May 1, 2023 • 38 mins
Some experiences are so profound they leave a lasting mark, shaping who we are and who we become. For retired Lieutenant-Colonel Stéphane Grenier, his time in Rwanda as a member of the Canadian peacekeeping team was just such an experience.
Stéphane’s personal experience with psychological injury became fuel for a career-long focus on improving mental health in the workplace. He’s left a big mark on the field of workplace mental health, championing the critical role of peer support and the urgent need to change workplace culture.
Contact Stéphane Grenier: https://stephanegrenier.com/
Contact Dr. Diane McIntosh: Website
More Episodes: Website
Please make sure you subscribe, share and comment. If you have a topic or guest suggestion for Dr. Diane, please reach out to Pod@drdianemcintosh.com.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
We can crowdsource human benevolence from within your existing organization.
And by the way,
all these people are already on your payroll.
They exist,
they show up and all you need to do is give them an opportunity to be part of the solution and allow them to pay forward in a safe way.
And if you build it,
they will come.
(00:22):
I'm Dr Diane McIntosh.
And this is Wicked Mind.
Today,
I'm talking with retired Lieutenant Colonel Stéphane Grenier.
Stéphane's story is a powerful one.
He served in the Canadian military.
And in 1994 he went to Rwanda as a peacekeeper during the genocide.
When he returned,
he realized that he was broken or at least his brain was.
(00:45):
And that was when he began the journey of turning his personal pain of ptsd into changing the mental health culture in the Canadian military.
I learned today that he coined the term Operational Stress Injury.
And like him,
this conversation is very special,
honest and raw.
Stéphane has you unique experience of war trauma.
(01:06):
And what he has done with that experience is what we're focusing on.
Today.
We talk about how you can sprain your brain psychological injury.
What is trauma and changing workplace culture?
And we talk about courage.
I think you're gonna love this conversation.
I remember that I was trying to figure out what it was that we met.
(01:28):
It was sometime in the late 90s or early 2000s.
I was working for the Canadian military as a civilian in one of the first operational stress injury clinics in Halifax.
And it's definitely when I first learned as a psychiatrist about the impact of peacekeeping on some of our military members.
(01:50):
And,
and I think most Canadians were learning at that time as well about the story of General Romeo Dallaire who was in Rwanda.
But really,
I don't think people understood that peacekeeping is not just keeping the peace,
there's a lot more to it and people are exposed to potentially really horrifying trauma during that experience.
(02:11):
And Stéphane your own mental health journey started in Rwanda as well.
Ultimately,
you were diagnosed with PTSD.
Can you talk a little bit about that,
about your journey?
Right.
So like many people,
I think my journey,
I've referred to it as the first day of the rest of my life.
I was on standby to go to Haiti.
(02:33):
And I remember the Deputy Chief of defense staff turned around and says,
Grenier,
aren't you?
French said,
yeah,
I said,
get yourself over to Rwanda and I left on a Friday and maybe 48 hours later,
I was on the ground and of course,
we knew what was going on over there from a distance,
but from the comfort of our own homes,
it's always a little different,
right to see everything in two dimensions with no smells and all that.
(02:55):
So,
you know,
arriving in Rwanda for me was,
you know,
the first day of the rest of my life.
Not that I knew that at the time,
but I know that now and the trajectory my life took in that 10 10.5 months.
I was,
there was really interesting because it was,
when I look back in hindsight,
it was a very gradual mental health decline to the point where,
(03:20):
um and here's the thing,
you know,
when your brain is not,
well,
the very part of the human anatomy that will tell you you're unwell,
is unwell.
You know,
that's the irony.
So as I look back as I was encountering all these situations,
my mental health was declining.
(03:41):
I wasn't aware of it.
And when I came back,
the clinical system was focused on those incidents that should otherwise have broken me.
Those were not the incidents that broke me.
So when I was in therapy,
we would talk about the boy who was shot beside me.
(04:02):
We would talk about me being stuck in a minefield.
At one point,
we talked about me having an AK 47 stuck in my face,
right?
Which traditionally would be seen as well.
That was traumatic.
It's very interesting to me because that is not what was keeping me awake at night.
What was keeping me awake at night was being so morally twisted into pretzels through the conflict inside me of how can human beings do this kind of stuff?
(04:33):
Of course,
none,
none of that was pleasant,
but I wasn't necessarily waking up with clear,
clear,
clear flashbacks of an AK 47 shoved in my head or when this guy cocked his rifle,
which is sort of the John Wayne thing,
modern society people.
So you were at war,
I was the shoot or get shot at.
(04:54):
Well,
there's a lot more perverse things happening in war or bad stuff than what we see kinetically,
right?
So what I find interesting is that we never focused on those things.
And which is why when I wrote my book after the war,
I think I ended my book by saying,
I don't think I have PTSD.
I think I have the largest darn moral injury that one could ever,
(05:17):
you know,
and I remember at the time talking about this and again,
doctors were saying there's no evidence that the brain is injured,
you know,
and lo and behold now there is,
right?
We know that the brain changes,
right?
But all this said,
you know,
it's that little girl,
you know,
with obviously a machete blow to the head and,
you know,
and I wasn't able to,
you know,
(05:37):
look at my own daughter's sleep for years.
You've been thinking about it now.
Right.
But is that trauma?
I don't think so.
It's conflicting because you realize how bad people can get right now.
One would say,
well,
that's trauma.
Well,
I think now it's not trauma.
I'm not,
(05:57):
I'm not afraid of that.
I'm just so that 10.5,
11 months put me and not hundreds but close to 100 situations which are bad days at work.
Some of them were traumatizing but those,
it's not that they're fine,
but it's,
it's okay.
(06:18):
My military training kind of took care of that.
It's the dark side of humanity that really took a toll,
right?
So that makes any sense.
Of course,
it didn't happen exactly this way with these words,
but I'm gonna kind of paraphrase this.
I mean,
you may remember that in 1999 2000 is when I was sort of given a mandate to give something new a try,
(06:42):
right?
Uh this three star general general who was an infantry uh person,
you know,
so,
so,
so outside the box,
he's the one who provided the soil for me to see.
So the seeds of innovation really because if nobody supports you at the top and you can't get anywhere,
right?
So I remember early on,
(07:04):
I'm thinking I can't be calling this the P T S D peacekeeping program.
And by the way,
at the time,
it's not that I had a premonition there but I was thinking,
I don't know about this PTSD thing,
right?
And I don't know about this trauma thing.
Not everything I went through in Rwanda was traumatizing,
very upsetting and very unsettling.
(07:26):
But you know,
we have other words in our language that can describe not so fun days at work.
And for some reason,
even today,
Diane,
everything has become trauma.
You're either having a good day or you're traumatized,
nobody's ever upset anymore or just disturbed,
right?
But back to what I was going to share is I coined the term operational stress injury,
(07:48):
as you remember.
And at the time of coining that term,
I remember being pulled into some meetings with the head of psychiatry.
One of the people in the surgeon general staff,
basically,
what they were saying is you can't invent a term.
And I said,
well,
I just did and then they said,
well,
who the hell are you?
And I said,
well,
who the hell are you?
It wasn't like that.
(08:09):
Of course,
I'm making light of that now.
But I remember having to tell clinicians,
this is not a term for you.
It's,
it's a term for the culture so that we,
the lay people can wrap our minds around the notion that the brain is not immune to injury or illness.
