0:06

It's a bit disheartening, I

0:08

think, to see, and

0:10

also not unexpected when you think about

0:12

the ways that things like unconscious

0:15

bias and racism

0:17

impact individuals. So I see

0:19

it. I see it in our emergency departments, I see it

0:21

on our wards. I see the

0:24

young Black men or

0:26

women. The behaviours are

0:29

automatically assumed to be psychosis.

0:31

We are more heavy handed with the medications

0:34

that we use to sedate

0:36

and prevent these behaviours from becoming an issue.

0:38

We are more heavy handed when we put

0:40

them in spaces to protect other

0:42

people because there is this assumption that they

0:45

are going to be more violent because

0:47

they have these illnesses and we don't

0:49

take the time to explore the ways

0:52

in which their presentation

0:54

could be or be due

0:57

to things other than schizophrenia.

1:11

So during the pandemic, the inequitable

1:13

treatment of racialized people was highlighted. But

1:15

how does race affect a person's ability

1:18

to receive proper treatment? As

1:20

we've heard through our discussions with experts,

1:22

people living with schizophrenia and with family

1:25

members, discrimination and

1:27

in some cases, clinician bias

1:29

can play a role into how a person is

1:32

treated within the mental health system. Multiple

1:34

studies illustrate that systemic racism

1:37

affects mental health care for racialized

1:39

Canadians. For example, some

1:41

research shows that Black people in Canada

1:44

wait twice as long as other Canadians

1:46

to access mental health services. Research

1:49

also shows that racialized people in Canada

1:52

are less likely to voluntarily

1:54

access mental health services and are more

1:57

likely to enter care. For a hospital

1:59

emergency department or through

2:01

the criminal justice system. Race

2:04

and serious mental illness is a massive

2:06

topic and it's not something

2:08

we're going to be able to cover in one episode.

2:11

But at least we are going to start having

2:13

this conversation and to help guide

2:15

us through this very difficult and thought

2:18

provoking conversation. Is Dr.

2:20

Amy Gajaria. Dr.

2:22

Gajaria is a clinician and

2:24

psychiatrist in Toronto. She's

2:27

also an assistant professor and

2:29

the associate director of Equity,

2:31

Diversity and Inclusion

2:34

for the Department of Psychiatry at the University

2:36

of Toronto. Dr. Gajaria,

2:38

thank you for joining us today and

2:41

welcome to the podcast.

2:43

Thank you so much and happy to be here.

2:46

Okay, big topic. Now,

2:48

some clinicians and academics have

2:50

said that racism is a mental

2:52

health issue because racism

2:55

causes trauma and that

2:57

trauma can contribute to having

2:59

a mental illness. So what

3:02

do you think is the connection

3:04

between racism and mental

3:06

illness?

3:07

Thank you. That's a big question and I

3:09

really appreciate you asking it. This

3:12

is a complicated question. It's a question that's

3:14

been asked over many years,

3:16

the relationship between culture and

3:18

mental illness, the relationship between culture

3:20

and mental health, race, mental health, ethnicity,

3:22

mental health. And now we're asking the question racism

3:25

and mental health. I think they're linked in a number

3:28

of ways. Questions of access, questions

3:30

of treatment experience and questions

3:32

of treatment, outcome based on racism

3:35

within the medical system, and then

3:37

the racism that people experience outside

3:39

of the medical system. We also have talked

3:41

about racism as a form of chronic stress

3:44

and as a form of trauma that exists

3:46

for people throughout their lives. And

3:48

all forms of trauma and stress

3:50

can increase risk of the development

3:53

of mental health concerns. The more

3:55

stress, the more adversity experience,

3:57

the higher risk it is that you might have

3:59

difficulties with your mental health or develop a mental illness

4:01

. And so racism,

4:04

and particularly structural chronic

4:06

racism can really increase the risk.

4:09

And that's not just the experiences of racism

4:11

or someone making a comment, but

4:13

it's also thinking about things like structural

4:16

racism and the idea that people

4:18

that are racialized often have less access

4:20

to employment, may

4:23

live in places where their housing is less

4:25

secure, they have more financial

4:27

difficulties, more food insecurity.

4:29

And so there's a direct link in a lot of indirect

4:31

links as well to the social determinants of

4:34

health.

