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Seen and Heard

Meet the People Making Mental Health Care More Accessible

“It’s so important to be able to have your story, and own the complexity of your own story,” Parneet Chohan tells me over the phone. Parneet is a counsellor who operates their own private practice here in Montreal. They have a Master’s in Counselling Psychology, and are currently training in somatic experiencing. After a day at work, they’re chatting with me about the peer supervision group they started for racialized practitioners, and why creating such a group was needed.

This strikes a chord – many of us can unfortunately relate to the gut-wrenching feeling of having your experiences reduced or dismissed. For anyone seeking mental health support, the risk of experiencing this feeling carries much higher stakes. Fears of being misheard, questioned in your experience, or the emotional burden of needing to explain are all a part of what Parneet describes as the effects of subtle stereotyping of racialized people [predominantly by white professionals] in counselling. This gulf in understanding is experienced not just by patients, but also by practitioners. The inability to own the complexity of your own story in a therapeutic space is a major barrier to getting or seeking healthcare.

“Private practice can be very isolating – you don’t get a lot of socializing time. Even though you’re working with people all day, you’re not necessarily working around people all day. I was wanting to spend time with other practitioners who understand the sacredness of the work and its weight. And not only from working with racialized clients, but as a racialized person myself – there is a way that I would want my colleagues to empathize and understand me as well. I wouldn’t want to have to explain myself continually to other [white] colleagues. There is something powerful about unspoken understanding.”

“There is something powerful about unspoken understanding.”

I ask Parneet how sharing an identity with clients impacts their practice, and how clients might feel about it. They share that in their experience, having a common identity eliminates shame surrounding culturally-specific struggles. “I’ve heard from clients with a racialized or minority identity that they feel scared to say ‘this is what’s happened in my family, or my community’, because they don’t want white counsellors to paint with broad strokes that this might be all Indian families, or Ethiopian families, or whatever it might be. And I can think of comments from people who have worked with white therapists, who will respond to a client with ‘well this makes sense, since you come from XYZ identity.’ These are subtle types of stereotyping that arise when you don’t work with diverse clients, or don’t have diverse friends which might sensitize you to their experiences.” When I ask Parneet about cultural competency training, they tell me that beyond professional schooling, updating diversity training is up to each individual to undertake on their own. “It is a fascinating profession, in that we really are on our own.”

Of course, it’s not just doubts about the safety and comfort of the therapy space that pose a barrier to seeking care. While racialized therapists might be fewer in number and difficult to find, therapy costs can also be exorbitantly high, putting it out of reach. For those living with a disability and those living in more rural areas, physical access to therapy spaces, especially culturally-competent ones, can be an issue. Stigma around discussing and seeking mental health care is an ongoing barrier to accessing healthcare. In this landscape, online support and resources have rapidly emerged as a potential solution to increasing access to care.

Eric Coly is an LA-based entrepreneur originally from Senegal who is seeking to close the therapy gap for racialized individuals and minorities, with a focus on intersectionality of identity. The platform AYANA Therapy is an app that seeks to connect individuals with accessible therapy where they find their own identities represented. Ayana asserts that “finding the right therapist is a right, not a privilege.” Following a detailed questionnaire, users are matched with a licensed therapist. The platform provides individuals with the option to call, video call, or text with the provider they are matched to.

Originally set to roll out in Fall 2019, the app will launch early this year. The delay is largely due to the overwhelming response from both clients and counselors. “We had 6500 emails in two and a half weeks that came in, and it spoke to the high demand and the gravity of the situation that exists regarding lack of access to mental health,” Eric explains. “We are dealing with a rather disappointed audience that has been ignored and ostracized [by the healthcare system] – so we need to be able to show up with as high a level of integrity as possible, which means – at minimum – being able to respond with as many counselors as possible.” He tells me that they already have around 80 counselors, with double that in applications received.

