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History of the Project

The context

The newspaper headlines in BC have been filling in the last few years with stories about people with mental health issues “falling through the cracks” and ending up committing crimes (some of them very violent), or having dangerous and sometimes fatal encounters with police. At the same time we are also seeing the shutting down of ‘patient-centered’ care facilities, such as the recent announcement of the closure of the Delta View Habitation Centre, which has been home to high needs patients, many of them seniors. The closure is happening in the name of efficiencies (budget cuts) and is one of many in recent years. While the Health Authority is promising that the patients will go into other facilities, the long-term relationships that have been established with care-givers (the relationships being equally important as the bricks and mortar) will be severed. This is an all-too often repeating pattern that is traumatic for the patients and the care-givers.

What is happening? As is the case with other sectors across Canada (education, general health care, environmental protection, the justice system), business models are replacing client care models; the humane systems we have created are mechanizing in the name of efficiency.

And yet: Over any 12-month period, about one in five individuals in the province of BC (20% of the population) will experience significant mental health and/or substance use problems leading to personal suffering and interference with life goals¹. Suicide is the second leading cause of death for youth aged 15-24 years and male adults aged 25-49 years in Canada.²

“In recent years, few areas of health care have received as much attention as mental health. Yet despite the attention, Canada's mental health care system remains deeply fragmented, with little coordination across sectors, little emphasis on exactly who is responsible for what and, hence, inadequate prevention and treatment programs.

One of the primary reasons for this unfortunate state of affairs is that Canada, alone among G8 nations, has not had a national strategy on mental health. But that all changed Tuesday, as the Mental Health Commission of Canada released its national strategy, Changing Directions, Changing Lives. And as is evident from a brief review of the strategy, everyone, including all levels of government, private industry and individuals, have a role to play in implementing this strategy.”³

One aspect of the society in which we currently live and work that contributes to difficulties dealing with mental health issues is the stigmatization that goes along with declaring one is struggling with the issue at all. The issue of stigmatization is a priority for governments and private organizations alike. The Provincial Health Authority has identified stigma as a major area for enhancing knowledge exchange. The issue of stigma was important enough for Vancouver Coastal Health to bring a diversity of people together (Sept. 13 and 14, 2011) into a two-day discussion on addressing stigma called, Collaborative Change-Making. Over 120 people, many of them representing organizations, including Headlines Theatre, attended this gathering.

Stigmatization and the fear of stigmatization stop people from seeking help. The stigmatization issue is itself often invisible, living underneath our conversations and professional and personal relationships. A step towards dealing with the issue, therefore, is to make stigma visible.

There is work being done on stigmatization issues in the public realm - in families, the streets, schools. A hidden and generally ignored aspect of this issue is how the health care system itself is entrenched in beliefs, values and policies that stigmatize people. This applies not only to people who are struggling with mental health, but also to the staff that care for these individuals. This invisible layer makes effective care much more difficult, regardless of how much money is invested in the area, and how deeply the public may or may not engage in solutions.

Participants in the Collaborative Change-Making meetings, many of them working in the mental health field, defined in numerous ways, a systemic "top-down" approach in health care as a central part of the issue of stigmatization; roles that stigma plays both for those that seek care and those that deliver care. Their discussions named issues that included:

• the artificial divide between various mental health services (silos in between programs);

• how a mechanizing model of care is relying more and more heavily on pharmaceuticals;

• how the health system expects patients and care-givers to conform to the needs of the system, rather than finding innovative patient-centered opportunities;

• burn-out of health care workers who themselves have little or no support;

• disparaging language (written and spoken) that health care professionals use to describe the people with whom they work;

• …and many more.

A new and emerging language of performance targets, length of stay, product lines, deployment strategy and project management, are creating a new narrative in the delivery of health care. Business models are replacing client care models.

Staff who identify at a human level with a client group or population who is marginalized, often become marginalized themselves within the system of care. People spoke of dehumanization and fragmentation; of feeling alone, powerless and voiceless inside their roles as caregivers. Within their contexts they speak of being stigmatized by the health care providers, knowing there is a strong similarity between what they experience and what their client groups express regarding their experiences.

Dealing with individuals who are struggling with mental health issues can often be 'messy'. People with mental health issues are often "non compliant". How do we navigate a space within the system that can handle a necessary "messiness" on both sides (patient and care-giver) in which people can give and receive what is being referred to as "authentic care"?

