Who’s caring for the caregivers? Symposium focuses on the mental health of women health care workers

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By Joanne Havelock

From Prairie Women’s Health Centre of Excellence

Anxiety, depression, stress and addictions, as well many other symptoms associated with poor mental health, are increasingly recognized as a work-related issues for health care workers. In addition to social costs, poor mental health leads to loss of work time and financial costs to individuals and our health care system.

The mental health of our caregivers affects us all—health care providers, and their patients, families and communities. And women in particular bear the brunt of the effects. Almost one-fifth of employed women work in health care and women account for over 80% of the health care labour force. Women work as doctors, nurses, nurse aides, cooks, cleaners, dietary aides, clerks, administrators and laundry workers. And they provide the majority of unpaid personal care for family and friends—especially the direct physical care.

Researchers from across Canada gathered to examine this topic in detail at the Symposium on the Mental Health of Women Health Care Workers in November 2008 in Vancouver, British Columbia. Organized by Women and Health Care Reform (WHCR) in partnership with the BC Centre of Excellence for Women’s Health (BCCEWH), 50 researchers, practitioners and policy-makers with expertise on mental health, gender and health care work, were guided by four questions:

1. Why is this a woman’s issue?

2. What are the issues for women?

3. Which women?

4. What can be done and who should do it, at what level of government, organization or community?

“Women’s mental health is defined, experienced and treated differently than that of men,” says Pat Armstrong, Chair of Women and Health Care Reform, and professor of sociology at York University. “We need to think about women’s mental health issues in relation to the effects on their bodies while placing those bodies and women’s care work within the context of their lives.” Examined in context, says Armstrong, we see that the stress from women’s paid work affects their responsibilities and relationships at home while stress from caregiving at home may affect a woman’s ability to function well in her paid care work.

Researchers at the Symposium addressed a range of related issues. Elaine Enarson, a gender and disaster expert, spoke about “Women on the Front Lines: Care Work in Disasters” and how emergencies and disasters affect women as paid workers and volunteers. Carol Amaratunga, Dean of Applied Research at the Justice Institute of British Columbia, discussed her work on the SARS outbreak. And Cyndi Brannen, Research Associate at Dalhousie University, examined biological and psychological effects of caregiving and secondary stress for women in the military and for military families.

“If we had a superhero, she would be a caregiver,” said Brannen. But she added that the skills and efforts of health care superheroes remain hidden, and their stress and trauma endured silently, largely because this is women’s work.

Sessions on “Chronically Caregiving” and “Caregiving in the Home” looked at long-term paid or unpaid caregivers including nurses, health care aides, counsellors, home care workers and mothers. In addition to issues of health reforms that set the stage, presenters Cathy Walker, former Director of Health and Safety at the Canadian Auto Workers; Karen Messing, professor of biology at the University of Quebec at Montreal; and Margaret Denton, Director of Gerontological Studies at McMaster University, spoke about the working conditions that are critical to mental health, such as job security, workload, shiftwork, control over one’s work, gender and teamwork and work-family balance. Katherine Boydell, a Senior Scientist at Toronto’s Hospital for Sick Children, highlighted the need to recognize the care and advocacy provided by mothers of children with mental health problems living in rural and remote communities. Nancy Milroy-Swainson, Director of Chronic and Continuing Care Division at Health Canada, and Penny Ballem, a physician and former Deputy Minister of Health in BC, offered reflections on turning research into policy and future priority issues.

On day two of the Symposium, the focus was on the concept of place or location, beginning with the keynote address by Madeleine Dion Stout from the UBC School of Nursing, “Weaving Death and Dance Baskets and Unraveling Space and Place Concepts.” A panel on “Social Locations” brought in the perspectives of caregivers working with or from several communities: Anna Travers, Director of Rainbow Health Ontario, spoke about lesbian, bisexual or transgendered women; Axelle Janczur, Executive Director of Access Alliance Multicultural Health and Community Services, spoke of work with immigrants and refugees dealing with gender, multicultural issues and racsim; Ellisa Johnson, Senior Policy Analyst from Health Canada, brought forward the challenges of being a First Nations health care worker on a reserve; Josephine Etowa, Associate Professor at the Dalhousie School of Nursing, described the challenges for Black women dealing with the intersections of class, gender, race and ethnicity; and, Paula Pinto, a PhD student at York University, spoke of society’s exclusion of women with disabilities.

