MAPPING MINDSCAPES

By SHAGORIKA EASWAR

Srividya Iyer’s name figures prominently on the list of Canadian women in global health.

Inducted as member, the College of New Scholars, Artists and Scientists, Royal Society of Canada, Dr Iyer received the Maude Abbott Prize (female faculty with outstanding contributions to research); and McGill University and Principal’s Prize for Outstanding Emerging Researchers.

A faculty member in the department of Psychiatry at McGill University, Dr Iyer is also a member of the Global Mental Health Program.

As the scientific-clinical director of ACCESS Open Minds, she is working in the field of youth mental health and early intervention in Canada and beyond.

“Improving access to quality services is specially important for youth because the key risk periods are between the ages of eleven or twelve and 25,” she says. “The same period during which critical milestones such as going to university, falling in love, looking for work, etc., happen. If young people don’t get timely help, it not only impacts their future negatively, society also suffers. We need a holistic approach – to focus not only on symptoms and the problem but on goals, needs and the desire to return to school, to work, to life.

“For psychosis, the age of onset is usually late teens to early 20s. Offering high-quality early intervention results in better outcomes and can, in many cases, prevent a downward spiral.”

ACCESS is a pan-Canadian youth mental health network that includes urban, rural, and Indigenous communities, the homeless young in Montreal and first-year university students in Alberta. Offered at 14 sites across the country, it helps researchers gain knowledge from different contexts. Such projects are usually conducted in urban, academic settings and conducting it in the real world has its challenges, says Dr Iyer. But it also allows them to take what they learn and apply to other communities that much faster because they partner with young people, their family members and service providers to identify their needs.

“It’s so cool!” she says enthusiastically. “It’s a lot more dynamic and creative. We use diverse means of communication to reach a diverse section of people. We’ve designed spaces that are youth-friendly.

“Mental health is stigmatised, but it touches all of us. It is so present, so common, and yet so taboo.”

After completing her Master’s, she became acutely aware of the universality of human suffering during her placement at Thane Mental Hospital in India. Working at KEM Hospital in Mumbai only intensified that. The hospital has a huge outpatient caseload with 1.8 million patients on average walking in every year. Dr Iyer was the sole psychologist, and describes it as a tremendous learning experience.

“In a resource-constrained environment, you do the best you can. It also results in creativity and reliance on natural supports. People think that the mentally ill are abandoned in India and while that is true in many cases, I also witnessed the strong support family provides.

“I studied the role of family in India and in Canada and found that culture can be unpacked in so many ways. In Canada, knowledge is based on science, other kinds tend not to be so valued. My work expands the definition of what we consider knowledge.”

Working with the Indigenous communities means acknowledging historical knowledge. They have experienced unique cultural traumatic events, she points out. The high rates of substance abuse and self harm can be traced back to inter-generational trauma.

In global mental health, she says, they are aware that they can’t rely solely on specialists. She was part of a project in Kashmir, India, a region that has seen so much conflict, but had few formal mental health services.

They trained people from the community to act as primary contacts for patients and their families. They worked with the imams, teachers, local police and the armed forces, respecting their social position and reach within the community. They received many referrals and saw remarkable reductions in symptoms of depression , trauma and psychosis. The quality of people’s lives improved as they stayed in contact with primary workers for longer periods.

These lessons she was able to apply to her work in the northwest territories in Canada where the prevalent belief was that specialists came and went.

“The flow of knowledge works both ways, local to global, global to local,” notes Dr Iyer. “We studied the best ways to building local pathways to care. Who would they go to first? We adapted and tailored that to context. We built relationships and trust.”

While access to health resources in rural areas can be complicated, Dr Iyer says there’s a growing and strong knowledge that urban living can be a risk factor in mental health. The rapid urbanization in India for example, the mass movement from rural to urban, results in the loss of a natural network, to isolation and loneliness. The same factors come into play for the immigrant communities in Canada.

