A Mental Health Strategy for ALL Canadians

In the age of WikiLeaks it is very naïve for the Mental Health Commission of Canada to release a document labeled DRAFT – NOT FOR CIRCULATION. Taking this approach with something as important as a Mental Health Strategy for Canada (D-MHSC) is more than disappointing. It is also not in the spirit of “Mental Health is everyone’s business.” as was stated in Toward Recovery & Well-Being.



As I read the D-MHSC I was cognizant of wise words from Mike Kirby. He often expressed his hope that each and every Canadian would agree with 75% of the work of the Commission. I can certainly agree with and support more than 75% of the draft strategy.

Hopefully any comment about what may concern us about the D-MHSC or the Commission will be in the context of overall support. The Mental Health Commission of Canada, imperfect as it is, continues to be Canada’s best hope for significant progress in the areas of mental health problems and illnesses.

With that said, I would like to express several serious concerns I have.

In January 2008 I personally heard Mike Kirby publicly state, as he announced the “Friends” program, that a successful social movement was critical to the success of the Commission. He recognized the necessity of broad public support and pressure to overcome the inevitable resistance to change which he expected to surface.

I am disappointed by Strategic Direction 6: Mobilize leadership. In my view this should read Mobilize Canadians. The third paragraph begins with the following statement: “In order to build on this momentum and sustain it over time, leadership at many levels will be required.” NO! In order to build momentum, Canadians at all levels and in great numbers must be mobilized. Canadians who have never before been active in the areas of mental health and mental illness must become engaged in this important cause.

The expression of the need for a strong social movement has been reduced to one paragraph in the D-MHSC. In Toward Recovery & Well-Being there was a chapter, A Call to Action: Building a Social Movement, which listed seven examples of the many ways a social movement could contribute to success. The language and action items of Strategic Direction 6 are quite different from those in the framework document. Is this a deliberate change in strategy? Or is this a reflection of the failure to date of the senior management team of the Commission to deliver on Kirby’s vision?

There is much good work that could flow from the 22 action items contained in the D-MHSC. But the style and the language do not stir passions and inspire and therefore the strategy as currently presented is unlikely to engage Canadians. But engaging Canadians at this time is clearly not the intent of an organization that circulates a document labeled NOT FOR CIRCULATION. The Commission knows how to engage Canadians. The D-MHSC has 141 end notes. The final document should also include 141 stories about the experiences of real Canadians.

As evidence for my perspective I note the article by André Picard, Mental health strategy draft doesn’t go far enough, in The Globe and Mail on August 31st. It is not the content of the article which troubled me but rather the fact that it generated only 49 comments on the website, 2 of which were by Commission insiders. If there were even the beginnings of a robust social movement, this article should generate 490 or 4900 comments! The passionate article by Susan Inman, Suppressing Schizophrenia, in TheTyee.ca on August 29th generated only 14 comments in spite of the fact it was mentioned by Picard in his article.

But I can point to a positive example of engagement. The COALITION FOR APPROPRIATE CARE AND TREATMENT FOR PEOPLE WITH SERIOUS MENTAL ILLNESSES (CFACT) published an open letter to the Commission as its response to the D-MHSC. I would like to compliment this organization for its approach. It would be nice to see a public response from the Commission to this excellent letter which made a number of important points.

Every organization which was asked to provide its feedback to the Commission should follow the courageous example of CFACT and self-identify and share their responses with all Canadians. Better yet, the Commission should acknowledge it has made a mistake and immediately put the D-MHSC in the public domain. Otherwise the final Mental Health Strategy for Canada will be seen as a document crafted by an elite behind closed doors instead of a document which will energize Canadians to force action.

Strategic Direction 5: Seek innovation with First Nations, Inuit and Métis should be a total embarrassment to the Commission simply because it is “UNDER DEVELOPMENT”. What an incredible statement of underachievement! From its start the Commission had a First Nations, Inuit and Métis Advisory Committee reflecting its recognition of the need for extra attention to this area. And, after over three and a half years, one page with no content in the D-MHSC is the best it can do?

Much good can come from the actions listed in Strategic Directions 1 to 4. However, as a package these actions have the feel of incremental progress rather than the profound change the Mental Health Commission of Canada has promised. Where are the bold giant steps forward?

I would also like to add comments to the criticism of the Commission that it is not adequately addressing in the D-MHSC the needs of people with severe and persistent mental illnesses, particularly schizophrenia and bipolar disorder. I agree that the Commission does not specifically address these needs and often generally speaks to one category which includes all those with “mental health problems and illnesses”. I agree that the Commission could and should go deeper. A Mental Health Strategy for Canada will be incomplete if this group continues to be marginalized.

But I urge everyone, including those with or speaking for people with severe and persistent mental illnesses, not to magnify your concerns to the point where it inhibits the Commission from leading the way to a transformed mental health system. Please continue to fight for your particular needs. Surely you can agree with at least 75% of what the Commission is doing. Let’s unite and move forward.

There is so much more which could and should be said about the D-MHSC. There need to be many more voices speaking up. Thousands more. It is time for Canadians to express their outrage with the status quo.

Upon request, I will gladly provide any Canadian with a copy of the Mental Health Strategy for Canada DRAFT NOT FOR CIRCULATION June 3, 2011 Mental Health Commission of Canada.

How is the Commission Doing?

The Mental Health Commission of Canada is now four years into its ten year mandate. I was a member of the Executive Leadership Team for three years and I remain hopeful that the Commission will indeed make a significant difference in the lives of people with mental illness and mental health problems. I outlined the reasons why the Commission should succeed in my recent blog entry Will the Mental Health Commission Succeed.

The Commission is required to submit to a comprehensive independent evaluation of its performance and release the report of this external assessment to the general public. That process is currently underway and the report should become available this year. In my view, the progress of the Commission has been generally impressive, particularly in what was achieved in 2008 and 2009. But the progress of the Commission has not been uniform across all of its major initiatives and there are areas which should be of concern.



A Mental Health Strategy for Canada

After less than two years of work, in December 2009 the Mental Health Commission of Canada released TOWARD RECOVERY & WELL-BEING. Howard Chodos and his team delivered a remarkable document which sets out in considerable detail seven goals that provide a framework for what a transformed mental health system should look like. The document generated an enthusiastic response in the mental health community across Canada.

While the published final version of the document was excellent, so was the process by which it was developed. In one of the finest examples of true consultation I have ever witnessed, I watched each draft get better and better as Howard Chodos and his team incorporated the input from the extensive public consultations held across Canada. This was a fine collaborative effort involving many Canadians without any preconceived outcome determined by the Commission.

I was and continue to be inspired by this document and hold as a prized possession a copy personally autographed by my former colleague, Howard Chodos.

But the initial phase of developing a mental health strategy for Canada was easier than the remainder of the task. Now concrete recommendations for achieving the vision described in the framework document are being developed. If the Commission does its job well, there will be resistance to change from some quarters. Building a social movement supporting those recommendations which is powerful enough to overcome such resistance is critical.

The strategy to first build support around a framework was successful and the stage is set. However, the country will not wait patiently for completion of this initiative for much longer. We are often reminded that Canada is the only G8 country with no national mental health strategy. In 2008 the Commission stated publicly that 2011 was the target year for the tabling of a mental health strategy for Canada. That was an extremely aggressive target. Will the Commission meet this target and if not, what is the new target date?

An Anti-Stigma Initiative

Opening Minds, which the Commission launched in 2009, is “the largest systematic effort to reduce the stigma of mental illness in Canadian history.”

In any area of society, it takes a long time and enormous resources to change attitudes and behaviors. As a positive example, we can look to the success of campaigns to reduce smoking rates. Less progress has been achieved in other lifestyle areas such as healthy eating habits and regular exercise, but not because of a lack of effort. Given the alarming rise in obesity, in this area ground is being lost.

When it comes to reducing stigma and discrimination against people with mental illness, in my opinion, the Commission does not have sufficient resources to meet the challenge. All of the $15 million annual funding of the Commission could easily (and wisely) be spent on this single initiative. Compared to what some other countries are doing with their anti-stigma campaigns, Canada’s allocation of resources falls short.

I believe that Mike Pietrus, Director, Opening Minds, has done as much as can be expected with the resources made available to him. The approach selected is “to identify and evaluate existing anti-stigma programs to determine their effectiveness and potential to be rolled out nationally.” But where will the funding come from to scale up proven programs? The Commission certainly does not have the funding for this at this time. Additionally, the Commission has not attracted any significant additional funding during its first four years and, hopefully, this will change during the next six.

Opening Minds is using a targeted approach to focus its activities. To date four target areas have been selected and they clearly are priority areas. It is not difficult to imagine many additional target areas and the Commission has done so. Again, the scope of the challenge clearly requires expanded resources.

The Commission’s Anti-Stigma initiative is critical to its overall success. No matter how good the recommendations in the mental health strategy for Canada will be, their implementation will be ineffective unless there is a widespread change in the attitudes and behaviors of Canadians.

A Knowledge Exchange Centre

Creating a Knowledge Exchange Centre is the third of the Commission’s original three initiatives. This initiative did not move forward during 2008 and 2009 for several reasons. The funding of the Commission ramped up gradually over its first four years and it was not possible to address everything at once. It was necessary to prioritize and working on a mental health strategy for Canada and an anti-stigma initiative were clearly priorities. Of course, leadership makes a big difference and Mike Kirby seemed less passionate about a Knowledge Exchange Centre than other areas of the Commission.

