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A New Program for Racialized Young Adults
Black folks, Indigenous folks and other people of colour face unique challenges with regard to mental health. This month, Stella’s Place launched a new co-designed 12-week Dialectical Behaviour Therapy (DBT) program for racialized young adults. This program consists of both group meetings and individual counselling sessions run by two clinicians and a peer supporter from that community. It is funded by Toronto Public Health and the Azrieli Foundation. This group is one of several new programs aimed specifically toward the BIPOC (Black, Indigenous, and People of Colour) community and is already seeing success.
Dialectical means “the existence of opposites.” In DBT, participants are taught two seemingly opposite strategies: acceptance (i.e., that their experiences and behaviours are valid), and change (i.e., that they have to make positive changes to manage emotions and move forward). DBT combines cognitive-behavioural techniques with mindfulness practice to help participants be more aware of the present moment, better identify and cope with unpleasant emotions, and communicate more effectively.
Barriers to Access for the BIPOC Community
Julian Waithe, a clinician at Stella’s Place and a co-facilitator of the BIPOC DBT group, noticed that the groups that were forming at Stella’s Place were much more homogeneous than Toronto’s population is. For many reasons, racialized young adults face increased barriers to treatment. Often services are hard to find and when they do find them, those services are not made for them. According to the Black Health Alliance, Black Canadians see twice the wait times than people of European descent do in Ontario. They are also less likely to see a family doctor regularly, meaning they are less likely to be referred to services as white people are.
Vanessa de Souza, the clinical co-facilitator of this new group, says a huge barrier to accessing services is stigma:
“There’s so much stigma in our communities, mental health isn’t even recognized, there’s not even a word for it in some languages.”
Even when people do manage to find and access services, when they show up, it’s likely their providers and their peers don’t look like them, which feels alienating and isolating.
For Anmol Samson, the Stella’s Place Peer Supporter working with the BIPOC DBT group, this was exactly what deterred her from DBT groups in the past:
“I would sometimes see BIPOC folks in the groups I was in but, like myself, they would kind of keep quiet…I felt like things never really landed for us. Often the people who would leave the groups in the middle would be BIPOC folks. Seeing other BIPOC folks not sticking with it made me feel like I didn’t need to stick with it, either.”
It was clear Stella’s Place needed to start offering services specifically aimed at the BIPOC community to encourage help-seeking, promote access and make racialized participants feel safe and comfortable staying.
The Co-Design Process
As with all Stella’s Place programming, this group started with a co-design process made up of Stella’s Place staff and young adults. Julian and Anmol recruited and facilitated a co-design group of 13 young adults who met twice for two hours and shared honestly what their needs and experiences were in the mental health care system.
“Co-design went really well because people were showing up and they were so compassionate about doing this for themselves but also for other racialized folks in the community,” reported Julian.
Once the co-design process was complete, the team at Stella’s Place went to work creating this new group. Stella’s Place started to recruit participants by working with community partners, and the group quickly filled up. Notably, there was no wait list, which is almost unheard of for any mental health service in this city.
Pairing group sessions with individual counseling allows participants to translate group skills into their own lives and helps the facilitators personalize group activities towards the needs of the group. This feedback loop makes the DBT groups at Stella’s Place particularly effective. Another reason why DBT at Stella’s Place is so effective?
“Yes we offer DBT and the skills, but we’re also trauma-informed and we incorporate anti-oppressive practices as well as anti-racist practices. Because it’s a bit more flexible, we can really talk about how folks are in this group, how their identity or their social location has really impacted their mental health and the intersection of these things,” explains Vanessa.
When asked why start a DBT group, Julian said simply, “Because it works.” Dialectical behavioural therapy has been a popular offering at Stella’s Place for many years. However, like many other evidence-based practices, DBT was created for and by people of European descent and many racialized people have found that sometimes the practical advice given in these groups didn’t translate to their own lives.
Julian elaborated: “To be taught skills that are taught for a certain population or come from a certain demographic, that skill might not translate as easily for someone from a racialized background because there’s stuff coming up with family or you can’t practice that skill in front of mom or dad because that’s frowned upon, perhaps, in my culture.”
Anmol had that exact experience when she tried DBT: “I always went to DBT and I was always resentful in the sessions because—how can I do this in my life? How was I supposed to apply these skills in my life, they don’t seem like they’re for me. That’s why I quit so many DBT groups.”
For example, the concept of ‘mindfulness’ has been heavily “capitalized and commodified by Western Society,” Vanessa adds and says many of their members feel alienated from this concept or don’t know how to incorporate a mindfulness practice into their own lives. She shared an anecdote from a client who felt alienated by the discourse around mindfulness until they shared with Vanessa that their family, who originally came from Ethiopia, used to have a coffee ceremony in which they would sit down together and drink coffee while they shared and reflected on their days. This, Vanessa suggested, was a mindfulness-based practice that was culturally-specific and approachable for that client, but wouldn’t likely be found in any DBT handbook.
The First BIPOC DBT Group at Stella’s Place
By all accounts, the group is doing incredibly well so far. Retention and engagement are high. Participants fill out feedback forms after every session and groups members are saying that it feels amazing to look around and see other people who look like them, that the material feels relevant, that there is a sense of safety, and that there is a high level of comfort and rapport in the group already.
Of course, this group is all virtual. Julian thinks DBT is especially relevant during COVID because of its focus on interpersonal connection during a time of isolation:
“Especially during COVID, there are very concrete [DBT] skills that can work across races…skills that we already have done in the past that maybe we stopped doing and maybe we need to get re-connected with.”
Both Julian and Vanessa spoke to the benefits and disadvantages of facilitating a group online: an online group takes more preparation and misses human connection but it is also more accessible to folks who might not have had the time or means of getting to Stella’s Place three hours a week.
Despite some of the difficulties of running a group online, this one is working. For Anmol, this is why she applied to work at Stella’s Place two years ago; she wanted to give support to her community. Now that she’s able to be a part of this group, she feels energized:
“Wow, I’m actually doing something that actively works within the system but is also pushing the boundaries the system has put us in…I [am] reaching and impacting people who were really needing it, of course everybody needs it, but often people who really need it are not remembered. It is a really moving experience.”
The BIPOC DBT group is not the only new program at Stella’s Place for racialized young adults. Stella’s Place is also launching a BIPOC Drop-In Support Group this Spring.
The story of this group is not unlike the founding of Stella’s Place. Donna Green looked for appropriate and specialized care for her child and could not find it offered in Toronto or anywhere else in Canada. Similarly, BIPOC folks have looked for appropriate and specialized care and have not found it offered, either. Stella’s Place was founded to fill a gap in mental health care and is continuing to do that.
This group is a huge step toward filling a gap in care for racialized young adults. Julian thinks that “we’re on the right track.” When asked what they’d like to see next, Anmol and Vanessa both said they want to see more. More services for BIPOC folks, more acknowledgement of their needs and lived experiences, more outreach, more funding, and more access. A key tenet to DBT is that you’re doing your best and that you can also do better. Here at Stella’s Place, we’re doing our best and we’re also trying to do better.