And that,
you know,
these things that we go through as human beings can be quite unsettling and A bit like a sprained ankle.
(08:32):
And now we know,
you know,
24 years,
22 years later,
we know,
you know,
the yellow,
the orange,
the red.
And often we make the analogy of it's,
I sort of talk that way,
you know,
you can sprain your brain,
you can't literally sprain your brain,
but it's like a sprained ankle.
And so we talk like that now,
but I remember back then had to sort of argue,
(08:53):
you know,
and say,
well,
I just did and it was shocking to me that and no offense to,
you know,
mental health professionals.
But I remember coming home one night thinking these mental health clinicians,
they have long feet.
And my spouse at the time said,
what do you mean?
I said,
well,
everywhere I go,
I'm stepping on toes,
it's like they're so territorial,
(09:14):
right?
For good reasons,
of course.
But yeah,
those were interesting days,
Diane,
for sure.
I look back now and I find the humor in it,
but at the time,
I did not have a sense of humor,
of course.
Right,
Stéphane,
I think our toes need to be stepped on.
And that's the whole idea behind this conversation is that there should be no sacred cows as we try to approach these problems.
(09:36):
You know,
I didn't realize that you were the person who coined the term "Operational Stress Injury".
And it's such an important term because of the fact that when you're exposed to traumatic events,
PTSD isn't the only outcome that people,
if they have a mental health outcome and the number one outcome is nothing that people recover,
(09:57):
they move through it.
But if you do become ill related to a trauma related experience,
that could be depression,
anxiety,
substance use PTSD.
So there's talking about being injured by an operational experience is I mean,
that was incredible that you came to that idea because I know when I was going through residency,
I didn't learn anything about PTSD.
(10:18):
I learned about this by working with military members and finding out that everyone's journey through.
This experience is unique as is trauma unique.
When I was working for the military,
I was part of a panel for veterans affairs and they were talking about how they used to write on the files of military members who they believed had PTSD L M F which stood for low moral fiber.
(10:46):
So we're talking about a system that you're working in where you're getting better care.
Although people were labeled and we know all the labels that happened within the military.
You were getting better care for your PTSD at a time when they didn't even have PTSD clinics because I was there at the beginning of the opening.
(11:06):
We're not getting care now.
And I know that your story of today is the story of every day for,
for my patients,
but also for the people that I work with and for family members who are trying to access care.
The system is broken.
So that's my next question is around working in a system like this where people were labeled as having low moral fiber.
(11:29):
It's pretty brave to stand up and say,
hey,
this is not right?
Where did that come from?
Where did the courage come from?
To say,
I want to make a difference.
I want to change things.
And this is bullshit.
What's happening?
How do we change it?
Right.
I don't think it took any courage at all.
I think I was just given an opportunity to do something.
So in a sense,
(11:50):
it's not courage,
it's really a blessing.
And I remember early on,
you know,
convincing this three star General that we got to do this,
we just gotta bring some leadership and a couple of rules and some boundaries to this.
If not,
we're just letting our people to their own and it's going to be disastrous,
which it was already,
right?
So I appreciate the confidence you have in me.
(12:11):
But I just think I don't know how I would live my life today without bringing my little thing for the benefit of others,
right?
And I know it makes a difference,
but it's a blessing every time we have an opportunity to help somebody else.
I got to tell,
we launched a phone service at the provincial level in a,
in a provincial health care.
It's,
it's actually announced by the minister.
(12:32):
So it's in Nova Scotia.
So where you started out with the N D,
right?
And I gotta tell you every day,
I'll spot check a couple of these contact notes.
These are contact,
there's no names.
Everything is just to understand what kind of colors called in.
There's no,
there's nothing,
there's no name.
Everything is de identified,
no phone number.
But when you read about a person who was just diagnosed with cancer,
(12:54):
terminal cancer,
they got six months to live,
they got nobody to talk to because they have no family and they call the 1 800 line to have a human connection.
Jesus.
You know,
I mean,
yeah,
so not courage opportunity.
I would say,
well,
I might argue with you a little bit on the courage front because I think what you said there was very important trying to talk a three star General into something that they don't believe in,
(13:22):
especially in an organization that is so hierarchical as the Canadian Military or any military organization.
I'm sorry.
But that does take courage and especially when you're struggling with your own mental health at that time.
Right?
And so here's the funny thing Diane,
the people who were blocking me were not the leadership,
(13:42):
ever,
ever,
ever.
I remember meeting the army commander at the time,
the commander of the Canadian Army because he said,
what are you doing there?
So we met and at one point I said to this other three star General,
I said,
I'm sorry,
sir.
But you are abdicating your responsibility to your women and men in uniform by just telling them go to the clinic,
(14:03):
mental health in the workplace is a leadership issue.
It's not a doctor issue when the person becomes sick,
go see the doctor,
but the leadership is failing our people.
Right.
And then I thought,
oh boy.
And he said,
Stéphane,
you're absolutely right.
I don't remember getting placated even by a leader,
a leader in a position of authority who could have,
(14:25):
you know,
let me guess,
don't say Stéphane,
I want to guess it was the leaders within the healthcare organization that were the barriers and especially the mental health leaders who were saying no,
no,
no,
no,
absolutely.
Back to my analogy.
Long feet.
Everywhere I go,
I,
you know,
I step on toes and I'll tell you,
you know,
when I launched the peer support program,
(14:46):
you may not know this story.
But before you know,
the program was launched,
I had to validate a few of my ideas,
right?
And that's how the program kind of started.
I talked to two patients and the two patients.
That's a freaking good idea.
I think we should do that.
Right.
And I went okay,
we're gonna do it.
(15:07):
But,
you know,
it's kind of funny because I pulled patients away from the doctors.
You know,
these patients were arguably very,
very ill in the eyes of the medical system,
but such a valuable asset to the institution but we had written these people off as just patients,
(15:28):
they were human beings,
they had so much to offer,
they had so much wisdom.
Right.
So anyways,
yeah,
absolutely,
the mental health medical system was definitely getting in the way of business,
but not the leadership,
not the culture,
the culture actually welcomed this,
but the mental health system didn't want to have it.
Can you talk about peer support and what makes it powerful and why it has to be designed in such a way,
(15:58):
are delivered in such a way to protect everyone who's participating and maybe you disagree with that.
But in my mind,
I want to make sure that the people are,
that are participating in peer support also don't take on other people's own weight and own illness.
And so there's training that's really important in having an effective peer support program.
(16:20):
Can you talk a little bit about that?
Right.
And I'll start by telling you that yes,
training is important,
but it's the least of my worries ever.
We've launched dozens of these large scale programs.
Training is the easiest piece ever.
The other important pieces selection.
And we say everyone in my company says,
if you don't select the right people,
(16:41):
you can't train a peer supporter.
The peer supporter has to have,
we,
we count around 66 behavioral indicators that must be sort of omnipresent in the person's,
you know,
sort of ecosystem there to actually match itself with the training,
if not,
the training is not gonna stick.
Right.
So often we're approached by an organization,
(17:02):
you see how we have a program here,
we'd like to do some training.
Can you train us and said,
well,
yes,
we can.
But unless we can read your policies,
understand your procedure,
especially your recruitment procedures,
we can't guarantee the outcome of training because we don't know who you're bringing into the room.
Right.
And so it takes a lot of elements in my book anyways to do this.