Of course these systemic issues erode our ability to support overall mental health in Metro Vancouver and BC and contribute to the terrible statistics in Healthy Minds, Healthy People.

It is vital that we understand the role stigma plays in the transformation of a client care model to a business model, and how we can assist in the development of a more compassionate, balanced dialogue about and with clients and staff. Stigma hurts those that serve, and those that are being served.

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What can a theatre company do?

If we agree that there are populations of clients (mental health) and health care providers who have poor interaction patterns due to stigmatization, and that these clients and providers are finding difficulty interacting in a healthy and productive manner, then we have the opportunity to experiment with new ways for these marginalized clients to access care and for the providers who work with these populations to be supported in both the health system and the larger mainstream culture.

The theatre can take statistics and transform them into personal stories; the theatre can be a true voice of people who are struggling with various aspects of the stigmatization issue; the theatre can open up the irony of the creation of 'the other' in a world where in fact there is only 'us' and in doing so, re-personalize 'the other'. Headlines has a 31 year, multi-award-winning history of creating this kind of theatre.

More than that, this production, created and performed by people who have struggled with mental health issues from inside the 'system', can create a vehicle to help adapt policy and plans for social service agencies and Governments (who are willing to listen) to ensure that services are effective.

What is Forum Theatre? And the evolution of Theatre for Living

Forum Theatre is an opportunity for creative, community-based dialogue. The theatre is created and performed by community members who are living the issues under investigation. Over the course of a six day THEATRE FOR LIVING workshop, participants engage in very specific games and exercises that help them investigate issues at a deep level. In a mainstage production such as this one, after the workshop, the cast, production team and director then have 4 weeks to make the best art we can, that tells the truths that have risen out of the workshop process. When I say "tells the truth", I mean as true questions - hard questions - the questions for which we don't have clear or easy answers.

The resulting play is performed once, all the way through, so the audience can see the situation and the problems presented. The story builds to a crisis and stops, offering no solutions. The play is then run again, with audience members able to "freeze" the action at any point where they see a character engaged in a struggle. An audience member yells "stop!", comes into the playing area, replaces the character s/he sees struggling with the problem, and tries out his/her idea. We call this an "intervention". The other characters respond with their truth, not to "make it better", not to "make it worse", simply to investigate a shared reality. What insights do we have? What do we think? What do we learn? Who agrees? Who disagrees? In this way we engage in a creative dialogue about issues in our lives. The process is fun, profound, entertaining and full of surprises and learning.

Headlines' THEATRE FOR LIVING workshops have evolved from Augusto Boal's "Theatre of the Oppressed". Since 1989 Headlines' work has slowly moved away from the binary language and model of "oppressor/oppressed" and now approaches community-based cultural work from a systems-based perspective; understanding that a community is a complexly integrated, living organism.

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Legislative Theatre

How is Legislative Theatre different from other Forum Theatre events? We will engage a mental health expert as Community Scribe for the project. At the Forum Theatre events it will be the Community Scribe's job to document the interventions, collate them, study them, and translate the desires at the core of the actions into policy language to be presented as a Community Action Report for the creation or revision of service provision policies and methodologies. This person will need to have a working knowledge of policy around these issues.

In 2004 Headlines collaborated with the City of Vancouver on an experiment in Legislative Theatre called Practicing Democracy.4

After a unanimous vote by the City Council of the day, we worked with people who were living issues of chronic poverty and created a main stage Forum Theatre project that asked questions about how the City could respond to cyclical issues of poverty in the Downtown East Side and beyond.

Through the audience interactive events, ideas were gathered from the public, for civic policy initiatives to address issues of health, housing, food, advocacy, etc. Practicing Democracy was a way for citizens to use the theatre to communicate with Government. Over 90 recommendations went forward to the City from the theatre project. Please see http://headlinestheatre.com/past_work/pd/finalreports/PDlegislativereport.pdf for the full report, prepared by Carrie Gallant, B.A., LL. B.

In 2009 we created and produced after homelessness… 5, another Legislative Theatre project, this time created and performed by people who had and were living the homelessness issue. We took the lessons from the previous project. The Community Action report, written by Gail Franklin, can be found here.

We received very positive feedback from the City of Vancouver and the Province of BC about the clarity and usefulness of the report. Various suggestions from that report, like landlord accountability in SROs, are becoming policy now.

