This is the third in a four-part series exploring the Let’s Talk campaign. Part One is here, Part Two is here. If you would like to read the article in its entirety right now, it is available on my Patreon.

Let’s Talk about social determinants of health, and moving beyond individualism – an interview with Flora

Flora (not her actual name) is a resident physician. She is a compassionate friend, a lover of horses, and a social justice-minded caregiver, with a practice that focuses on removing barriers to health for vulnerable people.

I think the Let’s Talk campaign is an important conversation starter, but it places the focus on mental health in the hands of individuals, when a lot of the mental health issues I see are related to societal issues that can’t be resolved by simply having people willing to talk about the way mental illness has impacted them personally.

No amount of talking about it is going to change housing, food, and job insecurity for vulnerable people. This isn’t to say that mental health doesn’t impact all of us, even those with the most privilege. But the individualist focus erases and ignores a lot of the ways that we create and then reinforce situations that create mental illness.

In medicine we see a lot of focus on resiliency as a cure for burnout in physicians. And I can’t help but read it as “Learn to deal with our abuse better.”

I don’t feel comfortable owning it at all. Like, labour laws don’t apply to us, the expectations on us are huge and the consequences of our mistakes are literally fatal. So don’t tell me that I just need to be more resilient.

To me resiliency is better conceptualized as “coping reserves.” It means the thing is still hard, because you have to cope, but you have the resources to deal with it.

I had a pretty big reserve after about two full years of solid mental health! But I’ve been slammed by a ton of stuff and my backups are empty now.

It’s frustrating, like running through the savings you’ve set aside for years in two months. You know you were putting it away for just this occasion but it still feels very vulnerable.

My program is super flexible and reasonable and supportive (yay public health, we understand the social determinants of health!) but I am terrified of what happens when I am struggling in the real world.

Within our microcosm, the system is designed to support my well-being primarily and then allow me to have output second, but the thing is I had to get through 8 years of “we don’t give a shit, produce the end product” to get to this place.

And so the people who struggled in undergrad, where’s their support and well-being? They provide counselling resources but that leaves the solution in the hands of the person who is struggling.

What about the people who were dealing with mental health and all the intersectional vulnerabilities who never even got the chance to access post secondary because of it? They have to hope they get a job with health insurance so they get $200 of counselling a year, as long as they pay up front and wait for reimbursement?

Starting the conversation is great. I’m glad more and more people are talking about it. It’s like the It Gets Better Project though. “Don’t kill yourself because we support you in a shitty situation and your situation might improve.” Not, “let’s fix the raging homophobia that drives you to suicidality.”

Both approaches are important but we can’t keep pulling people out of the river. Let’s keep them from falling in upstream.”

Flora offered a quick crash course in the social determinants of health with these links:

The Public Health Agency of Canada on “What Makes Canadians Healthy or Unhealthy

The World Health Organization on Social Determinants of Health

And this comprehensive PDF on Social Determinants of Health from Canadian Facts

When discussing how to refer to her in this article, she said, “I would prefer ‘a resident physician,’ or Flora, because I have no idea what the politics will be like when I go to get hired. You’d think it wouldn’t matter because my entire job is advocacy for social change but…”

That “but” is a critical part of this conversation. The fact that people who are actively engaged in health and wellness still can’t afford to be open about their experiences for fear of the impact on their careers is telling. It points to the fact that systemic change is necessary, and that these conversations are not going far enough. The Let’s Talk campaign may be sparking conversations, but it’s keeping the issue focused on individuals when the reality is so much more complex and systemic. It may be individuals who experience the negative outcomes of unsupported neurodivergence and mental illness, but the systems and structures that make this so challenging are much bigger, much broader, and will require solutions that move beyond the individual.

We need social change.

Let’s Talk about corporations

Shannon, who has accessed a range of mental health resources, questions whether the benefits are worth the cost of providing so much free advertising for Bell.

Do the posts still count if you delete them all tomorrow? That was kind of my plan. But after 20 tweets I just raised a buck and how much did I advertise some shitty company? I don’t think it’s worth it. I’m thinking a better option would be to just give a dollar to a mental health initiative that’s useful and talking can always be encouraged other ways. Also, I don’t think the whole thing should cause so much extra stress for me if the whole point is to “help” mental illness… whatever that means. By the way, I don’t really know what it does mean. I don’t think the campaign generally does encourage openness at all. I agree that having conversations is important. And at the same time they’re jerks for doing it. I feel like they’re taking advantage of me.

Marginalized communities are unfortunately very familiar with being the “benefactors” of awareness campaigns that are nothing more than thinly veiled advertising, or the “awareness” that doesn’t actually accomplish anything.

Corporations using vulnerable groups to generate advertising is not new. Pinktober, or the highly commercialized “Breast Cancer Awareness Month,” is a glaring example. Beatrice Aucoin, a breast cancer survivor and queer activist who writes extensively for ReThink Breast Cancer, says,

I think it’s good in that there is actual good being done with the Let’s Talk campaign: money donated by Bell for hashtag use or texts sent or whatever it is.

I think where criticisms can come in is thinking about what we are actually doing with whatever we share. I’ve seen some people on twitter start important conversations on it. I’ve also seen valid criticism of appearing to support: someone changes a profile photo to have a Let’s Talk frame or uses the hashtag when in reality when people want to talk to them about mental health, they are unsupportive or distance themselves from the person seeking support.

This has a more complicated edge for me than breast cancer corporate ties.

Slapping a pink ribbon on a product that doesn’t give to a charity or help breast cancer patients in some way? That’s bad and making money off of sick people. You also have to keep in mind what cancer charity is being given to, which is way more problematic in the US than in Canada. I’m part of a grassroots counter-culture of breast cancer patients who, mostly in October, examine products that are pink or say something about breast cancer. The ones that are clearly using us without giving back, we take photos and put them on social media and tag the companies to demand #whyisthispink. Some breast cancer peeps object to companies doing pink ribbon things at all, which I actually don’t because corporate giving and selling products are part of how charitable funds are raised.

If Bell supports charities that support mental health, that’s good. If that support doesn’t extend to allowing qualified employees with disclosed mental illnesses to work for them, that’s awful and needs to be called out, just as people who don’t support those in their lives with mental health issues need to be called out if they participate in the Let’s Talk campaign every year but don’t really support the people in their lives dealing with mental illness.

Shannon’s sense that the campaign doesn’t actually encourage openness, which Beatrice also points out, is supported by most of the people I spoke with. Although the campaign sparks conversations (mainly conversations about talking about mental health, rather than conversations directly about mental health) but these conversations didn’t extend far enough to open the door for people struggling to be honest about the details of their neurodivergences, and the impact of that on their lives, especially not with their employers.

In Part Four, we’ll talk about pushing the conversation out of that comfort zone and using the campaign as leverage with employers in an interview with B.