During 2008 and 2009 the Executive Leadership Team did not include a Director for KEC. Little progress was made but this did not seem to distract from the overall success of the Commission. However, leadership for this initiative emerged in 2010.

In 2009 I hired Geoff Couldrey as a consultant to assist me with the management of the information technology infrastructure of the Commission. While he was assisting me in recruiting a manager for the computer department, Geoff expressed his personal interest in working for the Commission and I hired him for his technical IT expertise. But I was taken by surprise when Louise Bradley promoted Geoff to a position on the Executive Leadership Team with greatly expanded responsibilities, including KEC.

A Knowledge Exchange Centre is the type of initiative that requires a lot of planning and behind the scenes work before progress becomes visible. It is not surprising that during 2010 activity was not visible. But now there is a clear articulation on the Commission’s website outlining how the KEC will contribute to the larger mission of the Commission and a beta website has been launched.

However, to truly succeed I believe that a KEC must be much more than an electronic platform for sharing knowledge, which is where the emphasis seems to lie. To put knowledge into action supporting “critical ideas and practices identified by the MHCC mental health strategy” will also require a lot of face to face engagement by the relevant stakeholders. Like the Anti-Stigma initiative, a robust KEC will require a greater allocation of resources than what the Commission is currently able to allocate. Therefore, the Commission will also need to find partners with additional resources supporting this initiative.

Partners for Mental Health

In January 2008 in Toronto I listened to Mike Kirby announce what was then called the Friends Program, later known as Partners for Mental Health. The name changed but the vision remains the same, to “mobilize a million people” and launch “a national social movement” to “advocate for profound change.” This would be the big influencer that would make it very difficult for decision makers to ignore the recommendations of the Commission.

However, while the Commission has many impressive accomplishments in other areas, today there is still no such social movement in Canada to join!

Mike Kirby had identified the strategic need for a social movement and created a compelling vision around what needed to be done. How to accomplish the task was appropriately delegated to management. But CEO Michael Howlett was not able to move this initiative forward one bit in his two years leading the Commission.

At the Into the Light conference in Vancouver in December 2009, a dedicated website and other activities for generating a social movement were unveiled. Since then, this has faded from view. There was no tangible evidence of progress with this initiative in 2010. Considering the vision he presented over three years ago, Mike Kirby must be very disappointed with the pace of progress.

I believe a large social movement supporting mental health reform is critical to the success of the Commission. Without public pressure, governments and other decision makers will bring change at the same pace as the last fifty years. There will always be change, of course, but the cause the Commission serves requires “profound change.”

I started this blog and went public with my own mental health story in March 2009 because I wanted to contribute, in whatever small way, to a social movement supporting mental health reform. Instead today I see the beginning of a social movement around the issue of obesity, another worthwhile cause but not one of personal interest to me. Agendas are always crowded and there is room for only a few “top” issues.

I do not share the concern that some had that the Commission was trying to “steal” their volunteers with a Partners program. Mike Kirby recognized that the energy for a successful social movement required attracting large numbers of new people to the cause. Having been a volunteer in the mental health community myself for many years, I have seen many dedicated volunteers who have worked very hard for many years and are now very tired. This is a cause very much in need of new champions.

Attempting to launch a social movement is a very risky undertaking. Even if the Commission did great work in this regard, there is no formula that guarantees that a spark will ignite a fire. To date, the Commission has not done much with this initiative and doing better is critical to its success. Recently a new VP for Partners for Mental Health was hired and I wish him every success. Last week a marketing agency was appointed and in its news release the Commission again stated its goal of engaging one million Canadians. Nothing is more critical to the success of the Commission than achieving this objective!

The Mentally Ill Homeless

Jayne Barker and I began our employment with the Mental Health Commission of Canada at about the same time in February 2008. Within days of hire our jobs were to change dramatically, hers far more than mine. In the budget speech near the end of February there was an announcement in Parliament of an additional $110 million for the Commission to fund a five year research project on the mentally ill homeless population. This was not the task Jayne had signed on for but she embraced it immediately when asked to do so.

The goal of this initiative, now named At Home / Chez Soi, is “to provide evidence about what services and systems could best help people who are living with a mental illness and are homeless.” There had never been a research project of this scale with this population. Canada was finally addressing one of its most shameful problems.

There was no map to follow for this project. But Jayne quickly assembled an impressive team and a sound action plan was developed. What is known to only a few is that at the same time Jayne was facing a significant challenge in her personal life. Yet her performance was outstanding even in difficult circumstances. All things considered, in my view, she is the most capable member of the Commission’s Executive Leadership Team.

But will the benefits of this research program justify the very high cost?

The anecdotal evidence tells the following story. In the 1980s and early 1990s governments were closing institutional beds for the mentally ill and moving towards expansion of community based support programs. However, the priority of the day became eliminating government deficits. Beds were indeed closed but there was little expansion of community support programs. Research which identifies the best interventions with this extremely difficult population can never be a bad thing. But to make a difference, the Commission must also demand that there be funding for such programs. A big difference would be made by simply expanding the existing supported housing programs across Canada.

The At Home / Chez Soi project utilizes a Housing First approach. It has become widely accepted that this approach is the best way to tackle the tough problem of homeless people living with mental illness. However, in the 1980s the federal government was withdrawing from the role of providing social housing. Again, to make a difference, the Commission must also demand that there be funding for social housing.

Mental Health First Aid

Mental Health First Aid was opportunistically acquired by the Mental Health Commission of Canada in 2010 and there was some external criticism of the Commission for doing so at the time.

The Commission says that it “does not provide services” and it would not describe MHFA as a service. But many community agencies across Canada deliver mental health educational programs and most would consider them to be a service. The Commission would respond that MHFA is a train-the-trainer program rather than an educational program. While this is a subtle distinction, no matter what language is used, the Commission is now in competition with other organizations in this area.

In my view, there is no reason why the Commission should not be undertaking this activity other than its own policy, which it is free to change at any time. As an independent non-profit corporation, the Commission certainly may expand its operations beyond the scope of its Health Canada funded initiatives. Yet for the sake of its external credibility with an important stakeholder group, the Commission should be more straight-forward and simply acknowledge the nature of what it has done.

MHFA is different from other Commission initiatives in another important way. It is not a funded program and is intended to be financially self-sustaining through program fees. The Commission should be commended for its willingness to take this risk. There was probably no organization in Canada better positioned to nurture the growth of this program.

As a member of the Executive Leadership Team, I supported the move in this direction by the Commission. Subsequently, I took the MHFA course myself and was pleased both by the content and the delivery. I have heard some criticism of the program which in my view is based mostly on misconceptions.

Peer Project

Some people believe that all that is required for effective peer support is lived experience with mental illness and a big heart. Indeed, this does go a long way and there will always be room for this approach. The Mental Health Commission of Canada’s Peer Project is not intended to push such programs aside.

The objective of the Commission is to significantly expand peer support programs and its strategy to achieve this is by developing national standards of practice.

Currently peer support programs are mostly targeted to a very high need area, people with severe and persistent mental illnesses. But the potential of peer support is to serve a broad spectrum of needs including people with relatively mild mental health problems.

In my view, comprehensive peer support could be a great preventative tool. By intervening early with a proven peer support program, a lot of mental health problems could be prevented from becoming far more serious and having far more costly consequences.

I know this is true from personal experience. At a time when I was coping with some serious mental health problems myself, in all of Calgary I could not find a suitable program to help me. I spent a year on a wait list for an outpatient mental health program. I can easily imagine a peer support program which would have helped me through that very difficult year.

I hope the Commission, when the time is right, will also advocate for the utilization of accredited peer support programs to be eligible for funding. At a minimum would be their inclusion in employee benefit plans. Ideally, they will become part of government funded health care services, but this is unlikely.

I am privileged to know Stéphane Grenier personally from the time we were colleagues at the Commission. He is a dynamic personality with a clear vision of where peer support should go. I wish him and the Commission success with this initiative.

This blog entry reflects my views on how the mental Health Commission of Canada is doing so far. I have commented only on the major initiatives undertaken by the Commission. However, what the Commission is not doing is also significant. I may address this topic in a future post to my blog.

Will the Mental Health Commission Succeed?

The Mental Health Commission of Canada has the most inspiring vision and mission of any organization I have worked for in my long career. The Commission is all about leading transformative change. Its vision is a “society that values and promotes mental health and helps people who live with mental health problems and mental illness lead meaningful and productive lives.” Its mission is “to promote mental health in Canada, and work with stakeholders to change the attitudes of Canadians toward mental health problems, and to improve services and support.”



I am acquainted with many people who suffer from mental illnesses or mental health problems. Unfortunately, I have known about a dozen people who died by suicide. For all these people and because of my own mental health problems, the work of the Commission is of deep personal interest to me.

I believe the Mental Health Commission of Canada should succeed for the following seven reasons:

Timing

People who have a mental illness are the only remaining large group in Canadian society who are still inappropriately stigmatized, discriminated against and marginalized. Since the pivotal decade of the 1960s, Canada, along with many other countries, has made great progress building a society that is increasingly inclusive of everyone. Discrimination against visible minorities and immigrants, women, gays and lesbians and people with physical disabilities has significantly decreased over the past five decades. But people with mental illnesses have remained in the shadows.

