Unit 4 Mental Health in British Columbia and Alberta: Ecological Model

25/10/2018

By Lorraine Brownlee and Shandel Grimm

BC vs Alberta on Mental Health

For the purposes of this blog, Lorraine Brownlee and I wanted to take another look at similarities and difference between our provinces (British Columbia and Alberta) while addressing multilevel influences on the issue of mental health.

Mental health refers to people's cognitive, behavioural, and emotional wellbeing, where the World Health Organization (WHO) (2014) defines mental health as "a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community." Also according to WHO, depression will rank second only to heart disease as the leading cause of disability worldwide by the year 2020. The Canadian Mental Health Association (2016) proposes that one in five adult Canadians (21.3%) will suffer a mental disorder in their lives, which translates into 4.5 million people, and by age 40, about 50% of the population will have or have had a mental illness. Within aboriginal communities, rates of hospitalization for mental wellness issues remain significantly higher for those living on reserve than the rest of the population. The mental health of an individual effects all aspects of their lives, the lives around them, and can also effect the economy. Reciprocally, environmental factors can also influence the mental health of individuals.

Due to the prevalence of mental health issues in Canada, it is important to consider the levels of influences. The ecological model of health promotes that health is influenced in multiple levels, such as public policy, community, institutional, interpersonal, and interpersonal factors (American College Health Association, n.d.). Following this ecological model of health, influencers of mental health in British Columbia and Alberta are discussed under the institutional and public policy levels.

Institutional influences: The Workplace

As majority of people living in Canada experience life in a workplace, it is a logical institution to focus on to discuss influences on mental health. Statistics Canada shows that in September 2018, Alberta had 103,700 people who were unemployed for over a month, whereas in British Columbia there was only 53,700 people. The average weekly hours worked in Alberta was 37.7, whereas the average in British Columbia was 36.2. In 2017, the average hourly rate in Alberta was $26.16, whereas in British Columbia the hourly rate was $25.71. Therefore, although hours and wages are fairly similar between provinces, there is a large gap in job security between the provinces.

Mental health of an individual can be effected by several aspects of a workplace, such as hours worked, workload, recognition, income, autonomy, job insecurity, and workplace safety. Many of these aspects initially cause an increase in stress, which can lead to more serious detriments to mental health such as depression and substance abuse. Workplaces often have policies that outline job expectations and vacation pay, however there are often deficits in policies that aim to relieve stress and improve mental health. Some ways in which employers can promote mental health is by providing mental health-related brochures, encourage employees to reorganize tasks to reduce stress, establish clear policies, promote voluntary health practices (such as onsite yoga classes, healthy food choices available, and fatigue management), and offer occupational health and safety training. Below is a table that outlines specific aspects of the workplace and how they can effect mental health.

Model

Description

Mental Health Effects

Job Strain

(Van der Doef & Maes, 1999; LaMontagne, et al., 2014)

The relationship between job demand, job control, and job support.

Job strain can negatively impact mental health. Research indicates that when job demand is decreased and/or job control is increased, there is improvement in mental health.

Effort-reward imbalance

(Eddy, Wertheim, Kingsley & Wright, 2017).

When insufficient recognition and/or reward is provided based on level of effort, emotional stress can occur. Studies show that an imbalance in effort and reward can adversely effect mental health.

Work hours

(Bannai & Tamakoshi, 2014); Frone, 2000)

Regards long working hours and anti-social work hours such as nights and weekends as factors in mental health. Both long and anti-social work hours have been found to affect psychological health outcomes.

Work-life conflict

(Sheikh, M.S., Ashiq, A., Mehar, M.R., Hasan, A., & Khalid,M, 2018)

Work-life conflict occurs when multiple life and work tasks are required to occur simultaneously, causing overload and interference. These conflicts and strains increase stress and are shown to be strongly correlated with mental health and substance use

Job insecurity

(Nolan, 2002; Griep, et al., 2016)

Job insecurity can be defined as perceived powerlessness to maintain desired continuity in a threatened job situation. Job insecurity can cause anxiety, depression, psychiatric morbidity, as well as cause stress on familial relationships.

Workplace safety

(Kim, Park, & Park, 2016)

(Verkuil, Atasayi, & Molendijk, 2015)

Workplace safety has psychological and physical components. The psychological component refers to threats of emotional hazards (bullying), while the situational component are threats to physical hazards.

Studies show that the perception of workplace safety can affect stress and overall mental health. Bulling in a workplace can cause depression, anxiety, and stress.

