Thank you for the invitation to present to this committee.
I'm speaking from my experience as a social worker in the mental health care system and as a researcher in mental health with an emphasis on issues that affect women of colour and LGBT+ communities.
I anticipate that other witnesses will speak in detail about the health gaps between men and women. My addition is to suggest that, when we consider these health gaps, we also consider the more extreme gaps that are experienced by people who are not occupying either of these categories. Trans and gender-diverse people face severe mental health disparities and significant barriers to accessing effective mental health care. Their issues are easily overlooked or marginalized in work that focuses on women and girls or on people identifying across the LGBT spectrum.
The issue of who gets overlooked, marginalized or silenced when systems attempt to meet the needs of populations is key to this discussion. Strategies for mental health promotion and the prevention of mental illness that are directed at young women and girls as homogeneous groups are inadequate for understanding and addressing health disparities. Although there is value in attempting to address the shared concerns, it inevitably mutes or erases important differences that have implications for mental health and well-being.
In Canada, we have been leaders in identifying social determinants as critical factors that influence the health of populations. We know that women and girls are disadvantaged or, better stated, disempowered in categories like income, employment, education and access to health care services. However, we also know that Black women, indigenous women and lesbian, bisexual and trans women are further disadvantaged and disempowered. Consequently, action on social determinants is critical, but action must be equitable.
The strategies that this government undertakes to address the mental health of women and girls must include strategies that are directed to addressing the specific disparities and health risks for Black women and girls, indigenous women and girls, lesbian and bisexual women and girls, and gender-diverse young people. Further, action on access to timely, effective, woman-centred, culturally appropriate health care is crucial to effective treatment and recovery from mental illness for BIPOC women and girls.
In addition, these strategies must emphasize that the health disparities faced by these groups are tied to exposures to interpersonal and institutional sexism, homophobia, transphobia and racism—exposures that are often augmented by intersecting identities that expose people to their combined effects. My own research has shown that women and trans people who are also racial minorities, lesbian, bisexual or lower-income face augmented risk for depression and unmet needs for mental health care. Exposure to discrimination is one of the major factors that link them to these poor outcomes.
I have further observed, over several research studies, that exposure to violence is a determinant of mental health for women. Women and girls who are Black, indigenous or LGBT+, or combinations of these identities, report lifetime exposure to violence that begins with childhood physical, racial and sexual traumas that continue into adulthood, in which violence occurs in unsafe housing conditions, unsafe working conditions, unsafe migration conditions and within relationships that cannot be escaped for safety.
All women and girls experience risk to their mental health in social and institutional conditions that do not protect them from violence. We label some of these women and girls as “at risk” when we should more accurately identify their environments as risky and unsafe. A comprehensive strategy to promote the mental health and safety of young women and girls requires multi-sector collaboration. This is especially necessary to address issues in BIPOC and LGBT+ communities.
I will close by emphasizing the importance of developing initiatives in collaboration with community-based women's, Black, indigenous and LGBT+ organizations to engage their deep knowledge of the relevant issues and their existing ties to communities, which will enhance the effectiveness of any interventions that are developed.
I make this recommendation with two cautions.
First, if our efforts on behalf of BIPOC women and girls are to be culturally acceptable, then they will need to recognize women and girls as daughters, mothers, sisters, aunties and community members whose ties to others are part of their mental health and well-being. Strategies that excise them from these relationships, which are also connections to healing and health-promoting social and cultural supports, will not be acceptable or effective.
Second, we should know that community-based organizations often implement innovative programming by pursuing grant opportunities, but sustainable gains are undermined by time-limited funding that prevents the transition from pilot programs to equitable, accessible mental health care. The path to sustainable gains for the mental health of women and girls is sustained investment that integrates community-based organizations as enduring components of our mental health care systems and strategies.
Thank you for this opportunity to share my insights and offer some potential strategies to this committee.