Introduction to Mental Health
MODULE 1
1. Defining Mental Health and Mental Illness
1.1 What is Mental Health?
The terms mental health and mental illness are often used interchangeably, but this is incorrect. Everyone has mental health - whether it is good (“flourishing”) or bad (“languishing”), but not everyone lives with a mental illness. In this section, you’ll learn how to distinguish between these two distinct terms, and understand how they are inextricably linked.
Mental health is defined by the World Health Organization (WHO) as “a state of well-being in which an individual realizes his or her own potential, can cope with the normal stressors of life, can work productively, and can make a contribution to his or her community.”
Mental illness implies that a person has received a clinical diagnosis and/or is experiencing clinically significant symptoms of mental illness. Mental illnesses envelop a broad categorization of conditions and can be short-lasting episodes or chronic, lifelong disorders.
Having a mental illness isn’t inherently “bad” and having symptoms of a mental illness isn’t either. It comes down to what “being healthy” and “recovery” means to each individual.
1.2 Who can diagnose mental illnesses?
In Canada, the following professionals can diagnose mental illness:
Family Physicians
Family physicians are medical doctors primarily trained in family medicine. Family doctors can prescribe medications and may be able to refer or connect you with a provider of psychotherapy.Psychologists
Psychologists hold a master’s and/or doctoral degree in psychology and often further specialize in specific areas of mental health. Psychologists specialize in providing psychotherapy.Psychiatrists
Psychiatrists are medical doctors who go on to specialize in mental health and mental disorders. Psychologists can provide pharmacotherapy (prescribe medications) and psychotherapy.
1.3 When are mental illnesses diagnosed?
The timing of developing a mental illness varies based on a number of factors (including biopsychosocial risk factors and the mental illness in question), but research suggests that 75% of mental illnesses occur before the age of 25 (Kessler et al. 2007).
Given that the average age for post-secondary students ranges from 18-25 - a period also referred to as emerging adulthood (Arnett 2000) - students are considered to be a particularly “at risk” group for mental health deterioration. Notably, post-secondary institutions are reporting that more incoming undergraduate students are arriving at school with pre-existing mental illnesses. In fact, recent research suggests that rates of mental illnesses in the post-secondary population are not significantly different from those found among the general Canadian population (Wiens et al. 2020).
That’s not to say that working towards improving mental health among post-secondary students is unnecessary - quite the opposite. These reports suggest that students are in need of tools and education to help build their resiliency in the face of a myriad of stressors faced over the course of their post-secondary education. We hope that Canada’s Student Mental Health Network can provide some of this support to students.
1.4 Why is mental health important?
As you’ve learned, we all have mental health, and the effects of poor mental health and mental illness can be wide-reaching. The Canadian Mental Health Association (CMHA) reports the following mental health-related statistics(opens in a new tab):
Approximately 1 in 5 individuals will experience a mental illness each year.
50% of Canadians have experienced, or will experience a mental illness by the age of 40
Mental illness will affect all Canadians at some point in their lifetime, either directly or indirectly (through a friend, family member, or acquaintance).
Mental ill health has a significant economic impact, too. The burden of mental illnesses to the Canadian economy was estimated to be $51 billion in 2003 (Lim et al., 2008), with more recent projections estimating the total cumulative costs over the next 30 years will exceed $2.5 trillion (Smetanin et al., 2011). This reflects both direct costs (i.e., healthcare) and indirect costs (i.e., loss of employee productivity, short- and long-term disability claims). In 2012, CMHA reported that approximately one fifth (21.4%) of the working Canadian population experienced either poor mental health or a mental illness, negatively impacting their productivity.
1.5 Section Summary
- Mental health and mental illness are distinct, but interconnected. Everyone has mental health. Not everyone has a mental illness.
- Mental illnesses can be diagnosed by family doctors, psychiatrists, or psychologists. Each care provider can provide different treatment options (medication, therapy, or both).
- The majority of mental illnesses have their onset during adolescence, and emerging adults (aged 18-25) are at increased risk.
- The impact of mental health is wide-reaching, both with respect to the proportion of Canadians it effects and its economic impact.