However, the beginning of real change is now evident. The direction of societal development seems to demand that people with mental illnesses come “Out of the Shadows Forever” as the tag line of the Commission calls for. From a historical perspective, the Commission was launched at the right time.

Leadership

While many played a part, the driving force that brought the Mental Health Commission of Canada into existence was Mike Kirby. He led the Senate Committee which tabled the Out of the Shadows at Last report in May 2006, a report which continues to be referred to as the Kirby Report. In a rare, risky and courageous act of true leadership, Mike Kirby resigned his Senate seat to lobby for the creation of a mental health commission. His considerable efforts succeeded and the Mental Health Commission of Canada was launched in March 2007.

Mike Kirby is now in his second term as Chair of the Commission. He continues to be its leader as he impatiently pushes the organization to achieve its vision and mission.

Resources

There are many excellent organizations in Canada dedicated to the cause of helping people with mental illnesses. There are many people with many good ideas for positive change and progress has been achieved. The current situation is much improved compared to fifty years ago. But everyone would agree that the degree and pace of change falls far short of what was desired.

To effect change requires resources and a significant reason for the underachievement of progress has been the lack of resources brought to bear on this cause.

The Mental Health Commission of Canada has significant resources. A funding agreement with Health Canada provides $130 million to fund the Commission for ten years. A second funding agreement with Health Canada provides $110 million for a five year research project on the mentally ill homeless population. This magnitude of funding for this cause is unprecedented and is the result of the leadership of Mike Kirby.

Strategy

In several critical areas the Commission has the correct strategic approach necessary to succeed in its vision and mission. Again, Mike Kirby is the architect of these strategies. While he certainly has his shortcomings, when it comes to strategic thinking he shines brightly.

Mike Kirby is realistic about where the Commission should be positioned as a catalyst for change. “Just inside the outer edge of political feasibility,” he has said over and over again. To advocate for only modest systemic changes will not result in enough change to be meaningful. To advocate for radical change is to over-reach and fail. Achieving the correct balance between these two extremes must be determined by political feasibility, which is a continuously shifting target. Ultimately, it is the power of governments that must make the necessary changes.
Over the years, the lack of action on sound recommendations in excellent reports from fine organizations stems partly from a lack of political feasibility. The recommendations were overly idealistic and beyond what governments were willing to do at the time.

But Mike Kirby and the Commission also have the right strategy to push the limits of what is politically feasible. It is well understood that politicians respond to public pressure. From the very beginning of the Commission, Mike Kirby recognized the need to generate a big social movement to support the recommendations the Commission will be making. Such a social movement will push the point of political feasibility in the right direction.

A third strategy employed by the Commission also originated with its leader - the (obvious) need to involve the people who themselves have mental illnesses. People with lived experience with mental illnesses are prominent at every level of the Commission. They are on the Board of Directors, they are on Advisory Committees and they are on staff. They have a strong voice.

They have a voice but they do not have the final, deciding voice. There are those in the mental health community who believe that people with lived experience should have the final say on all matters. I have heard expressed publically by leaders in this community that they should have control of the organizations that serve their needs through majorities on Boards of Directors. Were this to occur, I believe this would eventually move such organizations beyond what is politically feasible. There is a lot of anger amongst people with lived experience because their needs have not been adequately met and they have suffered greatly for a long time. But when this anger pushes for radical change beyond what governments can realistically deliver, the result is only token change rather than real progress. The Commission has wisely avoided this trap.

The Mental Health Commission of Canada listens to all voices – the established system, various professional associations, social service organizations, employers, governments and people with lived experience and their families. No one voice dominates nor should this be otherwise.

Of course there is little hope of complete agreement amongst widely different interest groups. Mike Kirby and the Commission have no such expectations and this is where the principle of equalized unhappiness comes in. If everyone likes 75% of what the Commission promotes, dislikes 25% and what is disliked is different for different groups, all will unite to achieve “their” 75%. This strategy should be a unifying force and should prevent the paralysis which would result from any misguided attempt to achieve a higher level of consensus.

Structure

The structure of the Mental Health Commission of Canada is important and has not received the attention it deserves. It is a non-profit corporation funded by the federal Government through Health Canada but independent from government. The Federal Government and Provincial Governments have seats on the Board of Directors but only a minority. Other Board seats are filled from the mental health community across Canada.

This structure is more conducive to achieving the Commission’s vision and mission than attempting to achieve system reform through the federal bureaucracy. A crown corporation or any type of entity controlled by governments would not be effective. No other existing organization in Canada could have successfully delivered on the vision and mission given to the Commission.

People

By being a new entity independent of governments, the Commission has been able to attract a wide variety of individuals with energy and passion for the cause.

The significant resources and bold strategies organized in an effective structure under the charismatic leadership of Mike Kirby have enabled the Commission to engage many talented and passionate individuals. Amongst the Board of Directors, Advisory Committees, Executive Leadership Team and staff are many people with high levels of skill, knowledge, experience, intelligence, energy and passion.

Momentum

The Commission has momentum and has quickly emerged as a leader in the mental health community. After its first couple of years, Mike Kirby remarked with great pride that the Commission “took off like a rocket.”

The Commission should succeed. It is now four years into its ten year mandate and its influence is continuing to grow. Major systemic change is not easy to accomplish and takes time. It will be several more years before it will be appropriate to evaluate the Commission’s impact. It may never be possible to determine what positive changes would have happened even without its existence. But that doesn’t matter because, as Mike Kirby says, it’s about the cause, not the organization.

The Mental Health Commission of Canada has many strengths which justify optimism. But it is a far from perfect organization and there are areas which should cause concern. As a former member of the Executive Leadership Team for almost three years, I was privileged to play a part in its formative phase. I will provide my perspectives on some of its initiatives, projects, accomplishments and shortcomings in the near future.

Inside the Commission

On January 28, 2011 my employment with the Mental Health Commission of Canada ended on mutually agreed to terms. My three years with the Commission was in many ways the highlight of my career. From start to finish it was an intense experience and a rare opportunity to be on the inside of an important, new organization.



As a Board Member of the Canadian Mental Health Association, I had been well aware of the launch of the Commission in March 2007. But I was taken by surprise, as was the whole country, when the Commission announced that the head office would be located in Calgary where I lived. The instant I heard the news I knew I wanted to work for the Commission.

I was further pleasantly surprised when Glenn Thompson was appointed Interim President. We knew each other from our time together at CMHA National – Glenn as Acting Chief Executive Officer and I as a Board Member and National Treasurer. I phoned Glenn and expressed my interest in joining the Commission as Chief Financial Officer and he invited me to apply.

On a Saturday morning in September 2007 I received a phone call from Glenn who was in Calgary for the Commission’s first Board meeting. Would I like to meet with Mike Kirby, he asked.

Later that day in the lounge of the Hyatt, I met with Mike Kirby, John Service, Howard Chodos and Glenn Thompson. During this “interview,” I deliberately tested the Commission by being quite open about my personal mental health problems. I have struggled with bouts of depression and anxiety since teenage. In many other organizations my disclosures would have ended any hope of employment on a senior management team. But after due process, I joined the Mental Health Commission of Canada in January 2008 as CFO.

The atmosphere at the January 2008 Board meeting was electric, full of anticipation. The number of attendees was quite large because Advisory Committee members were included. Together with Board and staff, this group became aptly known as the Commission Family.

My first six months with the Commission was the best period of my long career. I was highly motivated and full of energy. There were considerable challenges because this was a start-up situation and I literally began work on my kitchen table. I rose to the occasion with great productivity and accomplishment.

The Executive Leadership Team bonded almost instantly. Working with John Service, Howard Chodos, Mike Pietrus and Jayne Barker seemed almost effortless from a team dynamics perspective. Everyone was completely focused on whatever needed to be done. All of us were excited by the opportunity to really make a difference in a cause important to each of us.

But it certainly wasn’t perfect. Michael Howlett joined the Commission as Chief Executive Officer and he did not make a good first impression on me when we first met in Calgary in April. Something doesn’t feel right, I remarked to my wife after that first meeting. I quickly began having difficulty working with the new CEO and we disagreed on several significant matters. Fortunately he worked out of an office in Toronto where he lived and we saw little of him in Calgary.

The six month high I had been on ended abruptly with the first major negative event in the Commission’s history. In September 2008 Michael Howlett brutally terminated without cause the employment of John Service, Chief Operating Officer. I was further dismayed that the Board of Directors did not intervene. This unjustified act violated my core values and upset me deeply. For a couple of weeks my productivity plummeted and I considered resigning. Thankfully, I was encouraged to stay by Jayne Barker and I am glad I took her advice.

Naively, I had thought that the Mental Health Commission of Canada would be a special place to work both in terms of what the organization did as well as how the work was done. The work of the Commission was indeed special and the rapid start up and accomplishments of 2008 and 2009 was impressive. I found my job a CFO very challenging and stressful but also very rewarding. All things considered, there was no other place I would rather have been.

The challenges of a start-up, the extremely fast pace, the inevitable continuous change, the enormous expectations and trying to work with Michael Howlett added up to a very stressful situation for me, but I coped. Looking back, I am proud of my contribution.

But in July 2009 I had a serious mental health problem which I described in my blog entry Who gets Depressed on Vacation. I began to think about what changes I needed to make for the sake of my mental health. I also received some excellent advice from a psychologist who I see from time to time.