The Community Action Report for maladjusted6 will be aimed at service providers. Headlines is gathering written agreements from many organizations to use the maladjusted project and the resulting Community Action Report as a way for people on the ground who are dealing with these to have input into policy. Please see the letters of support, attached to this proposal.

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Focus of this production

Because the actual content of a project like this must come from the workshop participants and cast who are living the issues, it is impossible to be absolutely specific about what exactly will be addressed in the play, but we can be certain that the story will somehow deal with mental health and stigmatization, and how the culture in which we live and work contributes to our struggles with mental health at personal and organizational levels.

We at Headlines know from years of experience that this project can and will function as a true voice of people who have themselves struggled with the issues. Because the play creators carry this expertise the play will certainly help communities, agencies and Governments seeking grassroots input into both the social and the structural aspects of the issue.

The workshop participants and cast will be drawn from a diverse range of people who have experienced stigmatization regarding mental health in the past and/or the present as clients and as service providers. Having a living knowledge of the issue will be one of the essential criteria for participation.

It will also be understood that while wonderful transformations often occur for individuals who engage in this work, and this project will be no different, being in the project is not a healing opportunity - it is employment in a project the purpose of which is to create an artistic focal point for community discussion and transformation.

Support Person

Having said the above, this project will have a support person on salary throughout the community workshop process, creation/rehearsals and all performances. In some Headlines' projects we feel that having a professional whose role it is to counsel workshop participants and cast members, if necessary, is vital to the health of the project. The THEATRE FOR LIVING work creates a great deal of natural support within a working group. Because maladjusted is about mental health and stigmatization, we feel that this is one of those projects that would benefit from a position being dedicated to support. The support person will be present in all working sessions and be available to all personnel for one on one counseling and also referral to services, if necessary.

Using the play as a "magnet" for a mini-conference7

A project like this generates a "buzz" in the media, in the public realm and at very grassroots levels. How do we use the buzz effectively?

We want to hold what we are calling a "mini-conference" during the second week of the Vancouver run of the play. This would entail day and/or night time community dialogues in the performance space and perhaps, adjacent events on issues of mental health and stigmatization offered by other agencies working on the issues. Speakers and workshop facilitators would be gathered from the local community. The discussions from the community dialogues would be another way to engage the public and for the Community Scribe to gather input for the Community Action report.

RE:frame - digital story-telling project Zack Embree (Advisory Member - see below) and Tahina Awan are video artists who are raising funds for their own digital story-telling project on mental health and stigmatization issues. We are collaborating with Re:frame, opening up space for them to premiere their videos through the theatrical run of maladjusted. This will be great synergy.8

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The Advisory Committee

Ajay Masala Puri. Ajay is an advocate for social change and community empowerment. He is currently the Quality Leader, Communications and Engagement for the BC Patient Safety & Quality Council; he's interested in bringing social movement theory and action to the healthcare system in Canada. Over the last several years Ajay has co-founded and continues to co-lead many movement based organizations. Ajay was acknowledged for his commitment and passion for engaging diverse communities as one of Canada's top five volunteers in CBC's Champions of Change contest in 2010 and as the UBC Dean of Science Ambassador in 2001. He has spoken on his life and work in front of many audiences including TEDx. Academically he holds a Masters in Health Administration from UBC and is currently pursuing his PhD in health policy.

Heather Hay RN ; MA ; MSc - Ms. Hay is a consultant with over 40 years experience in Health Care. She is currently retired from Vancouver Coastal Health (VCH) after 24 years service. She held various positions within both acute and community care settings including: Director Addiction/Harm Reduction, HIV /AIDS and Aboriginal services with a focus on the Downtown East Side and most recently as the Regional Director for the Complex Mental Health and Addiction Program.

Sonja Sinclair completed a Bachelor's Degree in Child and Youth Care and a Master's Degree in Human Security. She has spent the past fifteen years working in the field of Mental Health with a variety of populations including adolescents, individuals in international conflict zones and developing nations, individuals struggling with homelessness on the Downtown Eastside, as well as individuals who have been victims of crime. She currently works in programs supporting youth with mental health and addiction issues and adults with mental health issues involved with the criminal justice system. She is also a Board Member of a non-profit in the Tricities area providing housing and recovery oriented day programs for individuals with mental health and addiction issues.