2. The Dual Continuum of Mental Health and Illness
2.1 Connecting Mental Health and Mental Illness
While mental health and mental illness are distinct concepts, they are inextricably connected. In his groundbreaking 2002 paper, Corey Keyes established the Dual Continuum of Mental Health and Mental Illness. Since its publication, the Dual Continuum has been widely adopted by subject matter experts and practitioners around the world studying mental health or providing mental health care.
This model conceptualizes mental health and mental illness as separate, but interconnected continuums. Mental health can range from good (or “flourishing”) to poor (or “languishing”), sitting anywhere along that spectrum. Our mental health moves flexibly along this continuum from day to day, month to month, etc. Similarly, an individual can move along the mental illness continuum, ranging from no mental illness to severe mental illness. Importantly, the severity of a mental illness can be influenced by frequency, longevity, and severity of individual symptoms, in addition to the degree to which the illness is being managed.
Importantly, it is possible for an individual to experience good mental health (or to “flourish”) while living with a well-managed mental illness. Similarly, it is possible for an individual to experience poor mental health without meeting the clinical threshold for a mental illness. In the best-case scenario, we would find ourselves in the upper right-hand quadrant of the Dual Continuum model, with good mental health and no mental illness. In the worst case scenario, someone “in crisis” might find themselves in the bottom left-hand quadrant of the model, with poor mental health and severe mental illness.
Remember: It isn’t inherently “bad” to live with a mental illness. Many people live with well-managed, lifelong mental illnesses (such as chronic anxiety, or even more complex mental illnesses like bipolar disorder) and still experience “flourishing” mental health.
2.2 Lived Experience Examples
Let’s check out some examples of young adults who have shared their lived experience with mental illness and/or fluctuating mental health.
Living with Anxiety and Depression — and Flourishing
Gisela is a lawyer, and a Black Dog Institute volunteer (a medical research institute in Australia). In her story, Gisela shares that she has experienced feelings of anxiety since high school, which worsened once she started university. Gisela was diagnosed with depression at 21.
With support from her friends, Gisela reached out for help, and now lives with well-managed anxiety and depression thanks to cognitive therapy techniques and a toolkit of breathing exercises. Gisela also finds that talking to people about her experiences is both meaningful and helpful in maintaining the flourishing mental health she now has.
Read Gisela's original post ↗
Taking Care of my Mental Health during the COVID-19 Pandemic
Alicia Raimundo is a Kids Help Phone National Ambassador and a mental health advocate. Like many of us, Alicia's mental health took a hit during the COVID-19 pandemic as a result of the uncertainties and social isolation.
In her story, Alicia shares five methods she used to cope with these changes and feelings over the course of the pandemic, including allowing herself to grieve and setting aside time for self-care and connection with family and friends.
Read Alicia's original post ↗2.3 Section Summary
- Everyone has mental health, but not everyone lives with a mental illness.
- Living with a mental illness is not inherently "bad" - in fact, it is possible to live with a well-managed mental illness and experience good mental health.
- Our mental health is flexible and can fluctuate from day to day and week to week based on a number of different factors; you'll learn more about this in the next section.
3. Risk Factors for Mental Illness
3.1 What Affects your Mental Health?
Mental health is complex, and can be affected by social, psychological, and biological factors. Certain aspects can place individuals at increased risk for experiencing deterioration in their mental health and/or the development of a mental illness. Fluctuations in our mental health are common and normal, and almost never stem from a sole reason.
3.2 The Link Between Physical and Mental Health
Physical and mental health are interdependent on one another. There are a multitude of physical factors that can influence your mental health, but we will focus below on the following three: diet, physical activity, and sleep.
Diet
What we decide to eat and drink can have a significant influence on the development, management, and prevention of mental illness and mental health deterioration. Evidence suggests that nutrition is a protective factor against depression and anxiety, while an unhealthy diet acts as a risk factor (Lim et al. 2016).
A healthy diet is defined by sufficient macro (carbohydrates, fats, and protein) and micronutrient (vitamins and minerals) consumption. See Canada's Food Guide for more detail on achieving and maintaining a healthy diet.
Physical Activity
Staying physically active not only keeps you physically healthy, but mentally healthy too (Tyson et al. 2010). Evidence suggests that endorphins released during exercise result in positive mental health effects. As little as 10 minutes of physical exercise can have a positive effect on energy, mood, and mental alertness, though adults should aim to get 150 mins of moderate-to-vigorous physical activity per week. Check out Canada's Physical Activity Guidelines for more information.