In January, 2010 Michael Howlett informed the Executive Leadership Team that he had resigned and would be leaving the organization at the end of March. Figuratively speaking, I leapt from my chair in pure joy. My two years of trying to work with him was the worst inter-personal experience in my forty year career.

Louise Bradley accepted the offer to move up to Chief Executive Officer. In a private meeting with Louise in March, she expressed her confidence in me and her intention for me to continue as CFO. However, I surprised her and replied that for the sake of my mental health, I wished to semi-retire and step down. Over the next few months we worked out a plan for a smooth transition for both me and the organization.

In September 2010 I left my position as CFO and joined the Commission’s Mental Health First Aid program, working in a part-time, non-management role. I thought we had arrived at a win, win and was pleased to remain with the Commission. However, on December 22, 2010, which by coincidence was the date of my wedding anniversary, I was placed on leave with pay. On January 28, 2011, my employment with the Mental Health Commission of Canada ended on mutually agreed to terms.

SNAKES IN SUITS

While on vacation a couple of months ago I read SNAKES IN SUITS When Psychopaths go to Work by Paul Babiak, Ph.D. and Robert D. Hare, Ph.D. This book is about the presence and behavior of psychopaths high in the ranks of management. The thoughts expressed by the authors are chilling.



The book was mentioned to me by my psychologist last year during a therapy session. It is her view that the impact of psychopaths is a big problem that is getting very little attention. She suspects that a number of her clients may be victims of psychopaths and that her experience may be widespread.

Psychopathy is classified in the DSM-IV as an Antisocial Personality Disorder and the proposed revision for the forthcoming DSM-V is Antisocial/Psychopathic Type. The American Psychiatric Association describes this disorder as follows:

Individuals who match this personality disorder type are arrogant and self-centered, and feel privileged and entitled. They have a grandiose, exaggerated sense of self-importance and they are primarily motivated by self-serving goals. They seek power over others and will manipulate, exploit, deceive, con, or otherwise take advantage of others, in order to inflict harm or to achieve their goals. They are callous and have little empathy for others’ needs or feelings unless they coincide with their own. They show disregard for the rights, property, or safety of others and experience little or no remorse or guilt if they cause any harm or injury to others. They may act aggressively or sadistically toward others in pursuit of their personal agendas and appear to derive pleasure or satisfaction from humiliating, demeaning, dominating, or hurting others. They also have the capacity for superficial charm and ingratiation when it suits their purposes. They profess and demonstrate minimal investment in conventional moral principles and they tend to disavow responsibility for their actions and to blame others for their own failures and shortcomings.

Those of us who have long been active in the field of mental health and mental illness know only too well how such difficulties often marginalize people. But knowing that individuals with very serious personality disorders can thrive in society and appear to be very successful paints a different picture indeed. It will be extremely challenging, probably impossible, to make psychopathy part of the conversation on mental health reform in Canada at this time.

Research on prison populations has shown that psychopaths may constitute 10 to 15 percent of criminals, significantly higher rates than their representation in general society, which is estimated to be about 1 percent. But psychopaths do not necessarily become criminals. Research by the authors of SNAKES IN SUITS found that about 3.5 percent of executives fit the profile of a psychopath. These executives cause problems, hurt people and often contribute very little real benefit to the organizations that employ them.

SNAKES IN SUITS provides the following list of behaviors that may be manifested by psychopaths in a business setting:

• Inability to form a team
• Inability to share
• Disparate treatment of staff
• Inability to tell the truth
• Inability to be modest
• Inability to accept blame
• Inability to act predictably
• Inability to react calmly
• Inability to act without aggression.

SNAKES IN SUITS also provides strategies for defending against psychopaths in the hiring and selection process. This is particularly important because such individuals are masters at presenting themselves as exactly what an organization may be looking for. Typically psychopaths have a well-crafted, impressive narrative about themselves and they often have a powerful, well-positioned patron who has bought their story.

Of course only qualified psychologists or psychiatrists can diagnose a personality disorder. Even for a trained professional, psychopathy is not an easy diagnosis to make. The advice of SNAKES IN SUITS to anyone encountering a suspected psychopath is to stay as far away from them as possible. Any attempt by an ordinary person to engage with a psychopath will almost always make a bad situation worse. I suspect that I have worked with more than one psychopath during my many years in management and in every case the dynamics closely followed the script presented in this most helpful book.

Men's Mental Health Matters

To say that men and women are different is to state the obvious. It may even provoke a chuckle. But there is also a very serious aspect to gender differences for people living with a mental illness or a mental health problem.



It is time to re-emphasize gender differences when the evidence supports doing so because there are benefits to be gained.

Western culture has been heavily influenced during the past fifty years by the feminist movement which sought to minimize gender differences in an effort to achieve greater equality for women. The objective was correct, but there have been unintended consequences. It has not been politically correct to emphasize gender differences and the potential of a gender specific understanding of mental illness and mental health has not been realized.

Soon after conception, males and females embark on different developmental paths. There are significant hormonal differences with male development influenced by testosterone and female development influenced by estrogen-type hormones. But the chemical differences go further and include some which are more closely linked to mental health. Males and females have different levels of serotonin, dopamine and oxytocin. These physical differences drive behavioral differences which play out in every aspect of life.

Researchers are continuing to discover identifiable differences in male and female brain structure. Specific areas of the brain linked to how information is processed differ by gender. Males and females even differ in how they use their brains (no jokes please). Right-hemisphere preference is more common in males and left-hemisphere preference is more common in females.

The nature-nurture debate is also relevant, of course. Boys and girls are raised differently, but probably much less so than fifty years ago. The feminist movement emphasized nurture as it wisely sought to expand opportunities for women. But the direction of scientific research today appears to be shifting the focus to nature.

Yes, but…

There is immense overlap between the genders. Of course the individual is more important than the gender. But this does not mean that gender is not significant. All differences between men and women should be viewed in the same way as obvious physical differences. Some women are taller than some men. But on average, men are taller than women. Gender is significant.

Yet it was in this century that speaking about gender differences landed Larry Summers in deep trouble while still President of Harvard University. He dared to link lower rates of female enrollment in sciences and engineering to gender. One woman was so offended that she walked out of the conference at which he was speaking. But he did not say that women were not capable of becoming very good engineers. Hopefully no one will be offended by those advocating for a gender specific approach to mental health and mental illness in areas where this approach is useful.

So far this is merely pre-amble before stating that almost four times as many men as women die from suicide. Yet women are more often diagnosed with depression. Why? We must find the reasons for these strikingly different outcomes. And we must understand what role gender plays.

Do men suffer less from depression or are men simply more reluctant to admit it? Does depression manifest differently in men, perhaps as mis-diagnosed physical symptoms? Do the causes of stress in the workplace differ for men and women and, if so, what gender specific coping mechanisms are most helpful?

Being a male can be bad for your health. Men have higher rates of heart disease and cancer. In fact, men lead women in all of the top ten causes of death. The life expectancy of men is significantly less than women and along the way men live sicker. This is less surprising when seen in light of women visiting doctors almost twice as often as men. Behavior is strongly linked to health outcomes. When it comes to health, both physical and mental, men behave badly. Gender ranks high as a determinant of health.

My Masculinity

About fifteen years ago I bought my first purse. The traditional male wallet no longer met my needs, being too small to hold all the items I wanted to carry and too uncomfortable in a back pocket. I have no need to refer to my purse as a “man bag”.

I have long realized that I do not fit the profile of a typical man. Of course, that very concept is highly problematic. Fortunately for me the society I live in has made significant progress in understanding the complexity of true masculinity. So have I.

The Bem Sex-Role Inventory was developed by Sandra Bem in 1974 and was the first test designed to objectively assess an individual’s masculinity and femininity. The BSRI has been both widely used and widely criticized for decades. Gradually society is moving away from stereotyping but there is still considerable room for more progress.

On the BSRI I score 60 out of 100 masculine points and 55 out of 100 feminine points. I wonder how many men would be uncomfortable with such scores? Why can’t all of us, both men and women, be completely comfortable with the way we are? That is not as easy as it sounds because understanding the self takes much effort, much struggle. The family and societal expectations we internalize are major barriers, insurmountable for some.

I would describe myself as often being moody, loyal, sensitive to others’ needs, tactful and gentle. I am not often competitive, assertive or ambitious. And I like who I am.

More than once in my career I have received feedback during a workplace performance appraisal that I am not tough enough as a manager. In my experience, managerial toughness is overrated and too often used as justification for unnecessary insensitivity to employees, particularly those at lower levels in organizations. Also, not enough credit is given to the tender for the ability of the head to rule the heart. A tender individual can make tough decisions and I have made my fair share during my career.

Compared to many men, I am quite emotional. While on far too many days I battle to keep my emotions under control, I find my emotional reactions very helpful and usually vindicated by subsequent events. Often when something doesn’t feel right, as time passes specific reasons emerge that confirm my original gut reaction. This can be a powerful advantage for a manager and I sometimes marvel at how slow executives can be to see the “obvious”. Perhaps I have a healthy amount of what gets mislabeled as women’s intuition!

Gender also plays out in significant ways in mental health and mental illness and that will be the topic of my next post.

My article gets published!