4:35

Now, you talked about some issues

4:37

around potentially accessing care

4:39

in Canada's mental health system. Let's

4:42

get into that a little bit more. What can

4:44

racialized people experience when trying

4:46

to access care?

4:47

The issue of access, I think, is a big one and

4:50

one that makes it hard to tease out other questions

4:52

around diagnoses and outcomes

4:54

and all of these things. What you will see is

4:56

that racialized people often

4:58

talk about a fear of accessing mental health care,

5:01

partially due to a fear of how they'll be treated.

5:04

And sometimes that comes from what they hear in their community.

5:07

Sometimes that also comes from having negative experiences

5:09

with the health system. And so

5:11

we see both in literature and in my clinical

5:13

experience, people often saying

5:16

they didn't like the way they were treated. They often

5:18

felt dismissed. People didn't understand

5:20

what they were saying. They just felt

5:22

they wanted to get rid of me. They didn't want to hear my

5:24

narrative. They didn't want to hear my story. So

5:27

people have negative experiences with the syste,

5:29

they're less likely to come back and

5:31

they're more likely to tell folks that they know, 'Hey,

5:33

this isn't a great experience. Maybe that's not the way

5:35

to solve your problem.' We

5:37

also know that wait times are longer

5:40

and there's an issue of people

5:43

not wanting to add discriminations. So

5:45

having additional identities of being stigmatized

5:47

against so having an identity

5:50

as a racialized person, we also already experience

5:52

discrimination in society. And

5:54

then adding in other discrimination as being

5:56

a person with a mental health condition and

5:59

making them more reluctant to access mental

6:01

health care, go through the mental health system.

6:04

We also know that people

6:06

aren't always sure that they're going to get a clinician

6:09

or have an experience in the system. Someone can

6:11

actually understand their experience.

6:13

And that, again, makes people really reluctant to

6:15

access care.

6:17

So we all know that there's a difference between having

6:19

a conscious and an unconscious

6:21

bias. So what do you

6:23

see as being some of those unconscious

6:26

biases that racialized

6:28

people may experience in the mental

6:31

health system?

6:32

One of the things that we talk

6:34

about quite frequently is the assumption

6:36

of dangerousness. And I do

6:38

think a lot of the time this is really unconscious.

6:40

People live in a society where the media

6:43

represents racialized people, particularly

6:45

Black men, particularly racialized men,

6:48

as criminals or as dangerous

6:50

or as violent. And that's something we commonly

6:52

see in our media representations. And

6:54

I think that affects health care providers.

6:57

We are people, we live in that system. We're exposed

6:59

to all of that. And I think

7:01

that really impacts the mental

7:03

health experiences,

7:05

especially for young men, especially for racialized

7:07

men and Black men, where

7:10

your care provider can look like they're afraid of

7:13

you. They can treat you with

7:15

more assumptions that you're going to do something

7:17

violent. They can overuse restraints.

7:20

They can put people in seclusion. More often.

7:22

They can overuse medications because

7:25

people have this implicit bias

7:27

about dangerousness and about what it means

7:29

to be that person. But in clinical experience,

7:32

they often see especially racialized young

7:34

men being dismissed

7:36

as having conduct problems, antisocial

7:39

personality structures that

7:41

they're trying to game the system

7:43

or they're lying

7:45

or they're trying to get out of charges, and I see a lot of dismissing of

7:48

their experiences that I don't

7:50

think would be dismissed if they were in

7:52

a different body. And I think, again,

7:54

that relates to us living in this society

7:57

that continues to give messages of what it means

8:00

to be certain kinds of people.

8:03

Thank you for that. We're now going to listen

8:05

to a clip from one of your colleagues,

8:07

Dr. Chintoh. And we had Dr.

8:09

Chintoh on an earlier episode, and

8:12

she shared this story about the

8:14

treatment of someone that she witnessed early

8:17

on in her career. Let's take a listen

8:19

now.

8:22

I have this both horrifying

8:24

but beautiful story of one night

8:27

when I was a trainee and I was in the emergency

8:29

department and the police brought this young

8:31

guy in in handcuffs. And he was young,

8:33

still a teenager, and he wasn't saying

8:36

a word. And I was like, I don't understand. Why

8:38

is he in handcuffs? They said, 'He's got schizophrenia.'

