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mental health, hiv/aids and hcv coinfection - Pacific AIDS Network

RESOURCE GUIDE

CHAPTER THREE

PSYCHIATRY AND HIV/AIDS

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MENTAL HEALTH, HIV/AIDS AND HCV COINFECTION

Psychiatric Disorders Fact Sheet 4

Psychiatric disorders are a barrier to medical care

and adherence to medications, and several studies

have found that depression, stress and trauma can

lead to disease progression and increased

mortality. 5,6,7,8 The power of mental health

treatment to reduce depression and anxiety,

improve adherence and HIV health outcomes and,

in turn, reduce the likelihood of death from AIDSrelated

causes speaks to the vital role of mental

health care in the web of HIV care. 8.9.10.11

People with serious mental illness are particularly

vulnerable to HIV infection as a result of the higher

prevalence among this group of a variety of factors,

including poverty, homelessness, high-risk sexual

activities, drug abuse, sexual abuse, and social

marginalization. Estimates of HIV infection rates

among people with mental illness in the United

States vary widely from 3 percent to 23 percent;

the average is about 7 percent. Their health

outcomes remain poor. 12

When it comes

to HIV/AIDS,

mental health

matters.

Diagnosis and

treatment of

mental health

issues are essential

to the physical

health and quality

of life for PWAs.

4 Information for this section is from: http://hab.hrsa.gov/publications/may2009/default.htm

5 Treisman GJ, Angelino AF, Hutton HE. Psychiatric issues in the management of patients with HIV infection. JAMA.

2001;286:2857–64. 3Lesser, 2008.

6 Lesser, 2008.

7 Starace F, Ammassari A, Trotta MP, et al. Depression is a risk factor for suboptimal adherence to highly active

antiretroviral therapy. J Acquir Immune Defic Syndr. 2002;31(Suppl 3):S136–9.

8 Whetten K, Reif S, Whetten R, et al. Trauma, mental health, distrust, and stigma among HIV -positive persons:

implications for effective care. Psychosom Med. 2008;70:531–8.

8. Cook JA, Grey D, Burke J, et al. Depressive symptoms and AIDS-related mortality among a multisite cohort of HIVpositive

women. Am J Public Health. 2004;94:1133–40.

9. Kalichman SC. Co-occurrence of treatment nonadherence and continued HIV transmission risk behaviors:

implications for positive prevention interventions. Psychosom Med. 2008;70:593–7.

10. Carrico AW, Antoni MH. Effects of psychological interventions on neuroendocrine hormone regulation and immune

status in HIV-positive persons: a review of randomized controlled trials. Psychosom Med. 2008;70:575–84.

11. Horberg MA, Silverberg MJ, Hurley LB, et al. Effects of depression and selective serotonin reuptake inhibitor use on

adherence to highly active antiretroviral therapy on clinical outcomes in HIV-infected patients. J Acquir Immun Defic

Syndr. 2008;47:384–90.

12. Weiser SD, Wolfe WR, Bangsberg DR. The HIV epidemic among individuals with mental illness in the United States.

Curr Infect Dis Rep. 2004;6:404–10

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RESOURCE GUIDE

HIV/AIDS PSYCHIATRY

A Review of Syndromes and Treatment

Stephen J. Fitzpatrick MD, FRCPC

Consultation-Liaison Psychiatry

St. Paul’s Hospital, Vancouver, BC

Clinical Associate Professor

Department of Psychiatry

Faculty of Medicine

University of British Columbia

HIV/AIDS PSYCHIATRY

A Review of Syndromes

and Treatment:

Presentation

as presented by Stephen

Fitzpatrick as the Keynote

Address

Director

Program of Consultation-Liaison

Psychiatry

Department of Psychiatry

University of British Columbia

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MENTAL HEALTH, HIV/AIDS AND HCV COINFECTION

•TO UNDERSTAND THE

BIOLOGY OF HIV IN THE CNS

• TO REVIEW COMMON

PSYCHIATRIC DISORDERS

ASSOCIATED WITH HIV

DISEASE AND THEIR

TREATMENT

• TO REVIEW IMPORTANT

INTERACTIONS BETWEEN

PSYCHOTROPIC AND

ANTIRETROVIRAL MEDICATIONS

•HUMAN RETROVIRUS IDENTIFIED IN

1984

•RNA PLUS REVERSE TRANSCRIPTASE

ENZYME

•RAPID REPLICATION AND GENETIC

MUTATION

•INFECTS BLOOD T-HELPER (CD4)

LYMPHOCYTES,

LYMPHOID TISSUE AND CNS

1 2

•SEXUAL BEHAVIOURS WITH

EXCHANGE OF BODY

FLUIDS

•INJECTION DRUG USE

•BLOOD TRANSFUSION

•PERINATAL

•PSYCHIATRIC

MOOD DISORDERS

BIPOLAR, DEPRESSION, DYSTHYMIA

PSYCHOTIC DISORDERS

SCHIZOPHRENIA, SCHIZOAFFECTIVE

PERSONALITY DISORDERS

BORDERLINE, HISTRIONIC,

NARCISSISTIC, DEPENDENT, ANTISOCIAL

• SUBSTANCE USE / ABUSE /

DEPENDENCE

• SOCIAL / GEOGRAPHICAL / FINANCIAL

FACTORS

3 4

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RESOURCE GUIDE

• 3-6 WEEKS AFTER INFECTION

• BURST OF REPLICATION AND WIDE

DISSEMINATION OF VIRUS

• NON-SPECIFIC FLU-LIKE SYMPTOMS

• BODY MOUNTS MASSIVE IMMUNE RESPONSE

PRODUCES ANTIBODIES

POSITIVE SEROCONVERSION AND

POSITIVE HIV TEST

• USUALLY LASTS FOR YEARS

• BALANCE BETWEEN VIRUS

REPLICATION/INFECTION OF NEW CD4

CELLS VS PRODUCTION OF NEW CD4 CELLS

• 10 BILLION VIRUS PARTICLES PRODUCED

DAILY - PLASMA VIRUS HALF-LIFE OF 6

HOURS

• NOT A DORMANT STATE

5 6

•PRODUCTION CANNOT KEEP UP WITH

DESTRUCTION AND REPLICATION

•FATIGUED IMMUNE RESPONSE SYSTEM

•CD4 < 200

•OPPORTUNISTIC INFECTIONS ARISE

Biology

HIV creates chronic, progressive, inflammatory CNS

disease

Viral load, CD4 count provide a ‗cross-sectional

snapshot‘

Serum and CSF viral dynamics may differ

Neuronal dysfunction – neurotoxins, chronic

inflammatory state, cytokine and chemokine

release

Apoptosis ( programmed cell death ) in sub-cortical

white matter, basal ganglia and frontal lobes

7 8

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MENTAL HEALTH, HIV/AIDS AND HCV COINFECTION

ANTIVIRAL THERAPY TARGETS DURING THE

HIV REPLICATION CYCLE

• EARLY PENETRATION INTO CNS (DAY 16) VIA

MACROPHAGES

ACROSS BLOOD-BRAIN BARRIER

• VIRUS INFECTS MACROPHAGES AND

MICROGLIAL CELLS, NOT

NEURONS

• NEUROTOXINS AND CHRONIC INFLAMMATORY

RESPONSE

NEURONAL DYSFUNCTION/DEATH

• CNS IS A RESERVOIR WITH SEPARATE VIRAL

DYNAMICS FROM

PERIPHERAL BLOOD

• BRAIN/LIMBIC SYSTEM DYSFUNCTION MOOD

SYMPTOMS,

SLEEP DISTURBANCE, MEMORY AND

CONCENTRATION

COMPLAINTS, MENTAL SLOWING, AGITATION

9 10

• DRUG-DRUG INTERACTIONS

• LIVER TOXICITY

• DEGREE OF DRUG CNS PENETRATION

• CO-INFECTION WITH HEPATITIS C

INTERFERON TREATMENT

• SIDE EFFECTS OF ARV THERAPY

• NUCLEOSIDE REVERSE TRANSCRIPTASE

INHIBITORS NRTI’s

• NUCLEOTIDE REVERSE TRANSCRIPTASE

INHIBITORS NtRTI’s

• PROTEASE INHIBITORS

PI’s

• NONNUCLEOSIDE REVERSE TRANSCRIPTASE

INHIBITORS

NNRTI’s

• RIBONUCLEOTIDE REDUCTASE INHIBITORS

11 12

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RESOURCE GUIDE

• Combination therapy most popular

One pill = 3 or 4 ARV’s

Atripla

Truvada

Kivexa

Raltegravir

Maraviroc

Etravirine

12 14

Challenges

- PROTEASE INHIBITORS GENERALLY INHIBIT METABOLISM OF

PSYCHOTROPIC MEDS, ESPECIALLY BUPROPRION,

BENZODIAZEPINES AND CLOZAPINE

- MONITOR DOSES, SIDE-EFFECTS, CLINICAL RESPONSE

- RITONAVIR (NORVIR)) AND RITONAVIR / LOPINAVIR (KALETRA)

REQUIRES MOST MONITORING

- EFAVIRENZ (SUSTIVA) HAS UP TO 34% CNS PENETRATION

–- FREQUENT CNS / PSYCHIATRIC MANIFESTATIONS

–- CAN HAVE ACUTE ONSET OF MOOD SHIFT, AGITATION,

SUICIDALITY

• What am I treating?

• What does the patient report as a problem?

• What do other people report as a problem?

• Adherence to ARV RX

• Substances

• Drug interactions

• Delirium

• Vague symptoms

• What is the problem?

15 16

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MENTAL HEALTH, HIV/AIDS AND HCV COINFECTION

– ADJUSTMENT DISORDERS

– ANXIETY DISORDERS

– MOOD DISORDERS

• DEPRESSION

• MANIA / HYPOMANIA

– PSYCHOTIC DISORDERS

• SCHIZOPHRENIA

• SCHIZOAFFECTIVE

• BRIEF PSYCHOSIS

– SLEEP DISORDERS

– COGNITIVE DISORDERS

• HIV - ASSOCIATED MINOR COGNITIVE MOTOR

DISORDER

H-MCMD

• HIV - ASSOCIATED DEMENTIA COMPLEX H-ADC

– SUBSTANCE ABUSE / DEPENDENCE

– DELIRIUM

17 18

- VERY COMMON

- ELEVATED PREVALENCE OF PSYCHIATRIC DISORDERS

PRE-HIV INFECTION

- ALL PERSONS WITH HIV WILL DEVELOP AT LEAST ONE

PSYCHIATRIC DISORDER OVER COURSE OF DISEASE

- BIO-PSYCHO-SOCIAL MODEL

- FREQUENT CO-MORBIDITY

- POLYPHARMACY

- DYNAMICS OF ACUTE AND CHRONIC MEDICAL DISEASE

- SOCIALLY MARGINALIZED, LIMITED SUPPORT, ISOLATION

FROM FAMILY

19 20

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RESOURCE GUIDE

– IMPROVE QUALITY OF LIFE

– FACILITATE ADHERENCE

– INCREASE LEVEL OF FUNCTION

– DECREASE HEALTH CARE COSTS

– IMPROVE RELATIONSHIPS

– EDUCATE RE:

• RISK REDUCTION

• SEXUAL BEHAVIOURS

• CO-INFECTION

– ADVOCATE RE:

• DISABILITY

• FAMILY

• BUREAUCRACY

– ADDRESS DEATH AND DYING ISSUES

21 22

Depression

– THINK GERIATRIC BRAIN

•START LOW, GO SLOW

– BALANCE RISKS AND BENEFITS

– POLYPHARMACY

– REVIEW CD4, VIRAL LOAD, ANTIRETROVIRAL (ARV)

MEDS, OTHER MEDICATIONS, LFTS

• Most common disorder

• Cascade of negative consequences

• Under recognized, under treated

• Normalization of Sx by others

• Overlap of HIV physical Sx with mood Sx

• Anhedonia, diurnal variation, early cognitive decline

• Responsive to Rx

23 24

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MENTAL HEALTH, HIV/AIDS AND HCV COINFECTION

Depression Rx

• SRI’s

• SSNRI’s

• Buproprion

• Psychostimulants

• Mirtazepine

• ECT

Augmentation

• Common

• Effective

• Multiple choices – other AD’s, Lithium, T3 (Cytomel),

psychostimulants, atypicals

• Caution - Drug-drug interations

• No TCA’s, MAOI’s – exceptions include

• Pain

• Sleep

• Augmentation

25 26

BIPOLAR DISORDERS

MEDICATIONS FOR

BIPOLAR DISORDERS

• lithium

• PRE-EXISTING BIPOLAR DISORDER BECOMES MORE FRAGILE WITH

HIV

• NEW ONSET MORE LIKELY ASSOCIATED WITH CNS HIV DISEASE OR

SUBSTANCE USE THAN FAMILY/PERSONAL HISTORY

• ? RECENT CHANGE IN ARVs

• MAY DO WELL WITH SUBTHERAPEUTIC DOSES

• valproic acid (EPIVAL)

• gabapentin (NEURONTIN)

• atypical antipsychotics

• avoid carbamazepine (TEGRETOL) and clozapine

• bone marrow suppression

• ? lamotrigine (LAMICTAL) - Steven’s-Johnson Syndome

• ? topiramate (TOPAMAX)

27 28

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RESOURCE GUIDE

PSYCHOTIC DISORDERS

• PRE-EXISTING AXIS 1 DISORDER MAY WORSEN

• APPEARANCE OF DE-NOVO PSYCHOTIC SX SUGGESTIVE OF CNS

HIV DISEASE OR SUBSTANCE USE

• PREFERENTIAL USE OF ATYPICAL NEUROLEPTICS

• HIGHER THAN USUAL RATE OF EPS

Psychosis

• Delirium or HIV- associated cognitive impairment?

• Organic work-up – CT, MRI, CSF viral load, syphilis

• New or changed ARV RX can precipitate

• Neuropsych testing

• Be Patient

• USE DEPOTS WITH CAUTION

• Accuphase

29 30

COGNITIVE DISORDERS

• COMMON COMPLAINTS

• POOR CONCENTRATION, MENTAL SLOWING

• SHORT TERM MEMORY PROBLEMS,

• I.E. RECALL OF NAMES, PHONE NUMBERS

UP TO 90% IS H-MCMD, ONLY 10% H-ADC

Cognitive Disorders

• Depression?