For me to write an article and get it published is a thrill!The following article was published in the October 2009 issue of CMA MANAGEMENT, a magazine which goes to all Certified Management Accountants in Canada. Hiring the mentally ill by John Stokdijk, CMA Would you knowingly hire someone with a mental illness? The Mental Health Commission of Canada, launched by the Government of Canada in 2007, faced this question in its early days of organizational life. The Commission is “a non-profit organization created to focus national attention on mental health issues and to work to improve the health and social outcomes of people living with mental illness”. My colleagues on the senior management team and I quickly agreed that it was important for the credibility of the Commission to “walk the talk.” Of course all potential employees must demonstrate that they have the skills, knowledge and experience to successfully perform the tasks which will be assigned to them. Organizations cannot afford to accept employee performance that does not meet expectations. But is there any other valid reason why someone with a mental illness should be excluded from consideration? The Commission believes the answer is an emphatic no and that all too often those with a mental illness are inappropriately discriminated against. To counter the many myths and misconceptions that abound about the mentally ill, the Commission is embarking on a multi-year anti-stigmatization, anti-discrimination campaign. When I hired my administrative assistant, I selected a candidate with bipolar disorder who had been out of the work force for twelve years. However, people do recover from mental illness. Given an opportunity, skills can quickly return as they did in this case. Most of the time, my administrative assistant performs at a level that exceeds expectations. But this story is about more than my staff. It is also about me. For the first time in my career, during my first interview with former Senator Michael Kirby, now Chair of the Mental Health Commission of Canada, and his team, I felt comfortable disclosing that I have experienced significant mental health problems. During my teen years I suffered from serious bouts of depression which continued throughout my adult life. Twice I have needed professional help because I was no longer able to function effectively in the workplace. Nevertheless, I was hired as the Chief Financial Officer of the Commission and am greatly energized by our organization’s motto “Out of the Shadows Forever”. Where is the leading edge of change in the workplace today? In recent decades, much improvement has been seen in how women are accepted and how motherhood is supported. Visible minorities are now part of the workforce everywhere. Employers have learned to make accommodations for the physically disabled. But people living with mental health problems or mental illnesses remain largely invisible. A new dimension in occupational health and safety is emerging in Canada – the idea that employers have a duty to provide a psychologically safe workplace. Earlier this year the Commission released a discussion paper, Stress at Work, Mental Injury and the Law in Canada by Martin Shain S.J.D., which will undoubtedly generate much discussion. The report describes a rapidly changing legal landscape and the implications for management. Organizations may be faced with an expanding duty to provide “a psychologically safe workplace... that permits no harm to employee mental health in negligent, reckless or intentional ways”. Stress in the workplace can sometimes reach unbearable levels and can lead to depression. Yet it can be difficult to successfully assert a short term or long term disability claim in such circumstances. Too often employers still expect employees to “suck it up and get on with it”. Is it really acceptable that employees have no option but to quit a job when they find themselves in these circumstances? Should the employer not bear some responsibility for mitigating workplace stress? Interestingly, employees with mental health problems or mental illness may have some advantage over other employees when it comes to coping with stress. Many of these employees have learned the hard way the importance of maintaining work-life balance and maintaining good physical health through proper eating, sleeping and exercising. In addition, many, like my administrative assistant and myself, are not reluctant to reach out for professional help when necessary. Employers may believe that they have fulfilled their obligations to employees by providing workplace wellness programs and employee assistance programs. Such programs have certainly made a significant contribution. However, the negative aspects of some organizational cultures too often still subtly overpower positive programs and policies. The need for organizational success and the need for containment of employee benefit costs are powerful forces which constrain the degree of employee support that is possible. But the direction of change must be to do more. The concept of comprehensive support for employees with mental health problems or mental illness has the potential to contribute to organizational success while reducing the costs for society as a whole. October 4 – 10, 2009 is Mental Illness Awareness Week. My challenge to my fellow CMAs across Canada is to consider hiring someone with a mental illness. Done properly, this can be a win, win, win for the organization, the employee and the country.

Who gets depressed on vacation?

As it turns out, I do. Recently I had the worst episode of depression and anxiety I’ve had in the past three years. Because it happened while I was on vacation, the experience was very discouraging and troubling. I have been struggling to understand why it occurred and what I can do better.


The pace at work is very fast and there is a great deal of activity but by the last Friday in July, I had my work sufficiently organized and I was looking forward to a week off.

On Saturday my wife Pat and I were on a short flight to Victoria. After settling into our hotel, we went for a long walk in this beautiful city, enjoying the scenery and the great weather. On Sunday, Pat decided to go shopping and I went for another long walk. I was thrilled with all the beautiful flowers everywhere, the hot sunshine and the relief of being away from the pressures of work. In hindsight, I was probably much too high that day but failed to pick up on this warning sign.

Later that evening, consistent with my pattern over the years, in an instant my mood changed. I remember thinking how silly it was not to be happy on vacation, but the avalanche of negative thoughts was unstoppable. Every flaw in my wife became enormously magnified. I was angry at myself for feeling this way while on vacation. If this could happen on vacation, I thought, it could happen during retirement. And if I was going to be miserable in retirement, what was the point of living? For the next four days I thought there was no hope of ever being happy and that I might as well put a gun to my head to end my misery.

I was functional for those four days. Pat and I did the things we had planned but I was living on two levels. I was merely going through the motions of doing what was planned but mentally I was miserable. We went to the Butchart Gardens, which are incredibly beautiful, but that did not lift my mood. We visited friends we had not seen in many years, but I was very much faking my mood. Each day I hoped to awaken feeling normal only to be disappointed.

When I am depressed I become very introverted. It is more than not feeling like talking, it is being in a state where talking would take great effort, more effort than I can muster. Needless to say, silence while on vacation is not conducive to positive interaction between a husband and wife. Unfortunately we feed off each others’ negativity and the cycle is hard to break.

But as always, after a few days, four in this case, the dense fog I was in lifted and my mood changed. I was again capable of talking. Life returned to normal and Pat and I enjoyed the remaining days of our vacation.

This episode shocked me because it was severe and I had not had such depression for several years. What just happened? Why?

For the first six months after joining the Mental Health Commission of Canada as Chief Financial Officer, I was on a constant high. I was excited about having a great job with a great organization. Life was very, very good.

After about six months an incident occurred which upset me and brought me back down to earth. It did not trigger depression or anxiety, but it did end the period of a prolonged high. The stress of a demanding job built up over time but I seemed to be handling the challenge well. I was exercising regularly and eating well. But over the year and a half in my current position, sleeping well became more difficult. There was always so much to think about and it was hard to relax. When I started this job I would take Amitriptyline as a sleep aid , but only weekends. Over time, my usage increased to every night, although at a very low dose.

Then early in July, while on a thirty-minute run and hoping for a fast finish, I pulled a leg muscle and limped home. As a result of the injury I had to stop running and this has always been one of the best ways I manage stress. I tried to stay active but walking and gardening are just not the same. I had lost my best means of coping with stress and relaxing.

On my first day back in the office after vacation I was pleasantly surprised to learn that my colleague and friend, Phil Upshall, was in the office. I shared my experience with him and, of course, he was understanding and empathetic. He had a number of helpful suggestions including journaling but I am choosing to blog instead. He also suggested I reconnect with the psychologist I had been seeing a few years ago. He urged me to develop a preventive plan for future vacations. It felt very good to talk with Phil.

Pat and I have been talking a lot about this episode as well. I fear I would be lost without her yet when I need her most, my behavior drives her far away. We are going to try to address this unhealthy dynamic in our relationship.
A week after vacation I went on a trip to Nova Scotia for a family wedding and had an inspiring visit with my mother. At 89, she is mentally completely sound and continues to enjoy a long, healthy retirement. Following in her footsteps is what I really want to do. I know I have much to live for.

My Early Career

Today I have the best job with the best organization of my whole career. As Chief Financial Officer of the Mental Health Commission of Canada, I have achieved excellent alignment of my skills, knowledge and experience with my passion and values. It has been a long journey.



I graduated from Central Colchester High School in 1968. At the tender age of seventeen, I began looking for a job. The Bank of Nova Scotia was the only employer I could find that was willing to hire someone so young.

I started as a bank teller and soon learned one of life's many difficult lessons. The Bank treated wealthy customers very differently from ordinary people and this was difficult for a farm boy from Nova Scotia to accept. One such customer always got access to the branch ten minutes after closing time because he did not want to stand in line. Another wealthy customer was exempted from paying service charges on money orders and bank drafts. Another customer came looking for the Branch Manager on summer afternoons when he could find no one else to play golf with without any regard for the work load of this man. After about a year, for several reasons, I quit my first job and moved to Alberta.

I decided to become an accountant and found a job as an accounting clerk. With the energy of a twenty year old, I worked during the day and studied on evenings and weekends. I rotated through all of the various clerical positions in typical accounting departments. To this day, I believe I still have an ability to understand and connect with employees at the lowest levels in organizational hierarchies because of starting my own career this way.

Looking back, in terms of healthy workplaces, there has been much change since the early 1970s. The pace of work and the expectations imposed on employees was much more reasonable back then. The manual systems of the day were labour intensive and could only deliver information slowly and this was entrenched as normal. The positive and negative impact of technology was yet to come.

The most unhealthy aspect of my early workplaces was the treatment of female employees, although along with much of management, I accepted the organizational cultures I was in as being fine. These cultures were almost completely male dominant. There was daily sexist humor at the expense of the female staff who had been conditioned to just laugh along. I witnessed some behaviors that were clearly abusive of women. Fortunately, much of what was normal over thirty years ago would not be tolerated today.

