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Summary of Reviews
Citizens expect and deserve mentally healthy communities. To that end, we connected with Ken Christian (City of Kamloops’ mayor and former environmental health professional) and Randy Sunderman (social economist and chair of the Aberdeen Neighbourhood Association) to explore local governments’ unique role in planning and building mentally healthy communities. They gauge Kamloops’ success in supporting mental health as recommended by the World Health Organization’s Healthy Community approach, which originated in Canada. They also talk about the realities of local government spending for social infrastructure, and the impact of COVID-19 on community mental health.
This podcast will help you understand:
- Concept and benefits of ‘community mental health’
- Roles of all levels of government in community mental health
- Evolution of local governments’ focus on social health, including mental health
- Social determinants of mental health
- Factors associated with the Healthy Communities/Cities approach
- Political commitment
- Citizen engagement
- Health-based public policy
- Inter-governmental and multi-sectoral collaborations
- Asset-based community development and mental health
- Impacts of COVID-19 on community mental health
- Role of local government planning in community mental health
- Realities of local government spending for social infrastructure
- Structural/bureaucratic barriers to community mental health
The Social Planning & Research Council of British Columbia (SPARC BC) is a leader in applied social research, social policy analysis, and community development approaches to social justice. Lorraine Copas and her great team support the council’s 16,000 members, and work with communities to build a just and healthy society for all. THANK YOU for supporting the HEADS UP! Community Mental Health Summit and the HEADS UP! Community Mental Health Podcast.
- City of Kamloops Planning Documents
- Aberdeen Neighbourhood Association
- World Health Organization
Ken Christian is Mayor of the City of Kamloops and a former senior environmental health professional. A Kamloops resident for more than 40 years, Ken has served his community as an elected representative continuously since 1993. He served as a school trustee for 18 years, including eight years as chair. He was first elected a Kamloops councillor in 2011 and then again in 2014. He was elected mayor in a September 2017 by-election, and then re-elected as mayor in 2018.
Before retiring, Ken’s day job was with Interior Health as a senior environmental health professional. Throughout his 37-year career, Ken was a leader in water and air quality, food safety, community sanitation, disease control, and emergency preparedness. In recent years, his interests have turned to public policy development, administrative law, sustainability, social determinants of health, and the relationship between health and the built environment.
Randy Sunderman is chair of the Aberdeen Neighbourhood Association, which was created by the City of Kamloops to serve 12,500 residents living in the southwest area overlooking Thompson Valley and much of the city. The association aims to foster a vibrant, inclusive, caring, and healthy community where residents are safe, active, and engaged in activities that support neighbourhood aspirations and overall community goals. Randy is also a board member for the Kamloops Voters Society and the Kamloops Area Preservation Association.
Randy is also a social economist with Peak Solutions Consulting, where he works with local, provincial, and federal governments, and Indigenous communities in the fields of economic development, land planning, and environmental assessment processes to support sustainable communities and business opportunities.
Jo de Vries is a community education and engagement specialist with 30 years of experience helping local governments in British Columbia connect with their citizens about important sustainability issues. In 2006, she established the Fresh Outlook Foundation (FOF) to “inspire community conversations for sustainable change.” FOF’s highly acclaimed events include Building SustainABLE Communities conferences, Reel Change SustainAbility Film Fest, Eco-Blast Kids’ Camps, CommUnity Innovation Lab, Breakfast of Champions, and Women 4 SustainAbility. FOF’s newest ventures are the HEADS UP! Community Mental Health Summit and HEADS UP! Community Mental Health Podcast.
Website: Fresh Outlook Foundation
PLAY IT FORWARD
The move toward community mental health becomes possible as more people learn about its challenges, successes, and opportunities. Please share this podcast with anyone who has an interest or stake in the future of mental health for individuals, families, workplaces, or communities.
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Ken Christian, Randy Sunderman Interiew Transcript
You can download a pdf of the transcript here. The entire transcript is also found below:
Welcome to the HEADS UP! Community Mental Health Podcast. Join our host Jo de Vries with the Fresh Outlook Foundation as she combines science with storytelling to explore a variety of mental health issues with people from all walks of life. Stay tuned!
Hey, Jo here! Thanks for Joining me with Mayor Ken Christian and economist/activist Randy Sunderman from Kamloops, British Columbia. I'm really excited about this episode because we're going to explore the role of local governments and their citizens in the move toward more mentally healthy communities.
But first, a few professional observations I think will help set the stage. I've been a public outreach and engagement specialist to local government for 30 years, with a focus on community planning, sustainability initiatives, and capital construction. Early in my career I noticed that municipalities were beginning to view community well-being differently. Federal and provincial governments were offloading responsibility for many social programs, and citizens turned to local government to fill those gaps.
In particular, I saw four things. First, municipal decision-makers were talking more openly about the social challenges facing their communities. I watched as they embarked on social planning exercises and debated issues that had not been discussed in Council chambers before... topics such as inclusivity and accessibility, homelessness and supportive housing. Today, social planning is common in communities of all sizes with adequate human and financial resources to support it.
Second, I noticed that municipal officials started to see the link between their built environments and public health outcomes, including mental health. They explored the costs and benefits of agricultural initiatives to support local food security, natural wetlands for wastewater treatment, bike paths for active transportation, and other infrastructure alternatives that supported their communities' social objectives. Today, companies that bid on municipal infrastructure projects must envision innovative social, cultural, and recreational objectives and outcomes, as well as the environmental and economic requirements.
Third, I saw that proactive leaders were also more likely to ask for public input at key community planning milestones, with many believing that grassroots engagement resulted in the most robust solutions. In the early days of engagement, public input wasn't always reflected in policies and programs, but today authentic engagement is common in communities of all sizes and guides the development of innovative solutions.
And finally, I've seen that local governments everywhere are benefiting from strategic partnerships with senior levels of government, businesses, nonprofit organizations, community groups, and educational institutions. They see that bringing people from different sectors and all walks of life together to focus on one community challenge results in customized solutions with strong community buy-in and long-term financial support. Collaborations are now considered by many municipalities to be the most efficient, cost-effective, and timely ways to mobilize positive change.