• The ‘aha’ phenomenon

• Inevitable – mild, moderate, severe

• SUBCORTICAL RATHER THAN CORTICAL PROCESS

• RULE OUT MEDICAL CNS PATHOLOGY – CT, MRI, CSF Viral Load

31 32

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MENTAL HEALTH, HIV/AIDS AND HCV COINFECTION

TREATMENT FOR COGNITIVE DISORDERS

COGNITIVE DISORDERS

• MAXIMIZE ARV THERAPY

• NEURO-PSYCHOLOGICAL TESTING HELPFUL

• 3MS, MOCA

• FINGER TAPPING, TRAIL-MAKING, SEQUENCING, VISUAL-SPATIAL

• ANTIDEPRESSANTS

• PSYCHOSTIMULANTS

• DEXEDRINE, METHYLPHENIDATE (RITALIN)

• MMSE IS LESS HELPFUL

• AUGMENTATION

• ATYPICAL NEUROLEPTICS, MOOD STABILIZERS

• PROMPTS, CUES, STICKY NOTES, DAY PLANNER/CALENDAR,

BLISTER PACK MEDS, ALARM FOR MEDS, COMMUNITY NURSING

33 34

SLEEP DISORDERS

MEDICATIONS FOR SLEEP DISORDERS

• VERY COMMON – chronic, refractory

• PRIMARILY INSOMNIA

• INITIAL, MIDDLE, NON-RESTORATIVE SLEEP

• CENTRALLY MEDIATED

• REVIEW SUBSTANCE USE

• NOT NECESSARILY ASSOCIATED WITH DEPRESSION

• OFTEN REQUIRED

• zopiclone (IMOVANE)

• trazodone (DESYREL), amitriptyline (ELAVIL), mirtazapine

(REMERON)

• clonazepam (RIVOTRIL), oxazepam (SERAX), lorazepam (ATIVAN)

• ATYPICAL NEUROLEPTICS

35 36

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RESOURCE GUIDE

OTHER INTERVENTIONS

OTHER INTERVENTIONS

• PSYCHOTHERAPY

• SUPPORTIVE, PSYCHODYNAMIC

• INDIVIDUAL VS GROUP

• TREATMENT SPECIFIC

• ANXIETY GROUP, PERSONALITY DISORDERS GROUP, COGNITIVE-

BEHAVIOURAL

• ADVOCACY

• EDUCATION

• COMMUNITY SUPPORT

• PWA SOCIETY

AIDS VANCOUVER

• FRIENDS FOR LIFE

• LOVING SPOONFUL

• POSITIVE WOMEN’S NETWORK

• OAKTREE CLINIC

• DR. PETER CENTER

• VANCOUVER NATIVE HEALTH SOCIETY

• THREE BRIDGES COMMUNITY MEDICAL CENTER

• SURREY COMMUNITY SERVICES

• HEART OF RICHMOND SOCIETY

• WINGS HOUSING SOCIETY

• ADDICTIONS COUNSELLING

37 38

SUMMARY

• PSYCHIATRIC DISORDERS ARE VERY COMMON IN

PERSONS LIVING WITH HIV BOTH PRE-INFECTION (AS A

RISK FACTOR) AND POST-INFECTION (AS A

COMPLICATION)

• HIV ENTERS THE CNS EARLY AND EVENTUALLY

CAUSES NEURONAL DYSFUNCTION AND NEURONAL

DEATH

• PSYCHIATRIC DISORDERS USUALLY RESPOND VERY

WELL TO TREATMENT

• BE CAREFUL WITH DOSING AND MINDFUL OF OTHER

MEDS

• I.E. ARV THERAPY, INTERFERON, OTCs

39

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MENTAL HEALTH, HIV/AIDS AND HCV COINFECTION

Clinical Resources for HIV and Mental Health

In BC, the BC Centre for Excellence develops and collates various clinical guidelines related to HIV.

However clinical guidelines related to HIV and HCV and mental health have either not been developed

or are not easily accessible.

In the United States, the AIDS Institute's Office of the Medical Director directly oversees the

development, publication, dissemination and implementation of clinical practice guidelines, in

collaboration with The Johns Hopkins University, Division of Infectious Diseases. These guidelines

address the medical management of adults, adolescents, and children with HIV infection; primary and

secondary prevention in medical settings; and include informational brochures for care providers and

the public.

HIV Clinical Resource

Office of the Medical Director, New York State

Department of Health AIDS Institute in collaboration with

the John Hopkins University Division of Infectious Disease

Title of Resource

http://www.hivguidelines.org

Formats Available

Mental Health Screening: A Quick Reference Guide for HIV Primary Care Clinicians

Updated January 2006

Somatic Symptoms: Mental Health Approach and Differential Diagnosis

Posted November 2008

Depression and Mania in Patients With HIV/AIDS

Updated June 2008

Suicidality and Violence in Patients With HIV/AIDS

Updated January 2007

Cognitive Disorders And HIV/AIDS: Minor Cognitive Disorder, HIV-Associated

Dementia, and Delirium

Updated September 2007

Trauma and Post-Traumatic Stress Disorder in Patients With HIV/AIDS

HTML

PDA

PDF

HTML

PDA

PDF

HTML

PDA

PDF

HTML

PDA

PDF

HTML

PDA

PDF

HTML

PDA

PDF

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RESOURCE GUIDE

Personality Disorders in Patients With HIV/AIDS

Updated May 2006

Anxiety Disorders in Patients With HIV/AIDS

Updated March 2006

Severe and Persistent Mental Illness in HIV-Infected Patients

Posted December 2007

Adherence to Antiretroviral Therapy Among HIV-Infected Patients With Mental

Health Disorders

Updated September 2006

HTML

PDA

PDF

HTML

PDA

PDF

HTML

PDA

PDF

HTML

PDA

PDF

Family Issues for Patients With HIV/AIDS

Updated March 2001

The Role of the Primary Care Practitioner in Assessing and Treating Mental Health in

Persons With HIV

Updated March 2001

Appendix I: Mental Health Screening Tools

Updated August 2007

Appendix II: Interactions Between HIV-Related Medications and Psychotropic

Medications

HTML

PDA

PDF

HTML

PDA

PDF

HTML

PDA

PDF

Updated January 2008

Copyright © New York State Department of Health AIDS Institute, 2000-2009. All Rights

Reserved.

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MENTAL HEALTH, HIV/AIDS AND HCV COINFECTION

MOOD

DISORDERS 10

Psychiatric Disorders Commonly Associated with HIV and AIDS 9, 9

Major depression

A disabling condition characterized by a persistent sad mood; a diminished

sense of well-being; and feelings of guilt, anxiety, or self-loathing. Symptoms

interfere with a person’s ability to work, sleep, study, eat, and enjoy oncepleasurable

activities, and they prevent normal functioning.

Dysthymia

Chronic, mild depression that can prevent normal functioning and persists for

at least 2 years in adults or 1 year in children.

Bipolar disorder

Dramatic mood swings from overly “high,” irritable, or both to sad and

hopeless, and then back again, often with periods of normal mood in between.

The periods of highs and lows are called episodes of mania and depression,

respectively.

ANXIETY

DISORDERS 11

Generalized

anxiety disorder

Chronic anxiety, exaggerated worry, and tension accompanied by a variety of

physical symptoms.

Panic disorder

Unexpected and repeated episodes of intense fear accompanied by physical

symptoms that may include chest pain, heart palpitations, shortness of breath,

dizziness, or abdominal distress.

Posttraumatic

stress disorder

Persistent frightening thoughts and memories of a terrifying event or ordeal in

which grave physical harm occurred or was threatened. Symptoms include

sleep problems and feelings of detachment or numbness.

9

Information for this section is from: http://hab.hrsa.gov/publications/may2009/default.htm

9. New York State Department of Health. Cognitive disorders and HIV/AIDS: minor cognitive disorder, HIVassociated

dementia, and delirium. 2007. Accessed November 3, 2008.

10. Coffey, S, Ed. AIDS Education and Training Centers National Resource Center. Clinical manual for management of

the HIV-infected adult. 2006. Accessed November 3, 2008.

11. Mental Health America. Fact sheet: personality disorders. 2006. Accessed November 3, 2008.

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RESOURCE GUIDE

OTHER 10

Adjustment

disorders

A psychological response from an identifiable stressor or group of stressors

that causes significant emotional or behavioural symptoms, including anxiety

and depressed mood, but does not meet criteria for more specific disorders. 12

DHIV-associated

dementia or AIDS

dementia complex

Progressive illness that is the result of HIV’s impact on the central nervous

system. May affect behaviour, cognition, mood, and motor skills. Patients may

develop ambulation or gait problems, mania, panic, psychosis, social isolation,

13, 14

or anxiety.

Personality

disorders

A group of mental disorders characterized by inflexibility, rigidity, and inability

to respond to the changes and demands of life. People with personality

disorders tend to have a narrow view of the world and find it difficult to

participate in social activities. 15

Substance abuse

Abuse or dependence on anything that is ingested to produce a high, alter

one’s senses, or otherwise affect functioning. 16

12. AllPsych Online. Psychiatric disorders: substance related disorders. Accessed November 3, 2008.

13. 10 Smith, personal communication, 2008.

14.

15.

New York/New Jersey AETC. Psychiatric medications and HIV antiretrovirals: a guide to interactions for clinicians. 2008.

Accessed November 3, 2008.

Emlet CA. An examination of the social networks and social isolation in older and younger adults living with HIV/AIDS.

Health Soc Work. 2006;31:299–308.

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MENTAL HEALTH, HIV/AIDS AND HCV COINFECTION

In the following section you will find fact sheets related to mental

health published on the:

Here to Help, A BC Information Resource for Individuals and Families Managing Mental Health

or Substance Use Problems Website @ http://heretohelp.ca

And further information can be found at:

BC Mental Health and Addictions Website @ http://bcmhas.ca

Mental Illness Fact Sheets

Aboriginal Mental Health and Substance Use

Alternative Treatments for Mental Disorders

Bipolar Disorder

Concurrent Disorders

Cross Cultural Mental Health and Addiction Issues

Depression

Getting Help for Mental Disorders

Improving Mental Health

Mood and Psychosis

Post Traumatic Stress Disorder

Suicide

Treatments for Mental Disorders

6 pages

2 pages

4 pages

4 pages

3 pages

4 pages

4 pages

4 pages

2 pages

4 pages

4 pages

3 pages

69


Let’s discuss...

Aboriginal Mental Health and

Substance Use

Aboriginal people make up only three per

cent of Canadian citizens, but this population

is one of the fastest growing in the country.

It is also the youngest. The average age of

Aboriginal people is 25. This is 10 years

younger than the average age of the general

population.

There is great variety in languages, beliefs,

traditions and cultures among Aboriginal

peoples. In British Columbia alone there

are 203 First Nations bands. About 30

different First Nations languages are spoken

in this province. Unfortunately, there

are also high rates of mental illness and

problem substance use in some Aboriginal

communities. This is due to a number of

factors, including a history of cultural trauma.

Still, a 2002-03 survey indicated that about

70 per cent of First Nations adults living

on reserves felt in balance physically,

emotionally, mentally, and spiritually. Also,

Aboriginal people suffering from mental

health problems have been shown to be

more likely than the rest of Canadians

to seek professional help (17 per cent

as compared to eight per cent). This is a

positive step towards healing for Aboriginal

communities.

What are the rates of mental

illness and substance use

problems among Aboriginals?

Aboriginal people have higher rates of posttraumatic

stress disorder and depression than

other groups:

• About 16 per cent have faced major

depression, which is twice the Canadian

average.

• More Aboriginal youth suffer from

psychiatric problems than non-

Aboriginal youth.

Suicide is the leading cause of death among

Aboriginal people under 44 years old:

• Rates of completed suicide are higher

among Aboriginal males than females,

and peak among young adults between

the ages of 15 and 24.

• According to the Regional Health Survey

in 2002-03, three in 10 adults (31 per

cent) reported having had suicidal

thoughts and one in six (16 per cent)

had attempted suicide at some point in

their lives.

• Among First Nations communities,

suicide rates are twice the national

average, and show no signs of

decreasing.

• The rates among First Nations youth

(between 15 and 24 years of age) were

Aboriginal people suffering from

mental health problems [are] more

likely than the rest of Canadians to

seek professional help.

Backgrounder | 2008 | Aboriginal Mental Health and Substance Use | www.heretohelp.bc.ca


from five times (among boys) to seven

times (among girls) higher than the

Canadian population between 1989

and 1993.

Aboriginal people are less likely to drink than

the general population. Only 66 per cent of

aboriginals drink alcohol. Still, among those

who do drink, problem substance use is a

serious concern:

• More than one quarter of Aboriginal

Canadians have a substance use

problem.

• Aboriginals are more likely to smoke

than people in the general population

• First-time use of tobacco, alcohol and

other drugs tends to occur at younger

ages in Aboriginal populations.

• Aboriginal youth are at a two-to-six

times higher risk for every alcoholrelated

problem compared to other

young people.

• Aboriginal youth are more likely

to smoke, use inhalants, and use

marijuana regularly.

• Substance use is a leading factor in

teen pregnancy among Aboriginals.

• Aboriginal women have higher rates of

substance use during pregnancy than

other women. This means they are

more likely to have babies born with

Fetal Alcohol Spectrum Disorder and

other problems.

Why are the rates of mental

illness and substance use so

high among Aboriginals?

A history of abuse and discrimination

Aboriginal people in Canada have been

treated unfairly for centuries. Until 1970,

many Aboriginal children were forced to

go to residential schools. At these schools

their culture, language and dignity were

taken away from them. Some were abused

physically and sexually. Because of these

attacks on identity and culture, Aboriginal

students and their families found residential

schools traumatic, even when school

personnel were kind and educational benefits

occurred. As a result, a high percentage of

residential school survivors suffer from mental

or behavioral problems. The last residential

schools closed in the 1980s, but their effects

can still be seen in Aboriginal families and

communities. The trauma felt by students and

their families has been passed down through

successive generations.

Barriers to health care

There are many obstacles that stand between

Aboriginal people and quality health care.

Some of these include:

• lack of access to service

• discrimination among health

practitioners

• lack of appropriate care

• cultural barriers (i.e., lack of experience

mixing traditional and modern

medicine)

• geographic isolation

A cycle of difficult family circumstances

Newer generations of Aboriginals are still at

higher risk for mental health and substance

use problems than the general population.

This is partly because of the stress factors that

continue to occur in many Aboriginal families.

Oftentimes poverty, ill health, educational

failure, family violence, problem substance use

and other difficulties reinforce one another,

perpetuating a cycle of dysfunction and

despair.

1. Early Childhood. Some Aboriginals

live in overcrowded houses in isolated

environments run by single parents who

survive on very low income. As a result,

some Aboriginal children fail to receive

the attention they need to develop

socially and emotionally. On reserves,

there are often many generations living

under one roof. In these situations

children may be exposed to alcohol and

other drug use from a young age. This

Primer 2007 | Post Partum Depression Factsheet | www.heretohelp.bc.ca

Backgrounder | 2008 | Aboriginal Mental Health and Substance Use | www.heretohelp.bc.ca


puts them at higher risk for substance

use in their teen years and later. Higher

than average rates of family violence,

including physical and sexual abuse,

also put Aboriginals at higher risk

for mental health and substance use

problems.

