Reflections on mental health equity and youth engagement

“Injustice and sorrow can remind us that we belong to each other, that what affects you is also my concern” – Krista O’Reilly-Davi-Digui

The pandemic reminded society as a whole that the community sector was the quickest, surest lever of mobilization; finding the means to adapt in the uncertainty. This may well reflect how powerful the sense of belonging to each other really is. Community work remains a very vital driver of change and of the same coin, a touchstone of wellbeing. Access to adequate, quality mental health and social services remains a pronounced need for young English-speaking adults and the community sector has been responding.

As our Youth Mental Health Initiatives journey towards the fall of our final year we enter a time when making our learnings visible through collective harvest helps us to deepen our understandings and our practices while bringing meaning to the celebrations of the land that we have partaken in this summer. It feels appropriate to lean into the indigenous ways of knowing (read on) to reflect on the nature of the community work we have supported through our youth mental health mandate.

Equity, diversity, and inclusion is mental health

Working in the community sector at the intersection of mental health and official language minorities immerses our network in the quandary of all our equity-deserving partners, perhaps in greater depth than health alone. Intersectionality is vital to the path of access to mental health care and community organizations (themselves built on the knowledge that relationships with the community are the greatest lever of systems change) are well aware of it. The challenge of access to public services of care in English remain proximity, capacity (bilingual interveners), and quality. Safe quality service provision is inextricably dependent on language and acutely so when factoring intersectionality as seen in the call for trauma-informed, culturally appropriate, and identity-affirming approaches.

Given how diverse our English-speaking communities are and how their vulnerability as a mental health care recipient is directly impacted by their histories of poverty, systemic discrimination, intergenerational trauma, minority stress, regional stigma, organizations working for access are speaking to these needs emerging from our young adults. A case in point from the Youth Pulse Check survey (read on) demonstrates how the relationship between financial stress and mental health was further compounded by the limited accessibility of English mental health services in the public sector, on the one hand, and the high cost of therapy accessible in English in the private sector, on the other. While financial precarity widens the divide of English-speaking youth excluded from mental health services, a situation that their French-speaking counterparts do not need to resort to, the financial struggles disproportionately affected the mental health of Black respondents (44% of whom said their financial struggles affected their mental health), of respondents who identify as nonbinary, transgender, Two-Spirit, or other (49%) and of respondents who have aged out of foster care (90%).

This and other evidence compel organizations to lean deeper into EDI practices and in so doing move inclusivity from intent to action. A commitment to doing differently and adapting in response to the needs and values of English-speaking young adults contributes to the authenticity of the relationship and solidifies a foundation for which to then advocate with and for them. This approach has emerged naturally over the course of the youth mental health initiative.

Youth as partners to community organizations

Actions among the network that are having the highest sustainable impact are the ones that have ensured accountability to youth in their design. For instance, not only has fostering the evolving connection with youth been forefront in every initiative but so too has assessing internally for youth-friendly practices, right up to the board level. Strong engagement practices, overall, depend on it. Organizations of our network have used a self-assessment tool based on the quality standard for youth engagement (Ontario Centre of Excellence for Child and Youth Mental Health, read on) to reflect on areas in need of development that either require an open self-critical discussion and/or some skill boosting to take off. Follow-through hangs on the foundational values of the organization itself, resources, and commitment.

According to a recent study by Imagine Canada (read on here), non-profit organizations who chaired a board with diverse representation held a stronger commitment to EDI practices which affects the organizations connection to under-represented communities downstream. The same goes for youth-friendly practices, in fact one of our groups boasts an entirely youth-led board as well as a youth advisory who guides projects. While exceptional, the learning is that if a board position is adapted to be accessible to youth, chances are that the organization has been practicing intentional means of engaging youth such as building programs that successfully employ youth-led democratic innovation. This framework requires “a commitment to empowering youth decision-making as well as reinforcing the value of skills, experience, and power of young people. Moreover, these programs need to allow youth to apply their unique skills, networks, and creativity toward undertaking projects of their own design while also allowing for meaningful and substantive decisions where power is shared” (Apathy is Boring, read on here).

