Jack Summit from a Medical Student’s Perspective

By Qadeem Salehmohamed

Last weekend, I had the pleasure of attending Jack Summit, the largest gathering of youth mental health advocates in the country. Two hundred delegates from across Canada gathered in Toronto for one purpose: to innovate ways to decrease the burden of mental illness in our society. It was a great weekend where I made amazing new friends and gained incredible insight into the current status of mental health advocacy work in the country. 

Jack.org (which is responsible for Jack Summit) is truly a remarkable organization, and I could write pages about its history and the amazing work that Jack does. Unfortunately, that is not the focus of this article, so if you are interested in learning more about Jack.org and getting involved with their advocacy work, please check out their website [1].

My goal for attending the summit was to learn about the discourse in the mental health advocacycommunity and compare that to what is being said and done in the medical community.Hopefully, through this, I could propose some solutions to the mental health crisis we are experiencing in Canada.

Before, I begin to get into details, let me be clear: I am not a mental health advocate. I have no personal history of mental illness. I have never participated in any mental health awareness campaigns, and, apart from Jack Summit, I have never discussed mental health in the context of advocacy. What I am, is a learner – an “objective outsider” that recognizes there is a mental health crisis in this country. 

And it is a crisis. 

The prevalence of mental illness is astonishing. 1 in 5 Canadians will experience mental illness each year [2]. According to Statistics Canada, suicide is the 2nd most common cause of death in people aged 15-34, with men being much more likely than women to die by suicide [3] [4]. Mental illness is not adequately addressed by the medical system. Less than half of adults seek care from their health care providers for symptoms of depression [5]. In addition to this, doctors fail to diagnose mental illnesses more than half of the time [6]. From an economic perspective, the cost of mental illness is $22.6 billion annually. Over the next 30 years, mental illness may cost us almost $1 trillion [2].

So what is currently being done to combat this public health issue? From my experience at Jack Summit, it appears that so far, efforts have primarily focused on addressing the “stigma” of mental health through awareness campaigns. It is widely thought that the reason so many mental health conditions go untreated and unrecognized is due to a societal aversion of the subject. A hauntingly common narrative is the story of the person who became mentally ill, and due to fear of judgement, did not reach out, allowing the mental illness to progress to the point of physical harm. Patients, families, friends, and health care providers are often afraid to speak about mental health out of fear of seeming weak-minded or offending others.

Reducing the stigma of mental health is the focus of projects such as “Wear Your Label”, a company that makes clothing “to create conversations about mental health” [7]. In fact, numerous organizations – often student groups at high school and post-secondary campuses –host events just to get people talking about mental health. Project Pilgrim itself, is such an awareness campaign.

After spending a weekend at the summit, I can tell you that much more of these projects are on the way, and efforts are now being made to make them more inclusive to racial, gender, and sexual minorities. However, what I found unfortunately lacking at the summit was real and tangible solutions to addressing the problem at hand. While there is still more work to do in destigmatizing mental health, I think that we are now at the point where we should be lobbying for structural changes in our society to improve mental health outcomes. Jimmy Kang wrote a guest blog on this topic, and he articulates his points much better than I do. So if you are interested in more detail about this, please see his post [7].

So what are my solutions? As a medical student, I have some ideas about how we might change the medical management of mental health…

The first has to do with preventative medicine. Mental health is often thought of as a dichotomy: you are either healthy, or you are mentally ill. In reality, however, it lies on a spectrum. This mental health spectrum extends from “healthy” all the way to “crisis”. As people become more mentally ill, they move across the spectrum towards the “crisis” end. Throughout this process, there are detectible signs and symptoms of deteriorating mental wellness. Without intervention, some people reach the “crisis” edge of the spectrum and often end up in the emergency room. This progression is not uncommon. I have witnessed times where the majority of people in the emergency department were there due to a mental health crisis.

Waiting to treat people until they are in a medical emergency is generally less effective and more expensive than intervening earlier. This is why physicians typically ask their patients to maintain their fitness through exercise and diet – the complications of diabetes or heart disease are severe and expensive to treat. The same applies to mental health. If we can be proactive, and prevent people from ever reaching the crisis level, then we can more effectively help patients. 

So how do we do this?

We need to train health care professionals, in particular primary care physicians and nurse practitioners to better screen for and identify early signs of mental illness. All patients who come in to see their primary care provider should have their mental status evaluated. We simply cannot continue to have physicians miss over 50% of patients with depression [6]. A physician would never forget to check a patient’s blood pressure; it should be the same for assessing a patient’s mental status.

Lastly, I want to address the strategy of the current mental wellness movement. Over the past few years, I have seen activist’s strategy move in the directions of encouraging people to “check in” with their peers to ensure that they are mentally well. The idea is that, if everyone is looking out for each other, then we will not miss people who need help.

My problem with this strategy is that generally, people who are struggling with their mental health will tend to isolate themselves from others. In addition, those at the highest risk for mental illness are usually already socially isolated. Who is there to “check in” on these people? I fear that we risk missing the people who need our help the most with this approach to the mental health crisis. It is for this reason that I believe this strategy is doomed to fail. 

The solution is to teach people to be aware of their own mental health status. This way, people are empowered to take care of their own mental health, and when they notice symptoms, they can seek help from the health care system. This requires us to teach people how to be mindful of their health. We can teach this skill through the public education system in elementary and high school. This way, by the time people enter the high-risk years for mental illness, they have the tools to look after their health. 

Overall, I was very impressed with the mental health advocate community. They have identified and are addressing a real problem through a large-scale coordinated effort. However, I feel that this movement needs to grow from what is mostly an awareness campaign, to providing and implementing real and tangible solutions to the mental health crisis. 

About The Author:

Qadeem is a medical student at the University of British Columbia in Vancouver, BC. He previously attended the University of Alberta for three years, where he was an executive in student government at Lister Centre Residence. Qadeem hopes to one day become an emergency physician.

 

References

[1] Jack.org, "jack.org," [Online]. Available: https://www.jack.org/. [Accessed 9 March 2016].

[2] P. Smetanin, D. Stiff, C. Briante, C. E. Adair, S. Ahmad and M. Khan, "The Life and Economic Impact of Major Mental Illnesses in Canada: 2011 to 2041," 2011. 

[3] Statistics Canada, "Table 102-0561 - Leading causes of death, total population, by age group and sex," Canada, 2012.

[4] S. S. Canetto and I. Sakinofsky, "The Gender Paradox in Suicide," Suicide and Life-Threatening Behavior, vol. 28, no. 1, pp. 1-23, 1998. 

[5] B. Diverty and M. Beaudet, "Depression an untreated disorder?," Health Reports, vol. 8, no. 4, pp. 9-18, 1997. 

[6] H. U. Wittchen, S. Muhlig and K. Beesdo, "Mental disorders in primary care," Dialogues in Clinical Neuroscience, vol. 5, no. 2, pp. 115-128, 2003. 

[7] Wear Your Label, "Our Story," 2016. [Online]. Available: http://wearyourlabel.com/pages/our-story. [Accessed 9 March 2016].

[8] J. Kang, "The Next Phase In Mental health Advocacy," 23 February 2016. [Online]. Available: http://projectpilgrim.org/guest-blog-mental-health-matters/2016/2/23/the-next-phase-in-mental-health-advocacy. [Accessed 9 March 2016]