2. Adolescence. Young Aboriginals

are at high risk for harms caused by

substance use. In comparison to youth

of the general population, Aboriginal

youth experience:

• more difficulties in school and

higher high-school drop-out

rates—this is often due to culture

and language barriers. Some youth

also experience discrimination

from teachers and peers related to

Aboriginal values

• confused ethnic identity—it can

be challenging for youth to identify

with their heritage while being

raised and educated in a non-

Aboriginal society

• lower self-esteem and selfconfidence

• higher rates of sexual abuse—

especially among females (nearly

one quarter of female sexual-assault

victims are younger than seven)

• more psychiatric problems

Unplanned teen pregnancy is an

important factor that plays a role in the

cycle of mental health and substance

use problems among Aboriginals.

Added to this issue is the fact that

Aboriginal youth often start using drugs

and alcohol to fit in with peers and

boyfriends/girlfriends. Young women

sometimes feel pressure to continue

using substances after they become

pregnant because they fear others

will find out. This is one cause of the

high rates of Fetal Alcohol Spectrum

Disorder (FASD) in the Aboriginal

population. These rates suggest that

some young women are addicted to

alcohol, or they may not understand the

risks of using alcohol and other drugs

during pregnancy. This is a big problem

because many expectant teen mothers

also have poor eating and exercising

habits. All of these factors work together

to create a high risk for delivering a child

with problems.

3. Adulthood. Aboriginal women often

have particularly stressful, hard lives

because of physical abuse and a lack

of support from their partners. Some

use substances to manage stress or to

cope with anxiety, depression and other

mental health problems.

Continuing the Cycle

with FASD

Fetal Alcohol Spectrum Disorder

(FASD) is the leading cause of

preventable mental retardation

in Canada. The rate of FASD in

the general population is about

one per cent. In Aboriginal

communities it can be 10 per

cent or higher. FASD cannot be

passed down from a mother

with the disorder to a baby

unless the mother was drinking

during pregnancy. However,

young parents with FASD have

a more difficult time taking care

of themselves, holding jobs and

raising healthy children. As a

result, the cycle of risk factors for

substance use continues.

Primer 2007 Backgrounder | Post | 2008 Partum | Aboriginal Depression Mental Health Factsheet and Substance | Use | www.heretohelp.bc.ca


Research has shown that there is a

higher incidence of intimate partner

abuse in Aboriginal communities than

elsewhere. The use of substances

by men has been shown to be an

aggravating factor for violence within

Aboriginal families. Some of the

consequences of male violence against

Aboriginal women include:

• diminished self-esteem and sense

of security

• damage to physical and emotional

health

• negative impact on children

(nurturing a sense of fear and

insecurity and the intergenerational

perpetuation of the cycle of

violence)

• negative impact on financial

security

• loss of matrimonial home and

sometimes relocation outside the

community

• self blame

What promotes resilience in

Aboriginal communities?

It is important to note that some Aboriginal

communities have fewer problems than

others. There are indeed factors that serve

to protect some First Nations people and

communities from the cycle of difficulty.

For example, in the past, Aboriginals had

very strong cultural practices that promoted

healthy connectedness and forms of conflict

resolution that encouraged reconciliation.

This and other similar strengths have helped

Aboriginals to survive despite the great

obstacles they have faced, and still face today.

Some other examples of strengths include:

• the traditional value that is placed

on sharing, humility and not hurting

others

• the value that is placed on cooperation

and non-competition

• the traditional value placed on

community conscience and a shared

sense of responsibility

• a history of spirituality, religious

practices and rituals

• a deep-seated belief in living in

harmony with the Earth and all other

creatures

Traditional strengths have sheltered some

Aboriginal communities more than others. It is

possible that these protective factors could be

called upon to promote and assist the healing

that is so needed today both within Aboriginal

Communities and in Canadian society at large.

Aboriginal people tend to consider mental

wellness holistically. Good mental health

means being in balance with family,

community and the natural environment.

Family and community have an important

role in helping individuals regain their sense

of balance. Therefore strong families and

communities also promote resilience in

Aboriginal communities.

Why is it important to address

mental health and substance

use problems in Aboriginal

populations?

Social responsibility

It is said that the measure of a civilized society

is how it treats its most vulnerable citizens.

Many Aboriginals are vulnerable and treated

poorly. Canadian society needs to find ways

to connect with all people who are struggling

and help them overcome issues that challenge

families and communities. At the same time,

society must recognize that lasting healing

for Aboriginal populations must come from

within.

Many of the difficulties Aboriginal people

face today are a result of the contempt that

was shown for their culture and identity in

the past. Therefore, it is very important that

Backgrounder Primer 2007 | | Post 2008 Partum | Aboriginal Depression Mental Health Factsheet and Substance | www.heretohelp.bc.ca

Use | www.heretohelp.bc.ca


healing processes for Aboriginal communities

draw on and support the resilience embedded

in traditional Aboriginal culture.

Economics

Canada’s Aboriginal population is relatively

small compared to the general population.

Yet the problems and difficulties Aboriginals

face are extreme, resulting in great expense

to the whole country. A disproportionate

number of Aboriginal people live in poverty,

are homeless, or lack appropriate education.

First Nations people experience more

challenges related to FASD, trauma and other

developmental factors. A disproportionate

number of Aboriginals are incarcerated or

involved with the justice system. High rates of

mental problems and substance use among

Aboriginals strain the health care system.

All of these imbalances taken together with

poor health, loss of productivity, lack of social

cohesion and other problems add up to

significant economic cost to society.

How can we move toward a

healthier future?

Aboriginal populations have unique patterns

and consequences of mental illness and

substance use. In order to address these, a

wide range of cultural, environmental and

historical factors must be considered.

It is now widely accepted that psychosocial

factors play an important role in individual

and social development. A call has been

made for the recognition of the influence of

culture on health as well. When considering

the substance use and mental health issues

of Aboriginal people, it is important to

acknowledge that Western culture has its

own difficulties in these areas. Therefore

the Western model may not be appropriate

for Aboriginals. In addition, the influence of

modern-day Western culture on Aboriginal

populations may be seen as the root of some

on-going substance use problems in these

communities.

It may be that taking part in the journey as

Aboriginals rediscover and strengthen their

communities based on certain traditional

practices could actually help mainstream

society to understand the importance

of practices like connectedness and

reconciliation in healing. This could help the

general population to better deal with its own

mental health and substance use problems.

Adopt a culturally appropriate attitude

Lessons from the work that has been done in

healing related to residential schools should

be remembered and used in the context of

healing in Aboriginal communities. Some

of the key findings in research done by the

Aboriginal Healing Foundation (AHF) around

the healing from the legacy of residential

schooling include:

1. Community healing is connected to

individual healing. Rebuilding family

and community support networks will

help stabilize the healing of individuals

have experienced childhood trauma

and family disruption.

2. Culture is good medicine. Culturebased

outreach and healing mediated

by survivors, local personnel and

Elders has proven successful in

reaching individuals who had

previously resisted interventions.

3. Resilience in individuals and

communities can be tapped. Healthy

individuals in distressed communities

were found to be good at promoting

change.

4. It takes time to heal. AHF funding was

limited to a few years, which proved to

be enough to get the healing process

started in many of the communities

where projects were conducted, but

not enough to see complete healing.

5. Services must be put in place and

kept in place to encourage individual

healing and help communities with

their healing journeys. Typically,

programs are short-term and project-

Primer 2007 Backgrounder | Post | 2008 Partum | Aboriginal Depression Mental Health Factsheet and Substance | Use | www.heretohelp.bc.ca


www.heretohelp.bc.ca

based, but research indicated that

services using local capacity and

Indigenous knowledge are effective and

economical.

6. As individuals and communities heal,

the depth and complexity of needs

can be seen, creating generating

demand for training.

Some of the most successful activities

conducted to date by the AHF include healing/

talking circles, interacting with Elders, oneon-one

counseling, and participating in

ceremonies.

Support sex education and

contraception for teens

If Aboriginal youth are not educated by their

parents or schools, they learn about puberty,

sex and relationships through their friends

and the media. Education should be provided

by both Elders and young First Nations role

models who youth can relate to and trust.

Many Aboriginal communities are isolated.

This means that youth must travel to get

to clinics for information, contraception,

and counselling. Health services should be

provided within communities and they must

be confidential. Teens must feel sure that their

use of such services will not result in labeling

or negative judgment by others.

Advocate for targeted,

culturally relevant programs

All programs that serve Aboriginal people

should include screening for substance use

and mental disorders. They should also target

the communities’ most vulnerable citizens,

like children and young women. Parenteducation

and family-support programs

that are culturally sensitive could help

lower violence and problem substance use.

Programs for pregnant teens could feature

cultural myths and be developed to focus on

FASD prevention strategies. (Some studies

show that Aboriginal youth are more likely

to pay attention to cultural myths about the

effects of eating strawberries or crabs during

pregnancy than to avoid using drugs and

alcohol. Adapting cultural myths to include

warnings about drinking alcohol during

pregnancy may help to reduce the risky

behavior of pregnant teens.)

Call a help line

If you are in distress, call 310-6789 (no

area code needed in BC) 24 hours a day to

connect to a BC crisis line that has received

advanced training in mental health referrals,

without a wait or busy signal. This line can

also connect you to Aboriginal Mental Health

Liaison workers who can help you to find the

assistance you need.

If you or someone you know has a substance

use problem, call the

Alcohol and Drug Information and

Referral Service: 604-660-9382 (in Greater

Vancouver) or 1-800-663-1441 (from

anywhere in BC).

You can also check out the Tips section of

the Here to Help website—www.heretohelp.

bc.ca—for more information on how to cut

down on or quit smoking, drinking and using

other substances.

The BC Partners for Mental Health and Addictions Information are a group of seven

leading provincial mental health and addictions nonprofit agencies. The seven partners are

Anxiety BC, BC Schizophrenia Society, Centre for Addictions Research of BC, Canadian

Mental Health Association’s BC Division, F.O.R.C.E. Society for Kids Mental Health, Jessie’s

Hope Society, and Mood Disorder’s Association of BC. Since 2003, we’ve been working

together to help individuals and families better prevent, recognize and manage mental

health and substance use problems. BC Partners work is funded by BC Mental Health and

Addiction Services, an agency of the Provincial Health Services Authority. We also receive

some additional support from the Ministry of Children and Family Development. The BC

Partners are behind the acclaimed HeretoHelp website. Visit us at www.heretohelp.bc.ca.

Produced by the Centre for Addictions Research of BC


● What are Mental Disorders?

● What is Addiction?

● Depression

● Bipolar Disorder

● Postpartum Depression

● Seasonal Affective Disorder

● Anxiety Disorders

● Obsessive-Compulsive

Disorder

● Post-traumatic Stress

Disorder

● Panic Disorder

● Schizophrenia

● Eating Disorders and

Body Image

● Alzheimer’s Disease and

Other Forms of Dementia

● Concurrent Disorders:

Mental Disorders and

Substance Use Problems

● Fetal Alcohol Spectrum

Disorder

● Tobacco

● Suicide: Following the

Warning Signs

● Treatments for

Mental Disorders

● Alternative Treatments

for Mental Disorders

● Treatments for Addictions

● Recovery from

Mental Disorders

● Addictions and Relapse

Prevention

● Harm Reduction

● Preventing Addictions

● Achieving Positive

Mental Health

● Stress

● Mental Disorders and

Addictions in the Workplace

● Seniors’ Mental Health and

Addictions Issues

● Children, Youth and

Mental Disorders

● Youth and Substance Use

● Childhood Sexual Abuse:

A Mental Health Issue

● Stigma and Discrimination

Around Mental Disorders

and Addictions

● Cross Cultural Mental

Health and Addictions Issues

● Unemployment, Mental

Health and Substance Use

● Housing

● Economic Costs of Mental

Disorders and Addictions

● Personal Costs of Mental

Disorders and Addictions

● The Question of Violence

● Coping with Mental Health

Crises and Emergencies

● What Families and Friends

Can Do to Help

● Getting Help for

Mental Disorders

● Getting Help for Substance

Use Problems

The Primer · 2006

online at

www.heretohelp.bc.ca

Alternative Treatments for

Mental Disorders

In BC, doctors routinely prescribe medications

for people with depression, anxiety disorders

and other mental disorders. But the widespread

use of medications doesn’t mean that drugs are

the only option for treating mental illness.

“We encourage people with mental illnesses

to explore both traditional and alternative forms

of treatment,” says Grainne Holman, from the

Health Promotion Department of the Canadian

Mental Health Association’s Vancouver-Burnaby

branch. “Some people with major depressive

disorder find that antidepressants and/or cognitive

therapy is the best route, but people with

milder depression sometimes feel better with

regular exercise or a change in diet, for example.”

Cognitive therapy is based on research

showing that people can alter their emotions and

even improve their symptoms by re-evaluating

their attitudes, thought patterns and interpretations

of events.

Although she doesn’t advocate any specific

therapy, Holman says many people with mental

health needs are discovering that alternatives

ranging from biofeedback to music therapy

can help restore peace of mind. “People need

to be aware that these alternatives exist,” says

Holman, but she cautions: “they also need to

know how to evaluate existing information

about how effective they are, and about whether

there are any adverse effects when alternative

treatments are taken together with traditional

treatments.”

Jane, a 30-year-old biologist, takes 900 mg

a day of St. John’s Wort, an herb that has been

routinely prescribed for depression in Germany

for decades. Large-scale research reviews indicate

that the herb may offset physical symptoms

of clinical depression. Moreover, the data shows

that consumers are slightly less likely to stop taking

St. John’s Wort than other anti depressants,

like SSRIs. The herb has undergone many safety

tests that explore possible herb-drug interactions

and side-effects, and these suggest that

it is safe and healthy to use under the control

of a physician, with only a few side-effects or

interactions reported.

Consumers should also be aware that the concentration

of active ingredients in herbal formulations

may vary from one manufacturer to the

next, therefore, it is best to seek the advice of a

naturopath about the most reputable brands for

a specific purpose. Jane says she likes the herb

because it is inexpensive and available at local

health stores unlike prescription antidepressants

which she tried for two months.

“One thing that makes me feel better about

St. John’s Wort is the fact that I’m in control of

it,” she says.

Michael Koo, 34, who has had depression

for at least a decade, agrees. He says the keys

to his recovery are reaching out to others and

expressing his feelings. He’s not alone. Nearly

10% of Canadians struggling with symptoms

of mental illness or addiction turn to self-help

groups, telephone hotlines and Internet communities

for support.

Koo also finds it helpful to take time to

connect with his body. “It involves stretching,

breathing, making sounds and getting up and

dancing to music, especially with other people,”

says Koo. “It’s going back to what animals already

do.”

Biofeedback is a technique that helps people

tune into their own body sensations by providing

real-time physical data about the body’s

processes. For example, a biofeedback machine

can be used to monitor rate of breathing, depth

of breathing, irregular breathing, and chest

breathing—all implicated as factors in panic

attacks. By attending to the data provided by

a biofeedback machine, individuals with panic

disorder can control their breathing based on

objective measures instead of their own feelings.

During a “fight-or-flight” response, monitoring

biofeedback levels can help ward off hyperventilation

and feelings of panic. When patients can

see that their bodies are receiving enough air,

this may prevent them from taking deep breaths

that send alarms to the system that something

is wrong, thus heightening an attack.

