Canada 2017·Personal Essay

Canada: let's really talk about mental illness and who's most vulnerable

On Mental Illness Awareness Week, Rudayna Bahubeshi says Canadians must pay more attention to who's missing from the mental health conversation.

Prejudice affects your level of care, says Rudayna Bahubeshi

On Mental Illness Awareness Week, Rudayna Bahubeshi says Canadians must pay more attention to who's missing from the mental health conversation. (Jessica LaForet)

I stood in line at the mood disorder ward for what felt like a long time, looking at the back of another patient's head. Some days, this was the most time I spent amongst other people.

Some of those people were nurses and other staff — those who could go home at night, who could lock doors, who could use everyday items like scissors and knives.

When I reached the front of the line, a nurse placed a small pleated white paper cup on the counter.

My prescriptions and dosages changed daily, and I was accustomed to the nurse quickly riddling off complicated words, but it was unusual for me not to recognize any of them.

"Sorry, what?"

"This is what the doctor has requested for you today, Maria," the nurse said.

"I'm not Maria."

Maria was the only other Black woman in the ward. She was in her 30s (I was 18), a couple of inches shorter than me and of a different ethnicity. I was being told to take her medication. 

I argued with the nurse until Maria ambled into the room, and when the nurse saw her, she silently capitulated, retrieving my medication.

Maria was the only other Black woman in the ward ... I was being told to take her medication.

It would take a couple years for me to discern what happened that evening and to take stock of the moments over the years where who I was and what I looked like affected the level of care I received.

That evening, I felt frustrated. Years later, I began to see the expansive, systemic gaps in care that could make two Black women interchangeable and their voices disregardable to a white staff.

Before I knew the words

I've struggled with depression since before I was a teenager, before I knew what mental illness was. I was a gregarious, high-performing student, but I would also spend hours lying awake in bed or crying when no one was around.

I saw so many doctors. As I continued to decline, it was advised I enter outpatient care at the local mental health hospital. Every week I would slip out of class to go to appointments.

Rudayna in highschool. (Courtesy of Rudayna Bahubeshi)

After many months, little changed. My psychiatrist, a woman of few words who managed my medications, was disappointed by my lack of progress and said it would be best if I committed to full-time hospitalization. But I could still outrun this, I thought at the time.

I would pull myself together, finish the semester, go to university and stop creating undue concern for my family. 

During those days, my mother, a single-parent on ODSP (Ontario Disability Support Program), would tell me not to worry about money as we tried therapists, psychologists or any programs I wished.

Feelings of excessive guilt are a symptom of depression, and with those feelings came tremendous self-reproach. I dreaded creating greater financial and emotional strain for my family.

I continued seeing the doctor assigned to me as an outpatient until one day she told me there was nothing else she could do for me. She said I was the most unresponsive patient she ever had. She expressed surprise I hadn't tried to kill myself.

I finally acquiesced. I withdrew from my final semester of highschool and was admitted to the hospital in spring 2007.

Some of us are more vulnerable

I expected the time I spent in the hospital to be difficult, but I hadn't given thought to the ways I might feel unsafe.

There were many men in the ward. Men who would hover, sit too close, talk too long. One man in particular would follow me around and tell people I was his girlfriend. Much to the staff's admonishment, I wouldn't get to know anyone. I hid behind books, spoke monosyllabically, looked at the ground.

I expected the time I spent in the hospital to be difficult, but I hadn't given thought to the ways I might feel unsafe.

This was partly because I was terrified. One day, as I was waking up, I turned over in bed and found the man who would follow me standing in my room. I yelled. I demanded the nurses do something, but I was made to feel I was overreacting.

Looking back at that moment 10 years ago, I see a young woman who was terrified and shielded her vulnerability with anger. And while I can't know what the nurses saw, I have to assume they didn't see someone who needed protecting.

After several weeks of feeling increasingly hopeless in the hospital, I checked myself out. For many years, I didn't seek mental health support.

Let's actually talk

Many Canadians may feel we've made a lot of progress when it comes to talking about mental illness. But I think we need to ask more questions about this progress and who benefits from it.

Let's talk about prejudices that affect whether people are treated with dignity and care.

During Bell Let's Talk last January, there was a quieter campaign called Bell Let's Actually Talk, by activist, educator and artist Gloria Swain. Something she said resonated with me: "Mental illness does not see race, sex or economical status; yet, those who are marginalized are the ones whose voices and needs are not prioritized in such campaigns and dialogue."

The Bell Let's Talk Facebook banner currently features Olympian Clara Hughes, sports journalist Michael Landsberg, actors Mary Walsh and Howie Mandel, plus singer Serena Ryder.

I can't say those who were negligent in overseeing my care had malicious intentions or made conscious assumptions related to my identity. But at the end of the day, do intentions matter when the ways in which I was vulnerable were overlooked and unacknowledged? 

Until we recognize the ways some of us are more vulnerable when it comes to mental illness and poor health interventions, we're not having a meaningful conversation.

Let's talk about prejudices that affect whether people are treated with dignity and care.

Let's talk about individuals who are precariously employed and can't take "mental health" days or afford costly medications.

Let's talk about studies like this one, funded by the Wellesley Institute, that connect the dots between poverty, racism and barriers to healthcare.

I know that my experience isn't singular.

Those in greatest need

It angers and saddens me to think about Andrew Loku, Pierre Coriolan and Abdirahman Abdi — individuals whose skin colour and mental illness were read by authorities as dangerous.

None of them were treated with the dignity they deserved or seen as individuals in need of help.

Andrew Loku, 45, was shot by police in 2015 after refusing to drop a hammer he was carrying. His death fuelled debate over implicit bias and the intersection between race and mental health. (Handout photo)

There is more to be done in researching and understanding the ways racism, poverty, sexuality, gender, religion and other identities play a factor when it comes to accessing quality mental health care.

Until our support extends to those who are in greatest need, we're only scratching the surface when it comes to talking about mental illness.

Today, my mental health remains a journey, but I am living a life beyond my expectations.

I owe much of that to my network of support — my family and friends — but not everyone has that good fortune. The way we grapple with who is being left out of the conversation when it comes to mental illness is of major consequence. In fact, it's life and death.

I hope that one day soon, more people like me can point to our formalized mental health systems as a source of healing.


Rudayna Bahubeshi is a social justice advocate working in the non-profit sector. She lives in Tkaronto (Toronto). You can find her on Twitter at @Rudayna_B