When John Wheatley first sought mental health support at a Vancouver clinic five years ago, the intake form offered two gender options. This seemingly small detail spoke volumes to Wheatley, a 33-year-old transgender man who had spent years navigating a healthcare system that rarely accounted for his identity.
“I remember sitting there thinking, ‘This is where I’m supposed to feel safe enough to discuss my deepest vulnerabilities?'” Wheatley told me over coffee at a Commercial Drive café. “How could I trust them with my mental health when they couldn’t even acknowledge who I am on a form?”
Across Canada, stories like Wheatley’s highlight a persistent gap in our mental health system: services designed without meaningful input from the communities they aim to serve. While nearly 6.7 million Canadians reported needing mental health care in 2018 according to Statistics Canada, the experiences vary dramatically based on identity, culture, and socioeconomic factors.
For Dr. Karina Vernon, a community psychologist working with Indigenous youth in Northern British Columbia, the problem goes beyond access. “We talk about wait times and funding – those are real issues – but we rarely discuss whose knowledge shapes these services in the first place,” she explained during our conversation at a community healing center in Prince George.
The center where Vernon works represents a different approach. Developed in partnership with local Elders and community members, it incorporates traditional healing practices alongside contemporary mental health support. Paintings by local artists hang on walls near rooms where both talking circles and cognitive behavioral therapy take place.
“When people walk in here, they see themselves reflected,” Vernon said. “That’s not just about comfort – it’s clinical efficacy. People heal better in spaces that respect their whole identity.“
Recent research supports this approach. A 2023 study published in the Canadian Medical Association Journal found that culturally adapted mental health interventions showed significantly better outcomes for racialized populations than standard treatments. Despite this evidence, such programs remain exceptions rather than the rule.
Maria Santos, a settlement worker who helps newcomers to Canada navigate health services in Surrey, BC, has witnessed firsthand the consequences of this gap. “I’ve worked with clients who waited months for counseling, only to discover the therapist had no understanding of their cultural context or migration trauma,” she told me. “One session and they never go back. Then the system labels them ‘non-compliant’ rather than examining why the service failed them.”
Santos recalled a Vietnamese family who sought help for their teenage daughter experiencing depression. “The clinician immediately wanted to discuss family dynamics in ways that felt deeply shameful in their cultural context. Without building trust first, the approach backfired completely.”
This cultural disconnect extends to many communities. Akua Owusu, who runs a Black mental health collective in Vancouver, points to how standard assessment tools often misread cultural expressions of distress.
“I’ve seen Black men diagnosed with anger issues when they’re expressing grief in culturally normal ways,” Owusu said. “I’ve seen South Asian women’s somatic symptoms dismissed because they don’t fit Western psychological categories.”
Walking through Vancouver’s Downtown Eastside with outreach worker Dani Rivera, I witnessed another dimension of the access gap. Rivera carries a backpack filled with harm reduction supplies, snacks, and information about mental health resources – most of which, she acknowledges, are difficult for her clients to actually use.
“The system expects people to show up at specific times, wait in public settings that may feel unsafe, and discuss trauma with strangers,” Rivera explained as we stopped to check on a woman she knows. “For someone living rough, maybe using substances to manage PTSD, that’s not realistic.”
The Mental Health Commission of Canada has recognized these gaps. Their 2023 framework specifically calls for “culturally appropriate, trauma-informed approaches developed in partnership with diverse communities.” Yet implementation remains inconsistent across provinces and territories.
Some promising models are emerging. In Toronto, the Centre for Addiction and Mental Health has developed specific services for LGBTQ2S+ communities and newcomers to Canada. In Winnipeg, the Aboriginal Health and Wellness Centre offers mental health support grounded in Indigenous traditions.
BC’s Foundry network provides integrated youth services with principles of cultural safety built into their model. During my visit to a Foundry center in Victoria, I observed staff receiving training on working with Two-Spirit youth from Indigenous knowledge keepers.
But these examples remain limited in scope and geography. Dr. Kwame McKenzie, CEO of the Wellesley Institute and a leading mental health equity researcher, argues that transformation must occur at all levels.
“It’s not enough to add cultural competency training onto existing frameworks,” McKenzie explained during our phone conversation. “We need to rethink who designs services, who delivers them, and how success is measured.”
McKenzie points to the growing movement for “nothing about us without us” – the principle that policies affecting marginalized communities must include their meaningful participation.
“Community expertise is clinical expertise,” he emphasized. “When we ignore lived experience in designing services, we waste resources on approaches that don’t work.”
The economic case for this approach is compelling. A 2024 report from the Conference Board of Canada estimated that mental illness costs the Canadian economy approximately $51 billion annually in lost productivity and healthcare costs. Improving effectiveness of services through cultural adaptation and community design could significantly reduce this burden.
For John Wheatley, change came through finding a community health center with staff trained specifically in transgender health. “The difference was night and day,” he recalled. “I didn’t have to educate my counselor about the basics of my existence. We could focus on actual healing.”
This healing looks different across communities. For some, it involves reconnection with cultural practices; for others, it means approaches that accommodate economic realities or physical disabilities.
At its core, the issue reflects a fundamental question about Canada’s approach to mental health care: Who gets to define what healing looks like?
“Mental health isn’t culturally neutral,” Dr. Vernon reminded me as we concluded our conversation. “Until our systems recognize that, we’ll continue developing services that miss the mark for too many Canadians.”
As our country continues investing in mental health infrastructure, the voices of those historically excluded from these conversations – Indigenous peoples, racialized communities, LGBTQ2S+ individuals, people with disabilities, and those living in poverty – must move from the margins to the center of planning and implementation.
Only then can we build a mental health system that truly serves all Canadians.