8:41

And so finally, it's two in the morning

8:43

and I'm trying to speak. And he's not saying anything.

8:45

And you could just tell he's just done. He's exhausted.

8:48

And finally he says to me, 'Why

8:51

am I even here?' And I said, 'Well, apparently

8:53

you have schizophrenia and you've not been taking your medication.'

8:55

And he's like, 'What? Who said

8:58

I have schizophrenia?' And he was completely

9:01

well, he had been in handcuffs

9:03

for hours because he was busy emergency.

9:06

He'd been in handcuffs for hours. And

9:08

it wasn't even a case of mistaken identity. It was just

9:10

that somebody had told the police, pick this guy

9:12

up, he's likely violent, this tiny

9:14

little young Black kid in

9:16

handcuffs for hours. And it was an

9:18

uplifting story because I took the time to

9:20

speak to him to get the history and to do a bit

9:23

of digging and realize that none

9:25

of what was being said was actually

9:27

true. And yet he had said

9:29

it was the third time within two

9:31

months that he had been picked up by police for

9:34

this. And it was, it was devastating.

9:40

Dr. Chintoh's experience echoes

9:42

the reports that say compared with white people

9:44

with the exact same symptoms that

9:46

racialized people in particular

9:48

Black people, are more likely

9:51

to be diagnosed with schizophrenia or

9:53

psychosis and less frequently

9:56

diagnosed with mood disorders.

9:59

What are your thoughts on this.

10:00

In children adolescence, you

10:02

will see that mood disorders and anxiety

10:05

disorders are less likely to be diagnosed

10:07

in Black and Hispanic youths

10:09

compared to what are called externalizing

10:11

disorders. So things like conduct disorder,

10:14

ADHD, behavioral problems. And

10:17

I think this is a similar phenomena

10:19

that you're seeing in adults. And I think it's because

10:21

people see the behaviour, just

10:23

like Dr. Chintoh said, they don't see

10:26

the person. So

10:29

I think what we see from that story,

10:32

from what we see in the data and what I thought about why

10:34

is this happening? And what I've

10:36

witnessed is that I don't think people

10:39

hear the story. They don't always see

10:41

the humanity. I think particularly

10:44

with this Black youth, there's

10:46

this idea that for

10:48

some reason people are not curious.

10:51

They're not interested in why someone is doing what

10:53

they're doing. They're not asking the questions

10:56

of why are you doing that? What happens

10:58

when we understand your experience and

11:00

we understand where you're coming from? We make an assumption

11:02

that you have a rich internal world. I think

11:06

that also goes back to unconscious biases.

11:08

If you look back to longstanding

11:12

philosophical literature, talks about this

11:14

idea that racialized people

11:16

are seen as bodies and not minds,

11:18

and that we don't think about the inaugural

11:22

racialized people. I think that is the process

11:24

by which this is happening.

11:26

So now let's talk about the

11:28

different mental health conditions

11:30

or mental illnesses and

11:32

how they differ between races.

11:35

So what are the most common illnesses

11:38

reported by Black, Indigenous

11:42

and people of color

11:44

based on your experience?

11:46

Interesting question. A difficult question is a couple

11:48

of reasons why it's difficult to answer. From

11:51

a Canadian perspective, we don't do a good job

11:54

of collecting race based data. People are

11:56

trying to change that and develop

11:58

that. That's quite hard at a population

12:00

level to answer that question because

12:02

we haven't been asking that question. I

12:05

think a lot of us will argue that it's

12:07

less the race of a person and more

12:09

their experiences. So it's more about

12:13

as a person who is Black or Indigenous or

12:15

Hispanic, it's not the fact that you're Black

12:17

or Indigenous or Hispanic that confers any

12:19

different risk for a mental health condition.

12:21

It's the fact that you experienced differential

12:24

racism access and inability to

12:26

have opportunities due to systemic

12:28

racism, not due to your actual race or ethnicity.

12:31

And actually, when you do look at some of the data

12:33

from United States, you see

12:36

a difference in diagnosis. But this is

12:38

also what makes it hard to say what is the true

12:40

difference in prevalence or rates, because

12:44

research is starting to do that. Starting

12:46

to ask what is the actual

12:49

diagnosis out there there versus like what is

12:51

the clinician make as the diagnosis is really

12:53

impacted by implicit bias. But

12:55

I would say those two things are less common. Often

12:58

you'll see something like the clinician or the psychiatrist

13:00

or the mental health provider made the diagnosis.