(17:24):
And if you get it wrong,
it's not going to be good words matter as you know,
of all people,
you know,
if you're supporting somebody with a broken leg and I'm a bit of an idiot and I tell you stupid things.
Well,
no words,
I say the words now the actions you might take afterwards might re injure you.
But my words will not re injure your leg in the cast,
(17:45):
right?
But in mental health it matters.
So,
So I think today in 2022,
there are so many organizations that are throwing themselves into this,
this cacophony of peer support,
which to us is our greatest,
greatest enemy because so many people experience peer support,
but they experience a bad version of it.
(18:05):
And then they say,
Oh,
no,
no,
no,
no,
we can't get into that.
Right?
So it's,
it's delicate and I'm glad you're raising the question because this is serious stuff.
We're not the only ones who do it well by the way,
but we do it really well and it either deserves to be done well or not at all.
You know,
I first learned about the power of these sexy topics was with critical stress debriefing,
(18:27):
right?
Where all of these companies got involved in critical stress debriefing.
Something terrible happened in a workplace and the company would come in and do this work.
And then after gathering data over many years,
it turns out that doing critical stress debriefing can cause PTSD the exact opposite of what's supposed to happen.
(18:47):
So we started this conversation talking about,
you know,
there's no science to say this works.
We do need science to show,
but that doesn't mean we don't try anything,
right.
Ultimately,
you have learned how to do this.
Well,
over time,
there is a value to science,
but science should not be a barrier to trying new things.
(19:07):
And that's this is I think what you came up against.
Well,
Diane,
if I can be very blunt,
Despite the fact that what you just said is 110% accurate.
If you made a pile of evidence,
you know,
to show do you do harm or at best no results,
you know,
with critical incident stress debriefings,
(19:28):
the pile would be I don't know,
three ft high.
The pile of evidence that says that critical incident stress debriefings is positive is maybe seven inches high despite all of that evidence.
I would say that over 80% of first responders organization in this country continue to do debriefings.
I'm working with a law enforcement organization today that continues to do this because there's nothing else.
(19:51):
So,
in fact,
there's so much compelling evidence to say,
stop doing this,
but they're not stopping,
they keep doing it because I think they don't know what to replace it with.
Therefore they keep doing it.
And I find that really bizarre because if,
you know you're doing harm,
at the very least,
you neutralize it,
you stop doing it right.
And to make matters worse,
(20:12):
if you'll allow me in Ontario here,
we have the PTSD legislation which presumes the presumptive legislation which presumes if you are a first responder,
like a law enforcement officer and you have PTSD,
it's presumed to be connected to the job.
Therefore,
you know,
workers compensation will support you.
And I'm thinking since when do we legislate on actual diagnosis?
(20:37):
That's like me.
I own a window washing company.
Diane,
I have 73 workers,
workers compensation supports my employees if they become disabled,
falling off a ladder.
As long as it's a broken leg.
If they break their arm,
they're not compensated.
In other words presumptive,
what do you mean?
Presumptive?
Just ptsd?
What if the law enforcement has depression?
(20:59):
So now the byproduct of that is that you have first responders who are meeting doctors like you.
The doctor says,
ah,
you got depression and the law enforcement for or the first.
No,
no,
don't give me depression.
I don't want that one.
I want ptsd.
And so,
you know,
the,
the,
the unintended consequence of good intentions.
(21:20):
There you go to me.
It's completely ridiculous.
And this is 20,
Right?
I mean,
this is absolutely ridiculous and especially,
and it's a whole other discussion around the fact,
something you said earlier,
which not everything is trauma and we use the word trauma,
you know,
just throw it around so casually,
you know what trauma is and trauma is however very subjective,
(21:43):
each individual has a different experience with that.
But again,
not every outcome of exposure to traumatic events is PTSD.
In fact,
most people don't have anything as an outcome,
they are able to manage that situation one way or another,
but there are other things That can happen.
(22:03):
So you started your company mental health innovations in 2012.
And as I understand,
this is built on technology services that help organizations not just to change their culture,
but to sustain that change.
And it's hard to change culture.
What are some of the big barriers that you face when you're talking to a new company and trying to help them to look at their culture and create change from a mental health perspective.
(22:32):
right?
So I came up with the,
I think it's on our website somewhere,
but I wrote a piece or there's a piece about the three buckets.
Let's say your potential client Diane said,
yeah,
we heard about your services.
What can you do for us?
I'll say,
well,
which bucket are you in?
There are three workplace mental health buckets.
Bucket.
Number one is the events bucket,
(22:54):
the committee bucket and the poster bucket.
And essentially we have committees.
We want to put out a new pamphlet,
will have a new 1 800 line,
right?
So this is like the event bucket,
right,
where we're going to be seen at doing something.
And by the way,
all of this is not bad.
Yeah,
you need committees and all that,
but some organizations get paralyzed in that work.
So the second bucket is really the bucket of belief that it's mental health and really the only thing that can be helpful our clinicians and you know,
(23:22):
Diane,
I'm very for clinicians.
In fact,
I take my happy pills every day.
I'm treatment compliant.
I'm,
you know,
I'm for clinical care,
right?
I'm for all of that.
But some organizations,
the culture is mental health equals doctors,
more doctors,
more psychiatrists or psychologists.
And I'm thinking that's good.
(23:43):
But that's the second bucket.
The third bucket is our bucket.
And the third bucket is really about change the narrative,
changing the narrative.
So,
you know,
nonmedical narrative,
a human narrative,
de medicalized narrative,
right?
And I told this to tend to a CEO of a very large organization two months ago,
(24:07):
they have 100 and 63,000 employees across Canada.
The CEO is meeting in Toronto with his C suite.
And I told the CEO I said,
you don't matter,
you have to understand.
You do not matter what matters for your employee on the shop floor is the employee 15 ft away from her or him.
Because as a layperson,
(24:29):
I don't need to know if Bob 15 ft away from me has bipolar or depression in order to muster the courage to lean in as opposed to to walk away,
lean in without judgment and say,
hey,
Bob you okay.
That person 15 ft away from your employee today is gonna make or break that employee with a look,
(24:52):
look of judgment.
Where the hell were you?
I had to do double shift for you this morning.
No empathy judgment because that's what Homo Sapiens do.
We judge,
we were incapable of bringing the empathy we have for family and friends and relatives into the workplace,
right?
And so I said,
of course you're mad or boss,
(25:12):
you're the CEO,
right?
But at the end of the day,
how you think about mental ill health in your workplace today?
This minute is less impactful than how your frontline employee thinks 15 ft away from that employees struggling because you know,
single,
you know,
mother trying to make ends meet three kids,
(25:33):
one is sick and all that and she's late,
the grief she's going to get on the shop floor is part of her undoing right now.
Anyways,
I went off on a tangent.
But ultimately,
you know,
that's what I think.
So,
I want to unpack two pieces of that.
Both I think critical points.
The first one was about humanizing,
(25:53):
de medicalizing,
making it a human narrative.
I 100% agree with you that the dia This matters actually less and less to me.
I more focus on what are you experiencing and how can I help you to manage those symptoms so that you can function,
that you have your quality of life back?
(26:13):
And we know that human beings care most about their quality of life.
Am I able to do the stuff that I want to do?
So,
I think you're 100% correct.