By 1976 at twenty-five years of age I had completed my accounting studies and passed my final examinations. In fact, I received the Gold Medal for being at the top on my class in Alberta! I was now a professional accountant.

During this time I was working for a small business man, Stan Reeves, keeping his books and helping him with financial analysis. He had many business interests including retail outlets, real estate developments and investment portfolios. The variety was great experience at a young age. In a small business environment an accountant sees every transaction and has a much better learning experience than in a large business where the scope of a job can be very narrow.

The stage was now set for a major step forward in my career. I joined a large conglomerate as Divisional Controller for CESSCO, an oilfield sales and service company. CESSCO was owned by Aerojet-General based in California which in turn was owned by General Tire. This was Big Business and I was the youngest divisional controller in the group. The annual controllers' training conference offered some of the best professional development of my career. Years later I would smile when being introduced to a new leading-edge concept that I had long been familiar with.

Locally I reported to the general manager of the division, Walter Royal, and I learned much from this seasoned manager. He had come up on the sales side of the company and his management style was that of master manipulator, mostly with good intentions and positive results. I could never get him to make the salesmen fill out their expense accounts properly, but instead he taught me that there was far more to achieving success in business than keeping neat and tidy accounting records. This was boom time in Alberta with big profits, big raises and big bonuses. Before my thirtieth birthday, my career was on a steep, upward trajectory.

But the boom ended suddenly. The price of oil collapsed and the Federal government passed the National Energy Program, still hated in Calgary to this day by those who remember. The division I worked for lost 80% of its sales in six months and the executives in California acted quickly. My boss was terminated and I was asked to liquidate the division. Selling off inventories at distress prices is not pleasant work but terminating long-term employees with very modest severance packages was emotionally traumatic. For the first time in my career, but not the last, I saw grown men cry at work. When an organization fails, employees who committed their whole working lives to it lose much more than a job. For many there is a loss of identity and a collapse of social networks. Consistent with the times, there was not one discussion about the well-being of employees. The focus was on cutting losses and getting the job done fast. Expressing concern for the mental health of an employee would have been very strange, but at that stage of my life the thought never crossed my mind.

After about six months of this ugly work, I was the only employee left and it was now my turn. As an incentive to do the dirty work, I had been able to negotiate an enhanced severance package. With this settlement my wife and I travelled for two months to Australia, New Zealand and Fiji. The trip was great therapy.

For about the next nine years during the 1980s, I worked for Alberta Wheat Pool, a large agri-business cooperative. Here I learned why cooperatives have captured less than one percent of economic activity in a free market. When owners and customers are one and the same, the result is an unresolvable conflict. Cooperatives seem to be more like political systems than businesses. The organization can only make a profit from the owner/customer who consequently is seldom satisfied.

Three serious droughts and an industry downturn hit Alberta Wheat Pool hard while I worked there. Cost cutting and employee terminations were necessary. Although assured otherwise by the CEO and senior management team, the first round of cuts proved inadequate. Employees understandably lost trust and became cynical as a second round of cuts was implemented.These were still not enough and the Board asked the CEO to retire.

"Big Don" Heasman was hired to save Alberta Wheat Pool. For two years he did his job as he led the painful re-organization and downsizing. But he was intensely disliked by many because he seemed to enjoy the task and few believed he cared much about the employees. His style was management by intimidation. It was common knowledge that he had a copy of the book Tough Minded Management on the corner of his desk. Under his leadership I again saw grown men cry at work. After financially stabilizing the organization, it was apparent that few of the remaining employees were willing to follow his leadership during better times and he was fired. Unfortunately, "Big Don" died prematurely of a heart attack in 2004, just as he was about to retire.

Because the skill level of senior management was quite low, at Alberta Wheat Pool I learned how not to do things. I also learned that it is almost impossible to sustain a healthy workplace environment when organizational survival is at stake. I had personally survived three emotionally draining rounds of downsizing but was left burned out and unmotivated.

There were two other aspects of my time with Alberta Wheat Pool which significantly affected my life well beyond the dimension of work. For several years I worked in the business development area evaluating new investment opportunities. One of these projects took me on a business trip to the south of France, a rather nice assignment. It was interesting work but Alberta Wheat Pool was retrenching rather than expanding. Frustrated by organizational realities and highly motivated to actually do something more than look, I asked for and received permission to pursue a couple of opportunities on my own. I was now an aspiring entrepreneur promoting deals. I quickly learned that to have credibility I had to put some of my own money at risk. I saw great potential in one venture and invested both sweat equity and cash. To my great disappointment, it failed but I have never regretted trying. I was focused on making money and if I had succeeded, I would be a different person today.

During the third round of downsizing, I emerged as one of eighteen candidates competing for six positions. Based on my career success to date, I was quite confident that I would be one of the chosen six. Alberta Wheat Pool had retained an industrial psychologist to evaluate each of us and he recommended against my selection. I was stunned. Still in my thirties, I was not ready to accept career plateau. In a follow-up interview I demanded an explanation and I'll never forget what the industrial psychologist told me. "Your career goals, your lifestyle choices and your values are not in alignment. You will not succeed until you resolve this" he said. I was still angry over missing out on a promotion and did not accept, or really understand, what he was saying. But I thought about it later. This became an issue to wrestle with during my male mid-life crisis and I was thinking deeply about many things.

Today I see clearly the wisdom of those words that were so hard to hear twenty years ago. I believe a healthy workplace enables employees to align career objectives, lifestyle choices and values. For both the employer and the employee, this is a significant challenge.

I left Alberta Wheat Pool and took a six month break from working. It was a time of re-charging, reflection and refocusing. I have been quite a different person since.

My Mental Health

I was born in Rijswijk, Netherlands, in 1951, near the peak of the baby boomer generation. I was the third of five children and have an older brother and sister and a younger brother and sister. Something possibly quite significant, which I will come back to at the appropriate time in this story, happened to me as a baby.

In 1954, my father joined the great Dutch post-war emigration, moving his family to Canada. We landed at the port of Halifax at Pier 21, now a very meaningful immigration museum. My family fell in love with Nova Scotia and stayed. After working for a couple of years, my father bought a farm and slowly built a business growing vegetables.

My childhood was very ordinary. We were poor but so were all our neighbors. As kids, none of us seemed to mind our circumstances and we were only vaguely aware that some in our community had much more than we did. Looking back, I believe it was a very good way to grow up because I learned that if I wanted something I had to work for it. I wanted a bicycle, so I worked and saved and finally bought one, a red CCM. I have no memories of being unhappy before my teen years.

In 1967 all of Canada was excited about celebrating one hundred years of nationhood. Our high school, like many others across the country, planned a class trip to EXPO in Montreal. But we were poor and my parents could not afford the expense, and I was saving for my first car. Yet it seemed that everyone was expected to do something to join this big national birthday party. Everyone was expected to have a Centennial Project and I decided that I would keep a diary. I recorded every day of my life in 1967 as a fifteen, then sixteen year old teenager growing up in rural Nova Scotia.

January 1, 1967
I’m in the middle of one of my many moods of depression and dread the thought of going to school again in a couple of days.

April 21, 1967
I feel very depressed today. Sometimes, like now, I don’t see much sense in living and feel like jumping off a cliff…

April 22, 1967
I am still in depression. Life seems but a useless existence. I wish I could see a definite purpose for living more clearly.

May 19, 1967
I feel hollow, lonely and depressed now. One song expresses my mood well:
He’s a real nowhere man
Living in his nowhere land
Making all his nowhere plans
For nobody.

November 24, 1967
…I felt pretty miserable and went to my room and broke down into tears wishing for someone, anyone to talk with.

The three years of high school were the unhappiest of my life. I had few friends and felt different from those around me. I was interested in different things from my classmates. I was very interested in world affairs and greatly enjoyed reading Time Magazine. I read non-fiction. I was interested in thinking about why I was born. These were not typical teenage activities. I was very awkward around girls and experienced much angst for not having a girlfriend, and thought I was the only boy who didn’t. I was very lonely.

At home I lived in a different world from my parents. This was the 60s and there were big generational differences between parents and children in our family. There were cultural differences because we were Canadian but our parents were Dutch and old-fashioned. There was much tension and little meaningful communication. My parents had no idea of the thoughts going through my mind. I don’t think my father ever understood me, then or later. I was not close to my brothers or sisters at that time. Our family was not loving nor emotionally sustaining, but it was decent and both my parents had many excellent values.

During these years I lived as though I was walking through a fog, a common metaphor often used by those who are depressed. I was often tired and I often had headaches. I read a lot because I loved to learn and because it was an escape from the real world. But I was able to function well enough at school to earn good marks. I was very focused on graduating and leaving home.

Early in 1967 something happened that profoundly impacted my life, and my mental health, for a long time. For the next twenty-five years much of my mental stability and my ability to cope reasonably successfully with life came from being a member of a benign cult!

February 7, 1967
I listened to a program “The World Tomorrow” on the radio. I liked it. This man forecasts things in the future on the basis of the Bible. He seems like a good Christian.

By keeping a diary I had also accidently discovered the benefits of journaling and continued writing down my thoughts the following year.

January 5, 1968
Last year I kept a diary on a daily basis. It began as a Centennial Project – one I look back on as a very good one indeed. The diary offered a means of expressing myself, a substitute for expressing myself to other human beings. When no one else would listen or understand, my diary would.