Other people seek religious and spiritual help

for their mental health problems. Although he

doesn’t believe in God, Allan, 31, says developing

a spiritual awareness has helped him recover

Alternative and Experimental

Treatments for Mental Illnesses

• sleep deprivation for bipolar disorder

(manic depression)

• herbal extracts of St. John’s Wort

(Hypericum perforatum) for depression

• music, art and play therapy

• light therapy for postpartum depression

• biofeedback

• repetitive transcranial magnetic stimulation

(rTMS)

• aromatherapy

• acupuncture

• homeopathy or naturopathy

• Ayurvedic medicine

• therapeutic massage


BC’s Use of Alternative

Therapies in Health Care

BC and other western provinces report using

higher levels of alternative therapies than Canada

as a whole. The five most popular consultations

with an alternative health care provider in the

previous year:






Chiropractor

Massage Therapist

Acupuncturist

Homeopath/Naturopath

Herbalist

Source: Statistics Canada

from the effects of a major depression, suicide

attempt and a history of physical and sexual

abuse. “Basically, spiritual meditation has been

really helpful in just connecting with the energy

around me,” he says. In Canada, around 4% of

individuals with symptoms of mental health

or substance use problems sought help from

members of the clergy; this percentage rises

to 25% in the United States. There are also a

number of other studies showing an association

between spiritual practices and better health

and mental health.

People with more serious mental illnesses

such as schizophrenia may benefit from a

combination of medication, cognitive therapy,

music and art therapies. Cognitive therapies

provide tools for reinforcing psychoeducational

concepts and dealing with persistent symptoms

such as hallucinations. Once considered to be

“alternative therapies,” cognitive therapies for

people with psychotic disorders are increasingly

being supported by clinical research and

incorporated into mainstream

mental health

care. Music and art

therapies allow people

to explore their feelings

through art and music,

make positive changes

in mood and emotions

and develop self-esteem

through participation in

creative activities.

“The body’s physiology

changes from one

of stress to one of deep

relaxation, from one of

fear to one of creativity

and inspiration,” according

to Michael Samuels,

a medical doctor

and art therapist. In BC,

creative arts are part of

treatment programs at

BC’s Riverview Hospital,

Vancouver Commu-

nity Mental Health Services and others.

Alternative treatments are not a cure-all,

especially for people with more serious mental

illnesses. But it is important for people to have

a sense of choice when it comes to treatment,

says Holman of the CMHA. “We tell people to

trust themselves and trust their own physical

and emotional reactions to different treatments,

no matter how helpless they have been made

to feel. We want them to find the combination

of alternatives that works for them.”

In addition to their treatment choices, people

with mental illness benefit from a holistic approach

to community support, she adds. Community

services should address the issues of

income, housing and employment, and provide

services offering peer-based and self-help support.

SOURCES

Knüppel, L. & Linde, K. (2004). Adverse effects of St. John’s Wort: A

systematic review. Journal of Clinical Psychiatry, Vol 65(11), 1470-

1479.

Meuret, A., Wilhelm, F.H. & Roth, W. (2004). Respiratory feedback for

treating panic disorder. Journal of Clinical Psychology, 60(2),

197-207.

Park, J. (2005). Use of alternative health care. Statistics Canada: Health

Reports, 16(2), 38-42. www.statcan.ca/english/ads/82-003-XPE/

pdf/16-2-04.pdf

Samuels, M. How art heals: Mind-body physiology.

www.artashealing.org/ahfw3.html

Statistics Canada. (2003, September 3). Canadian Community Health

Survey: Mental health and well-being. The Daily.

www.statcan.ca/Daily/English/030903/d030903a.htm

Wang, P.S., Berglund, P.A. & Kessler, R.C. (2003). Patterns and correlates

of contacting clergy for mental disorders in the United States.

Health Services Research, 38(2), 647-673. www.pubmedcentral.

gov/articlerender.fcgi?tool=pubmed&pubmedid=12785566

See our website for up-to-date links.

Partners:

Anxiety Disorders

Association of

British Columbia

British Columbia

Schizophrenia

Society

Canadian Mental

Health Association,

BC Division

Centre for

Addictions

Research of BC

FORCE Society for

Kids’ Mental

Health Care

Jessie’s Hope Society

Mood Disorders

Association of BC

For more

information call

the Mental Health

Information Line

toll-free in BC at

1-800-661-2121

or email

bcpartners@

heretohelp.bc.ca

web:

heretohelp.bc.ca


Learn about...

Bipolar Disorder

Mood swings. We all have them once

in a while. Sometimes we’re happy and

excited about the world around us. Other

times we’re sad and the world around us

seems overwhelming or dull. We can even

experience these very different feelings

within the space of a day. But for some

people these mood swings can happen to

the extreme. If your moods swing from

extremely low to extremely high you may

have a mental disorder called bipolar

disorder.

What is it?

Bipolar disorder is a type of mood disorder.

Bipolar disorder used to be called manic

depression. It was called manic depression

because people with bipolar disorder go

through periods of intense depression and

other periods where their mood is extremely

high. These “high” periods are known as

mania. It’s important to note that most

people with bipolar disorder also have

periods where their moods are “normal.”

There are different types of bipolar disorder

depending on how serious your symptoms

are and how long your mood swings last.

• Bipolar I disorder is when you

experience at least one manic episode

or mixed episode (see the box on page

3). Most people who have Bipolar I

disorder also experience episodes of

depression. Manic episodes last for

at least one week, and depressive

episodes for at least two weeks, but

both may continue for many months.

Bipolar I disorder is the most severe

form of the illness.

• Bipolar II disorder is when you have

mostly episodes of depression plus

occasional episodes of hypomania.

Hypomania (see the box on page 3)

is a milder and shorter form of mania

that usually lasts just a few days, but

it can still impair your functioning.

Between episodes, there are usually

periods of wellness. The risk of suicide

is high for this type of bipolar disorder.

Because it can be hard to tell the

difference between hypomania and a

“good mood” Bipolar II is also often not

recognized as easily as Bipolar I.

• Cyclothymic disorder is when

your moods change constantly and

quickly from periods of hypomania

to depression and you’re rarely in a

“normal” mood. Cylothymic disorder

usually begins early in life and the

symptoms are so constant that they are

often mistaken as just a part of your

You may be feeling on top of the

world one day and feeling down

and depressed the next day.

Primer Fact Sheets | 2009 | Bipolar Disorder | www.heretohelp.bc.ca


Could I have Bipolar Disorder?

Since bipolar disorder is made up of two parts, depression

and mania, the symptoms are very different depending

on whether you are in a manic or depressive period. The

depression you experience if you have bipolar disorder is very

similar to clinical depression.

Symptoms of Depression

I have overwhelming feelings of sadness or grief

I’ve lost interest in taking part in activities I used to enjoy

I find myself avoiding other people

I’m sleeping more or less than usual

I’m eating more or less than usual

I’m having difficulty concentrating or making decisions

I’m feeling extremely irritable and angry

I’m feeling guilty all the time

I’ve lost my energy; I’m feeling very tired

I’ve lost my desire for sex

I’m feeling worthless, helpless or hopeless

I’ve had thoughts of death or suicide

Symptoms of Mania













I’ve been in an excessively high or elevated mood

I feel extremely irritable or angry

I’m optimistic about everything, even when others aren’t

I’m making quick decisions often without thinking

them through

I’m spending money more quickly or my sexual

habits have changed

My thoughts are racing; I have a lot of plans

I’m really energetic; I can’t seem to stay still

I’m talking all the time

I’m talking more quickly than usual and people seem to

have a hard time understanding me

I’m feeling little need for sleep

I have an extremely short attention span

I’m seeing or hearing things that other people aren’t

experiencing

You don’t necessarily have to have all of these symptoms

to have bipolar disorder, and many of these symptoms can

be caused by other illnesses. The best thing to do if some of

these symptoms apply to you is talk to your doctor.

personality. But these mood swings

can impair your life and create chaos

as you may be feeling on top of the

world one day and feeling down and

depressed the next day. Some people

with cyclothymia go on to develop a

more severe form of bipolar illness

while for others, it continues as a

chronic (ongoing) condition.

Who does it affect?

More than 2% of the population will have

bipolar disorder at some point in their lives.

About 1% of people have experienced

bipolar disorder in the past year. Unlike

other causes of depression, men and women

seem to have Bipolar I in equal numbers.

Bipolar II however, is more likely to affect

women. Both types of bipolar affect people

of all ages, but tend to appear first in

young adulthood, and the risk decreases

slightly with age. Bipolar disorder looks

quite different in children than it does in

adults. Bipolar disorder does seem to run

in families. Having a close relative who has

bipolar disorder or another mood disorder

increases your risk of having bipolar

disorder.

What can I do about it?

Some common treatments for bipolar

disorder, used on their own, or in

combination are:

• Medication: There are many different

types of effective medication for

bipolar disorder, and different kinds

work in different ways, but they all

target the chemicals in the brain

that can get out of balance during a

depressive or manic episode, and they

can help keep your mood more stable.

Mania can make you feel so good that

you stop taking your medications. This

is very dangerous because symptoms

that return after stopping treatment

are often much harder to treat

properly. Talk to your doctor to find out

if medication is right for you and if so

what type, and how much, to take.

Primer Primer Fact 2007 Sheets | Post | 2009 Partum | Bipolar Depression Disorder Factsheet | www.heretohelp.bc.ca

| www.heretohelp.bc.ca


• Counseling: There are two types of

counseling that work best for people

with bipolar disorder.

› Cognitive-behavioural therapy

(CBT): A health professional who

uses this approach can teach you

skills to help change your view of

the world around you. They do

this by coaching you to break the

negative patterns of depression or

the destructive patterns of mania

including the thoughts and actions

that can keep the moods going.

› Interpersonal therapy (IPT): Often

when you are depressed or in

mania, your relationships with other

people suffer. A health professional

who uses IPT can teach you skills to

improve how you interact with other

people.

• Support groups: Support groups,

or peer support groups, are meetings

where people who are going through

similar experiences come together to

talk about it. Support groups for people

with bipolar disorder and their families

can be a great way to realize that you

aren’t alone, and you can share your

story with others.

• Self-help: For milder forms of bipolar

disorder, or when moderate or severe

symptoms begin to improve with other

treatments, there are some things you

can do on your own to help keep you

feeling better. Regular exercise, eating

well, managing stress, spending time

with friends and family, spirituality,

and monitoring your use of alcohol

and other drugs can help keep bipolar

disorder from getting worse or coming

back. Always making time to get

enough sleep is very important, as lack

of sleep is one of the most common

triggers for mania and depression.

Talking to your doctor, asking

questions, and feeling in charge of your

own health are also very important.

Always talk to your doctor about what

you’re doing on your own.

Some other terms connected

to bipolar disorder:

• Hypomania is a milder form of mania but

still more extreme that a regular good mood.

• Mixed episodes are ones in which you have

symptoms of both mania and depression

at the same time. For example you might

feel excitable and agitated like you do when

you’re in mania; while also feeling depressed

and hopeless. This combination of energy,

agitation and depression makes a mixed

episode the most dangerous for risk of

suicide.

• Rapid cycling is when a person with bipolar

disorder experiences four or more mood

swings or episodes in one year

Primer 2007 | Post Partum Primer Depression Fact Sheets | 2009 Factsheet | Bipolar Disorder | | www.heretohelp.bc.ca


www.heretohelp.bc.ca

Where do I go from here?

The best first step is always to talk to your

doctor. They can help you decide which, if

any of the above treatments would be best for

you. If you think you have bipolar disorder,

it’s important to see a doctor first to rule out

other explanations for your symptoms. If you

go to your doctor when you’re depressed,

it’s important to also mention if you have

other moods as well. This is because some

treatments like antidepressants that are very

helpful for depression can actually trigger

a manic episode if you’ve had one before.

So it’s important to give your doctor the full

picture of how you’re feeling, even if the

mania distresses you less. This will help them

prescribe the best treatments to prevent both

depression and mania. In addition to talking

to your family doctor, check out the resources

below for more information on bipolar

disorder:

Other helpful resources, available in English

only, are:

Mood Disorders Association of BC

Visit www.mdabc.net or call 604-873-0103 for

resources and information on bipolar disorder

and other mood disorders, including support

groups.

Canadian Mental Health Association,

BC Division

Visit www.cmha.bc.ca or call 1-800-555-8222

(toll-free in BC) or 604-688-3234 (in Greater

Vancouver) for information and community

resources on mental health or any mental

disorder.

BC Schizophrenia Society

Visit www.bcss.org or call 1-888-888-0029

(toll-free in BC) or 604-270-7841 (in Greater

Vancouver) for resources and information

on psychosis including support groups and

services for families of people with serious

mental illnesses, including bipolar disorder.

BC Partners for Mental Health

and Addictions Information

Visit www.heretohelp.bc.ca for our Mental

Disorders Toolkit, more detailed fact sheets

on bipolar disorder and personal stories. The

Toolkit is full of information, tips and self-tests

to help you understand your disorder.

Your Local Crisis Line

Despite the name, crisis lines are not only

for people who are in crisis. You can find the

number for your local crisis line online at www.

crisiscentre.bc.ca/distress/other.php or at the

front of your local phone book under

Emergency & Important Numbers> Distress

Centres> Crisis Line. Many are available 24

hours a day, 7 days a week.

Resources available in many languages:

*For each service below, if English is not your

first language, say the name of your preferred

language in English to be connected to an

interpreter. More than 100 languages are

available.

HealthLink BC

Call 811 or visit www.healthlinkbc.ca to access

free, non-emergency health information

for anyone in your family, including mental

health information. Through 811, you can also

speak to a registered nurse about symptoms

you’re worried about, or a pharmacist about

medication questions.

The BC Partners are a group of nonprofit agencies working together to help

individuals and families manage mental health and substance use problems,

with the help of good quality information. We represent Anxiety Disorders

Association of BC, BC Schizophrenia Society, Canadian Mental Health

Association’s BC Division, Centre for Addiction Research of BC, FORCE

Society for Kid’s Mental Health, Jessie’s Hope Society, and Mood Disorders

Association of BC. The BC Partners are funded by BC Mental Health and

Addiction Services, an agency of the Provincial Health Services Authority.


Learn about...

Concurrent Disorders

What is a concurrent disorder?

When a person has both a mental health

issue and a substance use problem, we say

they have a concurrent disorder. (In the past,

this condition was called “dual diagnosis” or

“multiple diagnosis.”)

Tobacco and alcohol are the most common

drugs used by people with concurrent

disorders. Cannabis and cocaine are other

drugs often used in this situation.

How does someone get a

concurrent disorder?

A person with a mental illness, like

depression, schizophrenia, or bipolar

disorder, might use alcohol or other drugs

to cope with their illness. This is sometimes

called self-medication, and it is one way a

person can develop a concurrent disorder.

