Dr. Karen Shin and Dr. Mariam Abdurrahman

Dr. Karen Shin and Dr. Mariam Abdurrahman

When Dr. Mariam Abdurrahman was encouraged to apply for the Chief of Psychiatry position at St. Joseph’s Health Centre, she wondered if this was for diversity reasons. On top of that, she never imagined herself in such a leadership role. She discussed the position with her family who wondered if it was too early in her career but at the same time challenged her mindset, asking her if she was content to stay in the box she had assigned herself.

“Our ongoing conversations about the opportunity reminded me that when someone gives you a box, you thank them for it, you explore the inside thoroughly and then you flip it over, climb on it and get a different vantage point. That will then give you an idea as to what else is available and what you want to do next,” said Dr. Abdurrahman.

Over at St. Michael’s Hospital, another leader in the psychiatry department, Dr. Karen Shin, was thrilled to hear about the new appointment. Over the course of her 16-year academic and medical career, she had been noticing an increase in female and racialized leaders, a shift that she hopes will inspire others to pursue their goals.

“Having those examples and mentors allows you to imagine yourself in certain roles. It’s nice to see more leaders reflecting what society looks like,” said. Dr. Shin.

We spoke with Dr. Mariam Abdurrahman, now Chief of the Department of Psychiatry at St. Joseph’s Health Centre, and Dr. Karen Shin, Interim Chief of the Department of Psychiatry at St. Michael’s Hospital, about their role as leaders, the relationship between equity and mental health, and why stepping outside the box is a necessary part of equity work.

What is the relationship between equity and mental health and why does equity matter in mental health treatment?

Dr. Mariam Abdurrahman: Mental health as a specialty is one of the most pressing areas where issues with inequity are most clearly demonstrated. There is a prevailing sentiment that inequitable treatment is a social experience and some people are able to be resilient while others aren’t. In mental health, we know it goes deeper than that. It becomes a biological process, and I think that’s not given enough respect.

The stress that people experience when they have recurrent inequitable experiences can be transferred biologically so that in the end it becomes disease. A person might be presenting with high blood pressure, but this might actually stem from the stress physiology of sustained marginalization. There’s a lot of power in the experiences of inequity and it often has broad health impacts.

Equity work is very important to me and I’ve given it a lot of thought: it’s difficult to deliver equity informed care if we don’t understand it. The diverse populations we serve at Unity Health emphasize how important this type of work is and how important it is to move from intention to action as a health-care institution.

Dr. Karen Shin: Mental illness can be visible or invisible, and when it’s invisible it can sometimes not garner the same sense of importance as other physical illnesses. When people are facing social challenges and have mental health difficulties, it’s going to make it harder for them to engage in financial equity, food equity and housing equity.

Our department tries to find ways to address that and support them because that can impact people’s wellbeing and prognosis of illness. As health-care professionals, we need to ensure we’re advocating for our patients and that their concerns are addressed in the same way as other physical health concerns because sometimes the impact of mental health disorders can be minimized. We need to ensure they receive the same attention, care and dignity as any other patient. Part of the work and research is understanding what the challenges are and how we can adjust our systems to ensure ongoing improvement.

As you mentioned, St. Michael’s and St. Joseph’s serve very diverse patient populations. How do you ensure that everyone receives equitable care?

Dr. Mariam Abdurrahman: When I think about my multidisciplinary team, everyone is passionate about seeing patients get the care that they need. But it’s an ongoing challenge to balance that with having the right resources because the system can be unwieldy to navigate. I think that a fundamental starting point is having it embedded in the organizational mission, and then going beyond that to enacting it in health-care practices. Every organization adopts their stance on social responsibility, but sometimes it doesn’t move beyond the mandate. What’s unique about Unity Health is that we’re looking at things differently and shifting to action. Our staff are so much more conscious of how essential fostering equity is in patient care and patient outcomes.