A rather innocent entry in my journal late in 1968 recorded the beginning of a life-long activity that has had a great positive impact on my mental health.

September 20, 1968
Nothing else of importance worth noting happened since my last entry. Oh, except I have started a program of exercise, running – 2.1 miles six times a week if weather permits. I ran six times this week. I have completed two weeks of exercise.

I had read and been influenced by a book entitled Aerobics, written by Dr. Kenneth Cooper. I soon gained several important insights. I learned that I loved running and that running calmed my mind and helped ward off depression. Back then, jogging had not yet become popular and many people mocked what I was doing. Seeing me running along the road in rural Nova Scotia in 1968, the neighbors thought I was a strange boy indeed. I remember my grandfather being very concerned, believing everyone was given a fixed number of heartbeats and that I was using up mine much too quickly. But I also discovered that I didn’t much care what others said, and so I ran. I still love running today.

In 1969 I left Nova Scotia. With my few worldly possession piled on the back seat, I drove my red VW beetle across Canada and settled in Alberta. I wanted to get away from a girl friend who was beginning to talk about getting married. I wanted to get away from my family, none of whom understood me. But most of all, I wanted to join a church, which I did, thinking I had found meaning and purpose for my life. It would be many years before I realized that I had joined a cult.

That church was the Worldwide Church of God, led by a very charismatic father and son team, Herbert W. Armstrong and Garner Ted Armstrong. Their vehicles of evangelism were the free Plain Truth magazine and The World Tomorrow radio program, which I had stumbled upon. They also founded Ambassador College which had three very beautiful campuses and I aspired to attend this institution. Much later I became very, very grateful that my applications were rejected.

I now understand that during this period of my life, while I thought I was responding to God's calling, in fact I was the victim of a benign cult. While there was a huge cost, financial and otherwise, it had its benefits. The church was very controlling, but this provided me with much needed stability. Within this closed society I was able to build some social skills and I found and married my wife, Pat. We are still together. Also, believing one has found the ultimate truth can have a remarkably positive effect on the mind, even if it really is a lie. Thus as a young adult, I was able to focus my energy on building a career and decided to become an accountant. I benefitted greatly from making a suitable career choice at only nineteen years of age.

Although I continued to have bouts of depression which I will describe, generally I was making my way in life with sufficient success for life to be worthwhile. Looking back, the church was a crutch, but better to walk with a crutch than fall on your face. Eventually I was able to walk without a crutch and I realized it was time to stop dragging it along.

My twenties were better years than my teens, and my thirties were better yet. Most of the time I had good mental health. But several times a year I would have bouts of depression. The usual pattern was for depression to hit suddenly, with no apparent triggering event. I was back in the fog. Slowly over a period of a few days the fog would lift. These bouts were difficult for my wife because I would become extremely withdrawn and barely talk to her. Neither my wife nor I had much understanding of what was happening. Other than my wife, very few friends or colleagues were aware of my depression. Those who were reacted with the observation that I had a good life and nothing to be depressed about. To me it was all quite discouraging.

I still clearly remember one particular episode. My employer had asked me to attend a two day conference being held at the very beautiful Kananaskis Village resort in the Canadian Rockies. It was always fun to get away from the office for a couple of days and the conference was interesting. Life was good. Suddenly, during an early conference session, depression! On one level I was still hearing the presentations and interacting with the other participants. But on another level I was withdrawing, turning inward, feeling very unhappy. I have often been amazed at how easy it is to function on two levels at the same time, hiding depression from others.

But this fog was thicker than most. I felt as though I was trapped inside an expanding house with rooms within rooms and I was going ever deeper and deeper inside. I remember being scared, afraid that I might never find my way back to the outside. But eventually the fog again lifted.

I was tired of living like this and decided I needed to do something. But what? At the time, we had a church pastor that I related to quite well and I decided to seek counseling from him. He introduced me to the book Feeling Good by David Burns. This book was the popularization of cognitive therapy and helped me a great deal. As much as anything, it gave me hope that I could do something about these dark periods that overcame me from time to time. Just understanding that by controlling my thoughts I could control my moods helped a great deal. There was considerable improvement in my mental health. But there continued to be occasions when the darkness and the fog overwhelmed good theory. During a bout of depression, even the knowledge that controlling my thoughts would make a difference didn’t help. I did not have the energy nor the will to do so and simply suffered and endured. “Think positive” or “Snap out of it” is very trite advice to give to someone who is depressed.

At mid-life I went through a few years of classic male mid-life crisis. This was a time to re-evaluate choices made during the years of early adulthood. Some choices were to be reaffirmed, others rejected.

Our church was experiencing considerable organization upheaval and went from being a source of stability to a cause of anxiety. Rapidly changing long-held sacred truths begged questioning. But I went much further than questioning the church; I questioned the very foundations of my faith. Desperately wanting to re-affirm my Christian beliefs, I fell to my knees and prayed to God for his guidance in my spiritual journey. Those prayers were never answered. After several years of mental turmoil, I left my church and became an unbeliever.

I remember lying awake at night for hours wondering how it could even be possible to live without faith. What if there is no God who cares about us? What if there is no life after death? What if there were no absolute values? How could one live sanely with such knowledge? How could one find any purpose at all for living?

Unless experienced, it is probably difficult to understand the degree of anxiety that can accompany a transition which results in a radical change of core beliefs and values. It certainly was not all negative. There were times of great excitement as whole new ways of thinking opened up.

Leaving a cult in which one found love and marriage was complicated. While I had come to clearly see myself as a willing victim of a benign cult, my wife continued to be a true believer, although she did have the beginnings of doubt. Pat and I were rapidly growing apart and I knew this could be the end of our marriage. More anxiety! In one of the best decisions of my life, I decided not to leave the cult but instead stayed by my wife’s side. About a year and a half later, we left together.

From mid-life on, I probably have had more struggles with anxiety than depression. Mostly it was low-level but constant anxiety, experienced as difficulty feeling relaxed and calm. It also meant difficulty sleeping well.

One particular Saturday I had a puzzling experience. It was an ordinary week-end day. Nothing unusual happened and I was not depressed or anxious. At the end of the day, my wife went to bed first and I was in the bathroom getting ready to retire for the night. Suddenly, while looking in the mirror, I saw it! There was a big blotch on my skin. Why had I not seen it before? I had skin cancer! I was going to die! I was too young to die. My heart raced. What was I going to do?

I went to bed but hardly slept. The next morning, I got up early and went immediately to the bathroom and looked in the mirror. Yes, it was still there, but maybe just a bit smaller. When Pat got up, I hardly spoke to her. As the morning wore on, I kept looking in the mirror at my chest. The blotch was looking less like a blotch and more like a big freckle. Pat finally asked, “What is the matter with you this morning?” Already beginning to feel silly, I explained everything. Pat looked at the spot and quite pragmatically suggested I have my doctor look at it. I agreed.

By Monday morning going to a doctor seemed like a waste of time but Pat insisted. In a way, my doctor was wonderful. No big deal, let’s just take a biopsy and send it to the lab. A few days later, I got the now expected all clear. Looking back, it is hard for me to conclude that my doctor did not see this incident for what it really was. But there was no probing of my mental state. I was not asked to describe the circumstances leading up to the visit to the doctor’s office. It was a physical examination concerned only with ruling out a physical problem.

During the 1990s William Shatner hosted a reality show called Rescue 911. The show consisted of re-enactments of real life emergency situations. One episode regularly comes back into my mind, causing anxiety. A beautiful little girl was visiting her grandparents, running around in great excitement in an unfamiliar house. She ran through a closed glass door. Shattered glass penetrated her body between her ribs and punctured her heart. Paramedics responded quickly and a battle to save a life ensued. Finally the battle was won in a hospital operating room. Although based on a true story, this was just a television show and one with a happy ending. Yet over and over again, from time to time it comes back into my mind and upsets me emotionally.

Another recurring memory goes back to the 1980s while working for Alberta Wheat Pool, a large agri-business cooperative. During a third round of necessary but painful cost-cutting, a colleague with twenty-five years of service was terminated. Even though we have not maintained contact, the memory of his sad face with tears running down his cheeks continues to haunt me. I continue to feel anger because only four employees were willing to attend his farewell lunch. An organizational culture had developed in which terminated employees were to be avoided as if they had a disease that others could catch.

I seem to absorb and retain the angst of others to a degree that does not seem normal and that does not reflect good mental health. At the same time, this sensitivity helps me intuitively see clearly what is strangely obscure to friends and colleagues.

All things considered, the 1990s, the decade of my forties, were the best years of my life. At one point I even thought that my bouts of depression and anxiety were gone forever. But the darkness and fog returned and the sequence of events taking me downward again are very clear.

In 2001 I was working as Director of Finance for the YWCA of Calgary. This is a very fine organization and a good fit for me both in terms of skills as well as values. But the job became extremely stressful. The organization had a million dollar operating fund deficiency that made financial management very challenging. On top of this, a capital project went out of control, escalating from a budgeted $2.1 million to an actual $3.4 million. The difference was unfunded and I had to lead repeated re-negotiation of bank loans while organizational credibility was sinking. Worse yet, the fundraising department was not meeting targets. This was real stress based on real circumstances, for none of which I was responsible. During such a period in an organization’s history, the behavior of otherwise well-intentioned individuals seems to become more selfish and opportunistic.

