World Mental Health Day 2024 – An Interview with Dr. Nick Kates

World Mental Health Day 2024 – Dr. Nick Kates.

October 10 is World Mental Health Day, a time to reflect on the importance of mental health and the ongoing need for greater awareness and support. Mental health affects every part of our lives, yet many still face barriers to care and stigma. This day reminds us that mental well-being is as vital as physical health, encouraging us to prioritize self-care, seek help, and work toward creating a society that values and supports mental health.

In recognition of this day, PEACH Health Ontario is spotlighting psychiatrists’ invaluable role in mental health care. This article highlights the dedication of these professionals, who provide care and advocate for systemic changes to improve services. By sharing their stories, we aim to spark further discussions about the importance of mental health within healthcare.

Meet Dr. Nick Kates, a psychiatrist at McMaster University’s Department of Psychiatry and Behavioural Neurosciences. For 11 years, Dr. Kates served as Department Chair and has been actively involved in community, social, and environmental mental health. Currently, he leads McMaster’s Division of Equity, Global, Transcultural, and Planetary Mental Health, where he has become more engaged in addressing mental health challenges related to the climate crisis. “It’s really been in that role that I’ve got much more involved in a wide range of issues related to planetary mental health, and mental health and well-being in the face of the climate crisis and the need for greater sustainability.”

Five years before becoming chair, Dr. Kates was the Ontario Lead for the Quality Improvement and Innovation Partnership (QIIP), which promoted quality improvement in primary care practices.

Q1. What inspired you to pursue this profession and take on such a diverse range of roles within it? 

“Looking at healthcare, I realized that there was just so much inequity and unfairness—not only in the way people accessed, received, and benefited from services, but also in the fact that there were so many other factors beyond sort of the biomedical that determine an individual’s health and well-being that needed to be addressed.” These overlooked factors, when ignored, led to a “much greater likelihood of mental health problems,” not just in prevention but also in access to treatment.

Recognizing the need for change, Dr. Nick Kates emphasizes the importance of “building partnerships with different non-traditional providers of service” and finding ways to “recognize and intervene earlier.” There was also the recognition that, as healthcare professionals, “we really didn’t have direct contact with a lot of the immediate agents of change,” which meant building relationships with various providers and patients to promote change was essential. “We needed to look at everything we did from the perspective of the individual person/patient’s journey through the healthcare system” and “create a healthcare system where the voice of the individual and their family were much more central to everything that we did, where they were equal partners in decision-making, equal partners in service planning.”

These insights have shaped Dr. Kates’ focus on mental health and expanded into climate-related areas. “The multiple impacts in every single way that you could imagine, and then some other ways that the climate crisis has on the mental health as well as the physical health of individuals,” along with the role of green environments, show the importance of addressing climate equity in mental health care.

Q2. How can individuals and communities contribute to fostering a more supportive mental health environment, especially in an increasingly stressful and fast-paced world?

 “I think all of these things really need to be understood at two levels—or maybe even three,” Dr. Nick Kates begins. “One is what individuals can do on their own. The second is the broader responsibilities of communities or sub-communities. And the third is what the wider community can do to educate, support, or promote individual initiatives.” These three layers of action are key to fostering a more supportive mental health environment.

Using cycling as an example, Dr. Kates explains how individual efforts need to be supported by the community. “An individual initiative would be, let’s say, more time on a bike, less time in a car. But it would need to be supported by a community that actually makes cycling easier for individuals, makes it less hazardous, and also builds in all kinds of ways in which individuals have access to bikes.” Bike Share programs or the creation of bike lanes illustrate how community-level actions can help enable individual choices.

At the third level, there is a need for broader community-driven initiatives. “The community needs to make statements that are clear and maybe a little bit directive about why we want to move people away from individual vehicles…towards bikes, so they’re trying to change the behaviours of people who won’t be using bikes to make it easier for people to bike as well.” By addressing all three levels, individuals and communities can contribute to a more supportive mental health environment in today’s fast-paced world.

Q3. For organizations like PEACH Health Ontario, which focuses on sustainable healthcare, how can promoting mental wellbeing contribute to a more resilient healthcare system?

 “The first thing would be just to make sure that PEACH is advocating for the multiple ways in which the climate crisis affects an individual’s mental health,” Dr. Nick Kates explains. Climate-related events, whether minor or major, impact mental health. “There are losses, migrations, loss of income, loss of career, loss of confidence, loss of safety— all those are important emotional factors.” Even situations like someone living in an apartment without air conditioning or adequate heat can deeply affect mental well-being alongside physical health.

Recognizing the integral connection between climate and mental health is key to promoting a resilient healthcare system. Dr. Kates adds, “I think the second is to continue to look at the ways in which some of these concepts can be incorporated into health as well as mental health care.” Initiatives like encouraging time spent in nature, PaRx, and deprescribing, which align with sustainable practices, are not just theoretical, but practical examples of how these ideas can be applied in everyday healthcare settings.

Furthermore, individual clinicians should consider climate-related issues as part of any routine assessments. Dr. Kates emphasized, “So, is there anxiety about what is happening to you as an individual as you look ahead and the potential changes? Are you dealing with issues related to the climate crisis that may be a part of your overall clinical presentation?” While these considerations may not apply every time, they are essential in understanding the broader impact of climate on mental health. For example, first responders or civic leaders witnessing community destruction due to climate disasters can experience immense stress. Kates highlights that even relatively smaller events, like basement flooding, “are things that we should be able to think about and just ask about routinely.”

Ultimately, fostering a resilient healthcare system through mental well-being involves “big changes and small steps,” where each individual is treated holistically and seen through the lens of both climate and mental health.

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Check out our website for additional profiles about psychiatrists for World Mental Health Day!