Jayne Melville Whyte with
The mental health of rural Saskatchewan women is threatened not only
by gaps in the provision of mental health services, but more importantly
by the social and economic conditions of being female in a rural setting.
In Saskatchewan, women with mental illness can experience not only the
social isolation and stigma of mental illness but practical considerations
related to access to fewer services, especially specialists, and particular
needs related to geographic distance and transportation.
The Senate Standing Committee on Social Affairs, Science and Technology
Report on Mental Health, Mental Illness and Addictions, Out of the
Shadows at Last1 extensively documents the needs
and potential direction for meaningful change in mental health services
"to help bring people living with mental illness into the mainstream
of Canadian society".2 This paper analyzes the Highlights and Recommendations of Out of the Shadows at Last with a gender-place lens focused
on women living in rural and remote areas in Saskatchewan:
This is a preliminary analysis, intended to stimulate discussion or
further research leading to implementation of positive changes in mental
health services and in the determinants of mental health for women.
- to draw out the references that would strengthen the response to
their needs, and
- to point to gaps not acknowledged in the report.
The authors acknowledge the particular concerns of northern and Aboriginal
women, but due to the experience of the authors, this paper does have
more of a focus on rural women in the southern half of the province.
The Three Pillars The Kirby-Keon report laid out three pillars as the
foundation for its recommendations. For rural remote and northern women,
the following comments are pertinent to the Three Pillars.
- Choice: Lack of transportation, bad roads, travel
costs and finding child care or respite care restrict the "choice"
of travelling to another community or city for services. The small
number of doctors and mental health practitioners limits choice for
women who would prefer a female practitioner, and lesbian women seeking
professionals with whom they can have a safe and comfortable relationship.
Other populations, for example Aboriginal (including First Nations,
Métis and Inuit women), immigrant women, or women with disabilities,
also need mental health support that recognizes their particular needs
- Community: In communities where services are reduced
by distance and small population bases, community support must be
developed through coordination and creative deployment of available
formal and informal resources. Their community can be a strength for
rural and remote women in providing social support, but can also be
a burden due to lack of privacy and stigma and lack of understanding
about mental health.
- Integration: Integration of physical and mental
health services can happen more naturally in communities with a small
number of health practitioners and other professionals who talk to
one another. Privacy legislation can work against information-sharing
across disciplines and between services. Particular difficulties arise
when services are obtained in another community without communication
with the family members, doctors, home care workers and other team
members in the home community. Rural and remote women also face the
constant change in the service personnel that prevents continuity
of care and trust-building.
A major gap with the Kirby-Keon report is the lack of specific gender
analysis. Such an analysis would have led to the stronger identification
of family violence, sexual abuse and other abuse as a critical factor
in addressing and preventing mental health problems for girls and women.
Women play major roles in the mental health system and the effects of
their gender on mental health, service utilization, unpaid care-giving
and paid health services work needs to be taken into account.
Priorities for Women
The Gender-Place Analysis of the Kirby-Keon report revealed several priorities
for women living in rural and remote areas in Saskatchewan.
The federal government has an opportunity to act quickly in the areas
in which it has direct responsibility: First Nations and Inuit health,
Corrections, the Canadian Forces, veterans, the RCMP, immigrants and refugees
and the federal public service.
- Continue efforts to address the underlying causes of stress and poor
health for rural and remote women: farm economy, poverty, Aboriginal
issues, family violence, balancing work-family-community responsibilities,
and the need for inter-generational connections and cross-cultural understanding.
- Provide locally-based mental health services to enable people to
continue to live well in their home communities, such as local community
health workers, peer support groups, respite care and other support
- Provide housing with supervision and support for people with mental
health needs, enable home ownership in small communities where this
is the norm, and improve housing both on and off reserves.
- Implement telemental health for psychiatry and psychology services
and continue support for the Farm Stress Line and mental health counseling
on the HealthLine, balanced with in-person services.
- Provide better training for the RCMP in understanding and handling
mental health crises.
- Orient services to meet the needs of seniors, children and youth,
First Nation, Métis and Inuit people.
The following are suggested to guide the process of improving health
services and the living situation of women with mental illness living
in rural and remote areas in Canada.
1 Kirby, The Honourable Michael J. L. Kirby, Chair and The
Honourable Wilfred Joseph Keon, Deputy Chair. Out of the Shadows at
Last: Highlights and Recommendations: Final Report of the Standing Senate
Committee on Social Affairs, Science and Technology. Ottawa: Senate
of Canada, May 2006. In this paper, it will often be referred to as the
Kirby-Keon report or the Kirby report recognizing its chair and deputy
- As a first step, establish and fund the Canadian Mental Health Commission
with the mandate to develop a strategic plan with timelines and budget
to implement the recommendations of the Standing Senate Committee on
Social Affairs, Science and Technology, Out of the Shadows at Last,
by Senators Kirby and Keon.
- Use gender-place-culture lenses in all programs, services, and activities
reviewed, initiated and maintained to serve the specific needs of women
and men who live in rural, remote and northern communities with respect
for the culture, race, and identity of all persons.
- Evaluate the effect of any policies and services on rural, remote
and northern women. Further, more detailed, work should be done on a
gender-place analysis of the Kirby-Keon report and other policy and
- Emphasize the determinants of health approach to address factors
affecting health including income, housing, social supports, education
and literacy, healthy childrearing, community environments of gender
and culture, as well as adequate and appropriate health services.
"Health policy is more than health services." 3
- Involve rural, remote and northern women, including Aboriginal women
in the planning, management and evaluation of programs that have an
impact on their lives, their families, and their mental health including
the proposed Canadian Mental Health Commission and Initiatives.
- Empower and value women in their roles as consumers of mental health
services, family and friends of people with mental illness, unpaid
caregivers, formal caregivers and professionals in the mental health
field, policy makers and management, community and political leaders.
In these often overlapping roles, they deserve personal and community
support including recognition of their contribution and their right
to influence and set policies.
2 Kirby & Keon. Out of the Shadows at Last: Highlights and
Recommendations, Foreword, page v.
3 Sutherns, Rebecca, et. al. Summary Report: Rural, Remote
and Northern Women's Health. Winnipeg: Centres of Excellence for
Women's Health, 2004, page 8.
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