Discussing the signs that parents and educators should watch out for, she says that it can be difficult to separate normal teenage behaviour from mental health issues.

“It can be difficult to tease them apart. Instead of one sign, it’s usually a combination of behavioural changes such as withdrawal from friends, irritability, anxiety. Look for a change from the usual. And how it is impacting them. Is it a one-day thing or long-lasting? If they were doing generally well at school but the grades have dropped.”

Stigma is problem across the board not just in desi communities, but she tells parents and families to trust their instincts when they feel something is wrong.

“Somewhere in your heart, you know, more than you give yourself credit for. If you are worried, seek help instead of dismissing it as nothing or that it’s just stress, you can deal with it. Don’t tell yourself you should be stronger. Seeking help early is key, delay impacts treatment.”

The service and delivery systems are trying to be linguistically and culturally sensitive, says Dr Iyer, but newcomers may also hesitate to open up about the issue as they may not know how to navigate the system, or worry about being perceived as bad parents. Then historically, there are stories of people being locked up in institutions or even at home, there’s the horror around it.

“It is difficult, even today, to have open conversations about mental health because it is something that is inherently about you as a person. It’s not the same as saying ‘My stomach hurts’ because so much of who we are is about our mind. We also struggle with notions of who is responsible for it. The feeling of having done something wrong to deserve it. Genetics can play a role, as can childhood stress, but this is such a complex issue. How do we understand it? And when we can’t make sense of something, we hide it.”

But a change in conversation is happening, and she is hopeful that with more young people sharing their stories of courage and hope, others will realize that they are not alone, their fears will be dispelled.

“I see a lot more willingness to have the conversation. It’s not easy, there are no quick answers and I see that as a good thing, it keeps us scientists humble as we grapple with an issue of this magnitude.”

Dr Iyer left India in 2001 to do her PhD in the US. She worked with older people with mental health issues, but realizing that she wanted to work with people earlier in their mental health journey, where she saw more hope, she looked around for alternatives. Canada was an obvious choice as her degrees were recognized and there was a lot of work being done in early intervention in psychosis here.

She came to Canada as a post-doctoral fellow in 2006. Though as an academic, she didn’t face the lack of Canadian experience barriers, her husband, Minaz Kerawala, a communications and media specialist, did.

“He faced challenges in finding meaningful employment and I was with him on that journey. French was an issue, too! I learnt the language and had to pass an exam. Our son Shaurya was born here and we had the same lack of social or family support common to many immigrants. I love the quality of life, I love being in Quebec, but there’s also the uneasy relationship between culture and diversity.”

Minaz now works for the non-profit Development and Peace and is her greatest strength, she says.

She works long hours, travels, and conducts research. She writes for publications and works with policy and decision makers. She teaches, collaborates with researchers on international projects and is on the phone a lot with her work even at home.

“It would have been very hard to do anything meaningful without my husband’s steadfast support, and pride in what I do,” she says.

She does her best to keep her early mornings and evenings free for Shaurya who is now nearly 11.

“Pack his lunch, see him off to school... You can’t get the desi ma out of an immigrant! Never thought I’d become one but am shamelessly so and love every bit of it.”

She tells newcomers and women who seek her advice not to put off personal milestones.

“It can be hard to do justice to both, but if you thrive personally, you thrive professionally. Resilience depends on a stable base of love and support.”

She tells them to find a core group that they can look up to. “Because there aren’t too many people like you in positions of power, the journey can be longer, there are setbacks, but if you have people like the seniors at my university who mentored me, it is such a boost.”

And to find something meaningful.

“It’s a long, hard journey. Newcomers, specially women, have to work twice as hard to prove themselves. You make the choices that make the most sense as you navigate a new country, a new system, but every step is worth it if it is meaningful.

“For me, it is so personally rewarding to work in partnerships that find data not just in numbers but in stories and in lived experiences. I’m very privileged to work in this field.”

• Grant’s is proud to present this series about people who are making a difference in the community. Represented by PMA Canada (www.pmacanada.com).