I wonder if there's a balance there though stuff around helping people to actually believe that these disorders are real that their brain disorders that,
you know,
(26:33):
depression is actually it becomes an inflammatory illness.
This is a real disorder just like rheumatoid arthritis or a broken leg.
And you know,
you,
I know I've heard this more often than I have the number of military members I heard say,
geez,
I wish my leg had been blown off.
At least people could see,
right?
My injury,
right?
(26:54):
And there's still that lack of belief.
So that was the one thing,
is there some balance there in what you're saying?
Yeah.
So I'll push back.
I say it doesn't matter.
And the proof's in the pudding when we set up the joint speakers bureau Suzanne Bailey and I years ago to pivot the culture inside the military of all those disbelievers,
those those hard soldiers that didn't believe there was not an ounce of clinical narrative.
(27:19):
It was all based on the credibility of speakers,
like minded people who were able to do education in an evidence based way and say nothing that goes counter to what the evidence says,
de medicalize the whole thing,
Increase emotional resonance for the audience so that they could relate.
(27:41):
And here's the thing is when you put in the military,
when you put a warrant officer,
infantry guy in a classroom of 30 aspiring leaders and articulate these issues from an ex experiential perspective,
reach some emotional residents and actually pivot the non clinical mind because,
you know,
quite frankly,
(28:02):
you know,
how many times have I heard psychiatrists,
you know,
and medical people present to a lay audience to say here's the Amygdala in the brain,
right?
Well,
it's very interesting,
it's factual,
but I don't know that that matters as much as some person sitting in the room.
But I think we underestimate the value of emotional resonance and the ability to connect at the core from the gut,
(28:27):
not the brain,
right?
So that's my view.
I totally agree with you.
Okay.
Those are the stories that stick with people that,
that create change that emotional resonance.
I guess my little gent until push back on that is they're talking about their symptoms.
So they're making it real.
They're using the term eating disorder or my mood was all over the place or I can't sleep or I,
(28:51):
so I agree.
I don't care what the label is.
What I care about is how does it feel to be in that situation?
This is real.
I can't do my job.
I couldn't do X Y or Z,
I couldn't parent,
I couldn't work.
I couldn't be a partner.
So I think we're saying the same thing you're coming at it from creating that emotional resonance.
(29:15):
And that's the thing that people take home.
They remember that guy standing up there saying I have panic attacks and it's not a pity party either.
It's not at all.
Well,
you're not the guy that pulls out the pity in people.
You get people going.
And so it's interesting that you mentioned and that's the part two I wanted to follow up on is saying to the CEO they don't matter.
(29:38):
And I agree with you.
It's the person you're working with that that cares or the person that you're working with that doesn't care.
And you've added more to their load because you're off.
And so you feel like I'm,
I'm adding to this burden and they hate me more for that.
But does change come from the top?
Does the CEO have to buy into it to create that culture change.
(30:01):
Absolutely.
100%.
100%.
That's step.
Number one.
How do we pivot the leaders to say I didn't see it that way.
Okay.
Now I get it,
let's do it differently.
Right?
And so we feel at M H I that people are stuck in one of the two buckets and they don't even see that there's a third bucket alternative,
(30:22):
right?
Rare are the C E O S or C Suite people that after we spend time with them aren't interested in learning more about the third bucket.
But to your point step,
number one is get your senior leadership engaged to be interested in the third bucket.
But once the leaders engaged,
(30:43):
I think leaders need to get out of the way and let the culture take over.
And in fact,
leaders need to surrender the outcome a little bit.
And when it comes to mental health,
we firmly believe that it has to be built.
Once the leader says let's do this gang,
the leader needs to empower its culture to say,
you tell me how we pivot this culture and I will follow your lead as long as it makes sense.
(31:08):
So yeah,
that's the third bucket is an interesting bucket to work in.
For sure.
I want to understand from you.
Your thoughts on what we do with these crazy lineups.
We can't access clinicians.
Do you have any thoughts on removing barriers to clinician access in Canada right now?
(31:29):
Do you think that there's anything that we can do that could have an immediate impact 100%.
And I think the reason why the lineups are so long is because everyone who's unwell is going to line up for the doctors in some cases right now.
You know,
some people ask me,
you know,
I've been caught saying,
thank God for stigma.
(31:50):
The lineups are long enough.
Now imagine if we eradicated stigma tomorrow morning,
how long would those lineups be?
Because there's no alternative.
There's one door,
it's the medical door,
right?
And I'm not saying that peer support replaces doctors.
Absolutely not.
However,
it can help descend gorge the system a little bit because not everybody who is going through a hard time is traumatized or diagnosable with some condition that needs intense treatment.
(32:19):
But right now,
there's really no alternative.
The problem is such that we have to elevate mental health care to where it belongs and take it out of the shadows and make it mainstream,
which is why I tell my clients,
I am not ashamed at all to charge you guys top dollar to implement stuff because this is valuable services.
(32:40):
And so absolutely,
we can help this engorged the system.
And the research shows four pointed to one return on investment in the U K,
right?
When implemented properly.
If it's implemented,
not,
well,
you're not going to see those returns.
And by the way,
here's a little anecdote and during the pandemic are peer supporters who work inside inpatient units before the pandemic were sent home during the pandemic.
(33:04):
You know,
a couple of weeks later,
the clinical team,
we're calling the government say call em H I,
we need,
we need these peer supporters back.
We are not enjoying the same health outcomes that we did before peer supporters in your car's full PPE back in the health care system.
That's a healthcare system that actually is pivoting,
(33:25):
right?
Meanwhile,
in,
you know,
across the rest of the country,
it's,
it's a shame because there's such great power in humans,
but we're not tapping into that yet,
right?
So that's what I would say about that.
And it's well said.
Now let me ask you this and it's my last question.
(33:45):
If you had the CEO of Canada's largest company sitting in front of you,
what would you say to them?
What's the one thing that you'd want them to know or better understand within the context of that third bucket?
I would say them,
we can crowdsource human benevolence from within your existing organization.
(34:06):
And by the way,
all these people are already on your payroll,
they exist,
they show up and all you need to do is give them an opportunity to be part of the solution and allow them to pay forward in a safe way.
And if you build it,
they will come and you can't imagine the change it will have because now we're no longer talking about the one in five,
(34:29):
we are empowering the one in five to be part of the solution.
These are no longer invisible people.
You eradicate stigma by actually showing people that the one in five matter and they are an asset,
not a liability.
That's how you change culture.
Thank you.
It was such a pleasure talking to you.
(34:49):
All right,
same here.
Take care.
Bye bye.
Reflecting on my conversation with Stéphane.
I was so inspired by how he took his personal pain,
something so deeply,
life changing and was able to innovate to change a way of thinking in the Canadian Military.
(35:10):
As we know,
it is not easy to move an organization to change.
A culture takes bravery and courage.
Stéphane truly is courageous.
There were so many important pearls I took away from the conversation.
But something that really stood out for me that Stéphane stated so eloquently was that when your brain is not?
(35:31):
Well,
the very part of the human anatomy that should tell you you're unwell is on.
Well,
it's truly one of the greatest challenges associated with mental illness.
This conversation left me wondering how we we can replicate this kind of courage.
People like Stéphane are not afraid to challenge the norms and suggest a different path.
(35:51):
Even when faced with their own Brokenness,
we need more Stéphane in the world,
more changemakers,
more people with a vision where there are no barriers to good mental health.
