The Riddle of Mental Health Care at the Heart of ‘Hello I Want to Die Please Fix Me’

“As far as national chauvinisms go, Canada loves being The One With Universal Health Care. But if your illness is in your brain, that universality is a lie,” writes Anna Mehler Paperny in her memoir-cum-exposé Hello I Want to Die Please Fix Me. I want to shout her line from the rooftops. Yes, yes, and more yes! The chapter title sums it up: “Mental Health is for Rich People.” Like so much of her book, it feels like a giant, national exhale. Finally! Someone is saying in public what (nearly) everyone has been saying in private for years and years and years as Canada’s mental health system fails and fails and fails. I want to root Paperny on, because someone needs to say this and keep saying it until it finally sinks in.

Hello I Want to Die Please Fix Me is published by Random House Canada
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I come from a family lineage known for mental illness in the way that some families are known for, say, farming, or making really good pies. It’s just a reality. We know that it’s genetic and intergenerational. It’s near legendary. To the point that one of the first members of the clan to settle on the North American continent was one of the women hanged in Salem in 1692. Does the family propensity for madness go back that far? Did that lead to Mary Parker’s damnation as a witch? To her execution on the last day of hangings? Maybe. The cloud is that large and that dark. I have not escaped unaffected.

As someone with first-hand experience in the landscape of mental health care in Canada, I found Paperny’s work insightful, sensitive, and incredibly accurate. She takes the reader on a tour into the state of psychiatry in Canada and the United States. And she covers a lot of ground. With her training in journalism, she tackles the epidemic of depression and suicide by hunting down experts in the leading fields of treatment. Their insights are illuminating; from cutting edge brain surgeries to the use of psychedelic drugs to treat depression, anything that has been tried has been tracked down and questioned by Paperny.

Her exploration of the state of pharmaceutical treatments is grave: there is little understanding of how anti-depressants work to make the brain less depressed. Advancements in drug treatments could be a decade away. Interest in development and research at the major pharmaceutical companies is dwindling, as is funding.

Treatment options other than drug therapy are in an even worse state. Psychotherapy is not covered by Universal Health Care. Often, intersecting factors of marginalization, racism, and classism means that those who need treatment most are less likely to receive it. Paperny dissects the state of mental health care for Indigenous communities in Canada. It’s safe to say that, well, there isn’t any. Which is profoundly, in huge capital letters, NOT OKAY.

Can I state for the record how ecstatic I am that Paperny has called out the #BellLetsTalk campaign, among other “awareness raising” activities which don’t do much except raise the PR profile for corporate offices? “We talk a big game about talking,” writes Paperny, and “Online hashtage culture creates a cult of confessionals.” Meanwhile, disclosure of a mental illness (especially in the workplace) can too often lead to negative consequences, both socially and professionally. Besides, how much can telling someone you are ill help if there isn’t the infrastructure of care in place to address that illness?  What Paperny describes is more of an endless merry-go-round of guesswork and medical fumbling.

“I am so beyond tired of the word ‘stigma.’ Perhaps it once had resonance. Maybe its utterance once conjured a concrete, clearly delineated concept. But repetition has rendered it meaningless, the way a surfeit of swearing robs cuss words of their sting.”

I want to go door to door, handing out this book like it’s a box of Girl Guide cookies. If something is going to change, really change, in the mental health care system of this country, everyone needs to be aware of what they might fall into if they ever become sick. For those who are dealing with the system with little help or knowledge, this book may be the lifeline they need to stay above water. It’s a heartbreaking road to take, to care for a loved one with a mental illness. It’s a dark and lonely road for anyone who has to deal with their own despair while trying to navigate the complexities of a system that favours doctors over patients. It often feels that you are lacking some secret knowledge that health care practitioners seem to hold in their hands like a deck of cards. If you could peek over, take a look at their hand, you might be holding Hello I Want to Die Please Fix Me.

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