13:04

But again, you don't know if those

13:06

diagnoses are accurate in racialized

13:08

people because of all of the

13:10

implicit biases and access and things

13:12

we've talked about. The few

13:14

studies that try to tease

13:16

this apart either see

13:18

similar rates or they

13:20

see higher rates in racialized people

13:22

than we would expect because we haven't

13:25

looked at actually what is the diagnosis, from the clinician .

13:28

What do you think the benefit

13:31

of having more race based

13:33

data would be?

13:35

Because we don't ask the question of do

13:37

treatments, access to treatment, treatment

13:39

outcomes, treatment experiences vary

13:42

on the basis of race. We actually can't tell

13:44

you anything about that

13:46

information, and that matters because

13:49

we don't actually know if

13:51

we're doing things right. How can you say we know

13:53

how to treat depression? We don't know how to treat depression

13:56

in certain populations because we haven't measured

13:58

it. We haven't actually said

14:01

CBT for depression in youths

14:03

work for Black youth. Does it work for Indigenous

14:05

youth? We say we have evidence

14:07

based guidelines and we should follow those guidelines,

14:10

especially in the treatment of different mental

14:12

illnesses. But we haven't asked,

14:14

do those guidelines actually work for

14:16

people of color? Do they

14:19

work in the same way differently? And

14:21

because there are so many assumptions out there, because

14:24

we put whiteness and white experience

14:26

as the norm, people don't think

14:28

to ask those questions because they assume

14:30

that everything is fine. Because if you have a majority

14:33

white system, you have researchers that

14:35

are majority white, you have health matters that are totally

14:37

majority white. They're not going to see

14:39

a problem with the fact that we don't ask these

14:42

questions. But racial people will tell

14:44

you, well, how come you don't have any?

14:46

You only have 5% people

14:48

in your study. People will also say we

14:51

can't recruit Black people to our study because

14:53

Black people are not interested in mental health care,

14:55

which I've heard before. They're not accessing services.

14:58

That's true. And yet we

15:00

have never asked that question or asked what

15:03

makes people not come or what is the

15:05

different experiences through the door for

15:07

asking those questions? We don't actually know

15:09

anything about our system.

15:11

Now, do you think we're making progress in this area?

15:13

Do you think we are starting to see an uptake

15:15

in having more race based data.

15:18

I'm a little bit of a cynical person, because

15:20

I'm interested in race

15:23

and racism and equity in social justice,

15:25

like probably since I was ten. And so I've

15:27

seen cycles and I think most of us

15:29

who've done this work have seen cycles. In

15:32

2020, everyone wanted to talk

15:34

about race and maybe into 2021.

15:37

I am hoping that that is sustainable.

15:41

But I had also seen in the past where people

15:43

say 'We've talked enough

15:45

about racism, we spend too much time

15:47

talking about social justice. We

15:49

need to actually deal with other things. People

15:52

are tired because of the pandemic. We

15:54

don't need to talk about these things.' Which I think

15:56

the pandemic is a racial health issue because it disproportionately

15:59

affects racialized people. But I've

16:01

just seen this over and over again. I've seen people get

16:03

really committed to something

16:06

for a moment. And then

16:08

there's the backlash that comes. People want

16:10

to revert back to what they're comfortable with, revert back to the mean .

16:13

So I see some movement. I

16:15

am concerned about how sustainable it is,

16:17

and I'm hopeful that

16:20

we are changing from the conversations in a meaningful

16:22

way. We are putting structures into place

16:24

that will last.

16:26

What about the chronic

16:28

and persistent mental illnesses?

16:30

What do you see is the connection

16:33

between mental illness

16:35

like schizophrenia and race?

16:38

I think it's a challenge with a chronic illness is

16:40

you have a lot more interaction with the health system. So

16:43

if you have an illness with episodic, you might

16:45

have one. It might be some of that doesn't

16:47

bring you into contact with the hospital

16:50

system. You might

16:52

have a couple of interactions and maybe that

16:54

stress is lower because you're like, 'I'm just going to

16:56

go two or three times. I don't have to see someone so

16:58

often.' But I think

17:00

all the systemic issues that we talk about become

17:02

even more apparent when you're a person who

17:05

from an early age is having constant

17:07

interactions and contacts with

17:09

the system. And sometimes that's

17:11

voluntary and quite often it's not if you're a racialized

17:14

person with a chronic and persistent mental illness.