I left this conversation feeling hopeful and I hope you did too until next time.
Thank you for listening.
The Wicked Mind podcast is a series of unique conversations with individuals that share experiences and perspectives on mental health care.
(36:19):
Together.
We will uncover ideas that inspire action.
Please make sure you subscribe,
share and comment.
And if you have a topic or guest suggestion,
please reach out to me at Dr Diane McIntosh dot com.
We can crowdsource human benevolence from within your existing organization.
And by the way,
all these people are already on your payroll.
They exist,
they show up and all you need to do is give them an opportunity to be part of the solution and allow them to pay forward in a safe way.
And if you build it,
they will come.
(00:22):
I'm Dr Diane McIntosh.
And this is Wicked Mind.
Today,
I'm talking with retired Lieutenant Colonel Stéphane Grenier.
Stéphane's story is a powerful one.
He served in the Canadian military.
And in 1994 he went to Rwanda as a peacekeeper during the genocide.
When he returned,
he realized that he was broken or at least his brain was.
(00:45):
And that was when he began the journey of turning his personal pain of ptsd into changing the mental health culture in the Canadian military.
I learned today that he coined the term Operational Stress Injury.
And like him,
this conversation is very special,
honest and raw.
Stéphane has you unique experience of war trauma.
(01:06):
And what he has done with that experience is what we're focusing on.
Today.
We talk about how you can sprain your brain psychological injury.
What is trauma and changing workplace culture?
And we talk about courage.
I think you're gonna love this conversation.
I remember that I was trying to figure out what it was that we met.
(01:28):
It was sometime in the late 90s or early 2000s.
I was working for the Canadian military as a civilian in one of the first operational stress injury clinics in Halifax.
And it's definitely when I first learned as a psychiatrist about the impact of peacekeeping on some of our military members.
(01:50):
And,
and I think most Canadians were learning at that time as well about the story of General Romeo Dallaire who was in Rwanda.
But really,
I don't think people understood that peacekeeping is not just keeping the peace,
there's a lot more to it and people are exposed to potentially really horrifying trauma during that experience.
(02:11):
And Stéphane your own mental health journey started in Rwanda as well.
Ultimately,
you were diagnosed with PTSD.
Can you talk a little bit about that,
about your journey?
Right.
So like many people,
I think my journey,
I've referred to it as the first day of the rest of my life.
I was on standby to go to Haiti.
(02:33):
And I remember the Deputy Chief of defense staff turned around and says,
Grenier,
aren't you?
French said,
yeah,
I said,
get yourself over to Rwanda and I left on a Friday and maybe 48 hours later,
I was on the ground and of course,
we knew what was going on over there from a distance,
but from the comfort of our own homes,
it's always a little different,
right to see everything in two dimensions with no smells and all that.
(02:55):
So,
you know,
arriving in Rwanda for me was,
you know,
the first day of the rest of my life.
Not that I knew that at the time,
but I know that now and the trajectory my life took in that 10 10.5 months.
I was,
there was really interesting because it was,
when I look back in hindsight,
it was a very gradual mental health decline to the point where,
(03:20):
um and here's the thing,
you know,
when your brain is not,
well,
the very part of the human anatomy that will tell you you're unwell,
is unwell.
You know,
that's the irony.
So as I look back as I was encountering all these situations,
my mental health was declining.
(03:41):
I wasn't aware of it.
And when I came back,
the clinical system was focused on those incidents that should otherwise have broken me.
Those were not the incidents that broke me.
So when I was in therapy,
we would talk about the boy who was shot beside me.
(04:02):
We would talk about me being stuck in a minefield.
At one point,
we talked about me having an AK 47 stuck in my face,
right?
Which traditionally would be seen as well.
That was traumatic.
It's very interesting to me because that is not what was keeping me awake at night.
What was keeping me awake at night was being so morally twisted into pretzels through the conflict inside me of how can human beings do this kind of stuff?
(04:33):
Of course,
none,
none of that was pleasant,
but I wasn't necessarily waking up with clear,
clear,
clear flashbacks of an AK 47 shoved in my head or when this guy cocked his rifle,
which is sort of the John Wayne thing,
modern society people.
So you were at war,
I was the shoot or get shot at.
(04:54):
Well,
there's a lot more perverse things happening in war or bad stuff than what we see kinetically,
right?
So what I find interesting is that we never focused on those things.
And which is why when I wrote my book after the war,
I think I ended my book by saying,
I don't think I have PTSD.
I think I have the largest darn moral injury that one could ever,
(05:17):
you know,
and I remember at the time talking about this and again,
doctors were saying there's no evidence that the brain is injured,
you know,
and lo and behold now there is,
right?
We know that the brain changes,
right?
But all this said,
you know,
it's that little girl,
you know,
with obviously a machete blow to the head and,
you know,
and I wasn't able to,
you know,
(05:37):
look at my own daughter's sleep for years.
You've been thinking about it now.
Right.
But is that trauma?
I don't think so.
It's conflicting because you realize how bad people can get right now.
One would say,
well,
that's trauma.
Well,
I think now it's not trauma.
I'm not,
(05:57):
I'm not afraid of that.
I'm just so that 10.5,
11 months put me and not hundreds but close to 100 situations which are bad days at work.
Some of them were traumatizing but those,
it's not that they're fine,
but it's,
it's okay.
(06:18):
My military training kind of took care of that.
It's the dark side of humanity that really took a toll,
right?
So that makes any sense.
Of course,
it didn't happen exactly this way with these words,
but I'm gonna kind of paraphrase this.
I mean,
you may remember that in 1999 2000 is when I was sort of given a mandate to give something new a try,
(06:42):
right?
Uh this three star general general who was an infantry uh person,
you know,
so,
so,
so outside the box,
he's the one who provided the soil for me to see.
So the seeds of innovation really because if nobody supports you at the top and you can't get anywhere,
right?
So I remember early on,
(07:04):
I'm thinking I can't be calling this the P T S D peacekeeping program.
And by the way,
at the time,
it's not that I had a premonition there but I was thinking,
I don't know about this PTSD thing,
right?
And I don't know about this trauma thing.
Not everything I went through in Rwanda was traumatizing,
very upsetting and very unsettling.
(07:26):
But you know,
we have other words in our language that can describe not so fun days at work.
And for some reason,
even today,
Diane,
everything has become trauma.
You're either having a good day or you're traumatized,
nobody's ever upset anymore or just disturbed,
right?
But back to what I was going to share is I coined the term operational stress injury,
(07:48):
as you remember.
And at the time of coining that term,
I remember being pulled into some meetings with the head of psychiatry.
One of the people in the surgeon general staff,
basically,
what they were saying is you can't invent a term.
And I said,
well,
I just did and then they said,
well,
who the hell are you?
And I said,
well,
who the hell are you?
It wasn't like that.
(08:09):
Of course,
I'm making light of that now.
But I remember having to tell clinicians,
this is not a term for you.
It's,
it's a term for the culture so that we,
the lay people can wrap our minds around the notion that the brain is not immune to injury or illness.
And that,
you know,
these things that we go through as human beings can be quite unsettling and A bit like a sprained ankle.
(08:32):
And now we know,
you know,
24 years,
22 years later,
we know,
you know,
the yellow,
the orange,
the red.
And often we make the analogy of it's,
I sort of talk that way,
you know,
you can sprain your brain,
you can't literally sprain your brain,
but it's like a sprained ankle.