No time to get to the gym? Remember that exercise can also be: walking, doing household chores, raking leaves or shovelling snow, etc. There are also online resources that can help you exercise outside of the gym (Nike Training Club App, Yoga with Adriene).
Sleep
We get that achieving the recommended 7–9 hours of sleep every night isn't always possible. However, it's important to note that lack of sleep increases the risk of mental health deterioration and the development of some mental illnesses. Lack of sleep can also cause heightened stress and irritability, while good quality sleep has been found to improve mental health and overall well-being (Scott et al. 2021).
On the flip side, mood and mental health can drastically affect sleep quality. Individuals with anxiety or heightened levels of stress tend to have more issues with sleep, making this a bit of a double edged sword. Resources for improving your sleep are provided by the Mayo Clinic and CMHA BC/Anxiety Canada.
3.3 Section Summary
- Social, biological, and psychological factors can increase our risk of developing a mental illness or experiencing mental health deterioration.
- Some of these factors may be out of our control (i.e., genetic vulnerabilities), while others are very much within our control (i.e., nutrition, physical activity, and sleep quality).
- Our physical and mental health are closely related - taking care of ourselves physically can help us to maintain good mental health.
4. Mental Health Care
4.1 Mental Health Care in Canada
Healthcare in Canada is governed by the Canada Health Act, with the goals of promoting and restoring the mental and physical health of Canadians and to ensure reasonable access to health services, regardless of factors like income, education, or culture. Provinces and territories are provided with funding from the federal government to provide coverage for health services deemed to be “medically necessary” (Canadian Civil Liberties Association 2017).
Unfortunately, the majority of mental health services are not considered “medically necessary” - psychological services are paid for out-of-pocket or covered by insurance, producing substantial barriers for many Canadians who are in need of mental health care. We’ll take a closer look at barriers to help-seeking in the next section. While mental illness accounts for approximately 10% of the burden of disease in Ontario, it receives just 7% of health care dollars (CAMH, 2022).
Since its inception in 2007, the Mental Health Commission of Canada has taken strides to improve mental health care in Canada, releasing (Changing Directions, Changing Lives) in 2012 - Canada’s first mental health strategy. The strategy highlights a number of strategic priorities, including promotion and prevention, recovery and rights, access to services, disparities and diversity, Indigenous mental health, and leadership and collaboration.
Mental health has long been recognized as a fundamental aspect of one’s health, however under our current health regime, the majority of mental health services do not meet the eligibility requirement of “medically necessary.”
4.2 Mental Health Care Providers
Earlier in this module, we explored three mental health care providers who can formally diagnose mental illnesses: family doctors, psychologists, and psychiatrists. A family doctor can provide you with a referral to a psychiatrist, and may be able to recommend a psychologist to you (though a referral is not required).
Each of these care providers is qualified to offer different types of treatment. Family doctors can prescribe medication, but do not typically provide psychotherapy. Psychologists specialize in providing psychotherapy, but cannot prescribe medication. Psychiatrists can prescribe medication and offer psychotherapy. It’s common to work with more than one care provider on your mental health.
It’s important to note that not everyone struggling with mental health deterioration will require medication and/or psychotherapy in order to recovery. In fact, many people - and especially those who have not yet hit the threshold for a mental illness diagnosis - may benefit from lower-intensity options.
Note that post-secondary students can access both physical and mental health services from their Student Wellness Services (SWS) on campus. You don’t need to wait until the next time you’re home to see your family doctor. The practitioners at your SWS will be happy to work with your family doctor back home to put together a treatment plan that works best for you.
4.3 The Mental Health Service Continuum
The Mental Health Service Continuum, shown below, describes the different levels of mental health care. As you can see, there is a relationship shown between the level of need (e.g., the severity of one’s mental health deterioration or mental illness) and the intensity of care provided.
The Mental Health Services Continuum is comprehensive, in that it shows services ranging from upstream to downstream. Upstream services are those that aim to intervene prior to the development of symptoms, while downstream services are intended for intervention following the development of symptoms (and diagnosis).
Ordered from upstream to downstream, the levels of mental health services described below include: mental health promotion, mental illness prevention, early detection, treatment, and recovery.