We're going to talk about these things, and how they relate to community mental health, with the progressive folks from Kamloops, a city of more than 100,000 people located in British Columbia, Canada. But before we hear their take on this very important issue, let's quickly get a common understanding from my researcher.
So, Rick, what is community mental health?
First, let's take a step back and define overall health. The World Health Organization (WHO) defines health as a state of complete physical, mental, and social well being, and not merely the absence of disease or infirmity. Mental health, more specifically, is described as a state of well-being where people can realize their own abilities, cope with normal stresses of life, work productively, and contribute to their communities to help them mobilize health at the community level.
Canadian health experts developed the Healthy Community approach in the early 1980s. The movement went global when WHO initiated the Healthy Cities project across Europe in 1986. The Healthy Community/Cities methodology is based on five key factors: political commitment, citizen engagement, health-related public policy, multi-sectoral collaboration, and asset- based community development.
We'll dive into these a little later with our guests. But first, let's outline the roles of different levels of government in Canada in the move toward mentally healthy communities.
Health care in Canada is governed by the Canada Health Act, which aims to protect, promote, and restore Canadians’ mental and physical well-being, despite personal factors such as income, education, or cultural differences. Specific to mental health care, the federal government also funds pan-Canadian policy development, mental health promotion, research and data collection, and improved access to mental health services across the country. With funding from the federal government, provinces and territories are the big players. They must provide medically necessary services to diagnose and/or treat injury or disability, maintain health, and prevent disease. This typically covers inpatient treatments you'd receive from your doctor or in a hospital.
What about local government?
Local governments have no formal role in mental health care, but certainly affect community mental health on the ground where people live. As you mentioned earlier, they do this through social planning, land-use planning and zoning, active transportation, parks and green spaces, and recreational planning and program delivery. Local governments also collaborate with other levels of government and other sectors to create the social infrastructure needed to ensure basic needs, such as food, housing, employment, and public health and safety. And they provide opportunities for learning, faith, creativity and artistic expression, and citizen engagement.
Before welcoming our guests, I'd like to thank our major HEADS UP! sponsor, the Social Planning and Research Council of British Columbia. SPARC BC is a leader in applied social research, social policy analysis, and community development approaches to social justice. Lorraine and her great team support the Council's 16,000 members and work with communities to build a just and healthy society for all. Thank you again... your support is just so much appreciated!
So, what we've heard so far is that while local governments may not play a formal or prescribed role in building mentally healthy communities, they do the vitally important work of creating the conditions for citizens to make healthy choices. Ideally, they also partner with other key stakeholders to enable and encourage health and well-being, of which mental health is a big part. This is what citizens deserve and increasingly expect from their municipal or regional governments.
So again, a big thank you to my guests for joining me to explore this further. I chose to showcase Kamloops because it's walking the talk in community mental health with an Official Community Plan, Sustainability Plan, Social Plan, Homelessness Action Plan, Affordable Housing Strategy, and an Accessibility and Inclusion Plan. First, let's welcome Mayor Ken Christian, who's served the City as an elected official since 1993. Ken's day job before retiring was with Interior Health, where he was a senior environmental health professional. His current interests include sustainability, public policy development, administrative law, social determinants of health, and the relationship between health and the built environment. Thanks for joining us, Ken!
My pleasure, Joanne.
Randy Sunderman, chair of the Aberdeen Neighborhood Association, is joining us as well. Randy is a social economist with Peak Solutions Consulting, where he works with local, provincial, and federal governments, and Indigenous communities, in economic development, land planning, and environmental assessment processes to support sustainable communities and business opportunities. Thanks for being here, Randy!
Thanks for having me.
Let's start with you, Ken. You've been a public health professional and an elected official for many years. In your own words, what is local governments' role in building mentally healthy communities?
It occurred to me some time ago, when I was practicing in public health, that most of the health gains we've seen over the last couple of centuries actually haven't come from hospitals and treatment centers; they’ve come from local governments. And I think the case with mentally healthy communities is exactly that. If we can create communities where there's a sense of inclusiveness, that we really work on connecting our citizens, and we really combat against social isolation, we will have created a mentally healthy community.
I agree with what Ken said, and I'd just like to add that a local government I really see as being the coordinator between the different levels of government, the quarterback, if you will, and pulling those views up, like Ken says, from the residents, dovetailing with the resources that are out there to help make it all work.
Before we go any further, Ken, can you explain the social determinants of mental health? And what they mean to decision makers and citizens at the local level?
I think that one should go back to the definition of health, the broader definition… and that's the complete social, emotional, and physical well-being of individuals, and not merely the absence of disease or infirmity. And so that broad definition includes mental health in terms of the social health of citizens…I think they're kind of the same. And I think that there's a lot that local government can influence that is going to make a positive impact on people's mental health, things like employment, things like education, early childhood development, housing, affordability, issues related to poverty reduction, food, security, all of those things, meld together to improve the health of the citizens in, our case, Kamloops.
So basically, everything outside of the health care system is a social determinant of mental health?
And how can the impacts of the social determinants be measured?
You mentioned some of them, Joanne, in terms of public policies that local governments can develop in conjunction with their residents. But there's also some bricks and mortar in terms of the facilities that they have invested in, and not just facilities like hospitals… things like the Tournament Capital Centre that puts seniors together walking the track, are equally important as some of the more specialized areas of the hospital.
In Kamloops, which do you think of the social determinants of health need the most work?
Well, we are in this post-COVID era or perhaps present COVID era. And there is, I think, a need for us to really combat against social isolation. And when we hear the Provincial Health Officer telling us repeatedly, "Stay the blazes home, and try to avoid contact with others," that takes its toll on people, particularly seniors and youth. And so, we need to have some strategies that are going to be able to allow people to connect by other means if we can't connect physically. And the other thing that I think we need to do is really be conscious of the economic challenges that this particular pandemic has placed on some of our citizens. We have to make sure our social support network is strong, because nothing will adversely affect your mental health like worry over meeting the rent payment, paying for groceries, feeding your children, those kinds of things.
Ken, how are residents talking with you about Council stepping up and making positive change? Are you hearing any specific requests around that?
