Are you fine or phine?
It’s a question that will be asked across Canada next week as May 5 marks the start of Mental Health Week, an annual national event put on by the Canadian Mental Health Association, aimed at encouraging people to learn and talk about issues relating to mental health.
The difference between fine and ‘phine’ is intended to show how people tend to cloak their feelings and mental well-being on a daily basis.
The issues of mental illness are wide-ranging from depression, psychosis, anxiety, dementia, eating disorders and addiction among others.
Some issues can come in relatively mild forms such as seasonal depression, whereas others are severe medical problems like cognitive impairment and schizophrenia.
Dave MacDonald is the executive director of Pathways Clubhouse, Richmond’s branch of the CMHA, which provides services for those affected by mental illness, such as meals, activities, health care connections, entry-level work opportunities and even housing placements.
The 30-year veteran employee of the clubhouse says about one in five people will be affected by mental health issues at some point in their lives and he hopes the trend toward accepting this fact continues to gain traction in Canadian society.
“I think the hope for this week is there is a bit more acceptance for people with mental health issues. I think people are becoming a bit more open about their illnesses too, and, fortunately for them, a lot more celebrities are being more open and that’s helped with the stigma in the past. It can affect anyone, no matter what sex, race, employment status or wealth. And it’s okay,” said MacDonald.
Network of support
Pathways is part of a network of non-profit health organizations, groups and societies in Richmond that helps people with mental health issues. The spectrum of illnesses is wide-ranging, as are the services. For instance, CHIMO Community Services will help provide crisis intervention for those at a crossroad. The Supporting Families with Parental Mental Illness Initiatives group provides programs for families on the whole who are affected by illnesses. Transitions is an organization that offers outpatient assessments for adults experiencing substance misuse, anxiety and/or psychiatric disorders. The list goes on.
What’s common among all these non-profits is that they help people and they themselves need help.
Recently, Pathways was granted a new space in a $20 million social housing development to be built on Granville Avenue near Richmond City Hall. It’s a one of a kind project for Richmond, but in order to make the move by 2017, Pathways is aiming to raise $2 million to subsidize its new mortgage, which, in turn, will free up money for operational and programming costs.
In Metro Vancouver funding for mental health programs recently came under fire when administrators at the Portland Hotel Society, a non-profit agency, were caught using money for luxury hotels, gifts, spas and parties. The subsequent media frenzy and public outrage led to Vancouver Coastal Health, one of the society’s primary funders, to appoint a new, interim board of directors and executive team.
MacDonald hopes one bad apple doesn’t spoil the whole bunch as his organization embarks on the important fundraising campaign.
“There will be harm. But at the same time people may now think twice and check them out and determine if the organization is doing good work,” said MacDonald, who has a message for donors and philanthropists: “Do your research. Talk to recipients of the service, they’re really the experts,” he said.
The advice is something Georgina Patko hopes people heed as they look to help organizations like Pathways. The management consultant was recently hired by Pathways to undertake the fundraising campaign. Patko recently armed herself with what she says is a significant finding from Success Markets, a research group that focuses on measuring the social return on investment (SROI) for charities.
Return on investment
According to Success Markets, Pathways produces a total of $14 in value to their members, and the community as a whole, for every dollar it receives. The company noted it typically finds an SROI of $2-5. Patko, who has worked with many other charitable groups, says it’s a balancing act to find the right mix of government funding and private donations.
“A lot of organizations have become used to receiving government funding and funding from gaming. The danger with that is it can be cut anytime, and we’re seeing more of that. There does seem to be a trend, and so, it makes sense for organizations to seek out donations from interested individuals,” said Patko.
MacDonald noted most of the financial pressures these days aren’t necessarily coming from cuts but rather from the inflationary costs of rent, utilities, food and materials.
“If you don’t get those increases from government it does feel like cuts,” he said.