For example, someone with an anxiety

disorder may develop a concurrent disorder

by getting addicted to drugs their doctor

has prescribed to help them cope with their

illness.

It works the other way, too. Alcohol or other

drugs may cause or aggravate psychiatric

symptoms. For example, studies show that

drinking heavily more than once a week is

linked to an increased risk of depression.

As well, the social consequences that often

come with problematic substance use

(broken relationships, money problems,

etc.) may cause depression or anxiety. In

other words, a person’s mental health—their

moods, perceptions and behaviours—can be

negatively affected by their use of alcohol or

other drugs.

How common are concurrent

disorders?

According to a survey done by Canadian

Community Health in 2002, about 435,000

adults in Canada had experienced concurrent

disorders in the previous year. However,

depending on the people being evaluated,

the overlap of disorders varied. The results

are shown below:

%

Prevalence of mental disorders

- Among people with no substance

use disorder

- Among people with a substance

use disorder

Prevalence of substance use disorder

- Among people with no mental

disorder

- Among people with a mental

disorder

8.4

15.9

11.0

20.7

Tobacco and alcohol are the

most common drugs used

by people with concurrent

disorders.

Primer Fact Sheets | 2008 | Concurrent Disorders | www.heretohelp.bc.ca


This study showed that the risk of having

either a substance use or mental disorder is

about twice as high if you also have the other

type of disorder.

Certain groups of people have higher rates

of concurrent disorders than others. For

example, from a representative group of

adults being treated for substance use

disorders in Ontario, it was found that 69.7

per cent also had a mental disorder. Groups

that tend to have high rates of concurrent

disorders in Canada include:

• people who are homeless

• people who have experienced early

trauma or neglect

• First Nations or Inuit people

• people involved in the criminal justice

system

Are some people more likely

than others to develop a

concurrent disorder?

The link between mental illness and

substance use is complex. The likelihood

of developing both a mental illness and

substance use problem involves biological

factors as well as environmental risks. These

factors influence a person’s resilience (the

ability to cope with pressures and bounce

back from problems).

Mental health problems may emerge in

childhood or during adolescence, and can

increase a young person’s risk of developing

substance use issues. Some people have more

risk factors than others and are therefore

more likely to develop both a mental illness

and substance use problem.

What are some of the risk

factors for concurrent disorders?

The risk factors for concurrent disorders are

the same as those for mental health problems

or substance use problems. These factors

include:

• poverty or unstable income

• difficulties at school

• unemployment or problems at work

• isolation or lack of a social network

• lack of decent housing

• family problems

• family history of mental illness,

problem substance use or concurrent

disorders

• past or ongoing trauma or abuse

• discrimination

• biological or genetic factors

How many risk factors do you

need before you develop a

concurrent disorder?

The more risk factors a person has, the more

likely they are to develop a mental health

or substance use problem or a concurrent

disorder. But not everyone with several risk

factors will develop a problem. Some people

may have protective factors that curb or

balance the risks and increase resilience.

These protective factors may include support

from family and friends and meaningful

involvement in the community.

How can you know if someone

has a concurrent disorder?

In some people it is difficult to diagnose a

concurrent disorder because their psychiatric

symptoms may be masked by their use of

alcohol or other drugs. Also, withdrawal from

alcohol or other drugs can mimic or give the

appearance of some psychiatric illnesses.

A person could end up receiving treatment

only for a mental illness because the health

care provider is not told about the substance

use problem. Or vice versa. A person could

end up receiving help only for their substance

use problem.

There are many reasons why a person with

a concurrent disorder may fail to disclose

information, including:

Primer 2007 | Post Partum Depression Factsheet | www.heretohelp.bc.ca

Primer Fact Sheets | 2008 | Concurrent Disorders | www.heretohelp.bc.ca


• lack of awareness. They may not know

they have the disorder. For example,

they may believe their mental health

problems are related to drug use only

and will therefore go away when they

stop using the drug.

• discrimination. They may believe that

an identity based on drug-use problems

will lead to less discrimination than

one based on mental illness. Or they

may identify more strongly with other

people who suffer from mental health

issues. They may be worried about

being thought of badly by others for

having a drug problem.

What happens if a person with

a concurrent disorder is not

properly diagnosed?

People with concurrent disorders are more

likely to relapse after mental health or

substance use treatment if the other disorder

is not treated. But the treatment system is not

well equipped to recognize and respond to

concurrent disorders. As a result, people with

concurrent disorders face additional barriers

to adequate treatment and other needs such

as supported housing.

People with concurrent disorders can get

caught up in a cycle that involves multiple

living problems resulting from:

• poverty

• lack of support systems

• isolation

• physical illness

• housing difficulties

• disrupted relationships with family and

friends

• problems related to impairment from

alcohol and other drug use

• negative experiences with previous

treatment

What to do if you or someone

you know is experiencing

a problem with concurrent

disorders

If you know someone who has concurrent

disorders, or if you are concerned about

yourself, it’s important to first see a doctor

and get a proper assessment of your

symptoms. In addition to talking to your

family doctor, consult the resources below for

more information.

In British Columbia there are several

programs and services available to help

people with concurrent disorders:

• The Dual Diagnosis Program of

Greater Vancouver is a service for

adults offering access to one-on-one

counselling, an addictions specialist, a

psychiatrist, and a resource centre. For

information call and leave a message at

604-255-9843.

• Vancouver Community Mental

Health Services offers the Early

Psychosis Intervention (EPI) Program,

a concurrent disorders program

specifically for youth aged 12 to 30 who

have not been hospitalized more than

once. To find out more, call

604-225-2211.

• Kids (or adults concerned about a

young person) can call the Vancouver

Child and Youth Mental Health

Services Referral Line to be referred to

the appropriate service at 604-709-4111.

• There are residential treatment

programs available in the Lower

Mainland including Berman House in

Vancouver. Call 604-254-6065.

• Support groups like Double Trouble,

Dual Diagnosis Anonymous, Dual

Recovery Anonymous and others offer

support. Call the Alcohol and Drug

Referral Service at 604-660-9382 or

1-800-663-1441 for groups in your area.

• Some addiction treatment centres

accept people with concurrent

Primer 2007 | Post Partum Primer Fact Depression Sheets | 2008 | Factsheet Concurrent Disorders | | www.heretohelp.bc.ca


The BC Partners for Mental Health and Addictions Information are a group of seven

leading provincial mental health and addictions nonprofit agencies. The seven partners are

Anxiety BC, BC Schizophrenia Society, Centre for Addictions Research of BC, Canadian

Mental Health Association’s BC Division, F.O.R.C.E. Society for Kids Mental Health, Jessie’s

Hope Society, and Mood Disorder’s Association of BC. Since 2003, we’ve been working

together to help individuals and families better prevent, recognize and manage mental

health and substance use problems. BC Partners work is funded by BC Mental Health and

Addiction Services, an agency of the Provincial Health Services Authority. We also receive

some additional support from the Ministry of Children and Family Development. The BC

Partners are behind the acclaimed HeretoHelp website. Visit us at www.heretohelp.bc.ca.

Produced by the Centre for Addictions Research of BC

www.heretohelp.bc.ca

disorders, but these services are not

geared towards the specific needs of

people living with mental illness.

BC Crisis Line

If you are in distress, call 310-6789 (no area

code needed in BC) 24 hours a day to connect

to a BC crisis line that has received advanced

training in mental health referrals, without a

wait or busy signal.

If you’d like publications about mental health

or substance use, you can contact the BC

Partners at 1-800-661-2121.

Call 811 or visit www.healthlinkbc.ca to access

free, non-emergency health information for

anyone in your family, including mental health

information. Through 811, you can also speak

to a registered nurse about symptoms you’re

worried about, or to a pharmacist about

medication questions.

For more information about concurrent

disorders, visit www.heretohelp.bc.ca,

www.carbc.ca, or www.cmha.ca.

Alcohol and Drug Information and

Referral Service

Call 604-660-9382 (in Greater Vancouver) or

1-800-663-1441 (from anywhere in BC).

Your Local Crisis Line

Despite the name, crisis lines are not only for

people who are in crisis. Call for information

on local services or if you just need someone

to talk to. You can find the number for

your local crisis line online at http://www.

crisiscentre.bc.ca/programs-services/distressphone-services/

or at the front of your local

phonebook under Emergency & Important

Numbers> Distress Centres> Crisis Line.

Many are available 24 hours a day, seven days

a week.

BC NurseLine

Call 1-866-215-4700 for 24-hour confidential

health information and advice through a

registered nurse, or to a pharmacist (after

hours).

HealthLink BC


● What are Mental Disorders?

● What is Addiction?

● Depression

● Bipolar Disorder

● Postpartum Depression

● Seasonal Affective Disorder

● Anxiety Disorders

● Obsessive-Compulsive

Disorder

● Post-traumatic Stress

Disorder

● Panic Disorder

● Schizophrenia

● Eating Disorders and

Body Image

● Alzheimer’s Disease and

Other Forms of Dementia

● Concurrent Disorders:

Mental Disorders and

Substance Use Problems

● Fetal Alcohol Spectrum

Disorder

● Tobacco

● Suicide: Following the

Warning Signs

● Treatments for

Mental Disorders

● Alternative Treatments

for Mental Disorders

● Treatments for Addictions

● Recovery from

Mental Disorders

● Addictions and Relapse

Prevention

● Harm Reduction

● Preventing Addictions

● Achieving Positive

Mental Health

● Stress

● Mental Disorders and

Addictions in the Workplace

● Seniors’ Mental Health and

Addictions Issues

● Children, Youth and

Mental Disorders

● Youth and Substance Use

● Childhood Sexual Abuse:

A Mental Health Issue

● Stigma and Discrimination

Around Mental Disorders

and Addictions

● Cross Cultural Mental

Health and Addictions Issues

● Unemployment, Mental

Health and Substance Use

● Housing

● Economic Costs of Mental

Disorders and Addictions

● Personal Costs of Mental

Disorders and Addictions

● The Question of Violence

● Coping with Mental Health

Crises and Emergencies

● What Families and Friends

Can Do to Help

● Getting Help for

Mental Disorders

● Getting Help for Substance

Use Problems

The Primer · 2006

online at

www.heretohelp.bc.ca

Cross Cultural Mental Health and

Addictions Issues

Mental illness and addiction know no colour,

affecting the one in five British Columbians

who identify as a visible minority equally

as much as the population at large. They are

equal-opportunity disablers, affecting anyone,

regardless of culture or ethnicity. But as our

communities reflect increasing cultural diversity,

few of BC’s mental health and addiction services

are able to adequately respond to this diversity,

although some efforts to make services more

responsive are underway, for example the Multicultural

Mental Health Liaison and the Cross

Cultural Psychiatry Outpatient programs, run by

the Vancouver Coastal Health Authority.

While there are a number of factors that

make services less likely to respond—e.g. lack of

awareness about the need, or uncertainty over

how to proceed—increasing the “cultural competence”

of our mental health and addictions

services is a necessary step to improving the

well-being of a significant and growing portion

of the population.

Data from the 2001 census reveal that over

one million citizens of BC’s 4-million population

are immigrants—60% of whom are from a visible

minority. Of the almost 40,000 immigrants

who arrived in BC in 2004, nearly three quarters

of them were from an Asian country.

Immigrant and refugee populations are often

grouped together, but have been shown to

have different risks for poor mental health and

mental disorder.

For example, refugees and those seeking

asylum are at increased risk for mental health

problems because of the physical, emotional,

social and economic stresses involved in migration,

resettlement and adaptation to a new

community and a new life. As they have often

lived in regions in conflict, they may have lost

their families, friends, home, status and income.

They may also face post-traumatic stress, unemployment

and poverty, social isolation, cultural

misunderstanding and shock, racism, feelings of

worthlessness and language difficulties.

On the other hand, researchers are still studying

a trend known as the “healthy immigrant

effect” which finds similar rates for major health

conditions between immigrants and Canadianborn

groups, but much lower depression and

alcohol use problems in the immigrant community,

particularly Asian and African immigrants.

In fact, they are around 20% less likely to report

mental health problems. This disparity seems to

disappear the longer immigrants are in Canada.

It’s thought that health requirements for entry

into Canada as well as personal characteristics

account for this phenomenon.

The one exception to the healthy immigrant

effect seems to be with young people. In one

recent BC survey, young people new to Canada

reported the same levels of psychological distress

as Canadian-born youth. They are also

more likely to face discrimination.

Racism is a real factor in the daily lives of

people of colour and has mental health consequences.

According to researchers, racism

contributes to increased emotional problems

and psychiatric symptoms, particularly those

of depression.

The stresses of daily living and discrimination

increase vulnerability to mental disorders

or emotional difficulties, but cultural attitudes

themselves can work to delay the help-seeking

process. Mental illness and addiction are generally

talked about more openly in the West,

leaving many non-Western cultures more prone

to burying or denying such problems altogether

or until they get severe. According to Stella Lee

who works with the Chinese Outreach Education

Program of the Canadian Mental Health

Association (CMHA), “There’s a fear of mental

illness because of the stigma attached to it. The

families tend to cover it up. They don’t want to

let other people know.”

Indeed, there is evidence that ethnic minorities

experience mental health stigma more

harshly than those from the majority group.

Though it’s not fully understood why, a greater

sense of group identity in Asian and African

Well-Being is Universal

The definition of mental health and well-being is

culturally bound. However, an Australian refugee

project found that there are many components of

well-being which are similar despite the cultural,

religious, gender, and socio-economic status of

individuals. These include:












feeling and being safe and secure

having meaningful and trusting relationships

having a sense of belonging to a social group

having a sense of identity

having basic needs of life met in terms of

housing, food, clothing, water

being in control of one’s own life

being independent

feeling good about one’s self

having physical and psychological health needs

attended to

having traumatic experiences validated

having a sense of optimism or hope for the

future

Source: Multicultural Mental Health Australia


cultures seems to extend stigma to the extended

family more than in the Western world. As a

result of this family-shared shame, coupled

with different cultural perceptions of causes and

treatments for psychological problems, research

confirms that some minority groups in Canada

delay longer in seeking any kind of treatment

than Euro-Canadians. For example, in Statistics

Canada’s most recent mental health survey,

people born outside Canada were less likely to

use a health service for mental health reasons.

This ethnic difference held true even after accounting

for language or acceptability barriers

(for example, people who prefer to manage on

their own or who do not think mental health

services will help). The authors suggest that

perhaps there is a specific issue around level

of awareness of mental health issues and available

resources in ethnocultural communities.

In cases where a would-be client is reluctant

to seek help, Stella Lee encourages others such

as family members to approach the person’s

family doctor.

A major part of the problem is a lack of appropriate

multilingual, culturally- and spirituallysensitive

mental health and addiction services

and a lack of active marketing of all mental

health and addiction services to non-Englishspeaking

minority groups. For example, in an

Australian survey, people who came from a

non-English background—especially those from

Southern and South-East Asia, the Middle East,

and Africa—were less likely to use any health

services than their Caucasian peers despite the

fact they reported higher levels of psychological

distress.