Yes, we hear requests all the time, of course about a myriad of issues. But one of the things that we're really hearing a lot from the residents is a lack of a sense of security. And so there really are a lot of concerns about walking alone at night, about crime rates, about vagrancy, about street-affected individuals, and of course, the opioid crisis. So, one of the things that we've done is established what we've called a Safe & Secure Kamloops Committee. What we've tried to do is bring citizens together with a lot of the service providers and the uniformed services like the police, fire. and bylaws people, and that's become a forum that is addressing some of those concerns. We have another initiative, which is on the more positive side, and that's Healthy Kamloops Collective, where we've put a bunch of NGOs and organizations together that really focus on a part of the whole in terms of the health of the citizens of Kamloops. So, we have a number of people like the Brain Injury Association, the Canadian Diabetes Association, those kinds of organizations that sit around a table and really talk about what we can do as a City, in terms of our public policies, to really enhance their causes.
Randy, what are your family, friends, neighbors, and association members saying about needed mental health initiatives? And what are you all seeing as priorities?
Well, different talk than what Ken's talking about. Most of the people I'm dealing with are talking about work-life balance, the importance of that for mental health… stress management. Anytime we face changes, like we're seeing right now, there is a level of stress that impairs the way people interact and how they feel in their community. So, that's certainly what we're picking up on up here in Aberdeen, which is a fairly affluent community. And we don't see a lot of the same issues that Ken is talking about, but certainly individuals are certainly feeling the stress of the current situation.
So Randy, when Ken talked about safety and security, how do you see that playing out in your neighborhood regarding the link between that and collective mental health?
Safety and security are one of those issues that's always present, whether or not it affects one's mental health. Certainly, when we have break-ins and what have you… we have a lot of smaller crime issues like our break-ins and that up here… so that certainly does affect people's mental health. But I think overall, it's something that is a secondary role to people's concerns in our area anyways, to what they're doing in the job place. What's happening with them more on a personal level, certainly being isolated, has impacted a lot of people in different ways that is not playing out well.
Planning for this episode, Randy, we heard from one of your neighborhood association colleagues, who wanted to talk about family mental health. How do you think the City fares in that regard?
Well, again, one of those wraparound services. So, what we were really talking about there is mental health of children and development of children through their early years. And whether or not we're supporting them having parents at home as they kind of go through those formative years. What was being discussed was that if we're able to provide a secure and safe environment for our children in those very early years, up to age five, we really lay the groundwork for having the type of well- developed and solid mental health start for children moving into their early teen years. So, that's really important.
And, you know, one of the comments she made was around parental leave for maternity and paternal leave, and how in Europe, they have up to four years. Well, we have short periods of time here. I think it reflects back on the comment earlier, "What is the role of local government?" So certainly, our school system plays a big role, or provincial government with daycare delivery and stuff like that. And then, you know, the City fills in the blanks where it can, but I think just by providing those fixed assets, like the parks and the services that go along with the programming are really the City's role, and I think in the City of Kamloops, we have some pretty good services in that regard.
I'd like us to talk about the Healthy Community/Cities approach I mentioned earlier, which was first practiced in Canada and then adopted by the World Health Organization. The first of five key factors in this approach is political commitment. As Mayor, Ken, how do you see that playing out on Council?
I, of course, have been kind of steeped in this with my background in public health, but what I found is we have a very diverse Council. You know, Councillor Singh bringing in this engagement piece, but Councillor Hunter, for instance, quite involved in issues related to disability management and accessibility, Councillor Sarai talking about things related to sports, and Councillor Dudy talking about things related to food security and food insecurity. And so, you have that variety on Council, and I think that really brings a lot of good discussion to the table. Also, they do some pretty good and intense research with the organizations that they have belonged to and liaise with. I think we have a very rich Council in terms of our focus on a lot of these healthy public policy topics.
How have public expectations changed since you've been on Council?
I first joined the Council as a City Councillor in 2011, and I think at that time there was a lot more focus on economic recovery from the 2008 recession. I think we moved then into a focus on environmentalism and that kind of thing. Around the same time, British Columbia established Family Day, oddly enough, we started focusing on a lot of issues related to livability.
And, certainly, this Council in its strategic plan has livability as one of its four pillars, and to Randy's point, livability means different things in different neighborhoods. Where Randy lives, and the group he represents, a lot of double-income families and issues about work-life balance are very important there... and family connectedness. Whereas in some of the lower socio-economic demographic neighborhoods, we are starting to see things like childcare, and access to unemployment insurance, and the social work in family violence as being things that they're quite concerned about. So, no city is all the same. They're not homogeneous. They're a collection of a somewhat disparate neighborhoods in many cases. And I think we have to as a Council balance the needs of all of those neighborhoods.
So, Ken, what difficult decisions is Council prepared to make in a transition toward a more mentally healthy community?
We have a Ministry of Health, we have a Ministry of Mental Health and Addictions, and that is above a health authority [in our case the Interior Health Authority], which has numerous divisions and departments that are quite well-funded for these kinds of things. Traditionally, cities have been the provider of core services, but more and more, we start to see the health of our citizens as being one of those core services that we have to fund. Now, it's a question of raising those kinds of taxes, and making the kinds of investments that we need. Ten years ago we never had a housing coordinator. We never had a social services monitor. We have those positions in our City staff now. And those positions are liaising with neighborhoods and liaising with a lot of the other core providers in terms of getting some synergy between City service offerings, as well as the offerings of those NGOs.
How are public expectations and Council decisions linked, aside from a purely political cause and effect?
I think this speaks right onto the engagement piece. And I know Randy would have some impressions about that. But when we are developing new policies, new plans, and new documents, active transportation being one we just did, we have an engagement process that we actually take out to neighborhoods, and we try to catch people where they might already be, so in shopping malls at events, like a hockey game, and things like that, so that we get a broader cross section of the public providing input into these planning exercises. And I think that serves us well. We never get more than 5 percent. If you had 5 percent of the population consulting on a particular plan, it would be wonderful, but we consistently get between 300 and 500 individuals that are quite actively engaged. And we have some platforms like our Let's Talk platform with our communications division that provides alternative ways other than going to meetings and open houses where people can provide that input from their own home.