I asked Eric about the match process, and what an emphasis on intersectionality means in that context. “Our objective is to make intersectional counselling available to those who want it. So if you tell me, “Look Eric – I am Muslim, biracial, and gay,” and it’s important for you to have a therapist who understands this well, we want to make that accessible for you. The most important pillars of the questionnaire are: race, ethnicity, gender orientation, and religion, all along specific modalities. After we ask for your ethnicity, we ask you how important it is for you to have a counselor of the same ethnicity as you. The answers to the questionnaire are nuanced, with a gradation of answers (very important, not important at all, etc.). The use of nuance is pretty important to us.” The match process, and emphasis on individual experience, is what sets Ayana apart from other – predominantly white – online therapy platforms. While some helpful resource options specific to certain groups exist (such as Therapy for Black Girls), there continues to be a need for intersectional options. “From a mathematical standpoint, to optimize matchmaking, we have to have enough of a sample to pick from, and I didn’t feel as though we currently have that. Which is [also] why we are pushing rollout, so we can be able to increase the number of counselors to 400.”

While there will be costs associated with accessing the app, in order to pay the licensed therapists providing services, Eric described a need to make the platform financially accessible. “Often those who need it the most are those who can least afford it, and for me, part of being able to base success is if someone from a local community who is low-income is telling me that ‘you’ve partnered with such-and-such foundation that has enabled me to have access to your product.’ That to me is so important.” Ayana is currently speaking with non-profit and community-based organizations for them to potentially assist in subsidizing access for lower-income clients.

Coming originally from a background in finance and fashion, Eric tells me that he is a “neophyte in this space.” It is passion for the project that has fuelled him to overcome the obstacles presented with learning and making moves in this [health] industry, which hasn’t been an easy journey. “Instead of looking up at the mountains (obstacles), I have really focused on the quarterly goals. Our focus is in mental health, which to me does not get enough attention in this country. It is very much looked at through the lenses of classism and racism – and the way people see cancer in this country is not the same way people see mental health issues. For example, half of the people who are homeless in L.A. have mental health issues. A substantial proportion of those people are black. So this has really fuelled my passion, as did my own issues with mental health. There is a strong relatability between myself and the people I’ve been fighting for.”

As more options for access to therapy open up, it’s worth remembering that the modality of modern psychology is eurocentric in itself and might not suit everyone. Parneet shares that “Psychology is very white, but we are seeing more East Asian/African and Latin American practices starting to show up that are not necessarily psychology, but are absolutely related to mental health. The older I get, and the more people I work with, and with my own healing journey, it is clear that it is all related, even if it’s not “mental health” per se. Our past traumas, how we eat, who we live with. It’s fascinating because in biological notions of health – everything is kept separate. In reality it makes a huge difference if the place you come home to is safe and supportive, yet that’s something that might not even get asked on an intake form for counselling […] I am happy to say that there is a lot more alternative medicine and wisdom (such as naturopathy, homeopathy and Ayurveda) showing up in a more mainstream way.”

As more options for access to therapy open up, it’s worth remembering that the modality of modern psychology is eurocentric in itself and might not suit everyone.

That said, for those of us seeking therapy, it can be difficult to know where to look. Parneet shares several resources for Montrealers with diverse identities to access (linked at the end of this article, many of which provide sliding scales), emphasizing that though there may not be a physical collective space for therapy in Montreal, there is ample online and collective support to find what you might specifically be looking for. “The online space broadens the types and price of resources available. For example, there are counselling services online where you can purchase 20 minutes with a counselor, which is small but can go a long way if that’s all you can afford.” The Facebook group Montreal Healing Space, and others, present a powerful part of online communities. In internet forums, support can be “fast-tracked” – you can simply put an ask out for something specific you’re seeking, and ideally someone else can point you in the right direction. Through an informal vetting process online, such as Facebook forums, trust is built around certain service providers in the city.

Eric says that though he keeps getting emails from Canadians, Europeans and Carribeans, the immediate needs and focus for Ayana are local and domestic to the United States. “In the future, yes of course. Toronto is one of the most diverse cities in the world. The country has yet to keep up with its demographic growth, and in terms of services many people of colour are not being served properly. There are many reasons why Canada would be a great market for Ayana. I just want to make sure we do it right.”

Montreal Resources:

The Argyle Institute- Pride Team

The OPEN Centre

Decolonizing Therapy

MUSIC (McGill University Sexual Identity Clinic)

Erratum: It was written that Parneet has a Master’s in Counselling Psychiatry. The correct title is a Master’s in Counselling Psychology. Mentions of ‘psychiatry’ or ‘therapist’ were replaced with ‘psychology’ and ‘counsellor.’