17:17

And so I think there's more and more space

17:19

for there to be negative experiences,

17:21

for people to feel mistrustful,

17:24

unheard, to have experienced medical trauma

17:26

as a result of those interactions.

17:29

So how does that unconscious

17:32

or a conscious racism impact

17:34

people throughout their entire lifespan

17:38

when dealing with a mental illness?

17:40

You see this so early. I see

17:43

and I hear from patients so early, especially

17:45

in the school system. And you've seen

17:47

these reports in the news of children being

17:49

handcuffed by police for behavioral issues.

17:52

I hear from patients all the time

17:54

who probably had learning problems or ADHD.

17:57

They never had access to a psychoeducational

17:59

assessment. They never were identified as a young

18:01

person with mental health difficulties. They

18:04

were always just sent to the office or expelled

18:06

or suspended or told they were a problem. I've

18:08

heard that story over and over and over

18:11

again, and you can understand that

18:13

early intervention is key. A lot of time for

18:15

mental health conditions. And if you're

18:17

in a system where you're a young

18:19

person and you're supposed to be identified by

18:21

the adults in your life, they're supposed

18:23

to care about you and identify the problems

18:26

you're having. If that gets missed for

18:28

ten years, then of course it's going to be

18:30

more complex. Would be present in

18:32

their twenties with untreated illnesses.

18:36

You're listening to Look Again: Mental Illness

18:38

Re-examined. A podcast brought to

18:41

you by the B.C. Schizophrenia Society

18:43

and B.C. Partner organizations. I'm

18:45

your host, Faydra Aldridge. This

18:48

podcast would not be possible without

18:50

the support of the community. From

18:52

the bottom of our hearts, w e want to thank

18:54

you for caring about serious mental

18:56

illness and everything that's around it.

18:59

Together, we truly can make a difference.

19:03

Welcome back to Look Again: Mental Illness

19:05

Re-examined. I'm Faydra Aldridge and

19:07

I've been speaking to Dr. Amy Gajaria

19:09

about how racism can influence

19:12

the diagnosis, treatment and

19:14

outcome of serious mental

19:16

illnesses for racialized populations.

19:19

Now, Dr. Gajaria, twice a year,

19:21

you head to Nunavut to provide

19:23

psychiatric care to underserved

19:26

communities, the majority of which

19:28

are Indigenous peoples. Now,

19:30

as a clinician, how do you differentiate

19:33

between someone who is experiencing

19:36

an incident of racism

19:39

versus someone who is having delusions

19:42

of experiencing racism due

19:45

to a mental illness?

19:46

The one thing I say is these two things can coexist.

19:49

So people can both experience psychosis

19:51

or delusions and be experiencing

19:53

racism at the same time. And frequently

19:56

we see it with Indigenous peoples in

19:58

different settings just based on kind of colonization

20:01

and systemic factors. It's a difficult

20:03

thing to tease apart. I think what I always

20:05

tell folks is that those two things can both

20:07

be present. You can't just dismiss

20:10

someone talking about racism as psychosis,

20:12

and that sometimes has led to that over diagnosis

20:15

of psychotic disorders in

20:17

racialized people for that reason. So something

20:19

we can say about getting to work with

20:21

people that are different than yourselves or have a different

20:23

lived experience is get

20:25

to know somebody within their context of the

20:28

history of where they live, get to know their community,

20:30

understand what is normative about their experience

20:33

and what isn't. That requires doing some work ahead

20:35

of time. And the more you do that,

20:37

the more you might understand what's within

20:40

what lots of people experience and what's

20:42

different. How

20:44

impaired is someone's behavior.

20:47

How unusual is

20:49

it compared to their community? And once

20:51

you've built trust, ask other people around

20:53

them. How is your loved ones

20:55

behaviour different from somebody else's? Is

20:58

it different, is it the same? Do you think

21:00

there's anything unusual of what they're doing or not

21:02

doing? Often, if

21:04

there was enough trust in the family bringing them to

21:06

you and saying there's something very different

21:08

here, there's something unusual,

21:10

they're not themselves. So

21:12

for a lot of people, I know that

21:14

are white they don't understand

21:17

how much people don't trust the police.