In Canada, we tend towards the “medical model” or “treatment model” when it comes to mental health - in other words, we focus on treating the symptoms of mental illness or poor mental health, and not the cause. Along with other experts in the field, the Mental Health Commission of Canada recommends that we work towards adopting a more comprehensive, holistic view of mental health care, placing emphasis on upstream services (i.e., mental health promotion and mental illness prevention). In doing so, we can work towards preventing the development of mental illness to begin with, thereby alleviating bottlenecking at the treatment level, which produces long wait times and other accessibility challenges.
4.4 Section Summary
- Health care in Canada is covered by the Canada Health Act, though many mental health related services do not qualify for funding under the current definition of "medically necessary".
- Not everyone struggling with mental health deterioration may require formal medical treatment - there are many different types of mental health care along the service continuum.
- Mental health promotion and mental illness prevention are upstream interventions that occur before the development of symptoms of mental illness.
- Early detection straddles upstream and downstream, aiming to intervene as soon as possible after the development of initial symptoms, while treatment and recovery are more firmly downstream services that aim to treat and manage mental illness.
5. Barriers to Help-Seeking
5.1 Reaching out for Help
So far in this module, we’ve learned that mental health problems are widespread, affecting a large proportion of Canadians. However, national data suggests that a large proportion of Canadians with a demonstrated need for mental health care do not reach out for help or treatment. Similar patterns of low levels of help seeking have been observed among Canadian post-secondary students. But why?
When you’re experiencing mental health deterioration, it can be really difficult to reach out for help. The longer you wait to reach out for help, the more severe your symptoms can become, making even more difficult to contact your doctor, or even get out of bed.
5.2 Help-Seeking by the Numbers
Data from the Canadian Community Health Survey (Statistics Canada, 2019) demonstrates the following:
Almost one-in-five Canadians needed mental health care in 2018, and half of them felt that their needs were fully met.
In terms of the type of care needed, the need for medication was the most likely to be met (85.4%) while the need for counselling was the most likely to be unmet (34.1%).
The most frequently reported reasons for having unmet or partially met needs were related to not knowing where to go, being too busy or not being able to afford to pay.
5.3 Barriers to Help Seeking
Three of the most common barriers to seeking help for mental health related issues in Canada are accessibility, affordability, and stigma. Click through the grid below to learn a bit more about each.
Accessibility
Issues of accessibility can include a lack of available care providers, a lack of appropriate care providers (i.e., culturally competent care, care providers that specialize in a specific mental illness), lack of available transportation to services, and long wait times.
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Affordability
Mental health services are most often paid out-of-pocket or covered by insurance, presenting a substantial financial barrier to many, particularly the unemployed or those employed in positions that do not include benefit plans.
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Stigma
In the context of mental health, individuals with mental illnesses often fear that they will be stigmatized or discriminated against as a result. Self-stigma, where an individual internalizes this stigma, can also be a barrier to seeking help.
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While accessibility, affordability, and stigma are often talked about, they stem from much larger, structural barriers to reaching out for help. In the same way that social inequality and disadvantage lead to disparities in mental health outcomes, they also lead to inequities related help-seeking. The barriers faced by individuals operate within three main levels: the individual level, the community level, and the system level. Explore the tabs below to learn more.
For an excellent, more detailed breakdown of the barriers to accessing mental health care in Canada, we recommend (Moroz et al.’s 2020 paper).
5.4 Section Summary
- Many Canadians with a demonstrated need for mental health care do not reach out for help or treatment, and the same can be said of post-secondary populations.
- Three major barriers to help-seeking include accessibility, affordability, and stigma. Visible minorities tend to experience some of these barriers more than others.
- Barriers to help-seeking operate at three main levels: individual (i.e., self-stigma, side effects of medication), community (i.e., lack of culturally appropriate care, language barriers, perceived stigma), and system (i.e., lack of available practitioners, lack of timely care).
Module Contributors
Ainsley Johnstone
Bachelor of Health Sciences Program
Queen's University
Role: Content Developer
Jin Byun
Bachelor of Health Sciences Program
Queen's University
Role: Content Developer
Health Sciences and Policy Research Institute
Queen's University
Role: Subject Matter Expert