Pathways is one of many non-profits listed on the website of Charity Intelligence Canada, which aims to promote transparent non-profit organizations. On its website you can see that Pathways receives about $2 million in government grants and spends roughly 10 per cent of its revenue on administrative costs, which appears to be standard for a well-run non-profit of Pathway’s size. There is also a link to its most recent external audit, which can also be found on Pathway’s website.
Guarding against abuse
MacDonald believes external audits are the best preventative measure for any non-profit that may face scrutiny. Such audits are not forensic ones that mull over each receipt but they do show cash-flow irregularities, as was the case with Portland. But in the case of most well-functioning, non-profit groups, a board of directors as well as a staff accountant will be an adequate line of defense against abusive spending, said MacDonald.
Vancouver Coastal Health spokesperson Viola Kaminski said all service providers with contracts exceeding $1 million are required to submit audited financial statements. She said pending approval, any new service contracts signed for 2015 will provide clearer language about the appropriate use of public monies.
“Other revisions include the strengthening of conflict of interest terms and clear definitions for non-compliance of spending guidelines,” wrote Kaminski in an email.
She also noted the likelihood of an incident like Portland is unlikely to happen in Richmond largely on account that there is no non-profit that comes remotely close to its $21 million worth of grants.
Both MacDonald and Kaminski noted forensic audits can take years and are exhaustive and costly. Such audits must be balanced against the probability that corruption is taking place.
MacDonald makes it clear that asking questions about where your money goes is not only important, but expected.
“I think it’s an important question. I feel good when I’m questioned. We’re using our taxpayer dollars and if we aren’t questioned on how we use our expenses then that’s kind of wrong. And if I feel uncomfortable in being questioned I must be hiding something,” said MacDonald.
Joking he would have to hide his office hot tub, this week MacDonald invited the Richmond Newsto the clubhouse.
The path to Pathways
It’s an aging, two-storey office building on Elmbridge Way in the city centre. Outside, its sign is small and its front door is unassuming, but when you walk inside, there is an immediate ‘wow’ factor that first-time visitors may feel on account of the bustling activity. Hundreds of people may visit the clubhouse on a daily basis. It provides members with a place to read a magazine, work on a computer and, most notably, have an inexpensive lunch and interact with one another. To become a free-of-charge member, all a person needs is a note from a doctor indicating a history of mental illness as well as an assurance he or she is not a threat to other people.
“For us at Pathways, we started up a young adult program. They can gather and do social activities that most everyone does, like go to the movies and paintball,” said MacDonald of one of the many programs offered to members.
Pathways is largely a tool to connect people with what they need, he said.
“A lot of times, when you’re first diagnosed, you don’t know how to navigate the system — medications, someone to talk to, dealing with family members. It’s a crucial part of what we’re trying to accomplish,” said MacDonald, noting Pathways shares a good relationship with other social agencies in the city.
On the visit to the clubhouse some members appeared reclusive, and understandably so as they may not have been having a good day.
As Patko noted, “the fact that they were able to get to the clubhouse is a huge thing. It means they’re not alone at home.”
Others, like Graham and Ariel, were happy to talk to the Newsand briefly share their stories.
Graham is a volunteer at Pathways, helping anywhere he can, be it with a group activity, working in the kitchen or helping with general duties. He’s unemployed at the moment but also spends his time speaking to community groups. Recently, he spoke to CHIMO, the RCMP and the local welfare office.
Finding a voice
The 32 year-old Richmondite has schizophrenia and came to Pathways years ago to seek help and connections to services.
“It makes you feel useful,” said Graeme.
Another local resident, Ariel, who suffers from depression, worked in manufacturing and security until he lost both jobs as a result of his illness. He says Pathways gives him a sense of belonging.
“Pathways helped me look for work and helped with my resume and cover letters. They also helped me go to a company that gives clothes for interviews. Everyone here is open and helpful,” he said.
Ariel and Graham are just two examples of Pathways members who have benefited from donations and government funding. They’re also two examples of people in need who were able to stay in their communities instead of heading to Vancouver’s Downtown Eastside, where Metro Vancouver’s social services are concentrated.