Racism within the mental health and addiction

system can leave many who do seek

out services struggling to integrate a medical

diagnosis of mental illness or addiction with

their different cultural, spiritual worldview

and conceptions of health, illness and healing.

For example, what may be a spiritual

experience to a patient may be psychosis to

a clinician unfamiliar with the person’s cultural

and spiritual views. In fact, it has been

acknowledged in studies that mental health

practitioners are generally more inaccurate

in diagnosing persons whose race does not

correspond with their own.

Cultural differences often make it difficult for

doctors and patients to communicate with one

another. For example, Ethiopian people might

consider frank discussions of medical problems

inappropriate and insensitive and would expect

bad news from doctors to be relayed to them

through friends. A Chinese person may report

bodily symptoms in a doctor’s office and only

offer emotional information about sadness

and hopelessness if directly asked. If a person

does communicate about emotions, it may be

expressed in terms of metaphors. For example,

in Chinese society, talking about “fatigue” or

“tiredness” is often an indication of despair.

Many First Nations people—who face similar

challenges to foreign-born cultural groups—may

be reluctant to seek help from mainstream

mental health and addiction services because of

the history of the way the community has been

treated by white institutions. These communication

barriers restrict access to care for many

people from different cultural backgrounds.

Moreover, immigrants in rural areas may ignore

their mental health needs because they are

isolated from the few services available that are

aimed at their cultural groups.

Local mental health and addiction services

in BC need to bridge the cultural gap and meet

the needs of these much-neglected Canadians.

Perhaps most importantly, a dialogue needs to

be found around cross cultural mental health

and addiction issues, particularly about how

social networks need to be supports, rather than

Contacts for Immigrant

Mental Health Services

• Education Program, Chinese Outreach

CMHA, Vancouver/Burnaby Branch.

Tel: 604-872-4902

• Vancouver Community Mental Health Services,

Multicultural Mental Health Liaison Program,

Asian & Latin American Services

Tel: 604-874-7626

• Chinese Crisis Line: Richmond

Tel: 604-279-8882 (Mandarin)

604-278-8283 (Cantonese)

• Family Services of the North Shore

Tel: 604-988-5281

• Immigrant Services Society of BC

Tel: 604-684-2561

• Surrey Delta Immigrant Services Society

Tel: 604-595-4021

• Mood Disorders Support Group: Vancouver

Tel: 604-738-4025 (Cantonese)

• SUCCESS (United Chinese Community

Enrichment Services Society)

Tel: 604-684-1628

• SUCCESS Burnaby-Coquitlam Office

Tel: 604-936-5900

• SUCCESS Vancouver Family and Youth Program

(Richmond Alcohol and Drug Action Team)

Tel: 604-408-7266

• Taiwanese Canadian Cultural Society

Tel: 604-267-0901

• Surrey Delta Progressive Intercultural

Community Services

Tel: 604-596-7722

• Alcohol and Drug Referral Service

Tel: 1-800-663-1441 (toll free in BC)

Tel: 604-660-9382 (Lower Mainland)

Partners:

Anxiety Disorders

Association of

British Columbia

British Columbia

Schizophrenia

Society

Canadian Mental

Health Association,

BC Division

Centre for

Addictions

Research of BC

FORCE Society for

Kids’ Mental

Health Care

Jessie’s Hope Society

Mood Disorders

Association of BC

For more

information call

the Mental Health

Information Line

toll-free in BC at

1-800-661-2121

or email

bcpartners@

heretohelp.bc.ca

web:

heretohelp.bc.ca


● What are Mental Disorders?

● What is Addiction?

● Depression

● Bipolar Disorder

● Postpartum Depression

● Seasonal Affective Disorder

● Anxiety Disorders

● Obsessive-Compulsive

Disorder

● Post-traumatic Stress

Disorder

● Panic Disorder

● Schizophrenia

● Eating Disorders and

Body Image

● Alzheimer’s Disease and

Other Forms of Dementia

● Concurrent Disorders:

Mental Disorders and

Substance Use Problems

● Fetal Alcohol Spectrum

Disorder

● Tobacco

● Suicide: Following the

Warning Signs

● Treatments for

Mental Disorders

● Alternative Treatments

for Mental Disorders

● Treatments for Addictions

● Recovery from

Mental Disorders

● Addictions and Relapse

Prevention

● Harm Reduction

● Preventing Addictions

● Achieving Positive

Mental Health

● Stress

● Mental Disorders and

Addictions in the Workplace

● Seniors’ Mental Health and

Addictions Issues

● Children, Youth and

Mental Disorders

● Youth and Substance Use

● Childhood Sexual Abuse:

A Mental Health Issue

● Stigma and Discrimination

Around Mental Disorders

and Addictions

● Cross Cultural Mental

Health and Addictions Issues

● Unemployment, Mental

Health and Substance Use

● Housing

● Economic Costs of Mental

Disorders and Addictions

● Personal Costs of Mental

Disorders and Addictions

● The Question of Violence

● Coping with Mental Health

Crises and Emergencies

● What Families and Friends

Can Do to Help

● Getting Help for

Mental Disorders

● Getting Help for Substance

Use Problems

substitutes, for mental health services. When we

move away from the misconception that “people

look after their own,” we can start to talk about

the way such services are planned, formed, and

delivered so that more ethnocultural groups in

BC know that there are places they can go to

for help.

This dialogue can also help us understand

different cultural approaches to healing that

promote recovery. For instance, the World Health

Organization has found that schizophrenia has

a better prognosis, or outcome, in developing

nations not because of better medical treatment

but because of community reaction and integration

of the person into the community. Many

Asian, African and Aboriginal philosophies and

remedies also value balance and harmony, appreciating

how spiritual, emotional, physical

and social elements work together and help or

hinder physical and mental health; this interaction

between mind, body and environment is

too-often lacking in traditional Western-based

clinical settings. The more knowledge-sharing

that can take place around mental health promotion

among cultures, the better care for the

person needing help.

SOURCES

BC Stats. (2005). BC immigration by area of last permanent

residence: January to December 2004. Province of British

Columbia. www.bcstats.gov.bc.ca/data/pop//imm04t1a.pdf

Boufous, S., Silove, D., Bauman, A. et al. (2005). Disability

and health service utilization associated with

psychological distress: The influence of ethnicity. Mental

Health Services Research, 7(3), 171-179.

Elliott, L. (2003). The National Mental Health Project: A

community-based program aimed at reducing mental

disorders amongst refugees in Western Australia.

Multicultural Mental Health Australia.

Hicks, J.W. (2004). Ethnicity, race, and forensic psychiatry:

Are we color-blind? Journal of the American Academy of

Psychiatry and the Law, 32(1), 21-33.

Kopec, J., Williams, J.I., To, T. et al. (2001). Cross-cultural

comparisons of health status in Canada using the Health

Utilities Index. Ethnicity and Health, 6(1), 41-50.

Lou, Y. & Beaujot, R. (2005). What happens to the ‘Healthy

Immigrant Effect’: The mental health of immigrants in

Canada. London, Ontario: Population Studies Centre of

the University of Western Ontario.

www.ssc.uwo.ca/sociology/popstudies/dp/dp05-15.pdf

McCreary Centre Society. (2004). Healthy youth development:

Highlights from the 2003 Adolescent Health Survey.

Burnaby: MCS. www.mcs.bc.ca/pdf/AHS-3_provincial.pdf

Mental Health Foundation. (2004). Refugees, asylum-seekers

and mental health [fact sheet]. www.mentalhealth.org.uk

Mok, H. & Morishita, K. (2002). Depression detection and

treatment across cultures. Visions: BC’s Mental Health

Journal, No. 15, 7-8. www.cmha.bc.ca/files/15.pdf

Oppedal, B., Roysamb, E. & Heyerdahl, S. (2005). Ethnic

group, acculturation, and psychiatric problems in young

immigrants. Journal of Child Psychology and Psychiatry,

46(6), 646-660.

Plant, E.A. & Sachs-Ericsson, N. (2004). Racial and ethnic differences in

depression: The roles of social support and meeting basic needs.

Journal of Consulting and Clinical Psychology, 72(1), 41-52.

Ryder, A.G., Bean, G. & Dion, K.L. (2000). Caregiver responses to

symptoms of first-onset psychosis: A comparative study of Chineseand

Euro-Canadian families. Transcultural Psychiatry, 37(2),

255-265.

Statistics Canada. (2002). Visible minority groups and immigrant

status and period of immigration for population, for Canada,

provinces, territories, census metropolitan areas and census

agglomerations, 2001 Census – 20% Sample Data. 2001 Census

Data: Ethnocultural Portrait of Canada. www.statcan.gc.ca

Vasiliadis, H., Lesage, A., Adair, C. et al. (2005). Service use for mental

health reasons: Cross-provincial differences in rates, determinants,

and equity of access. Canadian Journal of Psychiatry, 50(10), 614-

619. www.cpa-apc.org/Publications/Archives/CJP/2005/september/

cjp-sept-05-vasiliadis-7.pdf

World Health Organization. (1979). Schizophrenia: An International

Follow-up Study. New York: John Wiley and Sons.

See our website for up-to-date links.

The Primer · 2006

online at

www.heretohelp.bc.ca


Partners:

Anxiety Disorders

Association of

British Columbia

British Columbia

Schizophrenia

Society

Canadian Mental

Health Association,

BC Division

Centre for

Addictions

Research of BC

FORCE Society for

Kids’ Mental

Health Care

Jessie’s Hope Society

Mood Disorders

Association of BC

For more

information call

the Mental Health

Information Line

toll-free in BC at

1-800-661-2121

or email

bcpartners@

heretohelp.bc.ca

web:

heretohelp.bc.ca


Learn about...

Depression

After years of working hard at your job each

day, you’ve just been laid off. You feel sad,

tired and emotionally drained. The last thing

you feel like doing is getting out of bed in the

morning. This sadness is a natural part of

being human and feeling this way for a few

days is normal. In fact, many people hear

people say “I’m depressed” in their day-today

life when they are talking about that low

feeling that we can all have from time to

time. But if these sad feelings last for more

than a couple of weeks and you start noticing

that it’s affecting your life in a big way, you

may be suffering from an illness called

depression.

What is it?

Depression, also known as clinical or major

depression, is a mood disorder that will affect

one in eight Canadians at some point in their

lives. It changes the way people feel, leaving

them with mental and physical symptoms for

long periods of time. It can look quite different

from person to person. Depression can

be triggered by a life event such as the loss of

a job, the end of a relationship or the loss of

a loved one, or other life stresses like a major

deadline, moving to a new city or having a

baby. Sometimes it seems not to be triggered

by anything at all. One of the most important

things to remember about depression is that

people who have it can’t just “snap out of it”

or make it go away. It’s a real illness, and the

leading cause of suicide.

Who does it affect?

Depression can affect anybody; young or

old, rich or poor, man or woman. While

depression can affect anyone, at anytime,

it does seem to strike most often when a

person is going through changes. Changes

can be negative life changes such as the loss

of a loved one or a job, regular life changes

such as starting university or a big move, or

physical changes such as hormonal changes

or the onset of an illness. Because depression

can be linked to change, certain groups of

people are at risk more often than others:

• Youth: More than a quarter of a million

Canadian youth — 6.5% of people

between 15 and 24 — experience

major depression each year.

Depression can be hard to recognize in

youth because parents and caregivers

often mistake a teen’s mood swings

and irritability for normal adolescence,

rather than depression. Studies have

shown that gay, lesbian, bisexual or

transgendered youth have higher rates

of major depression.

People can’t just snap out of

depression. It’s a real illness,

and the leading cause of suicide.

Primer Fact Sheets | 2008 | Depression | www.heretohelp.bc.ca


Could I have depression?

• Older adults: Around 7% of seniors

have some symptoms of depression.

This can be brought on by the loss of a

spouse, a shrinking circle of friends or

the onset of an illness. It’s also much

more common among seniors living

in care homes or who have dementia.

Depression in people 65 and over

appears to be less common than in

younger groups, but researchers aren’t

sure if this is a real difference or an

issue with the research questions.

It’s likely that depression is at least

somewhat under-recognized in seniors.

Some symptoms like changes in sleep

or activity levels may be mistaken as

signs of aging instead of depression.

• Women: Depression is diagnosed

twice as much in women as it is in

men. Some reasons for this difference

include life-cycle changes, hormonal

changes, higher rates of childhood

abuse or relationship violence, and

social pressures. Women are usually

more comfortable seeking help for their

problems than men which likely means


I feel worthless, helpless or hopeless


I sleep more or less than usual


I’m eating more or less than usual


I’m having difficulty concentrating or making decisions


I’ve lost interest in activities I used to enjoy


I have less desire for sex


I avoid other people


I have overwhelming feelings of sadness or grief


I’m feeling unreasonably guilty


I have a lot of unexplained stomachaches and headaches


I feel very tired and/or restless


I have thoughts of death or suicide


I’m feeling more tearful or irritable than usual

If you agree with five or more of these statements and have

been experiencing them for more than two weeks you should

talk to your doctor.

that depression in men may be highly

under-reported. Men generally feel

emotionally numb or angry when they

are depressed whereas women usually

feel more emotional.

• People with chronic illness: About one

third of people with a prolonged physical

illness like diabetes, heart disease or a

mental illness other than depression,

experience depression. This can be

because a long term illness can lower

your quality of life, leading to depression.

• People with substance use problems:

There is a direct link between depression

and problem substance use. Many

people who are experiencing depression

turn to drugs or alcohol for comfort.

Overuse of substances can actually add

to depression in some people. This is

because some substances like alcohol,

heroin and prescription sleeping pills

lower brain activity, making you feel

more depressed. Even drugs that

stimulate your brain like cocaine and

speed can make you more depressed

after other effects wear off. Other

factors, like family history, trauma or

other life circumstances may make a

person vulnerable to both alcohol/drug

problems and depression.

• People from different cultures:

Depending on your cultural background,

you may have certain beliefs about

depression that can affect the way

you deal with it. For example, people

from some cultures notice more of the

physical symptoms of depression and

only think of the emotional ones when

a professional asks them. Attitudes

from our cultures can also affect who

we may ask for help. For example, in

one BC study Chinese youth were twice

as reluctant to talk to their parents

about depression as their non-Chinese

counter parts. Aboriginal people, on and

off-reserve, may also have higher rates

of depression, from 12-16% in a year,

or about double the Canadian average.

Primer Primer Fact 2007 Sheets | Post | 2008 Partum | Depression Depression | www.heretohelp.bc.ca

Factsheet | www.heretohelp.bc.ca


What can I do about it?

Depression is very treatable. In fact, with the

right treatment, 80% of people with depression

feel better or no longer experience

symptoms at all. Some common treatments,

used on their own or in combination are:

• Counseling: There are two types of

counseling that work best for people

with depression.

››

Cognitive-behavioural therapy

(CBT): A health professional who

uses this approach can teach you

skills to help change your view of

the world around you. They do

this by coaching you to break the

negative patterns of depression

including the thoughts and actions

that can keep the depression

going.