Randy, still on the topic of political commitment, in your view how effective is the current Council meeting community mental health needs?
I think the key political commitment is to see leadership drive mental health through all of their planning processes. And Ken talks about the linkages between the various plans and how they're connected to support livability, but there's always room for more to be done. Now, I'm definitely not saying spend more money, but what I am thinking is how we spend our money and how we address these issues. And you know, incorporate the well-being priorities throughout. It's one of those things. The Council has set a high bar for themselves, but as a resident, I always like to raise the bar that one notch further, and I think Ken can appreciate that.
The next factor in the Healthy Community/City approach is citizen engagement. And this is one of my favorites as an engagement specialist. Ken, can you recall a time when public engagement was particularly helpful in the development of a mental health policy or initiative?
I wouldn't limit it to a mental health initiative, but we've recently upgraded and updated our Official Community Plan... it's called KAMPLAN here. We had a really broad cross-section of the community weigh in on that document, and that's a foundational document. And I hear what Randy's saying that you never really have enough in terms of a consultation, but I think it's kind of like a weight of evidence approach... are we getting consultation from those individuals and those groups that represent the wider audience? And I think in the case of that KAMPLAN consultation we did… that resulted in a plan for development going forward that really addresses a lot of the things that is going to, over time, improve the mental health and wellness of the citizens of Kamloops.
Randy, what could the City do better with regard to citizen engagement?
I think there are best practices in the City, but I think what we’ve got to remember, there's always room for improvement. KAMPLAN is an example in the City that I think was done very well. And like Ken said, there was lots of dialogue. I believe I was actually at more than one event having a chance to review [what] had been revised. Those kinds of processes, those bigger processes, I think work well. Where we're falling short in the City is when we face some of our development activities, individual development activities. We just had an OCP amendment here in Aberdeen, where the Aberdeen Neighborhood Association was not invited to the local meeting... it was focused on local residents, like in the immediate area. I felt there we could have used more back-and-forth to ensure that we actually started to integrate that OCP amendment into the broader Aberdeen neighborhood. So, it's one of those things, just taking our time with all the various activities that are going on in the City. And I can appreciate the Mayor and Council are faced with an ongoing barrage of development and planning that's going on. So, it might be a little overwhelming at times. But for us in individual neighborhoods, it's ideal.
And if I may, Joanne, Randy makes a good point. And in retrospect on that particular development, [what] he's referring to is so significant, that we should have actually gone beyond what was a statutory requirement. And I hear him on that point, there are some consultations that are required in the Community Charter, like for our budget, for instance, we're supposed to have X number of meetings and access to the public and changes to our community plan. And some of those are limited to people within a certain radius of where the particular development might be occurring. And that's well and good in terms of satisfying the law, but I think we maybe have to go a bit farther than the law in terms of some of these important documents that need a broader citizen engagement.
Randy, with regard to your association, how important a role do organizations like yours play? And how can you be even more assertive in putting your ideas and your insights in front of Council?
I think our role is to communicate the broader feeling of the residents. We are another level of input to the City, we were created by the City, and people often turn to us for input. We have 12 board members who are distributed throughout Aberdeen, who all have their networks... they're on the school groups, they're in different parts of the neighborhood. So, I think from that perspective, we're a good sounding board for whatever the issue might be. So, from that perspective, I think it's important.
The next consideration in a Healthy Community/City approach is health-based public policy. And I know, Ken, you love this area. What are the most progressive community mental health policies you're hearing about from other communities?
That is an area of interest to me, both from an operational perspective as Mayor, but also from a research perspective. We're hearing a lot now in response to crises in and around homelessness. And we're seeing a lot of local governments go that extra step in terms of taking on some roles that had previously been reserved for provincial or federal governments, and [are] really getting involved in the housing game. And it's not just the roof over the head. It's about the wraparound services that go along with helping people get back to wellness from a substance abuse disorder or a chronic mental illness. And so those wraparound services are quite important. And you see places like Medicine Hat and Calgary, certainly in the last decade moving in some of those areas. Also, you see places like Bend, Oregon, where they really get focused on a lot of active transportation initiatives. And you see a lot of examples from Europe, and particularly in the Netherlands, where you see a lot of focus on family and family activities, and those kinds of initiatives being led by local governments.
Ken, what about a community's size? How does that impact its ability to either adopt some of these more progressive policies, or not?
You like to think that size doesn't matter, but it does, because size relates to the amount of money that you have for what would be discretionary kinds of spends. And so really, it's cities kind of 100,000 and above, up to about a million, that are really paving the way in terms of research and innovative public policy. The ones that are smaller are really reacting to issues that they've been dealt, and the ones that are larger, really have problems that are so significant and so ingrained, that they really need the help of other levels of government.
If you could propose one policy to Council knowing that it would be adopted, what would it be?
I would like Council to adopt this notion of 'people places' within the core areas of our city… so that pedestrian plaza concept where you would have places to meet and greet, to eat, to look at cultural and artistic events, that kind of town center, as it were, that really comes from Europe. We've gotten away from it; we've become such an automobile-centric kind of a society in North America… we really have lost a lot of that opportunity to connect with our neighbors. And if we had those kinds of investments in that actual bricks-and-mortar structure, people would animate it. And that would be something that I would like to see us do.
And with your focus for so many years on environmental public health, how does that relate to a community's mental health?
It does, because there is a connection directly between the built environment and the health of the people that live in it. And if you build an environment, when you're looking at densification, and that if you don't keep the person at the center of your thinking in and around that, then you're going to wind up just housing people like in warehouses, and that is not good for their mental health. We need to create spaces where people can do what they do best. And, you know, we're social creatures, and we're healthier when we engage in social activity.
Randy, recognizing that most policies require budget support, what policies would you like to see Council consider in the short term?
I agree with what Ken is saying, and the importance of connecting people. In Kamloops, we have a number of neighborhoods that have ideas on policies they'd like to see moved forward. And I'm thinking specifically of the Sagebrush neighborhood, which is trying to move forward a benchmark initiative to help older residents, and residents in general, move from one area to another and rest while they're going, so they can walk, as opposed to having to go long stretches before they get to a park or the downtown core. So how do we get things like that, for example, built into our overall social asset base, if you will? And it's more a policy thing, as opposed to being expensive budgetary items.