Then in August, 2001 there was a pivotal week for me. Every day that week the computer system at the YWCA of Calgary went down. I had been hired to lead a much-needed system replacement initiative which was on hold because of a lack of funds. The organization was running on borrowed time with a poorly maintained, out-dated computer infrastructure. I was going to work every day in a high risk environment with no access to resources to fix the problem. That week it became necessary to revert to manual ways of work which were inefficient and frustrating for many employees.

This situation is a good case study of how much responsibility an organization should bear for damage caused to an employee by workplace stress.

Stress had been building up over months and reached a peak that week. Every night I slept poorly, worrying about work, worrying about my employer. The stress and insomnia I experienced that week resulted in a permanent change in my sleeping patterns and I have never regained the ability to sleep soundly without aid.

A few weeks later on September 5, 2001 I collapsed on the sidewalk. My wife and I were at a restaurant enjoying dinner with close friends. I remember remarking how nice it was to relax and have a break from job stress. After dinner, I suddenly began feeling very dizzy. We had paid our bill and I wanted to get outside for some fresh air. While walking to our car, I passed out.

I regained consciousness just as the ambulance came around the corner. The paramedics quickly took charge and began monitoring vital signs. Concerned by my very low blood pressure readings, they decided to take me to emergency at the Foothills Hospital. I was treated with priority over those in the waiting room and a wide range of tests were conducted. Then there was a wait for a doctor that lasted for hours. When he finally arrived at around 3:00 am, I was feeling much better and my blood pressure was back to normal.

All the test results were normal. There was no evidence of stroke, no heart problems, no blood sugar problems. I could go home. I asked the doctor why I had fainted for the first time in my life. Sometimes these things just happen, came back the unsatisfying reply. The doctor asked if anything unusual had occurred in my life recently. I replied that I was experiencing severe job stress. I may as well have said nothing because this was clearly of no significance or interest to the doctor. Again, only ruling out physical causes was important and I was discharged.

There was another troubling aspect to my emergency ward visit that endures in my memory. Sometime during the hours waiting for the doctor I overheard a conversation close by that was emotionally upsetting. In very matter-of-fact tones a couple was being informed of “do not resuscitate” options and a decision was made to let a life end. Only curtains separate patients in emergency and conversations are not contained by such walls. But there seemed to be no awareness of what impact any emergency room activity could have on the mental state of others nearby.

Fainting was a wake-up call for me and I concluded it was caused by job stress. I decided I could not continue to cope and saw only one way out. I resigned from my job.

I knew from experience that my level of stress would not be judged by others as worthy of either a short term or a long term disability claim. And at the YWCA of Calgary at that time, in an organization that did so much good work helping so many with great need, a culture that rose above the norm in terms of employee support did not exist. Only one leader at the YWCA of Calgary expressed any concern or willingness to help me personally. During an organizational crisis, the needs of individual employees hardly get noticed. But surely the organization should have assumed more responsibility for the stress that had impacted me to a degree that quitting seemed like the only option.

Collapsing on the sidewalk became a symbol for the deterioration of my life. I was completely burned out. For several months I did not have the energy to even begin looking for another job. I had had enough of financial management and was disillusioned with my career. The depression and anxiety that I thought I had conquered returned. I was fortunate to have a wife with stable employment. I was fortunate to be living in a nice home. I was fortunate to have a few supportive colleagues.

One dear colleague at the Canadian Mental Health Association firmly told me that I could not handle my mental health problems by myself and I had better get some help. She recommended the Outpatient Mental Health Program at the Colonel Belcher Hospital. Armed with this knowledge, I asked for and received a referral from my family doctor.

What happened next is a common story. Nothing. Nothing happened. About six months later I received a letter acknowledging my referral and advising me I had been placed on a waiting list. After another six months went by I received a phone message asking me to book an appointment. Almost exactly one year from my visit to my family doctor, I had my first appointment!

From the beginning, I did not like the psychologist assigned to me. I found talking to her about all the negative stuff in my life anything but a positive experience. I never felt understood at all by her. After one particular session, I left feeling very angry and believing I had been deliberately provoked. After six or seven sessions, this psychologist wanted to refer me to a psychiatrist. She told me that unless I received medication and intensive cognitive therapy and discovered the cause of my depression and anxiety, I would never be free of it. I told her I wasn’t interested. Her response was that there was not much more she could do to help me. I never went back. A few weeks later I received a letter informing me that if they did not hear from me within three weeks they would assume I was doing well and would close my file. The one helpful thing I did learn from these sessions is that I have an intense, unhealthy fear of being alone.

Sometime during this period I hit a very low spot. One Saturday morning, life barely seemed worth living. In fact, I thought about two more specific things that were bad and could happen. I decided that if they did, I would end my life. I knew I should not be thinking this way but instead, I deliberately chose to think it through. I would buy a gun; that shouldn’t be too difficult. I would make sure to buy the right bullets that would inflict maximum damage. I would research proper positioning of the gun. I would stick it in my mouth and blow my brains out. I would drive out to Kananaskis Country and hike up a favorite trail. Somewhere off that trail would be the end of John Stokdijk.

The two things I feared never happened. I don’t know if I would have actually followed through on my intentions. I do know that at that time I was very wrong about myself and my life. Still not feeling confident enough to handle life without professional help, I began utilizing my wife’s Employee Assistance Program. This time I quickly received an appointment. And I instantly liked the psychologist assigned to my case.

From the start she seemed to understand me. She was totally supportive and completely non-judgmental. I have since remarked to a few friends and colleagues that this would be an incredible experience for anyone including those with no mental health problems! We had great conversations about experiential angst. We talked about not expecting affirmation for living from work. Even though she was openly Christian, we talked about leaving religion. We talked about my feelings towards my father. We talked about 9/11 and world affairs. All of these topics related to my mental health. In hindsight, she helped me recover what I needed most. Hope. Hope that life, my life, would get better. Hope that life, my life, was worthwhile.

One day I arrived at a session in what I thought was a very good mood. My psychologist had never seen me like this and seemed very surprised. Have you ever heard of cyclothymia, she asked. I had not. But typical for me, my curiosity was aroused and I found a book about it. I learned that cyclothymia is a mild form of bipolar disorder. During this period of my life I manifested many of the diagnostic criteria of cyclothymia.

We also discussed the work of Elaine N. Aron who wrote The Highly Sensitive Person. Her self-test makes twenty-three statements and twenty-one of them are true for me. More than anything I have found, this describes the real me.

I looked forward to every session with anticipation. Even after I felt strong enough to let go of this support, she agreed to continue with occasional sessions just to maintain contact and just in case my life took an unexpected downturn. After commencing my employment with the Mental Health Commission of Canada, my dream job, I went back one more time and somewhat reluctantly said goodbye.

Sometime during these difficult years, I was reminded of the value of sharing problems with close friends. One of my psychologists mentioned this and I had read this in one of my many self-help books. I told five close friends that I was experiencing serious mental health problems. And that I needed help. One friend ignored this overture for help from me but he has a wife who suffers from bouts of depression and helping her, understandably, is his priority. He has enough on his plate. Another friend of mine has a good heart but lacks the skills to help me. There is a friend who continues to disbelieve that I need help. I am puzzled by the lack of response from one very nice, long term friend. Perhaps because we are able to be very open with each other anyway, more is not needed. The best response came from the friend from whom I least expected help, more than making up for all the others. To this day, he regularly follows up, making sure I am all right. We have long conversations. He probes, going well below the surface. This is real support, genuine caring and it helps so much.

In 2003 I was invited to a presentation about how minor automobile accidents occasionally trigger serious mental health problems. As expected, it was interesting but then took an unexpected turn that made the hair on my neck stand up! The presenter made a comparison between the anxiety displayed by some adult accident victims and the anxiety experienced by adults who suffered medical trauma as babies. For the first time I saw a possible answer to the question “why?” Why have I suffered from depression, anxiety and other mental health problems? Why was I flawed?

As a baby I had three operations, probably mastoidectomies, before my second birthday. Learning that a severe ear infection could cause death if it reached the brain was startling. My mother told me I suffered from very severe earaches and screamed long and hard to a degree she could barely stand. I’m sure operations on babies in the 1950s were much more invasive than they are today. Could all this trauma have been at a level that impacted my brain development and left me damaged? I wonder and am still interested in finding some expert opinion on this.

In my opinion, the seriousness of a mental health problem or a mental illness is best determined by the degree of impairment it causes in a life. All things considered, my life has suffered only very minor impairment. Twice in my career I reached a point where I could no longer continue working. Twice I recovered. I have a very good life but I also believe it could easily have been very different. My life could have been a disaster or ended prematurely.

2008 was a very good year for me and my mental health was excellent all year. In many ways it was one of the best years of my life. The only impairment was with sleeping. Often I woke up too early, between 3:00 and 4:30 am. But with a mug of strong coffee and a couple of Advil, I could have a normal day most of the time. A few times I would have only two or three hours of sleep and on those occasions the next day was tough.

On weekends I take amitriptyline as a sleep aid and I have a good night of sleep. It leaves me wonderfully lazy in the morning and it takes time to get going. Vacations are also a time when I can take it several days in a row and recharge.

Today I am enjoying life to the full. Mostly I am full of hopes and dreams. My grandmother lived past her hundredth birthday. My mother is still going strong at age 89. I would like to follow in their footsteps.