Executive Summary

The mental health of rural Saskatchewan women is threatened not only by gaps in the provision of mental health services, but more importantly by the social and economic conditions of being female in a rural setting. In Saskatchewan, women with mental illness can experience not only the social isolation and stigma of mental illness but practical considerations related to access to fewer services, especially specialists, and particular needs related to geographic distance and transportation.

The Senate Standing Committee on Social Affairs, Science and Technology Report on Mental Health, Mental Illness and Addictions, Out of the Shadows at Last¹ extensively documents the needs and potential direction for meaningful change in mental health services "to help bring people living with mental illness into the mainstream of Canadian society".² This paper analyzes the Highlights and Recommendations of Out of the Shadows at Last with a gender-place lens focused on women living in rural and remote areas in Saskatchewan:

• to draw out the references that would strengthen the response to their needs, and
• to point to gaps not acknowledged in the report.

• Choice: Lack of transportation, bad roads, travel costs and finding child care or respite care restrict the "choice" of travelling to another community or city for services. The small number of doctors and mental health practitioners limits choice for women who would prefer a female practitioner, and lesbian women seeking professionals with whom they can have a safe and comfortable relationship. Other populations, for example Aboriginal (including First Nations, Métis and Inuit women), immigrant women, or women with disabilities, also need mental health support that recognizes their particular needs and culture.
• Community: In communities where services are reduced by distance and small population bases, community support must be developed through coordination and creative deployment of available formal and informal resources. Their community can be a strength for rural and remote women in providing social support, but can also be a burden due to lack of privacy and stigma and lack of understanding about mental health.
• Integration: Integration of physical and mental health services can happen more naturally in communities with a small number of health practitioners and other professionals who talk to one another. Privacy legislation can work against information-sharing across disciplines and between services. Particular difficulties arise when services are obtained in another community without communication with the family members, doctors, home care workers and other team members in the home community. Rural and remote women also face the constant change in the service personnel that prevents continuity of care and trust-building.

1. Continue efforts to address the underlying causes of stress and poor health for rural and remote women: farm economy, poverty, Aboriginal issues, family violence, balancing work-family-community responsibilities, and the need for inter-generational connections and cross-cultural understanding.
2. Provide locally-based mental health services to enable people to continue to live well in their home communities, such as local community health workers, peer support groups, respite care and other support for care-givers.
3. Provide housing with supervision and support for people with mental health needs, enable home ownership in small communities where this is the norm, and improve housing both on and off reserves.
4. Implement telemental health for psychiatry and psychology services and continue support for the Farm Stress Line and mental health counseling on the HealthLine, balanced with in-person services.
5. Provide better training for the RCMP in understanding and handling mental health crises.
6. Orient services to meet the needs of seniors, children and youth, First Nation, Métis and Inuit people.

1. As a first step, establish and fund the Canadian Mental Health Commission with the mandate to develop a strategic plan with timelines and budget to implement the recommendations of the Standing Senate Committee on Social Affairs, Science and Technology, Out of the Shadows at Last, by Senators Kirby and Keon.
2. Use gender-place-culture lenses in all programs, services, and activities reviewed, initiated and maintained to serve the specific needs of women and men who live in rural, remote and northern communities with respect for the culture, race, and identity of all persons.
3. Evaluate the effect of any policies and services on rural, remote and northern women. Further, more detailed, work should be done on a gender-place analysis of the Kirby-Keon report and other policy and planning documents.
4. Emphasize the determinants of health approach to address factors affecting health including income, housing, social supports, education and literacy, healthy childrearing, community environments of gender and culture, as well as adequate and appropriate health services. "Health policy is more than health services." ³
5. Involve rural, remote and northern women, including Aboriginal women in the planning, management and evaluation of programs that have an impact on their lives, their families, and their mental health including the proposed Canadian Mental Health Commission and Initiatives.
6. Empower and value women in their roles as consumers of mental health services, family and friends of people with mental illness, unpaid caregivers, formal caregivers and professionals in the mental health field, policy makers and management, community and political leaders. In these often overlapping roles, they deserve personal and community support including recognition of their contribution and their right to influence and set policies.