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HLTC02 Chapter 13 mas.docx

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Health Studies
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Anna Walsh

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HLTC02 Chapter 13: Women’s Voices Matter: Creating Women-Centered Mental Health Policy by Marina Morrow  Health care policy decision making in Canada varies from province to province and region to region  The discrimination and stigma associated with mental illness and the belief that people with mental illnesses cannot make competent decisions means that the engagement of mental health care recipients has lagged comparison with other populations  Three year comparative study explored from 2000 to 2003 of mental health reforms in the provinces of British Columbia , Ontario and Quebec, chosen for their unique mental health policies  WOMEN AND MENTAL HEALTH:  Has to understand mental health as a gendered concept. Women have been positioned more vulnerable to mental instability.  Women have historically been put in the irrational and nature side of the nature/culture binary therefore even in Western thinking, women more than men have come to known as mentally unstable  For example, in the olden days, it was said that hysteria is tied to women’s reproductive organs more likely a wandering uterus.  For most of the 19 century, a woman’s mental state was tied explicitly to her anatomy which means that being woman made you more susceptible to madness.  With respect to mental health, if a woman conformed to her gender role i.e being passive, she was seen as unhealthy as an adult but if she did not for example being assertive, she was deemed unhealthy as a woman. Traditional female sex role had negative mental health consequences for women  Men and women do not vary in the overall prevalence of mental illness, but sex and gender differences still exist  Gender differences exist in the rates of specific mental health. Women are TWICE as likely as men to be diagnosed with depression and anxiety while men are FOUR times more likely than women to be diagnosed with substance abuse problems or anti social behaviors.  Women are more likely than men to be diagnosed with seasonal affective disorder. Eating disorders, panic disorders and phobia. Women also attempt suicide more often than men but men have a higher incidence of completed suicide, substance abuse and antisocial personality disorder and early onset schizophrenia than women do.  OCD, schizophrenia and bipolar disorder are diagnosed equally among men and women.  Women are more likely to use mental health care services than men. Women are 2.9 X more likely to use primary health care services for mental health complaints  The effect of acculturation and racism on the mental health of immigrant women is being studied as well.  Result of an interaction between biological and psychosocial factors across lifespan. But research has more focused on biological factors leading to a biomedically biased mental health system.  Poverty and social inequality are two key factors in mental health which disproportionately affect women and especially Aboriginal and elderly women. Other social explanations for mental illnesses in women include the adverse effects of inferior social status, impaired self esteem, family caregiving burden, sexual abuse , sexual discrimination , economic inequities and constricted educational and occupational opportunities  Social differences that affect people’s status and access to resources include race, ethnicity, sexual orientation, gender identity and class to understand development of mental health problems.  Analyses of mental health must recognize that gender inequality is a feature in all populations while not losing sight of the importance of race, ethnicity, class and other social dimensions.  CITIZEN ENGAGMENT , THE MENTAL HEALTH SYSTEM and WOMEN  Citizenship is not just about having citizenship rights (e.g legal or civil rights, political rights, or social or economic rights), it is also about the capacity to practice as citizens.  Women were historically excluded from the rights and responsibilities of citizenship  For feminists, democratic ideals to be put into practice in the form of participatory democracy  Institutions and state and social practices shape the experience of citizenship for women with mental illness. For example, the practice of involuntary committal where women lose the right to determine their own treatment and the experience of many women with mental illness who are mothers who lose the right to have contact with their children are both illustrative of the ways in which women’s experience of citizenship is constrained by state practices.  Citizen engagement must be understood within the broader context of service delivery and policy development in mental health care in Canada, In Canada, mental health policy development in mental health care in under provincial jurisdiction and the delivery of services and management of mental health budgets are handled regionally in most provinces and territories (Ontario is an exception).  Commitments to involving mental health care recipients and their families in policy and treatment decision making processes emerged in formal policy statements and mental health plans in the late 1980s.  Degree to which the mental health system is responsive to women can therefore be assessed, through an examination of 1) degree to which governments have made explicit commitments to women’s mental health including resources to support those commitments and 2) the degree to which women who are or have been recipients of mental health care are supported in citizen engagement mechanisms for influencing mental health policy and practice.  These components are integrally linked  WOMEN AND MENTAL HEALTH POLICY IN ONTARIO, QUEBEC AND BRITISH COLUMBIA:  Ontario:  Ontario has a strong and radical movement of psychiatric survivors that have had a direct impact on the direction of policy that has resulted in the development of some important user- directed initiatives for example the Ontario Consumer Development Initiatives which supported mental health care recipients in peer directed projects and economic development models that have acted outside of the mental health system  The psychiatric survivor movement in Ontario has been characterized by a high degree of interaction between participants in the movement, other activists and mental health professionals.  This activity peaked in the late 1980s and early 1990s with the Canadian Mental Health Association initiative, Building a Framework of Support which was the first attempt in Canada to put into policy a framework that would bring psychiatric survivors together with policy makers and mental health care providers  Ontario had the widest range of hospital based specialized programs for women’s mental health  The bulk of these programs are concentrated in Toronto for example the Women’s Therapy Center.  The Women’s Mental Health and Addiction Research Section at the Center for Addiction and Mental Health (one of Canada’s leading addiction and mental health teaching hospitals) is active in professional training , education, and public forums and in maintaining community partnerships  Ontario, in the urban center of Toronto especially has a well developed women’s movement and a community based women’s service sector e.g women’s centers, shelters, rape crisis centers etc) and a well developed hospital based support system for women  Toronto also has well develop
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