And so we talk like that now,
but I remember back then had to sort of argue,
(08:53):
you know,
and say,
well,
I just did and it was shocking to me that and no offense to,
you know,
mental health professionals.
But I remember coming home one night thinking these mental health clinicians,
they have long feet.
And my spouse at the time said,
what do you mean?
I said,
well,
everywhere I go,
I'm stepping on toes,
it's like they're so territorial,
(09:14):
right?
For good reasons,
of course.
But yeah,
those were interesting days,
Diane,
for sure.
I look back now and I find the humor in it,
but at the time,
I did not have a sense of humor,
of course.
Right,
Stéphane,
I think our toes need to be stepped on.
And that's the whole idea behind this conversation is that there should be no sacred cows as we try to approach these problems.
(09:36):
You know,
I didn't realize that you were the person who coined the term "Operational Stress Injury".
And it's such an important term because of the fact that when you're exposed to traumatic events,
PTSD isn't the only outcome that people,
if they have a mental health outcome and the number one outcome is nothing that people recover,
(09:57):
they move through it.
But if you do become ill related to a trauma related experience,
that could be depression,
anxiety,
substance use PTSD.
So there's talking about being injured by an operational experience is I mean,
that was incredible that you came to that idea because I know when I was going through residency,
I didn't learn anything about PTSD.
(10:18):
I learned about this by working with military members and finding out that everyone's journey through.
This experience is unique as is trauma unique.
When I was working for the military,
I was part of a panel for veterans affairs and they were talking about how they used to write on the files of military members who they believed had PTSD L M F which stood for low moral fiber.
(10:46):
So we're talking about a system that you're working in where you're getting better care.
Although people were labeled and we know all the labels that happened within the military.
You were getting better care for your PTSD at a time when they didn't even have PTSD clinics because I was there at the beginning of the opening.
(11:06):
We're not getting care now.
And I know that your story of today is the story of every day for,
for my patients,
but also for the people that I work with and for family members who are trying to access care.
The system is broken.
So that's my next question is around working in a system like this where people were labeled as having low moral fiber.
(11:29):
It's pretty brave to stand up and say,
hey,
this is not right?
Where did that come from?
Where did the courage come from?
To say,
I want to make a difference.
I want to change things.
And this is bullshit.
What's happening?
How do we change it?
Right.
I don't think it took any courage at all.
I think I was just given an opportunity to do something.
So in a sense,
(11:50):
it's not courage,
it's really a blessing.
And I remember early on,
you know,
convincing this three star General that we got to do this,
we just gotta bring some leadership and a couple of rules and some boundaries to this.
If not,
we're just letting our people to their own and it's going to be disastrous,
which it was already,
right?
So I appreciate the confidence you have in me.
(12:11):
But I just think I don't know how I would live my life today without bringing my little thing for the benefit of others,
right?
And I know it makes a difference,
but it's a blessing every time we have an opportunity to help somebody else.
I got to tell,
we launched a phone service at the provincial level in a,
in a provincial health care.
It's,
it's actually announced by the minister.
(12:32):
So it's in Nova Scotia.
So where you started out with the N D,
right?
And I gotta tell you every day,
I'll spot check a couple of these contact notes.
These are contact,
there's no names.
Everything is just to understand what kind of colors called in.
There's no,
there's nothing,
there's no name.
Everything is de identified,
no phone number.
But when you read about a person who was just diagnosed with cancer,
(12:54):
terminal cancer,
they got six months to live,
they got nobody to talk to because they have no family and they call the 1 800 line to have a human connection.
Jesus.
You know,
I mean,
yeah,
so not courage opportunity.
I would say,
well,
I might argue with you a little bit on the courage front because I think what you said there was very important trying to talk a three star General into something that they don't believe in,
(13:22):
especially in an organization that is so hierarchical as the Canadian Military or any military organization.
I'm sorry.
But that does take courage and especially when you're struggling with your own mental health at that time.
Right?
And so here's the funny thing Diane,
the people who were blocking me were not the leadership,
(13:42):
ever,
ever,
ever.
I remember meeting the army commander at the time,
the commander of the Canadian Army because he said,
what are you doing there?
So we met and at one point I said to this other three star General,
I said,
I'm sorry,
sir.
But you are abdicating your responsibility to your women and men in uniform by just telling them go to the clinic,
(14:03):
mental health in the workplace is a leadership issue.
It's not a doctor issue when the person becomes sick,
go see the doctor,
but the leadership is failing our people.
Right.
And then I thought,
oh boy.
And he said,
Stéphane,
you're absolutely right.
I don't remember getting placated even by a leader,
a leader in a position of authority who could have,
(14:25):
you know,
let me guess,
don't say Stéphane,
I want to guess it was the leaders within the healthcare organization that were the barriers and especially the mental health leaders who were saying no,
no,
no,
no,
absolutely.
Back to my analogy.
Long feet.
Everywhere I go,
I,
you know,
I step on toes and I'll tell you,
you know,
when I launched the peer support program,
(14:46):
you may not know this story.
But before you know,
the program was launched,
I had to validate a few of my ideas,
right?
And that's how the program kind of started.
I talked to two patients and the two patients.
That's a freaking good idea.
I think we should do that.
Right.
And I went okay,
we're gonna do it.
(15:07):
But,
you know,
it's kind of funny because I pulled patients away from the doctors.
You know,
these patients were arguably very,
very ill in the eyes of the medical system,
but such a valuable asset to the institution but we had written these people off as just patients,
(15:28):
they were human beings,
they had so much to offer,
they had so much wisdom.
Right.
So anyways,
yeah,
absolutely,
the mental health medical system was definitely getting in the way of business,
but not the leadership,
not the culture,
the culture actually welcomed this,
but the mental health system didn't want to have it.
Can you talk about peer support and what makes it powerful and why it has to be designed in such a way,
(15:58):
are delivered in such a way to protect everyone who's participating and maybe you disagree with that.
But in my mind,
I want to make sure that the people are,
that are participating in peer support also don't take on other people's own weight and own illness.
And so there's training that's really important in having an effective peer support program.
(16:20):
Can you talk a little bit about that?
Right.
And I'll start by telling you that yes,
training is important,
but it's the least of my worries ever.
We've launched dozens of these large scale programs.
Training is the easiest piece ever.
The other important pieces selection.
And we say everyone in my company says,
if you don't select the right people,
(16:41):
you can't train a peer supporter.
The peer supporter has to have,
we,
we count around 66 behavioral indicators that must be sort of omnipresent in the person's,
you know,
sort of ecosystem there to actually match itself with the training,
if not,
the training is not gonna stick.
Right.
So often we're approached by an organization,
(17:02):
you see how we have a program here,
we'd like to do some training.
Can you train us and said,
well,
yes,
we can.
But unless we can read your policies,
understand your procedure,
especially your recruitment procedures,
we can't guarantee the outcome of training because we don't know who you're bringing into the room.
Right.
And so it takes a lot of elements in my book anyways to do this.
(17:24):
And if you get it wrong,
it's not going to be good words matter as you know,
of all people,
you know,
if you're supporting somebody with a broken leg and I'm a bit of an idiot and I tell you stupid things.
Well,
no words,
I say the words now the actions you might take afterwards might re injure you.
But my words will not re injure your leg in the cast,
(17:45):
right?
But in mental health it matters.