Dr. Karen Shin: Like Mariam said, ensuring that it is part of the values of the institution is one way to strive to provide everyone with equitable care. Another strategy is seeking feedback from the people who receive care. We seek feedback to ensure that our clinical services match with what’s needed in the community. We realize that the same service is not going to work for everyone and that having a mix of various types of clinics, such as drop-in clinics, homebased visits, and office-based appointments, is beneficial and helps meet the diverse needs of our patient population.

Dr. Mariam Abdurrahman: One thing our department stands to learn a lot more about from St. Michael’s is flexibility around models of care. For example, having drop-in clinics and home outreach as Karen mentioned. Even having conversations like this is part of the process of ensuring we meet the needs of all our patients.

Many of today’s current events are impacting people’s mental health, including the COVID-19 pandemic, social isolation, homelessness, news of racially-motivated violence and many others. Moving forward, what can be done to provide mental health supports to those feeling affected by what we’re seeing in the news?

Dr. Mariam Abdurrahman: I think about the different groups who have been inordinately affected, for example high school and university students. This process of returning to being in person involves a high level of anxiety. I think that hospitals and health-care organizations have an important role in establishing a presence within school settings to deliver supports. Health-care organizations have a concentration of expertise, but that age group tends not to come to the hospital because they’re generally healthy. This means there’s a chance to intervene at the community level through school engagement and partnerships with Public Health.

Dr. Karen Shin: That’s a big question. All the events mentioned are things that we feel very powerless against and are inundated with through our smartphones and social media. It brings this feeling of distress that universally connects us. The advice I have is coming back a bit smaller, moving away from the things that are so big and focusing on one’s own wellness. We all have to find ways to focus on our wellness and how can we work on improving it. There are ways that we can impact these big events, and we can find some agency in action that can help our sense of power. But other times, it’s looking at what you find meaningful in your life, the connections that are important and ensuring those are getting nurtured because that can help you feel engaged. As one person, we may not have a way to change certain situations. We can, however, spend time and make effort to take care of ourselves.

As a leader in your field, how do you prioritize equity and inclusivity in your day-to-day work, for your team and for your patients?

Dr. Mariam Abdurrahman: Our teams are multidisciplinary and one thing we do quite well is recognizing the richness of people’s diverse clinical backgrounds because that is what brings new ideas about problem solving to the forefront. We make a point of acknowledging different levels of training and perspectives as teams working together to create better solutions and improve patient care. The other thing we do as a team is talk about episodes of care and this often results in a discussion about psychosocial backgrounds and barriers that patients may face. These discussions help raise awareness and remind us of our responsibility to advocate for our patients in areas of exclusion and marginalization.

Dr. Karen Shin: We also have a very diverse complement of health-care providers and team members. As a leader, I strive to provide my team with the opportunity to have a voice and influence on the way programs in our department are developed. We try to incorporate the lived experiences of people to help drive the changes we make. It’s important to listen to the experience of racialized individuals, be aware of the challenges staff may be facing and bring it to people’s attention. In our clinical setting, sometimes people who are racialized may be targeted by patients and this can be an extremely stressful experience for staff. I try to create a safe environment for staff to talk about the challenges, share stories and come up with solutions for change.

Now that you are both in leadership positions, what advice would you share with the younger version of yourself if you could meet them today?

Dr. Mariam Abdurrahman: Don’t be afraid to speak up and share ideas that are a little out of the box. The configurations of the box never change if you don’t try and do something different. Be broad-minded, no matter what has been served to you. This is a necessary part of equity work. We keep talking about how we want a new generation of leaders that is very representative of the population we serve, but that can’t happen if there is no self-assessment. Challenge and remind yourself that with nothing ventured, nothing can be gained.

Dr. Karen Shin: I agree. It’s worthwhile to take chances, and even if sometimes you end up at a dead end, you’ll learn and grow from the experience. I also think mentorship is important as well. Looking back, it’s something you hear about and maybe pass off, but having someone who has gone through a similar experience and can share their advice with you makes a big difference.

Throughout my career, there has been a bit of a shift where I’ve seen more female and racialized individuals take on leadership positions. Having those examples and mentors allows you to imagine yourself in certain roles and inspires others to pursue these goals.

This interview has been edited and condensed.

By: Jessica Cabral