The next factor is another one of my favorites, multi-sector collaboration. Ken, can you explain why communication and collaboration among people from all sectors is so vital in this move toward mentally healthy communities?
It is critical, and there's a synergy and a lived experience out there that you really want to tap into when you're really developing programs for people with either chronic mental illnesses, or people who suffer social isolation, or seniors’ groups, or the preschool groups, and things like that. When you're working with early childhood educators, the Canadian Mental Health Association, ASK Wellness [Society]... those kinds of organizations come to the table with not only some great ideas, but they also bring with them a source of funding that may not be available to local governments to provide varying kinds of services, be they to feed the poor or to provide programming for seniors and those kinds of things. To try to do it on your own as a local government is a folly, and that you would be well advised to seek out those organizations in your community that share a vision and engage them in finding solutions.
How is the City partnering with other levels of government and Interior Health to advance mental health in Kamloops?
We're working with [Minister] Judy Darcy of the [BC] Ministry of Mental Health and Addictions quite extensively because of the opioid crisis. We have lost just countless souls to drugs, specifically fentanyl and carfentanil in Kamloops, and the person years of life loss is just startling. Since the pandemic occurred, we’ve lost one life to COVID-19, and at the same time, we lost 24 souls to opioid overdose. So, we need to put that in perspective, and we need to continue to find solutions. People don't wake up wanting to become addicted to opioids, they get into that cycle of addiction through a whole host of other things that are neglected within their mental health psyche. And, you know, we as a community can build more resilient residents if we work with organizations like Judy Darcy's ministry and the mental health component of the Interior Health Authority to build not only episodic kinds of treatment and facilities for individuals that already have to come to addiction, but also addiction prevention kind of things... working with the school district, working with organizations that support youth, the Boys and Girls Club, the YMCA, those kinds of organizations... to make sure that we have a resilient youth that are feeling good enough about themselves that the option of opioids is not something that seems like the only way out.
Randy, in an ideal world, what would a perfect relationship look like between your association and the City of Kamloops?
I think there's two parts to that question. One is formal stakeholder engagement, which comes with recognizing when there's a need to communicate with the community or the neighborhood, and being that formal outreach. But there's a second part as well, and that's the ongoing dialogue that happens between neighborhood representatives and the City. And I must say that Council as a whole does a very good job on that engagement. I can phone Ken or email Ken or send him a letter or what have you, and by and large, as long as he's not on holidays, he'll get back to me in a reasonable amount of time. I think a lot of what happens happens behind the scenes in private conversations, and then slowly builds into that formal dialogue. So those two elements, I think, are the keys to making it work.
The last Healthy Community/City factor is asset-based community development. Ken, what does that mean, and particularly from a mental health perspective?
There's a number of actual assets that we need in terms of infrastructure that are going to support the mental health of the citizens of Kamloops... outpatient treatment facilities, a sobering centre, the kinds of treatment centers that you need for opioid addiction. We need to have a strength in terms of our first responder communities, and we need to educate them to look beyond the addiction and look at the individual and try to help them with the source of the anxiety which has got them into the predicament that they're in. And so, there's a whole bunch of social assets, and there's some physical assets that you need, and the list goes on. It doesn't end at an institution... anything but, in fact, is better... but where it does need to be there, acute mental health services are required.
Randy, can you add to that?
I think from that perspective, as well, it's a matter of how do we allow the neighborhoods to reflect their priorities in that overall discussion? And, as Ken mentioned earlier, our city is made up of a number of different socio-economic classes. We have quite a wide range of different communities dispersed across the region. I think things like, for example, McDonald Park doing their mural program to try and create a more community-oriented or family-oriented park area. Things like the downtown, we call it the Old Man's Park pushed by local residents, and the City's following up on turning that into a tree park, so we'll see a variety of different trees to make it again supporting what the residents feel supports their well being. Westsyde Pool, as Ken can tell you, the Westsyde Community Development Association lobbied long and hard to make sure their indoor pool remains intact, given the importance of that for their families and children out there in Westsyde, which is quite a distance from the downtown of the city. So those things that we can do to make sure that the individual neighborhoods are able to reflect themselves in the spending and finding that the City undertakes, giving them all an opportunity to be reflected in what their priorities are.
And I see all of these are reflected in the amount of social capital you have. Ken, can you explain what that is and how you think Kamloops is doing in building that social capital?
People shouldn't be confused by the capital part of social capital, it's not all about the money. It's about that commitment you have across a broad section of your community to meaningfully address the health of the citizens and, in this case, the mental health of the citizens. In Kamloops, we have a network of organizations from the United Way all the way to professional organizations that are really united in terms of their approach to a mental wellness kind of approach to their work in our city. And they're looking at it across a broken front in terms of the needs of various components of our citizenry.
The more we are able to connect with the people around us, I feel the better chance we have to be all on the same team on these issues. And Ken talks about a number of other providers in the community [that] are absolutely critical for the overall success of any type of social capital approach.
And I think, too, it harks back to the whole definition of sustainable communities where you have an abundance of social, cultural, environmental, and economic capital. And it's the balance and the integration of all of those that will really give you the most livable community.
For lack of a better description, you're trying to create a team... a team that plays well together... [that] is going to lead you on the most successful path. And I think that's really what we're all trying to do here. We have different perspectives and different ways of approaching it, but at the end of the day, if we can create that team, I think we're in a much better place.
We can't have a discussion about mental health without touching on COVID-19… certainly it's mental health impacts on communities. Ken, as a former public health professional with Interior Health, you developed pandemic response plans. Given your informed perspective, what surprises you most about how the pandemic is affecting people in your community?