So,
So I think today in 2022,
there are so many organizations that are throwing themselves into this,
this cacophony of peer support,
which to us is our greatest,
greatest enemy because so many people experience peer support,
but they experience a bad version of it.
(18:05):
And then they say,
Oh,
no,
no,
no,
no,
we can't get into that.
Right?
So it's,
it's delicate and I'm glad you're raising the question because this is serious stuff.
We're not the only ones who do it well by the way,
but we do it really well and it either deserves to be done well or not at all.
You know,
I first learned about the power of these sexy topics was with critical stress debriefing,
(18:27):
right?
Where all of these companies got involved in critical stress debriefing.
Something terrible happened in a workplace and the company would come in and do this work.
And then after gathering data over many years,
it turns out that doing critical stress debriefing can cause PTSD the exact opposite of what's supposed to happen.
(18:47):
So we started this conversation talking about,
you know,
there's no science to say this works.
We do need science to show,
but that doesn't mean we don't try anything,
right.
Ultimately,
you have learned how to do this.
Well,
over time,
there is a value to science,
but science should not be a barrier to trying new things.
(19:07):
And that's this is I think what you came up against.
Well,
Diane,
if I can be very blunt,
Despite the fact that what you just said is 110% accurate.
If you made a pile of evidence,
you know,
to show do you do harm or at best no results,
you know,
with critical incident stress debriefings,
(19:28):
the pile would be I don't know,
three ft high.
The pile of evidence that says that critical incident stress debriefings is positive is maybe seven inches high despite all of that evidence.
I would say that over 80% of first responders organization in this country continue to do debriefings.
I'm working with a law enforcement organization today that continues to do this because there's nothing else.
(19:51):
So,
in fact,
there's so much compelling evidence to say,
stop doing this,
but they're not stopping,
they keep doing it because I think they don't know what to replace it with.
Therefore they keep doing it.
And I find that really bizarre because if,
you know you're doing harm,
at the very least,
you neutralize it,
you stop doing it right.
And to make matters worse,
(20:12):
if you'll allow me in Ontario here,
we have the PTSD legislation which presumes the presumptive legislation which presumes if you are a first responder,
like a law enforcement officer and you have PTSD,
it's presumed to be connected to the job.
Therefore,
you know,
workers compensation will support you.
And I'm thinking since when do we legislate on actual diagnosis?
(20:37):
That's like me.
I own a window washing company.
Diane,
I have 73 workers,
workers compensation supports my employees if they become disabled,
falling off a ladder.
As long as it's a broken leg.
If they break their arm,
they're not compensated.
In other words presumptive,
what do you mean?
Presumptive?
Just ptsd?
What if the law enforcement has depression?
(20:59):
So now the byproduct of that is that you have first responders who are meeting doctors like you.
The doctor says,
ah,
you got depression and the law enforcement for or the first.
No,
no,
don't give me depression.
I don't want that one.
I want ptsd.
And so,
you know,
the,
the,
the unintended consequence of good intentions.
(21:20):
There you go to me.
It's completely ridiculous.
And this is 20,
Right?
I mean,
this is absolutely ridiculous and especially,
and it's a whole other discussion around the fact,
something you said earlier,
which not everything is trauma and we use the word trauma,
you know,
just throw it around so casually,
you know what trauma is and trauma is however very subjective,
(21:43):
each individual has a different experience with that.
But again,
not every outcome of exposure to traumatic events is PTSD.
In fact,
most people don't have anything as an outcome,
they are able to manage that situation one way or another,
but there are other things That can happen.
(22:03):
So you started your company mental health innovations in 2012.
And as I understand,
this is built on technology services that help organizations not just to change their culture,
but to sustain that change.
And it's hard to change culture.
What are some of the big barriers that you face when you're talking to a new company and trying to help them to look at their culture and create change from a mental health perspective.
(22:32):
right?
So I came up with the,
I think it's on our website somewhere,
but I wrote a piece or there's a piece about the three buckets.
Let's say your potential client Diane said,
yeah,
we heard about your services.
What can you do for us?
I'll say,
well,
which bucket are you in?
There are three workplace mental health buckets.
Bucket.
Number one is the events bucket,
(22:54):
the committee bucket and the poster bucket.
And essentially we have committees.
We want to put out a new pamphlet,
will have a new 1 800 line,
right?
So this is like the event bucket,
right,
where we're going to be seen at doing something.
And by the way,
all of this is not bad.
Yeah,
you need committees and all that,
but some organizations get paralyzed in that work.
So the second bucket is really the bucket of belief that it's mental health and really the only thing that can be helpful our clinicians and you know,
(23:22):
Diane,
I'm very for clinicians.
In fact,
I take my happy pills every day.
I'm treatment compliant.
I'm,
you know,
I'm for clinical care,
right?
I'm for all of that.
But some organizations,
the culture is mental health equals doctors,
more doctors,
more psychiatrists or psychologists.
And I'm thinking that's good.
(23:43):
But that's the second bucket.
The third bucket is our bucket.
And the third bucket is really about change the narrative,
changing the narrative.
So,
you know,
nonmedical narrative,
a human narrative,
de medicalized narrative,
right?
And I told this to tend to a CEO of a very large organization two months ago,
(24:07):
they have 100 and 63,000 employees across Canada.
The CEO is meeting in Toronto with his C suite.
And I told the CEO I said,
you don't matter,
you have to understand.
You do not matter what matters for your employee on the shop floor is the employee 15 ft away from her or him.
Because as a layperson,
(24:29):
I don't need to know if Bob 15 ft away from me has bipolar or depression in order to muster the courage to lean in as opposed to to walk away,
lean in without judgment and say,
hey,
Bob you okay.
That person 15 ft away from your employee today is gonna make or break that employee with a look,
(24:52):
look of judgment.
Where the hell were you?
I had to do double shift for you this morning.
No empathy judgment because that's what Homo Sapiens do.
We judge,
we were incapable of bringing the empathy we have for family and friends and relatives into the workplace,
right?
And so I said,
of course you're mad or boss,
(25:12):
you're the CEO,
right?
But at the end of the day,
how you think about mental ill health in your workplace today?
This minute is less impactful than how your frontline employee thinks 15 ft away from that employees struggling because you know,
single,
you know,
mother trying to make ends meet three kids,
(25:33):
one is sick and all that and she's late,
the grief she's going to get on the shop floor is part of her undoing right now.
Anyways,
I went off on a tangent.
But ultimately,
you know,
that's what I think.
So,
I want to unpack two pieces of that.
Both I think critical points.
The first one was about humanizing,
(25:53):
de medicalizing,
making it a human narrative.
I 100% agree with you that the dia This matters actually less and less to me.
I more focus on what are you experiencing and how can I help you to manage those symptoms so that you can function,
that you have your quality of life back?
(26:13):
And we know that human beings care most about their quality of life.
Am I able to do the stuff that I want to do?
So,
I think you're 100% correct.
I wonder if there's a balance there though stuff around helping people to actually believe that these disorders are real that their brain disorders that,
you know,
(26:33):
depression is actually it becomes an inflammatory illness.
This is a real disorder just like rheumatoid arthritis or a broken leg.
And you know,
you,
I know I've heard this more often than I have the number of military members I heard say,
geez,
I wish my leg had been blown off.
At least people could see,
right?
My injury,
right?
(26:54):
And there's still that lack of belief.