21:20

And I actually don't understand how much white people

21:22

talk about trusting the police. That's a completely different

21:24

experience for me. And so I think

21:26

it's just a willingness to really understand

21:28

that just because you've had one experience and

21:30

you've lived in one way, it doesn't mean it's everybody's

21:32

experience.

21:33

And as you touched on, context is

21:35

obviously extremely important,

21:38

both with what the person is experiencing,

21:41

but also how their community and the people

21:43

around them respond to them

21:45

and their experiences. What

21:47

role do you think context

21:50

can play to both the

21:52

under diagnoses and

21:54

or the mis diagnoses

21:57

of mental illness for people of color?

21:59

I see people swinging two ways, right? So

22:02

initially they might have said

22:04

if you talk about police violence, you have schizophrenia

22:06

or you have psychosis. Back in the sixties,

22:08

if you challenge if you're part of the civil rights movement,

22:11

you have schizophrenia. And then

22:13

now what I see is the opposite. If people talk about

22:15

being followed by the police. People might say,

22:17

Oh, no, no, that's totally normal. No one can have

22:20

psychosis and talk about that. And

22:22

what's really important is you have

22:24

to be contextual and you have to understand

22:27

someone as a full person. You have

22:29

to be curious. You have to take the time.

22:31

You have to wonder with somebody

22:33

about what's going on. And that

22:35

sometimes leads you from swinging in one

22:38

direction or the other. And in terms

22:40

also under diagnosis, sometimes

22:42

this also goes to that conversation or

22:44

there's an expectation that every racialized person

22:46

has experienced constant oppression in

22:49

the sense that people who are racialized

22:51

can't be successful, they can't

22:54

be professionals, they can't have

22:56

money. And so sometimes

22:58

there can be a well-meaning approach

23:00

to people, particularly

23:02

Black and Indigenous people in Canada. They're

23:05

very well-meaning, but they just assume that

23:07

they live in poverty. They

23:09

assume that people have come from trauma,

23:12

that they never had positive family structures.

23:15

And that's also important to challenge

23:17

that. There's lots of healthy families

23:20

and successful people and resilient folks

23:22

within these communities. And if you overfocus

23:25

on trauma and

23:28

all of the negatives and actually missed that

23:30

part, you also miss part of the picture.

23:33

So throughout this entire conversation,

23:35

we've been talking about the patients that you care

23:37

for and the people you work

23:39

with. But now I'd like to talk

23:41

about you. What has been your

23:44

experience as a mental health

23:46

care practitioner of color?

23:48

I think it has actually been in

23:51

some ways similar to my patients. So I

23:53

say that because it

23:55

is incredibly valuable to me to work

23:57

with racialized patients, to

23:59

be able in my practice to

24:02

see a majority people of color,

24:04

to work with families from different communities.

24:07

And I'm from Toronto. I work in Toronto

24:09

to see a practice that feels like it

24:11

reflects the city that I live in and

24:13

that is currently. But in my training that wasn't

24:16

the case and I

24:18

didn't see people whose experiences I could

24:20

relate to who I felt.

24:22

I understood a lot about how

24:24

they lived or what their childhoods were like,

24:26

what their neighbourhoods were like or their lived experiences

24:29

like. And I'm

24:31

just realizing, as I'm saying this, that there is

24:34

such a gift to be able to

24:36

work with people where you have some

24:38

shared experience. And I know that

24:41

patients say that as well, that for

24:43

them it's such a gift to have a provider that

24:45

they think they can actually talk to or they

24:47

can talk about certain things with. But

24:49

also I think there's the challenge of all the time

24:52

before that when I wasn't doing that, especially

24:54

in my training and people would many

24:56

times question whether racism exists. This

24:58

is before 2020, people would four or

25:00

five years ago ask questions like, 'Isn't that reverse

25:03

racism' and just questions

25:05

that are frustrating. Take

25:07

issue with the fact that I wanted to work with underserved

25:09

folks or people living in certain experiences

25:12

or racialized people, and they

25:14

ask questions like, 'What is it about you that makes you want

25:16

to do that?' as if it was a problem. And

25:18

I'd say 'We never question the idea that people

25:20

feel comfortable having a mainstream practice

25:23

unquestioningly homogenous

25:25

in a certain way. Why is it suddenly

25:27

problematic to want to work with people who

25:30

are not represented in the system?' or even just have

25:32

I shared lived experience with So

25:34

I would say training as a mental health provider

25:37

was extremely difficult as a person of colour.