In addition to how the workplace can influence mental health in individuals, the mental health status of individuals can also influence the workplace and overall economy. The Canadian Mental Health Association (2016) shows that mental health problems and illnesses are rated as one of the top three drivers of disability claims by more than 80% of Canadian employers. Furthermore, mental health problems account for more than $6 billion in lost productivity costs due to absenteeism (Canadian Mental Health Association (2016).

Public Policy Influences

There are many government policies and regulations that affect each of the other levels in the ecological model, including institutions, which in turn influences the mental health of individuals. For example, there are provincial policies that dictate minimum workplace standards, such as wage, hours of work, maternity leave, and termination (British Columbia see: Employment Standards Act (https://www.bclaws.ca/EPLibraries/bclaws_new/document/ID/freeside/00_96113_01#section3); Alberta see: Employment Standards Code (https://www.qp.alberta.ca/documents/Acts/E09.pdf). In addition to influencing institutions, public policy can directly influence mental health status of individuals. Both British Columbia and Alberta have public policies that include frameworks for improving mental health of individuals within each province. Each province also includes a framework that specifically focuses on Aboriginal mental health, as policies require tailoring to the specific values of Aboriginal people. These framework for policies can influence mental health by means availability and allocation of public resources available, such as treatment options and prevention programs. There are certain laws in each province that also dictate mandated support and supervision requirements for mentally ill individuals (Alberta: Mental Health Act (https://www.qp.alberta.ca/1266.cfm?page=m13.cfm&leg_type=Acts&isbncln=9780779793822); BC:https://www.bclaws.ca/EPLibraries/bclaws_new/document/ID/freeside/00_96288_01)

In 2004, mental health provincial government expenditures per capita were $207 in Alberta which focused resources for hospital inpatients, and $230 in British Columbia which allocated resources heavily on community mental health initiatives (Canadian Mental Health Association (2016). Furthermore, Alberta (16%) and BC (18%) are the highest in Canada for prescription psychotherapeutic drugs as a percentage of total drug expenditures. In addressing mental health issues, there are slight differences between the two provinces in terms of wait times for a consult with a psychiatrist after a referral from a general practitioner. According to the Canadian Mental Health Association (2016), the wait time for urgent referrals is approximately 2 weeks, and 8 weeks for elective referrals; however, British Columbia has an eight week wait period for both urgent and elective referrals. This is an interesting statistic, as there are more psychiatrists available per 100,000 people in British Columbia than Alberta, which possibly demonstrates a difference in provincial policies. A mental health services satisfaction survey was completed in Alberta in 2004, with results showing that 68% of people were satisfied with provincial services, and only 14% were dissatisfied (Canadian Mental Health Association (2016).

Mental Health Resources Between Provinces:

Resources (per 100,000 people)

Canadian Average

Alberta

British Columbia

Psychiatric beds

48.8

Psychiatrists

15.22

11.51

15.87

Psychologists

38.8

52.5

22.1

Psychiatric nurses

Social workers

100.2

192

Alberta

British Columbia

Aboriginal Mental Health: A Framework for Alberta

https://www.albertahealthservices.ca/assets/healthinfo/MentalHealthWellness/hi-mhw-aboriginal-framework.pdf

Goals:

1. To provide background information and
described factors that influence the unique and
complex needs for mental health services and
supports that will serve the various Aboriginal
groups in the province of Alberta.

2. To develop a document in Mental Health that
reinforces and reflects the Aboriginal Policy
Initiative.

3. To provide strategic direction for service
providers that will be beneficial in the
development of services to the Aboriginal
communities of Alberta.

4. To coordinate and facilitate joint service
planning, service delivery, capacity building, i
innovation, research and evaluation.

A Path Forward: BC First Nations and Aboriginal People's Mental Wellness and Substance Use Ten Year Plan

Goal: To ensure that mental wellness and substance use strategies and actions for Aboriginal people reflect individual and family needs and are community-driven and nation-based.

https://www.health.gov.bc.ca/library/publications/year/2013/First_Nations_Aboriginal_MWSU_plan_final.pdf

Children's Mental Health Plan for Alberta: Three Year Action Plan (2008-2011)

https://open.alberta.ca/dataset/0fd6499b-2e9c-45fd-b707-3ea83121647e/resource/00ae5c9b-7ee5-4438-88d6-dff715a26fb6/download/2008-mental-health-plan-children-08.pdf

Goals:

Implement co-ordinated access standards
Increase rural access
Improve transition services
Increase mental health service delivery models

in schools

5. Reduce risk factors for special populations

6. Early intervention strategies for infants and
preschoolers at risk

Healthy Minds, Healthy People: A Ten-Year Plan to Address Mental Health and Substance Use in British Columbia

Goals:

Improve the mental health and well-being of the population.