So that was the one thing,
is there some balance there in what you're saying?
Yeah.
So I'll push back.
I say it doesn't matter.
And the proof's in the pudding when we set up the joint speakers bureau Suzanne Bailey and I years ago to pivot the culture inside the military of all those disbelievers,
those those hard soldiers that didn't believe there was not an ounce of clinical narrative.
(27:19):
It was all based on the credibility of speakers,
like minded people who were able to do education in an evidence based way and say nothing that goes counter to what the evidence says,
de medicalize the whole thing,
Increase emotional resonance for the audience so that they could relate.
(27:41):
And here's the thing is when you put in the military,
when you put a warrant officer,
infantry guy in a classroom of 30 aspiring leaders and articulate these issues from an ex experiential perspective,
reach some emotional residents and actually pivot the non clinical mind because,
you know,
quite frankly,
(28:02):
you know,
how many times have I heard psychiatrists,
you know,
and medical people present to a lay audience to say here's the Amygdala in the brain,
right?
Well,
it's very interesting,
it's factual,
but I don't know that that matters as much as some person sitting in the room.
But I think we underestimate the value of emotional resonance and the ability to connect at the core from the gut,
(28:27):
not the brain,
right?
So that's my view.
I totally agree with you.
Okay.
Those are the stories that stick with people that,
that create change that emotional resonance.
I guess my little gent until push back on that is they're talking about their symptoms.
So they're making it real.
They're using the term eating disorder or my mood was all over the place or I can't sleep or I,
(28:51):
so I agree.
I don't care what the label is.
What I care about is how does it feel to be in that situation?
This is real.
I can't do my job.
I couldn't do X Y or Z,
I couldn't parent,
I couldn't work.
I couldn't be a partner.
So I think we're saying the same thing you're coming at it from creating that emotional resonance.
(29:15):
And that's the thing that people take home.
They remember that guy standing up there saying I have panic attacks and it's not a pity party either.
It's not at all.
Well,
you're not the guy that pulls out the pity in people.
You get people going.
And so it's interesting that you mentioned and that's the part two I wanted to follow up on is saying to the CEO they don't matter.
(29:38):
And I agree with you.
It's the person you're working with that that cares or the person that you're working with that doesn't care.
And you've added more to their load because you're off.
And so you feel like I'm,
I'm adding to this burden and they hate me more for that.
But does change come from the top?
Does the CEO have to buy into it to create that culture change.
(30:01):
Absolutely.
100%.
100%.
That's step.
Number one.
How do we pivot the leaders to say I didn't see it that way.
Okay.
Now I get it,
let's do it differently.
Right?
And so we feel at M H I that people are stuck in one of the two buckets and they don't even see that there's a third bucket alternative,
(30:22):
right?
Rare are the C E O S or C Suite people that after we spend time with them aren't interested in learning more about the third bucket.
But to your point step,
number one is get your senior leadership engaged to be interested in the third bucket.
But once the leaders engaged,
(30:43):
I think leaders need to get out of the way and let the culture take over.
And in fact,
leaders need to surrender the outcome a little bit.
And when it comes to mental health,
we firmly believe that it has to be built.
Once the leader says let's do this gang,
the leader needs to empower its culture to say,
you tell me how we pivot this culture and I will follow your lead as long as it makes sense.
(31:08):
So yeah,
that's the third bucket is an interesting bucket to work in.
For sure.
I want to understand from you.
Your thoughts on what we do with these crazy lineups.
We can't access clinicians.
Do you have any thoughts on removing barriers to clinician access in Canada right now?
(31:29):
Do you think that there's anything that we can do that could have an immediate impact 100%.
And I think the reason why the lineups are so long is because everyone who's unwell is going to line up for the doctors in some cases right now.
You know,
some people ask me,
you know,
I've been caught saying,
thank God for stigma.
(31:50):
The lineups are long enough.
Now imagine if we eradicated stigma tomorrow morning,
how long would those lineups be?
Because there's no alternative.
There's one door,
it's the medical door,
right?
And I'm not saying that peer support replaces doctors.
Absolutely not.
However,
it can help descend gorge the system a little bit because not everybody who is going through a hard time is traumatized or diagnosable with some condition that needs intense treatment.
(32:19):
But right now,
there's really no alternative.
The problem is such that we have to elevate mental health care to where it belongs and take it out of the shadows and make it mainstream,
which is why I tell my clients,
I am not ashamed at all to charge you guys top dollar to implement stuff because this is valuable services.
(32:40):
And so absolutely,
we can help this engorged the system.
And the research shows four pointed to one return on investment in the U K,
right?
When implemented properly.
If it's implemented,
not,
well,
you're not going to see those returns.
And by the way,
here's a little anecdote and during the pandemic are peer supporters who work inside inpatient units before the pandemic were sent home during the pandemic.
(33:04):
You know,
a couple of weeks later,
the clinical team,
we're calling the government say call em H I,
we need,
we need these peer supporters back.
We are not enjoying the same health outcomes that we did before peer supporters in your car's full PPE back in the health care system.
That's a healthcare system that actually is pivoting,
(33:25):
right?
Meanwhile,
in,
you know,
across the rest of the country,
it's,
it's a shame because there's such great power in humans,
but we're not tapping into that yet,
right?
So that's what I would say about that.
And it's well said.
Now let me ask you this and it's my last question.
(33:45):
If you had the CEO of Canada's largest company sitting in front of you,
what would you say to them?
What's the one thing that you'd want them to know or better understand within the context of that third bucket?
I would say them,
we can crowdsource human benevolence from within your existing organization.
(34:06):
And by the way,
all these people are already on your payroll,
they exist,
they show up and all you need to do is give them an opportunity to be part of the solution and allow them to pay forward in a safe way.
And if you build it,
they will come and you can't imagine the change it will have because now we're no longer talking about the one in five,
(34:29):
we are empowering the one in five to be part of the solution.
These are no longer invisible people.
You eradicate stigma by actually showing people that the one in five matter and they are an asset,
not a liability.
That's how you change culture.
Thank you.
It was such a pleasure talking to you.
(34:49):
All right,
same here.
Take care.
Bye bye.
Reflecting on my conversation with Stéphane.
I was so inspired by how he took his personal pain,
something so deeply,
life changing and was able to innovate to change a way of thinking in the Canadian Military.
(35:10):
As we know,
it is not easy to move an organization to change.
A culture takes bravery and courage.
Stéphane truly is courageous.
There were so many important pearls I took away from the conversation.
But something that really stood out for me that Stéphane stated so eloquently was that when your brain is not?
(35:31):
Well,
the very part of the human anatomy that should tell you you're unwell is on.
Well,
it's truly one of the greatest challenges associated with mental illness.
This conversation left me wondering how we we can replicate this kind of courage.
People like Stéphane are not afraid to challenge the norms and suggest a different path.
(35:51):
Even when faced with their own Brokenness,
we need more Stéphane in the world,
more changemakers,
more people with a vision where there are no barriers to good mental health.
I left this conversation feeling hopeful and I hope you did too until next time.
Thank you for listening.
The Wicked Mind podcast is a series of unique conversations with individuals that share experiences and perspectives on mental health care.
(36:19):
Together.
We will uncover ideas that inspire action.
Please make sure you subscribe,
share and comment.
And if you have a topic or guest suggestion,
please reach out to me at Dr Diane McIntosh dot com.
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