25:39

I think there's a lot that needs to be changed.

25:43

I was never particularly interested in medical education,

25:45

but I went into it because I had a lot of

25:47

experiences that were negative and I didn't want

25:49

to see trainees have those same

25:51

experiences and wanted us us to change our culture,

25:53

change our curriculum, change

25:55

the way we treat trainees that

25:57

are racialized, because

26:00

there is a lot of racism that

26:02

you experience as a resident and as

26:04

a medical student that you think

26:06

you're going to be protected from a little bit because you

26:08

have all this power and you

26:10

have a certain position in society and then

26:12

you realize that doesn't necessarily protect

26:14

you from all those experiences, which again,

26:16

I think reflects what some of my

26:18

patients are telling me who are

26:20

professionals or lawyers or doctors and

26:22

yet still are having these experiences.

26:25

Thank you for sharing that. What

26:28

do you think needs to change

26:31

within the system itself, with education,

26:33

with research, with policies to

26:36

make mental health care across

26:38

our country more equitable?

26:41

I, I would love if we had equitable funding. That

26:44

would be wonderful. A great place to start.

26:46

Money is great. And I always say for people in equity work

26:49

is when you want to see change,

26:52

ask people where the money is and

26:54

where the power sharing is. I can

26:56

give you a thousand suggestions on what we

26:58

can actually do with what we have. But

27:00

the ultimate question that I always ask

27:02

is are people who are at the top, who

27:04

always have power, willing to

27:06

give up some of that power? Are they willing

27:08

to be uncomfortable and to be challenged

27:11

and to sometimes have difficult and

27:13

uncomfortable feelings? And

27:15

are they willing to fund this? Because

27:17

if the funding is not there, if

27:19

community services are constantly underfunded,

27:21

if mental health care in Canada is underfunded,

27:24

if we're not funding culturally specific

27:26

care, if we're not putting people in positions

27:29

of power that can make these changes that have had

27:31

these experiences, that have this expertise, nothing

27:33

else happens. And so often

27:35

people want you to do it the other way. They want you to suggest,

27:38

'Give me a plan and then I'll see if it's worth

27:41

funding.' My thing is, are you even willing

27:43

to have a conversation about funding? Are

27:45

you even willing to have a conversation about changing

27:47

structures of power if you're not

27:49

willing to have that conversation? There's nothing

27:51

that can be done.

27:52

Thank you so much for joining me today.

27:55

We at least got the conversation started

27:58

and I realized it's a huge and very

28:00

difficult topic and I'm sure I'll be connecting

28:02

with you again. So thank you for your experience

28:05

and for sharing your thoughts with me today. And I truly

28:07

appreciate it.

28:09

Thank you so much. Was really thought provoking.

28:12

I appreciate your time.

28:14

And a huge thank you to you, our audience,

28:16

for joining us for this very difficult

28:18

episode. Together, we can change the

28:20

narrative around mental illnesses like schizophrenia

28:23

and start to end the many myths

28:26

and stereotypes that still exist

28:28

today. If you have any questions

28:30

or any comments, tweet us at @BC

28:32

Schizophrenia and to get our latest episodes,

28:35

be sure to hit follow n Apple Podcasts,

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28:41

hear more about how schizophrenia affects

28:44

families, we have another podcast

28:46

for you three moms from the East

28:48

Coast, West Coast and Middle America

28:50

ost a unique podcast about

28:53

mental illness. Each host has

28:55

an adult son with schizophrenia, and

28:57

they've written acclaimed books about their

28:59

journeys. They say it like it is

29:01

with the goal of helping families learn

29:03

more about serious mental illnesses.

29:06

Listen to Schizophrenia: Three Moms

29:08

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29:10

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29:20

This podcast is brought to you by the BBC Schizophrenia

29:23

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29:25

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29:27

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29:29

quality information to help individuals and

29:31

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29:33

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29:40

Use Research, Canadian Mental Health Association's

29:43

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29:48

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29:50

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29:53

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29:58

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