2. Improve the quality and accessibility of services
for people with mental health and substance
use problems.

3. Reduce the economic costs to the public and
private sectors resulting from mental health and
substance use problems.

https://www.health.gov.bc.ca/library/publications/year/2010/healthy_minds_healthy_people.pdf

Positive Futures - Optimizing Mental Health for Alberta's Children & Youth: A Framework for Action (2006-2016)

https://open.alberta.ca/dataset/cc340bda-f521-4e86-affb-9a20278ca088/resource/7ec9a2f7-0b3b-4c67-bcc5-e28850593ce7/download/2006-mental-health-framework-child-06.pdf

Goals:

1. Build capacity to enhance/increase factors

that promote mental health and well-being;

2. Remove or reduce risks to well-being and

mental health

3. Provide support and treatment to children,

youth and their families.

Model Core Program Paper: Mental Health Promotion and Mental Disorders Prevention

https://www.health.gov.bc.ca/library/publications/year/2009/mental-health-promotion-disorders-prevention-core-program-paper.pdf

Goals:

Enhance protective factors that contribute to
positive mental health in individuals, families,
workplaces and communities.
Prevent and/or reduce the social, environmental and individual risk factors that influence the occurrence of mental disorders.
Reduce the incidence, prevalence and recurrence of mental disorders as well as the severity and impact of the illness on individuals, families and society.

Creating Connections: Alberta's Addiction and Mental Health Action Plan 2011-2016

https://www.albertaaddictionserviceproviders.org/ccactionplan2011.pdf

Goals:

1. Build healthy and resilient communities

2. Foster the development of healthy children,

youth and families

3. Enhance community-based services, capacity
and support

4. Address complex needs

5. Enhance assurance

B.C.'s Mental Health and Substance Use Strategy 2017-2020

https://www.health.gov.bc.ca/library/publications/year/2017/mental-health-substance-use-strategy.pdf

Goals:

Focus on wellness, prevention and intervening early
Support navigation and expand service reach
Co-ordinate services beyond boundaries

It is important to understand that there are many social levels that influence mental health, whether promoting mental health or treatment mental health problems. There is often a negative stigma that is associated with mental health problems, and a deeper understanding that the issue is rooted beyond that of a sole individual will help to relieve some of the stigma and improve mental health in Canada. Each level of influence needs to makes efforts to increase mental health in order to create a healthier future.

References

Alberta Health Services. (2006). Aboriginal Mental Health: A Framework for Alberta. Retrieved from: https://www.albertahealthservices.ca/assets/healthinfo/MentalHealthWellness/hi-mhw-aboriginal-framework.pdf

Alberta Health Services. (2011). Creating Connections: Alberta's Addiction and Mental Health Action Plan 2011-2016. Retrieved from: https://www.albertaaddictionserviceproviders.org/ccactionplan2011.pdf

Alberta Health Services. (2013). Its our business: Addiction and mental health in the workplace. Retrieved from: https://www.albertahealthservices.ca/assets/info/amh/if-amh-iob-manual.pdf

Alberta Health and Wellness. (2006). Positive Futures - Optimizing Mental Health for Alberta's Children & Youth: A Framework for Action (2006-2016). Retrieved from: https://open.alberta.ca/dataset/cc340bda-f521-4e86-affb-9a20278ca088/resource/7ec9a2f7-0b3b-4c67-bcc5-e28850593ce7/download/2006-mental-health-framework-child-06.pdf

Alberta Mental Health Board. (2007). Mental health: Economic statistics. Retrieved from: https://www.albertahealthservices.ca/assets/info/res/mhr/if-res-mhr-mental-health-econ-stats-pocket.pdf

Bannai, A., & Tamakoshi, A. (2014). The association between long working hours and health: A systematic review of epidemiological evidence. Scandinavian Journal of Work, Environment & Health, 40(1), 5-18. Retrieved from: https://www.jstor.org/stable/43187983

BC Ministry of Healthy Living and Sport. (2009). Model Core Program Paper: Mental Health Promotion and Mental Disorders Prevention. Retrieved from: https://www.health.gov.bc.ca/library/publications/year/2009/mental-health-promotion-disorders-prevention-core-program-paper.pdf

British Columbia Government. (n.d.). B.C.'s Mental Health and Substance UseStrategy2017-2020. Retrieved from: https://www.health.gov.bc.ca/library/publications/year/2017/mental-health-substance-use-strategy.pdf