Asking the hard-to-reach vulnerable youth to be a partner requires the community organizations to adopt various adapted and low-barrier forms of participation open to youth. Organizations have been doing the labour of reviewing how youth-friendly they are before asking a young person to pave their way into working with them. This approach is preferred and is akin to that of culturally adapting programs without expecting BIPOC partners to subsidize white learning (by having them do the work) or asking LGBTQIA2S+ communities to audit their spaces for safety (when organizations can inform themselves).

Shifting the perception of youth as objects to recipients to resources is what reframes how the work is done to, for and with youth respectively (Lofquist’s Spectrum of Attitudes, read on here). It has been a climb for many upon Roger Harts Ladder of Young Peoples Participation (read on here) to ensure that youth participation or agency is seen in planning, executing, and evaluating. These areas of involvement are ones that reflect the depth of connection the organization has with their young community members and are the precious seeds of buy-in that will reap sustainable outcomes such as youth empowerment (feeling that they have the skills to identify, communicate and advocate for their mental health). Co-development with youth is ideally designed at the get-go of an initiative but many organizations still new to this work are progressing along the path towards meaningful partnerships with youth which can take a lot of effort and time to cultivate. Reaching this level of engagement adds sense to the work being done (why are we making this?) and brings resources to the table (how can we tap into the power of young expertise and skills?). The input of young English-speaking Quebecers adds valuable perspective to what it is like to navigate a system of care that was not necessarily built with them in mind.

Wellbeing of young community care-keepers

Lastly, if we want to show up for those we want to be in community with, then we need to receive, reciprocate, and replenish ourselves. Non-profit community organizations under our network have weathered many difficult changes in the aftermath of COVID-19. Among them staff turnover & leadership transition, point-person shifts in partnering organizations and establishments (schools and social services), low resources for core organizational needs like communication & salaries despite rising project-specific funds for mental health. Often within our youth mental health initiative, organizations have rightly turned to hiring youth. It bears mentioning though that these young adults, while best placed to know the systemic barriers they and their peers face in accessing mental health care, remain the least supported as demonstrated early in the pandemic (read on) as well as in our own collaborative community survey in 2022 (read on).

Not exclusive to this experience are vulnerable youth with intersecting identities who may be advocating for mental health services in English and in the same breath calling for culturally competent sources of care. Truth & reconciliation puts colonialized systems into a place of discomfort in calling for them to acknowledge the harms done and commit to restorative practices, but these are also the systems of power that Indigenous and BIPOC community workers have to tread carefully through to be funded, to be heard, and to build influence with.

What can the community organizations collaborating with youth do to level the weight youth carry in their role as advocate and underserved? Asking them to raise their voices on the gaps and barriers to services in mental health is quite personal and taxing, so how are they managing their own wellbeing within the overall mission? Organizations that have found the answer have sought to not only to avoid burnout but to adopt policies and procedures that represent a human and holistic understanding of the toll of working for and of the community sector. Few can step away from the work being done because its outcomes are exceptionally personal to their lives as community members. However, organizations can fix healthy boundaries in their workloads and ensure strong lines of support within the organization backed by clear policies that acknowledge the intricacies of privilege and power dynamics of adult – youth partnerships. Being a part of a network, a collective, embodies the power of belonging to each other and serves as a protective factor in that tackling similar challenges together can rebuff some of the overwhelm of dealing with mental health inequity when it feels out of our control or circle of influence. Knowing full well that our young mental health community workers are themselves of the cohort we seek to support, organizations can promote their resiliency, showing them how to direct care, empathy, and compassion back towards themselves.

*Watch more on applying intersectionality in public health: A two-part webinar series by the National Collaborating Centre for Determinants of Health :

https://nccdh.ca/workshops-events/entry/lets-talk-about-applying-intersectionality-in-public-health
https://youtu.be/g5SzMC4E-2o?si=K3mb5IHf2K14jmPr&t=1550

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