We talked a little bit about it earlier, the issues related to isolation and that sort of constant reminder from the Provincial Health Officer that to beat the infectious nature of this disease we have to stay apart is really counterintuitive when you talk about the mental health and well-being of a community, because it's events like the Seniors' Picnic, it's events like Ribfest Music in the Park, those kinds of things really help build and strengthen the mental health of our residents. So, we have this kind of dichotomy that we have to deal with, and it's affecting people differently. And certainly seniors because of their vulnerability to the novel Coronavirus are experiencing a lot of isolation. And then you're seeing people who are that sort of street-affected group that really have no place to go now. And they have access to funds that had otherwise not been available to them through a number of the federal CERB programs and things like that. So, they are experiencing a problem that we didn't anticipate, and that's manifesting itself in an increase in our COVID-19-related opioid deaths.
Can you speak to the impacts of COVID on City coffers and the community's economy? I know that certainly your budgets have been hugely impacted by this. How will that impact your ability to deliver on some of these mental health Initiatives?
Yeah, that's a great question. Just for reference, we're about a $200-million-a-year operation. We anticipated at the outset of the COVID crisis that we would lose about seven-and-a-half million dollars if this went on until September . The good news is we've recast that forecast and we're probably only going to lose $5.5 million [by September 2020]. But that's a loss. Whatever way you wash it, that is pale by comparison to the loss within the community. And, in particular, my concern rests with those involved in the hospitality and tourism industry, and all of the jobs that are associated with those industries. And so, you're going to see waitstaff, housekeeping staff, taxicab drivers, people unemployed, and as we talked about initially, one of the social determinants of health is employment and financial security. And so, we're going to see people suffer, and it's likely that there'll be a bit of a lag in terms of when that manifests itself as a mental health issue that we're going to have less money to deal with a bigger problem.
Tell us about the impact on mental health of a one-time event like a wildfire, and an ongoing threat like COVID? How do you communicate with your citizens and serve your citizens differently during these two types of trauma?
Yeah, and we've had both, unfortunately, here. So, if you look at the one that I'm most familiar with was the 2003 wildfire season that we had, because I did a number of pieces of research after that. But one of the things we found was that in communities where they had a lot of devastation, I think in the North Thompson, I think in Barriere where they lose their sawmill and that after the fire goes out, there's this sort of numbness and people thinking, well, I'll get back on my feet. But after they realize that their job is gone, then the financial worries start to take effect. And then you see a marital collapse because husband or wife are working away from the community. You see increases in things like alcoholism, and those kinds of artificial supports. And eventually you see marital breakup, family violence, those kinds of things happening, that's all predicated on the financial loss had nothing to do with the smoke and the wildfire.
And in the context of the pandemic, the unfortunate part that we are in right now is we don't know when this will end, the phase for which the Restart BC [Plan] is kind of predicated on four phases. They're saying phase four won't really come into effect until there is an effective vaccine. Well, those of us that have spent a lot of our lives looking at the efficacy of vaccines... the manufacture of vaccine, the delivery of vaccine, the contraindication of vaccine... realize that's a long way out. So, we are going to be facing the effects of COVID-19 well into 2021, and perhaps beyond. We are anticipating just in Kamloops, we operate the airport, we don't see us getting back to 2019 passenger volumes until 2024. But each one of those people that fly in and out of Kamloops on a plane spend money in Canada, so we can anticipate that the financial consequence of this will last a long time. And that will bring with it a lot of pressure on mental health in our community.
I've talked with a number of folks who say that the pandemic, despite its negative implications, has encouraged them to think about life differently... about what's really important. And I'm just wondering, is that something that Council is talking about? Is that something that your residents are talking about with you?
We talked about a new normal, and we talked about a better normal, and some of the things that have been put forward to Council are things like less dependence on automobiles, less dependence on that rush-and-worry kind of society that we're living in, and more focus on eating at home, growing your own food, preserving your own food, doing things as a family, those kinds of things which would actually serve to strengthen the mental health in the community. Those are all good if you have some surety about the roof over your head and the groceries in your fridge. And if you don't, then, and a lot of people don't, that's when the effects of the pandemic will become potentially much more noticeable in our health of our population.
We hear some people say that they're looking forward to our economy bouncing back to where it was before. And then you have other people saying that we should use this opportunity to refocus on a different kind of economy, a more green economy, a more socially driven economy. What do you think about that, Ken? How might that play out in local government?
There's been some opportunity. When we've seen fewer cars on the road, we've seen a marked increase in air quality; when we've seen industries close, less co2 emissions. Those are kind of short-term gains if you're really just wanting to focus on the health of the entire population, because unfortunately, there are winners and losers in those equations. And I think as a Council, and as a community, we want to take a broader look and know what's best.
We have in Kamloops a great dependence on TRU World [Thompson Rivers University]. Our university here has fully 40 percent of its enrollment from international students, and those international students pay more to go to school here than our domestic students. And they, in fact, subsidize the access to post-secondary education for our own kids. If they're not coming, yeah, maybe there's a greenhouse gas benefit of people not coming here from some of the far-flung places where they come from, but there really is a loss to our community in terms of diversification and diversity, and certainly a loss to the culture in Kamloops.
As I mentioned earlier, I'm very interested in the importance of integrating social health with cultural, environmental, and economic well-being, as any sustainability model or framework calls for. Randy, as a social economist, what can you say about the role of good mental health in a strong economy, knowing that they're linked in very important ways?
Ken's touched on a lot of the key components around retaining the various elements of the economy. I think when people have a job, and they're secure in their job, and they know it's going to be there tomorrow, then you're much more likely to perform well. Our community is made up of an immense number of very highly skilled entrepreneurs and small business operators, and their ability to seize opportunities and move forward [with] opportunities often come from the confidence they see in the local economy. So, when our local economy struggles, that kind of sets back everybody's interest in spending money and making those diversification moves that create the employment and the wealth that help pay the City taxes and keep people employed.
There's clearly a link between the psychological aspects of an issue like the pandemic. I did some work last year on the wildfires in the Caribou [area of BC], and I was very surprised at how hard the economy was hit by individuals who are not even affected by the fire, but their psychological aspects and their decisions to make business decisions moving forward by what happened to their neighbors, the people down the street, the people in the adjoining community. So, we're all connected a certain way, and when we enter a pandemic, I think it can add some Black Swan event like we're seeing now, can really set back all the economy without particularly impairing individuals that may be pulling back or changing the way they do business.
