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Health Status Health Services Health Care Reform Diverse Communities of Women
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"Hearing Voices": Mental Health Care for Women Marina Morrow and Monika Chappell, British Columbia Centre of Excellence for Women’s Health
Women’s mental health cannot be understood in isolation from the social conditions of women’s lives. These conditions are characterized by social inequities such as sexism and racism which influence the type of mental health problems women develop and affect how those problems are understood and treated by health professionals and by society. The differences between men’s and women’s experiences of mental health concerns, and in particular, the links between social conditions and women’s mental health, have been well documented.[4] There is also an emerging body of clinical research on the ways in which chronic mental health problems develop differently in women and men as well as research on the connections between women’s mental health status, biology and women’s life cycle stages (e.g., Seeman, 1981 & 1983; Seeman & Lang, 1990). The recognition that mental health is in part socially determined has led to commitments in some national and provincial mental health policy frameworks to shift from a bio-medical understanding of mental health towards a "bio-psycho-social" understanding (BC Mental Health Plan, 1998; Canadian Mental Health Association, 1993). Additionally, some jurisdictions have singled women out as a group that needs particular attention (e.g., BC Mental Health Plan, 1998:27). Nevertheless, the recognition of the socially determined nature of women’s mental health has yet to be fully realized in mental health policy development and in the delivery of mental health services. Despite stated commitments to women as a special population in mental health, there are as yet few mechanisms for examining the experiences of women with mental health problems on an ongoing and in a systematic way. This project was carried out using a feminist collaborative process and involved interviews and focus groups with over 200 women with chronic and persistent mental health problems, service providers, women family members and caregivers in British Columbia.[5] The study revealed that a gendered analysis of policy and service delivery has not been systematically and consistently integrated into existing policy and service delivery structures. Services which recognize the specific needs of women are often dependent on the will of individual service providers, and women’s mental health planning is ad hoc and unsystematic. The implications of this lack of a gendered analysis are profound in terms of consumer satisfaction, clinical outcomes and service utilization. Drawing on interview and focus group data, this study details women’s experiences of mental health services. While in some communities services were virtually non-existent, in others services were fragmented or inaccessible. Consumer survivors and family members described the challenges of obtaining affordable, appropriate, compassionate care while service providers recounted the challenges of providing such care under conditions of fiscal restraint and with limited human resources. Some attention is paid in this report to describing the experiences of women of colour, women with disabilities, Aboriginal women, younger women, senior women, and immigrant women. Women identified language and culture as barriers to accessing care as well as the stigma of being labelled a user of mental health services. The report also documents how mental health services are provided in a two-tier system which permits women with the economic means to maintain autonomy and privacy by seeking care from private counsellors and psychiatrists while low income women more often receive publicly funded – and hence publicly monitored – care. We have begun to document trends in mental health reform in Canada, with a particular focus on developments in British Columbia. Mental health reform in Canada can be seen as part of a philosophical shift in the understanding and treatment of mental illness as well as changes in the fiscal and service-delivery structures for mental health problems. Across Canada, mental health reform has taken similar forms: the gradual down-sizing of large psychiatric institutions and a move to a de-centralized, regionalized mental health care delivery system. Mental health reform has also entailed changes to provincial mental health legislation and policy making mechanisms. These trends are having myriad effects upon the availability and focus of service delivery and thus affect service providers, families of persons with mental illness and consumers themselves. In general, gender has not been a feature of the development, implementation or evaluation of the elements of mental health reform. This broad exploratory study begins to point to the need for more systematic examinations of how the rearrangement of mental health fiscal and service delivery structures in Canada are affecting service delivery to women. Further, more concentrated research and program evaluation is needed to determine the kinds of policies and service delivery models that can best respond to women’s unique mental health needs. Over the next three years, research on the effects of mental health reform on women in Ontario, Quebec and British Columbia will be undertaken by the British Columbia Centre of Excellence for Women’s Health. This work was funded by the BC Centre of Excellence for Women’s Health, the BC Ministry of Health, the Minister’s Advisory Council on Women’s Health (BC) and the BC Ministry of Women’s Equality. For further information contact NOTES CMHA National. (1993) A New Framework for Support for People with Serious Mental Health Problems. Toronto: Canadian Mental Health Association. Seeman, M.V. (1981). Gender and the Onset of Schizophrenia: Neurohumoral Influences. Psychiatric Journal of the University of Ottawa 6:136-138. Seeman, M.V. (1983). Schizophrenic Men and Women Require Different Treatment Programs. Journal of Psychiatric Evaluation 5:143-148. Seeman, M.V. & M. Lang. (1990). The Role of Estrogens in Schizophrenia Gender Differences. Schizophrenia Bulletin 16: 185-194. [5] The project was overseen by a 15 member Advisory Committee under the leadership of women mental health consumers and included mental health service providers, policy makers and researchers. |
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