››

Interpersonal therapy (IPT): Often

when you are depressed your

relationships with other people

suffer. A health professional who

uses IPT can teach you skills to

improve how you interact with

other people.

• Medication: There are many different

types of effective medication for

depression, and different kinds work

in different ways, but they all target the

chemicals in the brain that can get out

of balance during depression. Talk to

your doctor to find out if medication is

right for you, and if so what type, and

how much, to take.

• Electroconvulsive therapy (ECT): This is

a safe and effective treatment for people

with severe depression or who can’t take

medications or who haven’t responded

to other treatments. ECT is a treatment

done in hospital that sends electrical

currents through the brain.

• Self-help: For mild depression, or when

moderate or severe depression begins

to improve with other treatments, there

are some things you can do on your own

to help keep you feeling better. Regular

exercise, eating well, managing stress,

spending time with friends and family,

spirituality, and monitoring your use of

alcohol and other drugs can help keep

depression from getting worse or coming

back. Talking to your doctor, asking

questions, and feeling in charge of your

own health are also very important.

Always talk to your doctor about what

you’re doing on your own.

Some people find that herbal remedies, such

as St. John’s Wort, help with their depression

symptoms. Remember that even herbal

remedies can have side effects and may

interfere with other medications. Dosages can

also vary depending on the brand you use. Talk

about the risks and benefits of herbal or other

alternative treatments with your health care

provider(s) and make sure they know all the

different treatments you’re trying.

• Light therapy: This treatment has

been proven effective for people with

Seasonal Affective Disorder. It involves

sitting near a special kind of light for

about half an hour a day. Light therapy

should not be done without first

consulting your doctor because there

are side effects to this treatment. It is

being researched for use in other kinds

of depression as well.

Primer 2007 | Post Partum Depression Primer Fact Sheets Factsheet | 2008 | Depression | | www.heretohelp.bc.ca


www.heretohelp.bc.ca

Where do I go from here?

The best first step is always to talk to your

doctor. They can help you decide which, if

any, of the above treatments would be best

for you. They can also rule out any physical

explanations for your symptoms. In addition

to talking to your family doctor, check out

the resources below for more depression

information.

Other helpful resources are:

BC Mental Health Information Line

Call 1-800-661-2121 (toll-free in BC) or

604-669-7600 (in Greater Vancouver) for

information, community resources, or

publications.

Mood Disorders Association of BC

Visit www.mdabc.net or call 604-873-0103 for

resources and information on mood disorder

support groups.

Canadian Mental Health Association,

BC Division

Visit www.cmha.bc.ca or call 1-800-555-8222

(toll-free in BC) or 604-688-3234 (in Greater

Vancouver) for information and community

resources on mental health or any mental

disorder.

Your Local Crisis Line

Despite the name, crisis lines are not only

for people who are in crisis. You can call for

information on local services or if you just need

someone to talk to. You can find the number for

your local crisis line online at www.crisiscentre.

bc.ca/distress/other.php or at the front of your

local phonebook under Emergency & Important

Numbers> Distress Centres> Crisis Line. Many

are available 24 hours a day, 7 days a week.

BC NurseLine

Call 1-866-215-4700 (toll-free in BC), 604-

215-4700 (in Greater Vancouver) or 1-866-

889-4700 (if you are deaf or hard of hearing).

BC NurseLine provides confidential health

information and advice. If English is not

your first language, say the name of your

preferred language in English to be connected

to an interpreter. More than 100 languages

are available. Anywhere in the province, call

BC NurseLine to speak to a registered nurse

24-hours or a pharmacist from 5 pm to 9 am

every day. Have your CareCard number ready.

If you do not have a CareCard or don’t want to

give your CareCard number, you can still get

service.

BC Partners for Mental Health and

Addictions Information

Visit www.heretohelp.bc.ca for our Depression

Toolkit, more fact sheets and personal

stories about depression. The Toolkit is full

of information, tips and self-tests to help you

understand your depression.

The BC Partners are a group of nonprofit agencies working together to help

individuals and families manage mental health and substance use problems,

with the help of good quality information. We represent Anxiety Disorders

Association of BC, BC Schizophrenia Society, Canadian Mental Health

Association’s BC Division, Centre for Addiction Research of BC, FORCE

Society for Kid’s Mental Health, Jessie’s Hope Society, and Mood Disorders

Association of BC. The BC Partners are funded by BC Mental Health and

Addiction Services, an agency of the Provincial Health Services Authority.


Tips for...

Getting Help for Mental Disorders

IMAGINE THIS: One day, you develop a

nagging cough, or get sharp back pain. Most

of us wait a few days to see if things get

worse or improve, then we might do some

research on things we can do at home. We

go to friends and family for advice. If the

problem still doesn’t go away on its own, we

usually go to the doctor to get it checked out

so it doesn’t get worse and to find out what it

is, what to do about it, and how to prevent it.

NOW IMAGINE THIS: One day, you wake up

and realize that emotionally, you’ve been

feeling different lately. You’re not sure what

it is but you (or others) notice that you’re

acting differently, feeling unlike yourself

and having thoughts that bother you. Two

months later, you still feel the same way—

it’s even getting worse—but you still haven’t

asked for help. You think it will go away

on its own, that it’s not serious, that it’s all

in your head. You reason that maybe it’s

just your personality or your age or stress.

Things you might try on your own don’t

seem to help. Or maybe you suspect what it

could be and you’re scared of what family,

friends and coworkers would say. So you

keep it to yourself and just try to get by day

to day, hoping it will change.

Why do we treat our mental health so

differently from our physical health?

How do I know if I need help?

There are many kinds of mental disorders.

Although mental illnesses have a lot in

common with each other, each type is quite

different. Symptoms of mental illness can

look different from person to person. Just

like physical illness, symptoms can be mild,

moderate or severe and you don’t have to

show every possible symptom to have the

illness. Probably the best way to know if you

might have a mental disorder is if you’re not

feeling, thinking or acting like yourself—or

if people you care about notice changes in

you like some of the following:

• I suddenly no longer have interest in

activities I used to enjoy

• I find myself feeling angry or sad for

little or no reason

• I have strange thoughts or voices that

I can’t seem to get rid of

• I used to be healthy, but now I always

feel a bit sick

• I eat a lot more or less than I used to

• My sleep patterns have changed

• I feel fear, worry and terror about

things in life that people around me

seem to cope well with

• I’ve been missing more and more

time from work or school

• I have a constant fear that someone is

going to hurt me

• I’ve been drinking heavily and/or

using drugs to cope

• I find myself avoiding people

• Sometimes I just want to die

The best way to know if you might have

a mental disorder is if you’re not feeling,

thinking or acting like yourself.

Primer Fact Sheets | 2008 | Getting Help for Mental Disorders | www.heretohelp.bc.ca


Why should I get help?

In a Canadian mental health survey, only a

third of us who had feelings and symptoms

of a mental illness went to a professional

for help; that means that most people (twothirds)

who had symptoms of mental illness

didn’t ask for help. There are a number of

mental health myths that prevent people

from getting the help they need:

• Myth: I just need to snap out of it, I can

deal with this on my own. Fact: Mental

disorders are real illnesses—they are

more than just the ups and downs of

life—and like other illnesses they need

to be treated. This doesn’t mean you

won’t have an important role to play

in your health; but part of taking care

of yourself means getting professional

attention when your life is being

affected by your symptoms.

How to talk to your doctor? P.R.E.P.A.R.E.

• Plan: Make a list of the main points you want to tell

or learn from your doctor or health care provider.

• Report: During your visit, tell your doctor what you

want to talk about.

• Exchange Information: Make sure you tell the

doctor about what’s wrong. Printing out an online

screening tool, or bringing a diary you may have

been keeping can help. Make sure to describe the

impact your symptoms or side effects are having on

your day-to-day life. Sometimes it can help to bring

someone along for support and to help describe

your behaviour and symptoms if you’re unable to.

• Participate: Discuss with your doctor the different

ways of handling your health problems. Make sure

you understand the positive and negative features

about each choice. Ask lots of questions.

• Agree: Be sure you and your doctor agree on a

treatment plan you can live with.

• Repeat: Tell your doctor what you think you will

need to take care of the problem.

Source: Institute for Healthcare Communication

• Myth: It’s not serious enough to require

help. Fact: Untreated mental illnesses

are among the most disabling of

all health problems in terms of lost

potential and productivity, according to

the World Health Organization. Because

suicide is so often linked to untreated

mental illness, mental illness must

always be taken seriously.

• Myth: If I go for help, the people I care

about will judge me and think I’m “crazy”

or weak. Fact: It’s true that some people

will find it easier or harder to ask

for help. You may find it both useful

and comforting to meet others going

through what you are, so you can see

for yourself that mental illness can

affect anyone. If you’d like to help your

family and friends learn more, there are

lots of support groups and educational

resources to help them understand what

you’re going through, as well as deal

with their questions and worries. Asking

for help is not a sign of weakness; it

takes incredible strength and courage.

• Myth: What’s the point of getting help?

Treatments don’t work anyway. Fact:

There has been great progress in the

development of treatments for mental

illness. There are a variety of wellresearched

and effective therapies

available, from special kinds of

counseling to medications, light therapy

and other treatments. For example,

80% of people who have depression

can be successfully treated.

As with so many other illnesses, early

treatment is the key to recovering from mental

disorders. The sooner you get treated, the less

time you’ll spend in treatment, and the better

chance you’ll catch it before it gets worse. In

other words, the sooner you do something

about it, the sooner you’ll be back to yourself.

More good news is that the same national

survey that found that most people didn’t get

help for their mental health problems, found

that those who did get help were happy with

the help they received.

Primer Primer Fact 2007 Sheets | Post | 2008 Partum | Getting Depression Help for Factsheet Mental Disorders | www.heretohelp.bc.ca

| www.heretohelp.bc.ca


Who can provide

professional help?

• Your family doctor — can rule out

any other causes for your symptoms,

prescribe medications, do limited

counseling and refer you to a

psychiatrist or other special services.

For many people, family doctors are the

main source of professional support for

managing a mental illness. They are a

good resource for information and a

great place to start getting help.

• Psychiatrists — are doctors specially

trained in diagnosing and treating

mental illnesses. They are covered

under BC’s Medical Services Plan

(MSP) but you will need a referral from

your family doctor or mental health

program to see one. As doctors, they

can prescribe medications and many

psychiatrists also do counseling.

• Counselors — include psychologists,

clinical counselors, and social workers.

These professionals can help diagnose

mental illnesses and provide counseling

that can look at your thoughts, feelings

and behaviours. Because they are

not doctors, they cannot prescribe

medication. Unless they are part of

a hospital program or mental health

team, they are usually not covered by

MSP. Some counselors charge their fees

based on your income.

Other sources of counseling:

››

Schools and campuses provide

counseling services to students.

››

Many workplaces also offer

counseling services through

benefit programs like an Employee

Assistance Program (EAP) and

through extended health coverage.

EAP counselors provide short-term

counseling to deal with specific

issues. Most EAP programs are

for both the employee and the

employee’s family.

››

If you belong to a certain group,

you may have access to counseling

through special services. For

example, military veterans can

access counseling through Veterans

Affairs Canada. An aboriginal

person can access counseling

through their Band, Friendship

Centre, Aboriginal Mental Health

program, or a branch of Health

Canada. A member from a faith

community may have access to a

helpline or counselor through the

networks connected to their place

of worship.

• Mental health teams — are another

resource. Most communities in BC

have both an adult mental health team

(or centre) as well as one for children

and youth under 19. Mental health

centres use teams of different kinds of

professionals including social workers,

nurses, mental health workers,

peer support workers, occupational

therapists and others. Physicians often

consult there as well. Mental health

teams provide assessment and an

ongoing connection for people with

long-term mental disorders. They

can also provide life skills support

and connection to other community

assistance, such as income or housing.

You can refer yourself, but centres

appreciate a referral from a family

doctor (and busier centres will require

a referral). They are covered by MSP.

Primer 2007 Primer | Post Fact Partum Sheets | 2008 Depression | Getting Help Factsheet for Mental Disorders | | www.heretohelp.bc.ca


www.heretohelp.bc.ca

How do I get the help I need?

If you are experiencing some of the

symptoms in the “How do I know if I need

help?” section then the next step is to look at

your options.

• We suggest you see a family doctor

(also known as a general practitioner or

GP) to rule out other explanations for

symptoms you may be feeling. You can

see a doctor through a walk-in clinic

or by appointment through a family

practice. If you don’t have a family

doctor and would like to find one,

contact the BC College of Physicians

and Surgeons for a list of doctors

accepting patients at www.cpsbc.ca

or 1-800-461-3008 (toll-free in BC) or

604-733-7758 (in Greater Vancouver).

Available in English only.

• If you feel panicked, overwhelmed

or thinking of suicide and need help

immediately, call your local crisis

line. Despite the name, crisis lines are

not only for people who are in crisis.

You can call for information on local

services or if you just need someone

to talk to. You can find the number for

your local crisis line online at www.

crisiscentre.bc.ca/distress/other.php

or at the front of your local phonebook

under Emergency & Important

Numbers> Distress Centres> Crisis

Line. Many are available 24 hours a day,

7 days a week.

Other helpful resources are:

BC Mental Health Information Line

Call 1-800-661-2121 (toll-free in BC) or

604-669-7600 (in Greater Vancouver) for

information, community resources, or

publications.

BC Partners for Mental Health and

Addictions Information

Visit www.heretohelp.bc.ca for personal

stories and information about different mental

disorders, including our Mental Disorders

Toolkit. The Toolkit is full of information, tips

and self-tests to help you understand your

mental disorder.

Canadian Mental Health Association,

BC Division

Visit www.cmha.bc.ca or call 1-800-555-8222

(toll-free in BC) or 604-688-3234 (in Greater

Vancouver) for information and community

resources on mental health or any mental

disorder.

Kelty Resource Centre

Contact this BC resource centre at www.

bcmhas.ca/keltyresourcecentre or 1-800-

665-1822 (toll-free in BC) or 604-875-2084

(in Greater Vancouver) for information and

support for children, youth and their families

in all areas of mental health and addictions,

including eating disorders support for adults.

The BC Partners are a group of nonprofit agencies working together to help

individuals and families manage mental health and substance use problems,

with the help of good quality information. We represent Anxiety Disorders

Association of BC, BC Schizophrenia Society, Canadian Mental Health

Association’s BC Division, Centre for Addiction Research of BC, FORCE Society

for Kid’s Mental Health, Jessie’s Hope Society, and Mood Disorders Association

of BC. The BC Partners are funded by BC Mental Health and Addiction Services,

an agency of the Provincial Health Services Authority.


Tips for...

Improving Mental Health

When it comes to our physical health, we all

know what things to do to stay healthy. We

might take the stairs instead of the elevator,

or make sure we eat our veggies, or wear

sunscreen to protect our skin. Safeguarding

our mental health is just as important.