In Kamloops, how specifically are businesses feeling the pinch from the pandemic?
Well, I think in Kamloops and again, Ken touched on this about our hospitality and our retail sector, you know, some parts of it, the grocery stores and that are continuing to move along, like there's no tomorrow. So, some of our economy is doing fine. But like Ken said, Thompson Rivers University is not seeing its international students, so you know there's going to be job layoffs up there this September. When you see institutions like that speaking about job loss, we know it's already going to percolate through to our service sector where restaurants and the like, are going to employ less or in some instances close. And that's already starting to happen where we've seen a couple of quality restaurants close their doors because they just weren't prepared or don't have the resources to muscle through such a long closure.
I know, Randy, that you conducted a survey of your Aberdeen neighborhood residents, what did that tell you about their general response to the pandemic? How are they feeling about it?
First of all, one of the questions we asked was around their employment situation. So, I'm very pleased to say that of the people responding, and I think it was fairly representative of the neighborhood, no one's lost their job... or at least at the time we took the survey. We conducted the survey in a call from the City to help support economic strategies and transitions. The Mayor struck a taskforce looking at economic transition, so that's the context of the survey. About 17 to 18 percent of the respondents had temporarily lost their jobs, and the other big change was about 27 percent were working from home. Other than that, they're either retired, or they are continuing to work as normal. A small amount, about 5 percent, is as busy as [they've] ever been. So, from that perspective, the workforce in the Aberdeen area seems to be holding in there.
What we noticed about their behavior... we asked a question about, "What are you doing differently now?" We gave them choices... we did kind of martial along a certain direction. But interestingly enough, and kind of a theme of what we've been talking about today, 74 percent of our residents said they were doing a lot more walking, they're getting out walking more. And that was over things like communicating with family and stuff like that. And real far down the list was they were watching more TV. And we had another host of things like activities and what have you. But that whole idea of getting out and being in your neighborhood walking around seemed to be the big thing they were doing.
With regards to direction for Council, I was surprised at the cautious tone that people reflected when asked, "What economic activities should we be fostering to support our local business?" The overwhelming response was to open cautiously, be careful at how quickly we open. At large, everybody reflected that kind of concern. And then overwhelmingly, again, the second kind of leading feedback we got was about what we can do to support the local businesses we have here in Kamloops. I got a host of suggestions on specific things that we can do to support our local business. Well, that was the kind of feedback we're getting on that survey. So overwhelmingly, I think residents have turned inwards and look what they can do to support each other and their local businesses.
Ken, one last COVID question about the social and economic impacts on communities of different sizes? You're a medium-sized community. What are you hearing from your colleagues in small communities or large communities? What is their experience?
It depends very much on the community. If you look at a community like Sun Peaks, or a community like Blue River, their economies are largely dependent on international travel... they're kind of devastated. If you look at a smaller community like Logan Lake that really survives off the copper industry and Highland Valley copper, it's really been seamless for them, right. And so, the smaller communities, it's dependent on how invested their economies are in those aspects of the global economy that's being affected by the pandemic.
With bigger municipalities, and I speak with Mayors on this topic every week as we try to sort this out, the bigger the community and the bigger the budget, the bigger the hit in terms of the shortfall I described [earlier] as being about five-and-a-half million dollars. In places like Vancouver, it's much, much more. So that's really a sliding scale, and I think that we haven't seen the end of this. You don't think of Kamloops as a port city, but in terms of the impact of the port of Vancouver on Kamloops and the Rocky Mountaineer train system that provides 100,000 room nights in Kamloops that aren't here this summer. That has a huge impact on our local economy. So, everything is connected. The plight of Vancouver and YVR [Vancouver International Airport] really at some point in time rolls up on the shores of Kamloops and Sun Peaks.
Something else I'd like to explore with you both, and that's the role local government planning plays in the move toward community mental health. As mentioned earlier, the City has a variety of social plans intended to support its overall community planning documents. Ken, can you explain how community and land-use planning contribute to a more mentally healthy community?
You should really ask Larry Frank [Director of the Health and Community Design Lab at the University of British Columbia]. He's really the expert in this, but the bottom line is that the way that you plan and design a community has a demonstrable effect on the health of the citizens that are going to live there, and so you best keep that as the primary tenet when you make land-use decisions. Everything from things like CPTED (Crime Prevention Through Environmental Design) for those kinds of decisions and how you make your communities more or less dependent on transit and getting there by car or by public transit. All of those things really impact the health of the citizens and their community mental health.
The problem with plans is that they often sit on the shelf, I’m hoping that's not the case in Kamloops. How is Council planning to actually move forward with recommendations in these plans?
[Your] comment about plans are on the shelf, and I guess that's a physical reality, but they're taken off the shelf every day in Kamloops. As each development application comes in, that is tested against what our plan said we were going to do in Brocklehurst, in Westsyde and Barnhartvale, Dallas, Aberdeen. And so, we check the development plans against the master plan that we have, and we try to make the best fit. Largely, we have to negotiate some of these things with developers and as Randy pointed out, we have one of those as an example in Kamloops just recently with our public hearing on the Aberdeen hills development expansion, and those kinds of discussions that, hopefully, use all of the expertise that you put into doing the plan, and you marry that with the designs of a developer to fulfill that plan in terms of the way Kamloops will be built out.
If I can just jump in here, Joanne, I think a couple of things when you're talking about land-use planning, one of the key elements to is to make sure that we're creating the proper lands in order to generate the revenues for the City. Ken's heard from me a couple of times over the past... we just had a review of our heavy industrial lands, the tax rates for the heavy industrial lands in the city, how important it is to have that mix of light and heavy and commercial and residential, all contributing to your tax base. And as the Mayor well knows, our light and our heavy industrial tax base pay a considerable amount based on their size to the overall tax base. I think that's an important element that's directly tied to our overall implementation of plans. So again, I would support that plans don't necessarily sit on the shelves, but at some point, we make hard decisions around how much effort we can put into them based on the resources we have at our fingertips. So, a wealthier community might be able to move a lot quicker, where a community with less resources is often hands tied when it comes to moving forward some of the nicer to do things in plans.
