Why Everyone Should Practice Self-Advocacy in Healthcare and Therapy

When seeking mental health support through Canada’s healthcare system or looking for a private therapist, self-advocacy is essential. Self-advocacy is simple but can be hard to do — speaking up (and standing up) for your needs, your rights, and your preferences as a patient. Easy in practice, but not always so easy in execution. 

It means proactively researching and learning more about the options available to you, having meaningful—sometimes difficult—conversations with administrative staff and care workers, and making yourself heard until you get the care you need.

Self-advocacy is an important practice. It can be as straightforward as expressing your needs to your therapist in your first few sessions. Or, it can involve the in-depth process of advocating across bureaucratic levels and institutional practices. 

Alana’s story, the focus of this article, represents the latter. Whatever your specific requirements for self-advocacy might be, her story highlights how critical the practice is for anyone seeking therapy or mental health support.

Alana's Self-Advocacy Journey

Alana Salsburg was no stranger to Canada’s mental health care system. For over a decade she had worked in mental health education and promotion initiatives throughout the country.

But her own experiences seeking care were frustrating. Alana has struggled with an eating disorder, and with severe episodes of depression, which she continues to manage. Despite her experience and insight, it wasn’t until 2022, when she was diagnosed with breast cancer, that she was able to access the care she needed.

Alana shared her story on LinkedIn, and it resonated with many readers who had struggled in their own pursuit of effective mental health support.

Here’s what Alana had to say about her own experiences, the value of finding the right professional, and why it’s sometimes important to be a “squeaky wheel” in the machine.

“I’m sure I’ve been diagnosed a million different times, but I would never put any kind of value on those diagnoses, because they didn’t ask the right type of questions that contextualized me and my mental health.”

Searching for the Right Care

Alana spent years seeking help in the healthcare system, but struggled to find a professional with a treatment plan that helped her symptoms.

“I have ‘talked it out’ so many times, and I haven’t really found talk therapy to be that effective,” she said.

She often felt the therapists she saw oversimplified her condition, offering surface-level advice that sounded good but, given her symptoms, was not practical.

“It’s very easy for [the healthcare professionals] to say, ‘Look on the bright side,’ or ‘Go have a bubble bath,’ or ‘What about the gym when the depression hits?’” she said. But that type of care did nothing to alleviate her symptoms.

“I know what I’m not supposed to be doing, or what I should be doing,” she said. But that knowledge alone wasn’t enough.

Persevering Through the Public Health System

After giving up on finding a private talk therapist, Alana was left to the public health system for support.

Alana recalls one instance when, during a mental health crisis, her family doctor referred her to a psychiatrist who was part of her family health team in Ontario.

“I would get access to him for a few different engagements, but he wasn’t keeping track of me as a human being,” she said. “He wasn’t asking the right questions that could contribute to a clear understanding of what kind of support I needed.”

Alana felt she was being treated more like a number—or a bundle of symptoms—than a person. 

Her psychiatrist took “a medication-first approach,” she said. She tried many medications, but none of them prevented or managed the depression she'd fall into.

This wasn’t Alana’s first time seeking help from doctors, either. She had talked to psychiatrists before. And she would talk to more psychiatrists in the future. All of them, she said, followed a mechanical, one-size-fits-all approach to her treatment.

“I’m sure I’ve been diagnosed a million different times,” she said, “but I would never put any kind of value on those diagnoses, because they didn’t ask the right type of questions that contextualized me and my mental health.”

Her sessions with psychiatrists were always limited to quick, 15-minute interviews, followed by medication treatment. This never achieved a lasting impact. 

“[Doctors] are trying to move people as quickly as possible through the initial diagnosis process,” Alana said, but “there are so many people that need more than 15 minutes.”

The Self-Advocacy Secret: Be the Squeaky Wheel

Some doctors, when Alana went to see them, were surprised to look at her file and learn just how many professionals she’d been to.

She recalls one doctor saying something to the effect of, “Holy smokes, you’re just getting passed around, and nobody has really engaged long enough.” 

“Our society doesn’t know how to clearly define and support recovery when it comes to mental illness,” Alana said. But that didn’t deter her. She kept looking.

It was because of her relentless self-advocacy—her willingness to be the “squeaky wheel” drawing attention to the shortcomings of the mental health care machine as a whole—that she saw so many professionals. The alternative would have been giving up.

Ironically, it would be a physical health crisis that would lead to Alana getting the mental health support she needed.

Hitting the Redline

In 2022, Alana received a breast cancer diagnosis.

She’s quick to point out that her diagnosis was timely, and the treatment was preventative. In her LinkedIn post, Alana said she was “never ill” due to the cancer.

It was the mental and emotional effects of the diagnosis that had the greatest impact on her.

“I did not face it with stoicism, grace, or bravery,” she said in her post. Instead, her seasonal depression, worsened by fears raised over the cancer diagnosis, hit her “like a ton of bricks.”

She was virtually immobilized by her depression, unable to follow her doctors’ instructions. It was a dangerous place to be.

“In order for somebody to engage and … follow the treatment protocol dictated by their cancer,” she said, “they have to be able to function and not fall to pieces.”

Without effective treatment, she wouldn’t be able to go through with the complete course of treatment. So it was only now, when her physical wellbeing was in jeopardy due to her mental health struggles, that Alana was able to find the help she needed. 

She had crossed the red line between mental suffering and imminent, physical danger. It’s a line many Canadians are forced to cross before the public health care system finally provides them the support they need.

Finding the Unicorn Psychiatrist 

Alana was referred to yet another psychiatrist. But this time she met a specialist who was truly prepared to help her.

“Cancer is terrifying,” Alana said. A psychiatrist working with cancer patients must be “working with people and understanding the fear, and all the different triggers, that cancer can cause. They have to be part of the recovery plan.”

Her new psychiatrist gave Alana the time and attention she needed to finally begin progressing on her mental health journey.

“She was and continues to be very interested in my brain,” Alana said of her psychiatrist. “Not just the ‘messed up’ brain—I mean she really appreciates my … concerns and criticisms when it comes to the mental health sector.”

Today, Alana is cancer free. And, importantly, she’s continuing treatment under the professional she calls her “unicorn psychiatrist,” someone dedicated to focused, long-term support.

Looking Ahead: Normalizing Self-Advocacy in Healthcare

Alana is now acting as a lived experience advisor and patient partner on research projects, where she hopes to improve systems supporting patients’ mental health as they undergo treatment.

She is adamant that patients seeking mental health treatment—whether or not they also face a serious medical diagnosis—must learn how to advocate for themselves.

“What I encourage people to do is get educated enough that they can be a pain in the ass and self-advocate,” she says.

That means learning the ins and outs of the medical system and its mental health components, and finding the courage to speak up and stand out when necessary—to be a “pain in the ass,” as Alana puts it, until they get the treatment they need.

“I’m very lucky that I can speak the language of self-advocacy. I know exactly how far to go to pressure for better engagement,” she says. And she hopes her story will encourage others to learn to speak the same language.