group submitted a formal written response to the Senate, entitled, “Women, Mental Health and Mental Illness and Addiction in Canada: An Overview,” highlighting the importance of sex- and gender-based analysis (SGBA) for any accurate and comprehensive understanding of mental health issues in Canada.
Workshop participants met to make sure that all of this important research on women’s mental health concerns – only a small sample of more than two decades worth – would not be left out of the work of the current Commission. To set the stage, the workshop began with an overview of the Kirby Senate report on mental health by Dr. Marina Morrow from the BC Centre of Excellence for Women’s Health, highlighting the lack of SGBA and the significant gaps regarding women’s and girls’ mental health in the report.
Workshop participants also heard from Dr. Howard Chodos, a representative of the newly formed Mental Health Commission, and Madeleine Dion Stout, co-chair of the Commission Board of Directors and one of the founding members of the Aboriginal Women’s Health and Healing Research Group (AWWHRG). Participants also held breakout discussion groups to brainstorm on specific concerns, such as the Commission’s proposed anti-stigma campaign, as well as the links between mental health issues and youth, the effects of violence and trauma, and workplace/workforce mental health issues.
Many workshop participants committed to working together in the future to produce written submissions to the Commission, and develop further strategies for making SGBA and women’s health central pillars of the Commission’s on-going work. The Canadian Women’s Health Network agreed to coordinate initiatives resulting from the workshop, and we are currently in the process of collecting reports and information about innovative, gender-conscious mental health programs, as well as developing a national working group on Gender, Women and Mental Health to respond to the on-going work of the Commission.
Stay tuned for more on this topic, by visiting www.cwhn.ca or contact: 1-888-818-9172.
by the Canadian Women’s Health Network, adapted from a presentation by Marina Morrow at the Women, Gender and Mental Health Workshop at Carleton University, October 15th, 2007.
Sex and gender matter when discussing mental health, mental illness and addiction.
Conditions can be more prevalent or less prevalent among women or men; for example, in Canada, women are almost twice as likely as men to either experience or be diagnosed with depression and anxiety while men are more likely to have problems with addictions to alcohol. Women are also more likely than men to be diagnosed with seasonal affective disorder, eating disorders, panic disorders and phobias. Men, especially elderly men, are more likely to commit suicide, while women are more likely to attempt suicide and engage in self-harming behaviours without intent to die (used as a coping mechanism when faced with overwhelming emotion).
Sometimes conditions appear to be gender neutral but in reality have different signs and symptoms requiring different treatments and services. An example of this is schizophrenia; men typically develop schizophrenia younger than women, therefore requiring different forms of treatment and services. With addictions, the forms of substance use among men and women differ as well, in their seriousness, prevalence and health impact.
There are also pharmacological differences; sex differences such as variations in lean body mass, hormonal concentrations and gastric absorption have been shown to affect the absorption, distribution, metabolism and elimination of drugs and the biochemical and physiologic effects of drugs. Women are more frequently prescribed anti-depressant and anti-anxiety (psychotropic) drugs, and are far more likely to consume these medications than men. These medications are potentially addictive and are associated with other problems such as falls.
Women access the mental health system more frequently and have higher rates of hospitalization for psychiatric problems than men do. When discussing mental health services, women cope with stress and life events in different ways and vary from men in how they signal their distress.
Gendered roles in society also influence mental health. Women bear the burden of responsibility associated with being wives, mothers and caregivers of others. Over 80% of caregivers are women. Unpaid caregivers have very high rates of stress—which affects both emotional and physical health. Female caregivers are often part of the “sandwich generation” caring for young families as well as elderly parents. Caregivers of those with serious persistent mental illness often take on the role of nurse, counsellor, advocate, crisis worker, homecare worker and income provider all in one.
Unpaid caregiving responsibilities also have an impact on women’s relationships with paid employment; women leave paid work, more frequently work part-time positions and have less access to benefits. This employment picture contributes to the higher rates of poverty in women across their lifespan and why access to new social programs such as daycare, home care or mental health care is a “women’s issue.” Women, especially elderly women, Aboriginal women and single mothers, are disproportionately poorer than men.
But women and men are not homogenous groups. Socioeconomic status, race, ethnicity, age, ability, sexual orientation and gender intersect and influence mental health, mental illness and addiction in many ways. The process of resettlement and pre-immigration experiences affect mental health, sometimes resulting in increased anxiety and depression. Language barriers, weather induced depression, reduced family ties, unemployment, lack of social integration and racial discrimination are some of the post-migration stressors experienced by those who have immigrated to Canada. This may be more so for women, as immigrant and refugee women have fewer opportunities than immigrant and refugee men to learn English and French during the post-migration period, and immigrant and refugee women experience far more unemployment than Canadian-born women (and if employed, are often more likely to be underpaid).
In Aboriginal communities, the legacies of colonization and residential schooling have resulted in cultural discontinuity that has been tied to high rates of depression, alcoholism and suicide. It is estimated that the suicide rate of Aboriginal women is more than three times the rate for Non-Aboriginal Canadian women. Also, lesbians, gays and bisexuals have higher rates of suicide than the general population. In British Columbia, young women who identified as lesbian were nearly five times more likely to attempt suicide than young women who did not.
There are strong connections between experiences of violence/abuse and mental illness and addictions. Women are at greater risk of interpersonal victimization, including childhood sexual abuse, sexual abuse and intimate partner violence. Substance use and mental health problems frequently co-occur among women who are survivors of violence, trauma and abuse, often in complex, indirect, mutually reinforcing ways.
Thus a sex- and gender-based analysis of mental health, mental illness and addiction in Canada means more valid and reliable evidence that leads to better recommendations, interventions and outcomes for individuals and communities.
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