Treatment of mental health conditions has long been institutionalized, using interventions based on a medical model. Karen Goldenberg fights for community-based occupational therapy mental health services. Goldenberg is an alumna of University of Toronto's Occupational Therapy program and a member of the Order of Canada. She spoke to writer Sandra Sokoloff about respect, dignity, acceptance, and the ability to listen without judgment.
How has your work investigated mental health?
I am not a researcher but have always recognized the need to document, analyze and look at impact. In my early years as an occupational therapist my colleagues and I gathered data and looked at implications of our practices. We quickly realized that many of our patients had secondary diagnoses of mental health challenges. At that time, however, the prevailing view of government was that therapy to address mental health needs was not funded in the home care system.
We challenged this perspective because we felt strongly that occupational therapists made a difference in the area of mental health and believed that people with a primary diagnosis of a mental health condition should qualify for OT services. We initiated a pilot study at the Clarke institute (now CAMH) and I became the first mental health home care coordinator. We marketed our services to general hospitals and community organizations, and since there was a tremendous need for support for people with mental health conditions our services were very welcome.
Our role in providing support for clients with mental health conditions expanded and we received funding for an Aftercare program. We launched Community Occupational Therapy Associates (COTA), which became a primary provider of community-based mental health services in the Toronto area. COTA’s success was a result of our advocacy, and our passionate belief that we must treat the whole person.
Advocacy has also played a large and important role in my other professional roles and personal life. I’m currently on the board for a therapeutic residential treatment program for transitional youth in Ontario, and have met with ministers of health and community leaders to build capacity for this program.
What has your work shown about environments that promote mental health?
My approach to supporting people with physical and mental health challenges has always been community-oriented, taking treatment and after-care services into the community where people live, work, interact with their families, and engage with the community at large.
One example outside of my work with COTA is when I worked with JVS Toronto, which provides employment and vocational services that support people with disabilities. I moved my staff out of the offices and into community organizations several days each week, so people could receive services in the environments where they received care, whether at a community health centre, a mental health agency or a shelter. We focused on how to build supports within their community. This approach was very much shaped by my training as an occupational therapist, which assesses how people function and integrate within their own communities. Taking career counsellors and rehabilitation staff out into the community is one of my most significant contributions. When you become part of that community you can better see the needs and experiences of individuals and families in their natural environments. I see similar impacts of bringing services into clients’ communities in my work with people who are homeless, as well.
Given what you know about environments that promote mental health, what steps can be taken to create them?
Consistent support, relationship-building, acceptance of people for who they are and without judgment, and treating people with dignity and respect are essential for creating such environments. In the workplace, talking about mental health is important. There are numerous opportunities and approaches for supporting employees with mental health conditions: creating professional development and educational opportunities, training your human resources personnel or others in your organization to be supportive and welcoming, and exploring various accommodations are examples. An enlightened and progressive employer will increase resources dedicated to supporting accommodations and make mental health education and prevention resources available. As occupational therapists, we’re very good at identifying suitable accommodations.
Respecting people’s choices and giving them an opportunity to tell their story is really important. The ability to talk without shame and acknowledge that mental illness is a real issue in our society is really important, so creating safe spaces and programs that allow for this sharing is vital. Because the prevalence of mental health conditions is so high, rarely do you find someone whose life hasn’t been touched by it.
What does your work show about strategies that individuals can use to support or maintain their mental health?
Building acceptance in the community – creating safe spaces, encouraging dialogue, knowing about resources available to people in need.
Ability to listen without judgment, to provide relevant resources or accommodations, and just be there are essential. The safer and more comfortable we feel, the more likely we are to share our stories, and the less stigma there is in the knowledge that we’re not alone.
Strategies that increase the availability of safe spaces, provide education and appropriate resources, and promote acceptance that mental health is part of the human condition are crucial.
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