Lynn Skillen from the Faculty of Nursing at the University of Alberta presented her research on nurses in remote communities, and spoke about working with rural and farm women. And Patti Melanson, a Health Services Coordinator at the Phoenix Youth Program in Halifax, spoke about her work caring for young people at risk in the Halifax area.

The inclusion of Aboriginal opening prayers, ceremony and drumming brought an added dimension to the conference, including an oil lamp ceremony presented by Reepa Evic-Carleton, Program Therapist at Mamisarvik Healing Centre, who also spoke about the impacts of geographic location and colonialism.

And, finally, the Symposium provided a venue to launch the new book Women’s Health: Intersections of Policy, Research and Practice, edited by Pat Armstrong and Jennifer Deadman, and published by Canadian Scholars’ Press.

Following the Symposium, in an effort to move this research into action, researchers hosted a Policy Forum on the Mental Health of Women Health Care Workers in February 2009 in Ottawa for senior policy-makers from the federal government and national organizations. The Forum focused on three federal responsibilities: 1) health and human resources related to paid and unpaid caregiving; 2) emergency preparedness services; and, 3) First Nations and Inuit services.  Participants clearly recognized the need for gender-based analysis in the area of mental health of health care workers and agreed to examine where the Symposium and Forum recommendations could lead to action within their areas of responsibility. A summary of the research presented at the Symposium and feedback from the Forum will be included in a publication to be released this year by the researchers at WHCR.

Joanne Havelock is a Policy Analyst with Prairie Women’s Health Centre of Excellence in Regina, Saskatchewan.


A case for gender-based analysis


The mission of the Family Caregivers Advisory Committee of the Mental Health Commission of Canada (MHCC) is to help “create conditions that will promote full and meaningful lives for people diagnosed with mental illness and for their families and friends who often serve as their primary support network.”


Research done by the Canadian Mental Health Association (2004) shows that 80% of caregivers are women, mostly wives and daughters belonging to the “sandwich generation,” caring for young families and elderly infirm parents at the same time.


A Health Canada study in 2002 reported that caregivers are most likely to feel stressed in terms of their emotional health with close to eight out of 10 reporting that caregiving has resulted in significant (29%) or some (48%) emotional difficulties for themselves. Over one million working Canadians take care of a person diagnosed with a mental illness, and of these, one-third report that it interferes with their paid job due to chronic health problems, depression and excess stress when the burden of work or caregiving increases. Evidence shows that family members (mostly female) caring for those with serious and chronic mental illness play multiple roles including nurse, counsellor, advocate, crisis worker, home-care and income provider.


Marika Morris writes in Gender-Sensitive Home and Community Care and Caregiving Research: A Synthesis Paper: Final Report, that in caregiving, women and men experience different socioeconomic contexts and gender role expectations, which result in “women giving more hours of unpaid care than men, performing more demanding forms of caregiving than men, traveling farther and more often to provide unpaid care than men, and more often having responsibility for more than one care recipient than men.”


Research by the Canadian Institute for Health Information (2005) has shown that women are more likely to care for parents while men are more likely to care for partners. Men are more likely than women to feel they have other options available to them when deciding to become a primary caregiver. It has been shown that women are more likely to experience difficulties as a result of providing care to someone diagnosed with a mental illness in particular; they were more likely to report difficulties in terms of their own physical and mental health. Yet men have reported being less likely to get a break from caregiving when they needed one.


By doing a gender-based analysis of caregiving, one can discover areas where men and women are equally affected and areas where their needs differ in caregiving for people with mental illness. Sex- and gender-based analysis is crucial in the work of the Family Caregiving Advisory Committee of the MHCC.

- From the Ad Hoc Working Group on Women, Mental Health, Mental Illness and Addictions