A failed policy
It’s an issue the City of Vancouver is trying to steer away from, according to Vision Vancouver councillor Kerry Jang, who is also a member of the Metro Vancouver Housing Committee.
“When you look at why, it was a deliberate policy to concentrate services in one place and that has been a failed policy because of the problems we see. The 1970s saw an increase in cheap drugs. There was an epidemic of overdoses and people were easy to prey on. …So in response (the government) dumped services there,” said Jang, a professor of psychiatry at the University of B.C.
Jang said Vancouver is now trying to disperse its services throughout the city. He said the same should be done throughout the region.
“You’re actually taking people out of their safety zone. What we want them to do is get services close to where they are,” said Jang.
Jang noted that because services are so concentrated in Vancouver, it likely leads to those with mental illness to leave their community.
“I would probably suspect that Richmond is being short changed and could use more services. And it’s not so much about lessening Vancouver’s burden, but rather ensuring how as a region we can solve these problems.
Surrey has taken up the challenge. New Westminster has done well to respond in kind. Richmond is kind of interesting. In some ways it’s more of a suburban community but it’s changing as it develops its own downtown,” said Jang.
“More interestingly you have a large Chinese population and they have a different view of mental illness. They won’t call it mental illness and it’s often hidden and not treated,” he said.
Treating Chinese
Treating the Chinese-Canadian community in Richmond is something that is becoming more and more of an issue as the new generation of Canadians attempts to integrate into society.
Pathways runs a Chinese Support Program, citing on its website that mental illness in the Chinese community is often viewed as bringing shame upon the entire family. In turn, those who are ill, as well as their families, tend to not seek support.
The program attempts to integrate the Chinese-Canadian community into the clubhouse. Last year, Pathways counted 59 ethnic Chinese members.
The tide of saving face may be shifting, however, according to Dr. Carolyn Steinberg, a child psychiatrist at Richmond Child Health Clinic at Richmond Hospital.
“I’ve been here for eight years. When I first started up the clinic I was concerned the Western model might not translate, however, I’ve been very surprised in that my case-load is at least appropriate to the population in Richmond. The Asian families are very dedicated to their children; they’re enthusiastic about accessing services,” said Steinberg, who’s visited China.
Late last year, Steinberg was visited by a group of Chinese developmental pediatricians who were interested in learning about Western approaches to mental illness in children.
She was invited to visit China where she made several interesting observations that she says will help her deal with the influx of Chinese patients.
"In China they have very few child psychologists. For a population of about 1 billion they have less than 200. So pediatricians end up dealing with emotional and behavioural problems of young children, but they don't have the same kind of training as a child psychologist here would have,” said Steinberg.
“We don't tend to work in the same kind of work groups or in strong intergenerational family systems. We tend to be individuals and when children come of age they're eager to move out, whereas families in Asia live in a trans-generational home. I will look more carefully at this. It will make me more sensitive to when (Chinese immigrants) are away from their family group what an enormous impact that may be," explained Steinberg.
Treating children
At her clinic Steinberg is noticing more behavioural problems among children as a result of busier, changing home environments.
"More parents have less resources. Life has gotten expensive. Two parents are working and kids are in daycare earlier and parents have less to give. Some kids tolerate this more than others,” said Steinberg.
"We’re social animals. We can't survive without parents when we’re born and we seek out relationships later to manage. It’s important for families to find support so they can think through issues to raise their children. When we talk we all feel better," she added.
Steinberg’s advice to parents is to take the effort to enjoy playing with their children.
“Don’t educate them, don’t train them. Just hang around. The children will feel listened to and they will grow up having learned that when someone is present and listening to them they feel better. And it becomes full circle,” said Steinberg.
Ariel has a similar message to those who may need help.
"There is help out there and you're not alone. There are places you can go to if you feel different from the outside. It’s about asking for help and accepting that you need help,” he said.
