Mental health care for rural Black people in N.S. lacking, year after Desmond report

The Lionel Desmond Tragedy and Beyond: Addressing Mental Health Care in Rural Black Nova Scotia

The Lionel Desmond tragedy remains a stark reminder of the systemic failures in mental health care, particularly for rural Black Nova Scotians. On January 3, 2017, Desmond, a veteran who served in Afghanistan, died by suicide after killing his wife, daughter, and mother in their home in Upper Big Tracadie, Nova Scotia. Desmond, who struggled with severe post-traumatic stress disorder (PTSD) and depression, had long-faced barriers in accessing adequate mental health support. His death prompted a $3.4-million fatality inquiry, which uncovered glaring gaps in the province’s mental health care system, especially for Black communities in rural areas. The inquiry’s report, released on January 31, 2024, outlined 25 recommendations to address these issues, but more than a year later, many concerns remain unaddressed.

Challenges in Accessing Mental Health Care for Rural Black Nova Scotians

The inquiry highlighted the unique challenges faced by rural Black Nova Scotians in accessing mental health services. These challenges stem from a lack of culturally informed care and the limited availability of mental health professionals who understand the specific needs of Black communities. The report emphasized the need for virtual care to bridge the gap in rural areas and called for the hiring of more Black mental health workers. However, progress has been slow. According to Lana MacLean, a social worker who testified during the inquiry, the virtual care services currently provided by the province fail to address the culturally diverse needs of African Nova Scotians. This disconnect underscores the broader issue of systemic neglect in addressing the mental health needs of marginalized communities.

The Province’s Response to the Desmond Inquiry Recommendations

The Nova Scotia government has made some efforts to implement the inquiry’s recommendations, but critics argue that the response lacks transparency and accountability. The Health Department has expanded virtual care services across the province, and the IWK Health Centre has received funding to develop an African Nova Scotian model of services for youth and caregivers, which includes recruiting Black mental health providers. However, these initiatives fall short of addressing the systemic issues faced by adults in rural communities. The inquiry also called for the creation of a monitoring committee to ensure the recommendations were not forgotten over time. Instead, the province merged this responsibility with a committee overseeing the recommendations from the inquiry into the 2020 Nova Scotia mass shooting, which killed 22 people. This decision has led to criticism, as the merged committee operates behind closed doors, leaving many unclear about the progress being made.

The Importance of Culturally Informed Care

One of the key recommendations from the Desmond inquiry was the need for culturally informed mental health care. This type of care recognizes the unique experiences and challenges faced by Black communities, including systemic racism and historical trauma. The province has acknowledged this need, at least on paper, but the implementation of culturally informed care remains limited. MacLean, who helped develop the IWK program, noted that while the program has been successful for children and adolescents, it does not yet extend to adult services, leaving a critical gap in care. Furthermore, the inquiry revealed that mental health workers who interacted with Desmond before his death failed to address his history of intimate partner violence and abuse, highlighting the need for better training and protocols to identify and intervene in high-risk situations.

Challenges in Implementation and Transparency

Despite some progress, the province’s response to the Desmond inquiry has been criticized for its lack of transparency and accountability. Many of the recommendations remain in limbo, leaving families and advocates wondering if meaningful change will ever come. Adam Rodgers, a lawyer who represented Desmond’s family during the inquiry, expressed frustration with the lack of clarity around the implementation process. “It’s hard to see where the work is being done, if anywhere,” he said. “At this point, ‘wait and see’ is starting to sound more like, ‘maybe never.’” The province has fulfilled some recommendations, such as creating a men’s helpline and launching a public awareness campaign about domestic violence, but these efforts are insufficient to address the systemic issues at hand.

Moving Forward: Accountability and Action for Mental Health Reform

The Desmond tragedy serves as a call to action for mental health reform in Nova Scotia, particularly for rural Black communities. The inquiry’s recommendations provide a roadmap for change, but without accountability and transparency, progress will remain elusive. Advocates like MacLean and Rodgers emphasize the need for the province to prioritize culturally informed care, expand successful pilot programs, and ensure that mental health workers are trained to address the unique needs of marginalized communities. The province must also be more transparent about the steps it is taking to implement the recommendations and ensure that the voices of those most affected are heard. Only then can the lessons learned from the Desmond tragedy lead to meaningful change and prevent similar tragedies in the future.