If you have an area that is zoned residential or parkland or whatever, it's fairly easy to build social infrastructure within those areas. What about commercial and industrial areas? What are you hearing about best practices from around the world as to how to make those areas more mentally healthy as well?
On the commercial areas, I think there's already a lot of good examples of walkability. We hear stories from Barcelona, there's been examples [from] a lot of the European cities which had some advantages around their livability… their plazas, their squares… that create that environment and actually supports the commercial developments in the downtown and the community in general. And so, I think that's important to recognize that when we're talking about livability and walkability, it often incorporates our commercial design and development.
On the industrial side, I think it's really a discussion around how do we make it all fit together? How do the pieces of the puzzle fit together? The City of Kamloops went through a fairly diversified exercise where we had a mining project proposed in very close proximity to my neighborhood. Where do we put these types of developments so that they support the city as opposed to degrading externalities for other parts of the community. And where we can find them fitting together nicely, you're going to find that it supports the community... creates the resources required the jobs and the income, and the tax that will allow us to create the walkability and livability that we need.
Despite everyone's best intentions, local government support for social infrastructure is always limited by budget capacity and community priorities. So, to increase the number of social programs, for example, taxes would have to be increased, which is never popular. So, Ken, what is the cost of moving forward toward a more mentally healthy community? And are your citizens prepared to pay the cost?
I think they probably were quite prepared to engage in some of these kinds of supports prior to the COVID crisis. Now, I think there is an undercurrent of uncertainty and so they really are looking for our Council and the City to kind of pare back and focus on those core services... police, fire, building inspection... those kinds of things that they're used to having provided by their local government without necessarily broadening our look and getting in involved in some of these finer points.
And I would support that perspective, in fact, [I was] part of the group that asked the City to consider reducing taxes for residents and commercial businesses during the pandemic, and the City obliged and actually reduced their tax rate. So, kudos to them on that one. But a lot of the citizens are facing hardships at home with their budgets and stuff, and we have to be sensitive that. And I think that's one of the real keys when we look at these things, how can we do what we want to achieve with the resources we have? And that's something that's always got to be consideration when we enter into these kinds of discussions?
Let's bring this all to a finer point. Ken, what did you learn from the conversation today that you could take forward to Council for consideration and potential action?
I appreciated the discussion because it put mental health in the context of something that local governments should do. And I appreciated hearing from Randy and his representation from the Aberdeen community that citizens have ideas, and we have to find a mechanism that's effective in mining those ideas and sustaining that engagement in a meaningful conversation. And so, from that perspective, I think it's been a worthwhile hour. And I think that we've had a good chance to canvas mental health as a real component of the overall health of our community.
Randy, what would you like Council to know about your vision for a more mentally healthy city?
Well, I think at a highest level is how do we dovetail City priorities and opportunities with our desire for mental healthy neighborhoods? And how do we allow neighborhood associations to move forward with their priority initiatives without always focusing on the barriers and start to look at the solutions more?
And this question is for both of you... maybe start with Ken. If you could ask the citizens of Kamloops to adopt one behavior that would advance community mental health, knowing that they would all comply? What would it be?
Let's go with embracing active transportation.
I would say reach out and learn and listen and turn it into action.
We're fast approaching the finish line, so I'd like to bring us back to the title, which is ROLE CALL: Local Governments' Contribution to Community Mental Health. I'd like each of you to share one word or sentence what you think about the following after what you've learned from each other today.
The greatest challenge Kamloops faces in mobilizing community mental health.
Avoid NIMBYism and embrace a full definition of health.
Ensuring coordination and being effective.
The greatest structural or bureaucratic barrier to community mental health...
I think the split between the BC Ministry of Mental Health and Addictions and the health authorities [throughout BC] needs to be smoother.
Allowing neighborhood associations to move forward with their priority initiatives without always focusing on barriers.
A key benefit of mentally healthy communities…
A more engaged and productive citizenry.
Community cohesiveness... making it a desirable place to live.
How the City can partner with citizen groups to affect change right now…
Seek out partnerships and employ the best practices from their core areas.
Reach out and learn to listen and turn it into action.
And finally, your personal commitment to being the change you want to see in this field…
Well, I think my resume says it… I will always be a strong supporter of the social determinants of health, and the application and role that local government can play in improving those.
And I guess for me, I would say continue to let the City know what I'm thinking… and do my research... provide the best efforts... to make sure that we're making good decisions for the city, and my neighborhood's moving along with the best.
And I promise to continue the conversation about all sectors' roles in building mentally healthy communities. Thank you again Ken and Randy for joining me. Having worked with local government elected officials and staff for almost 30 years. I know how difficult it is to balance a community's social, cultural, environmental, and economic needs and particularly to find room in your tight budgets for all of them. So, I wish you the best of luck in your move toward a more mentally healthy community.
Thank you, Joanne for hosting the conversation. I think it's an important one that we need to maintain.
Yeah, thank you, Jo. I appreciate you having me on. It's always fun to be on the same forum as the Mayor is, and all the best to you on your show.
Thank you. Oh, you guys are so amazing. You are both so articulate... this was a real pleasure. Thank you very much.
For more info on City of Kamloops policies, programs, and services, visit kamloops.ca, and you can connect directly with Ken Christian at Mayor@kamloops.ca. For more about the Aberdeen Neighborhood Association, visit facebook.com/Aberdeenneighborhood, and to connect with Randy visit peaksolutionsconsulting.com. Check the show notes at fressoutlookfoundation.org for more contact information and all episode resources.
I'd like to thank Steven Russo from the BC Ministry of Community Sport and Cultural Development who helped fact check the script before we did the recording.
Again, a big shout out to a major HEADS UP! sponsor, the Social Planning and Research Council of BC.
And thank you for listening. If you've enjoyed the podcast and would like to follow us on social media, visit facebook.com/FreshOutlookFoundation or twitter.com/FreshOutlook. And I'd really appreciate you leaving a review where you listen to your podcasts.
In closing, as Winnie the Pooh says, I'm so lucky to have something that makes saying goodbye so hard. So instead, I'll say... be healthy, and let's connect again soon.
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