Zack Embree - Zack is an artist and a facilitator of both creative and dialogic processes. He is a core member of both the Addressing Addictions related Stigma initiative and the Community ARTreach Team, a collective of artists that develop and deliver "strength-based" creative and community development programs for marginalized people suffering with mental health and addictions issues. He is currently expanding beyond his work with Vancouver Coastal Health pursuing his emerging passion in gathering and telling the story.

A multicultural project

The mental health issue does not confine itself to any one cultural sector of society. Both the workshop group and the cast will reflect the diversity of the issue.

It also seems to us at Headlines that the project presents an opportunity for communities throughout the cultural spectrum in Vancouver to come together and work on a shared problem. Headlines has been very successful for many years at drawing out a broadly diverse audience. The audience's engagement in the Forum Theatre process will build cross-cultural understanding and also help investigate solutions to the issues that are relevant to all audience members, in the communities in which they reside.

After 31 years of community-based work on a myriad of issues, Headlines has very strong community networks. Our community-based working methods dictate to us that strong and broad-based community support and engagement is what helps create the success of our work.

Recent projects like Us and Them and after homelessness… have been surrounded by 100+ community organizations who have helped us understand the complexity of the issues, find workshop participants, cast members, and then bring audiences to the interactive events. maladjusted will follow the same model.

Project Timelines

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The Community Workshop

In January 2013, we will gather a group of 20 participants9 together who are living the issues. 143 people applied to be workshop participants and/or cast members in our recent production Us and Them. Notice of maladjusted will go out in September 2012. We will process all applications and interview up to 40 of the applicants. We will decide on a cast and workshop group that is representative of the diversity of the issue. The workshop participants and cast will be a mix of service providers and people accessing services. The reason to decide on casting before the community workshop starts is so that the workshop is not an audition. It is important that each person coming into the process knows what their involvement and time commitment will be.

All 15 workshop participants and 5 cast members will be paid to participate in a week long THEATRE FOR LIVING workshop, out of which will come the core material for the Forum Theatre play.

Using theatre games and exercises, we will explore how the issues affect the lives of the participants. We will, at that point, be investigating the stigmatization they face, in both the public realm and in service provision. It is these points of tension that will form the subject matter of the play.

Using the workshop as the material from which the performance grows, the cast, a professional production team of designers and I, will then have 4 weeks to create an artistic production for presentation to the public. This is the same creation model as was used in many of Headlines' productions including Practicing Democracy, after homelessness… and Us and Them. The first two productions had very intense 3 week creation periods; the last had 5 weeks, because of the multi-layers of co-directing a physical theatre process. This production will have 4 weeks of creation/rehearsals.

The Performances

The interactive Forum events will ask the audience to engage in the investigation of solutions to the issue of stigmatization, inside the service provider model.

We have confirmed the Firehall Arts Centre, in Vancouver's Downtown Eastside, for the Vancouver run and mini-Conference.

Reaching further

We are currently in very preliminary conversations with SHAW Community TV who are interested in collaborating on an interactive web broadcast, and taping the closing night for airing on SHAW Television. This would greatly increase the reach of the project. We have done interactive webcasts with SHAW on all of Headlines' main stage projects for many years.

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Why is this project important?

One of the roles of theatre in my mind is to make the invisible, visible; to connect the dots between seemingly disconnected parts of a puzzle. The issues of mental health and stigmatization, while being invisible to a great deal of the population, affect us all on a daily basis. Building public awareness of the issue is important to the overall health of our communities. It is an essential element of overall community wellness that health authorities on which we rely for support in times of mental duress be themselves healthy places for both clients and staff.

The prevalence of stigma in our society creates serious barriers to both accessing and providing effective care. It is in the stories of our society's most vulnerable, and the stories of those who provide care and service that we may find some keys to unlocking those barriers for all of us. It is through uncovering these stories that we may be able to 'sensemake'10 in the midst of this complex issue.

How do we create space for 'messiness' inside a system that is mechanizing?

Understanding that the suffering of those with mental health issues is part of the continuum of human experience may go a long way towards the emergence of a compassionate model of care.

This project is an opportunity for people who are living issues of stigmatization to articulate a story that will be a community focal point for making sure that health authorities are as free of stigmatization as possible. The insights from this project also have, I believe, ripple effects into other issues that compromise the health of our communities.

maladjusted is a creative model that attempts to involve the public in real dialogue, that can lead to actual public input into policy planning.

David Diamond
Artistic and Managing Director

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