Unfortunately many of us don’t consciously

make an effort to stay mentally healthy. Part

of the reason for this might be that many

people see mental health as only meaning

not having symptoms of mental illness. In

reality it is much, much more than that.

Mental health means feeling good about

who you are, having balance in your life and

in your thinking, and being able to respond

constructively to life’s highs and lows.

Everyone should practice good mental health;

not only can it help protect you from mental

illness, it can help you get the most of

out of life.

Eat well

OK, so you’ve heard it all before, eating

right is good for your physical health. But

evidence suggests that healthy eating can

actually help boost your mental health

too. Choosing the right foods more often

and having a healthy breakfast and regular

meals can give you slow burning energy.

This can keep your mood and energy levels

steady and keep irritability away. Certain

kinds of nuts, fish, fruits and vegetables also

contain ingredients that are good for both

mind and body.

› Tip: For more information on

making the right food choices, visit

www.dialadietitian.org or call 811

on your phone to talk to a dietician

for free.

So what does it take to be mentally healthier?

Here are some tips and advice on protecting

and improving your mental health:

Healthy bodies = Healthy minds

Exercise

We know how good it is for our bodies; but

exercise is also good for our mental health.

Research confirms that exercise is a great

stress reliever. It reduces muscle tension,

improves blood flow and floods your body

with feel-good chemicals. People who

exercise often report having less anxiety.

Exercise has also been shown to reduce

symptoms of mild depression.

› Tip: The best way to increase your

activity levels and see the mental

health benefits is to make small

changes. Take a brisk walk on your

lunch break. Play outside with the

kids. Find ways to be active that fit

into your schedule.

Primer Fact Sheets | 2009 | Improving Mental Health | www.heretohelp.bc.ca


Mental Health Meter

Drink sensibly

Watch what you drink. Alcohol and

caffeinated drinks like coffee, black tea, and

cola can all affect your mental health. Alcohol

is a depressant which means it slows down

your brain activity. Because it’s a depressant,

if you’re already feeling down about

something when you drink, the problem can

seem worse when you sober up. Caffeine is a

stimulant, which means it temporarily gives

you more energy. But caffeine can make you

feel nervous, irritable or restless.

› Tip: Avoid certain drinks at bedtime.

Don’t drink caffeine or alcohol at

least two hours before you go to

bed. This can help reduce the effects

these substances have on your sleep

patterns.

› Tip: Get your H 2

O. Drinking lots

of water is important because it

replenishes brain cells and helps

fight fatigue.

Read the 5 statements below. For each statement decide if

you agree or disagree with it.

I’m able to enjoy the present instead of regretting the

past and worrying about the future.

When I’m faced with a difficult situation I focus on

what I can learn from it.

I make time for the things I love to do like hobbies,

vacations or spending time with friends and family.

I recognize both my strengths and my weaknesses

and work on making both better.

I cope well with change.

If you disagreed with any of these statements, or would like

to take our full online mental health quiz* to find out about

five features of mental well-being, please visit

www.cmha.bc.ca and click on Mental Health Meter on the

left side of the page.

*available in English only

You can have a diagnosed

mental illness and still

have mental health

A person can have a mental illness

and still have positive mental health.

Because mental illness can happen in

cycles, most people have times when

they are well. And during those times,

people being treated for a mental disorder

often have great mental health. This

is because through the process of treatment

and recovery, they have learned

that taking care of their mental health

can help prevent relapses in their mental

illness, and help them stay well longer.

Get enough sleep

Easier said than done, right? Difficult or not, if

you don’t get enough sleep you can feel sad,

anxious, stressed or grumpy. It can also leave

you so tired that it’s hard to concentrate or

get things done. Good-quality sleep rests the

brain and repairs and replenishes brain cells.

A refreshed brain helps our mood, decisionmaking

and social interactions. If worrying

thoughts keep you from getting a good

night’s sleep, see the next section on healthy

thinking.

› Tip: Get into a routine. Try to go to

bed and wake up at the same time

every day—including weekends.

Practice healthy thinking

We know that our thinking affects us. It’s

tied to how we feel emotionally and physically.

It also affects how we decide to deal with

things. We often hear about how we should

practice positive thinking. The problem with

positive thinking though, is that no one can

think positively all the time. For example, it’s

probably hard to think positively about losing

your job no matter how much of an optimist

you are. So the best thing we can do is think

in healthy, helpful ways. Healthy thinking

Primer Primer Fact 2007 Sheets | Post | 2009 Partum | Improving Depression Mental Factsheet Health | www.heretohelp.bc.ca

| www.heretohelp.bc.ca


is thinking about something in a balanced

way. Balanced thinking means looking at all

factors in a situation—the good, the bad, and

the neutral—and then deciding how you feel

about it. Practicing healthier, more balanced

thinking can not only help you respond to life

events and relationships better but it can also

improve your confidence and self-esteem. It

can do this by helping you see your good and

not so good qualities in a realistic way.

› Tip: Talking to a professional about

what’s bothering you can really help.

Counselors can help you by teaching

you how to work through your issues

and identify your “thinking traps”

which are common ways of thinking

that aren’t balanced. You may have

access to a counselor through school,

work or through special services for

your cultural or faith community.

Build a healthy support network

Having healthy relationships with friends,

family and co-workers is vital to having good

mental health. Not only can loved ones be

there to lean on and help you get through

hard times, they can also help build selfconfidence

and give you a sense of being

valued. A support network is valuable because

friends and family can provide emotional

support or practical help, like picking you up

from the airport. Your support network can

also help by sharing advice or information

based on their own experiences.


Tip: Put yourself out there. If you

want to build up your support

network, you need to take risks. Join

a club or sports team, attend that

family or work event, or reconnect

with people you’ve lost touch with.

Place yourself in situations where

the type of people you are hoping to

meet will be. If you’re not shy, get

talking! If you are shy, try situations

with smaller groups of people, or start

by calling an old friend or sending an

email or letter.

Connecting to things bigger

than you is good for mental health

The desire to have a purpose, and connection

to things bigger than ourselves, is one of the

qualities that make us human. It boosts our

mental health by giving us perspective and

meaning, but it can also connect us to people

who care about the same things we do and so

build a stronger social support network:

• Connect to a cause you care about: join

a rally, sign a petition, raise money or

volunteer

• Find a spirituality to call your own:

individual prayer or meditation, formal

services of worship, or even connecting

with nature

Primer 2007 | Post Primer Partum Fact Sheets Depression | 2009 | Improving Factsheet Mental | Health | www.heretohelp.bc.ca


www.heretohelp.bc.ca

Where do I go from here?

While most people say that mental health

is important to them, a recent national poll

found that only two-thirds of people are

committed to making changes to improve

their own mental health. To maintain positive

mental health you need to take positive

action. Reading this sheet was a great start

but there are more things you can do to

protect yourself. The following resources can

provide you with more information about

positive mental health.

Resources available in English only:

BC Partners For Mental Health

and Addictions Information

Visit www.heretohelp.bc.ca for useful

information on positive mental health

including our Wellness Modules. These

modules are worksheets that can help you

learn important skills for maintaining your

mental health. There are eight worksheets in

total, covering:









Mental Health Matters

Stress and Well-Being

Social Support

Problem-Solving

Anger Management

Getting a Good Night’s Sleep

Eating and Living Well

Healthy Thinking

Your Local Crisis Line

Despite the name, crisis lines are not only

for people who are in crisis. You can find the

number for your local crisis line online at

www.crisiscentre.bc.ca/distress/other.php or

at the front of your local phonebook under

Emergency & Important Numbers> Distress

Centres> Crisis Line. Many are available 24

hours a day, 7 days a week.

Resources available in many languages:

*For each service below, if English is not your

first language, say the name of your preferred

language in English to be connected to an

interpreter. More than 100 languages are

available.

HealthLink BC

Call 811 or visit www.healthlinkbc.ca to access

free, non-emergency health information

for anyone in your family, including mental

health information. Through 811, you can also

speak to a registered nurse about symptoms

you’re worried about, or a pharmacist about

medication questions.

Canadian Mental Health Association,

BC Division

Visit www.cmha.bc.ca or call 1-800-555-8222

(toll-free in BC) or 604-688-3234 (in Greater

Vancouver) for information and community

resources on mental health or any mental

disorder.

The BC Partners are a group of nonprofit agencies working together to help

individuals and families manage mental health and substance use problems,

with the help of good quality information. We represent Anxiety Disorders

Association of BC, BC Schizophrenia Society, Canadian Mental Health

Association’s BC Division, Centre for Addiction Research of BC, FORCE Society

for Kid’s Mental Health, Jessie’s Hope Society, and Mood Disorders Association

of BC. The BC Partners are funded by BC Mental Health and Addiction Services,

an agency of the Provincial Health Services Authority.


Mood and Psychosis

Signs & symptoms of psychosis for people with mood disorders

“Psychotic symptoms were some of the

scariest parts of my mood disorder. At first,

I didn’t talk about them, but I realized in

order to get well I needed help with this

too. Telling my doctor about the strange

things I was experiencing was the best

thing I did for my own health.”

Hearing voices and seeing things that other’s don’t.

Feeling suspicious and paranoid.

Feeling and behaving in ways that are not yourself.

Having difficulty thinking and organizing your thoughts

If you have depression or bipolar disorder and are experiencing some of these

symptoms, it is important to tell your doctor about them. While not common,

psychotic symptoms can be a part of a number of mental illnesses.

It is in the normal range of human experience to have symptoms such as

hearing voices or having visual hallucinations very occasionally, especially on the

edge of sleep or waking, or if you have not slept or eaten for a long time. However, if

you have these types of symptoms often or persistently, then it’s time to talk to your

doctor.

While schizophrenia is commonly thought of as the main mental illness that has

psychotic symptoms, there are several mental illnesses that can have psychotic

symptoms associated with them. This is not surprising, as these illnesses tend to be

connected to similar types of problems in the brain.

Bipolar disorder—in bipolar disorder, psychotic symptoms tend to fit in with the

person’s mood. For example a person who is depressed might hear voices telling

them to kill themself, or a person with mania might believe they have special

supernatural powers.

Schizoaffective disorder—A person with this disorder has both a mood disorder

and psychosis, and the voices, hallucinations or false beliefs are more independent of

what is going on with their mood, and may be present even if their mood is stable.

Depression and Post Partum Depression—a person who is depressed may hear

voices telling them things that go with the depression.


Mood and Psychosis

Signs & symptoms of psychosis for people with mood disorders

Continued...

What Causes Psychosis?

We don’t completely

understand what

causes psychosis or the

psychotic symptoms

sometimes associated

with mood disorders.

Many medical

researchers think some

people are born with a vulnerability or

tendency towards psychosis. This doesn’t

mean they’ll automatically become ill, but

that if they are exposed to enough stress it

can trigger psychosis.

Vulnerabilities may be genetic (inherited

through your genes from your parents) or

caused by things that happen during

pregnancy or to the baby while being born.

Stresses might include difficult life events or

situations or drug use. Psychosis is

sometimes also the result of other medical

problems.

Psychosis is a medical condition and it can

be treated.

Almost always, psychosis improves

with treatment. The sooner a person is

treated the smoother their recovery

will be.

How to Manage Symptoms

If you are already

receiving treatment for

your mood disorder,

speaking to your

doctor or care team

about these

experiences is a good

place to start. Your

medications may have

to be adjusted to deal

with these symptoms as well.

Cognitive behavioural therapy has been

demonstrated to have good results with

psychosis symptoms when combined with

medication.

Many street drugs such as crystal meth

(methamphetamine) and cannabis

(marijuana) have been shown to increase

psychotic symptoms. These drugs do noone’s

brain any good, but if you have

experienced psychotic symptoms it is

particularly important to avoid these drugs.

“You don’t have to deal with this

alone. Help is available.”

Help is available. Treatment works.

For more information:

BC Schizophrenia Society—www.bcss.org Information on psychosis and information for families.

Early Psychosis Intervention Information www.psychosissucks.ca

Other fact sheets in this BC Partners series on topics related to psychosis, including post

partum depression & psychosis, and resources for families and children are available at

www.heretohelp.bc.ca

www.heretohelp.bc.ca

© 2005 BC Partners for Mental Health & Addictions Information. Prepared by Sophia Kelly,

DVATI, for the BC Schizophrenia Society on behalf of BC Partners for Mental Health & Addictions

Information with funding from the Provincial Health Services Authority. Permission to

copy and use this publication is granted for non-profit educational purposes.


Learn about...

Post-Traumatic Stress Disorder

You’re driving down the highway, the road is

wet and cars keep racing past you, splashing

water on to your windshield. Suddenly

you lose control of the car and feel the car

plummeting down an embankment. You

hear glass breaking, metal screeching and

feel searing pain all over your body. You open

your eyes and realize that you’re sitting in

your cubicle at work on a sunny Tuesday.

You’ve just relived the car accident you were

in two months ago for the hundredth time

since it happened.

People are strong, but when faced with this

kind of trauma sometimes it’s too much to

bear. Often after a traumatic event like a car

accident or being a victim of crime, people

continue to relive the experience through

flashbacks and it starts to impact their lives

in a big way. This is called post-traumatic

distress disorder, and it’s a form of mental

illness.

What is it?

Post-traumatic stress disorder (PTSD for

short) is a type of anxiety disorder that can

appear after a traumatic event. Traumatic

events can include:

• Natural disasters, such as:

› hurricane

› earthquake

• Crime

› rape or physical assault (including

childhood abuse and relationship

violence)

› burglary, mugging or hold-up

• War

› military combat or peacekeeping

› war crimes

› torture

› a civilian in a war zone

• Major accidents

› workplace

› automobile

› airplane

• Being a witness to any of the above

Symptoms of post-traumatic stress disorder

usually appear about three months after

the event but can show up even years later.

Sometimes a life event such as the death

of someone you know, another traumatic

event or the birth of a baby can trigger the

onset of PTSD well after the original trauma

occurred. Often depression, drug or alcohol

use problems can show up along with posttraumatic

stress disorder.

People continue to relive the traumatic

experience through flashbacks and it starts

to impact their lives in a big way.

Primer Fact Sheets | 2008 | Post-Traumatic Stress Disorder | www.heretohelp.bc.ca


Could I have post-traumatic stress disorder?

It’s normal to feel stressed, anxious, shocked and

overwhelmed immediately after a traumatic event. It’s also

normal to feel different things or not much of anything at

all—people respond differently to different situations. Most

people who experience trauma won’t develop post-traumatic

stress disorder. But if you feel as though you’ve lost control

of your life, that the memory of the event is controlling you,

or have several of the following symptoms for more than a

month, you should talk to your doctor.
















Recurring thoughts, ‘flashbacks’ or nightmares about

the event (Each person’s experience with flashbacks is

unique. Some people have “complete” flashbacks like the

example in the opening paragraph of this fact sheet while

others may re-experience a feeling, smell, sight or sound

from the event without losing touch with the present.)

Changes in sleep patterns or appetite

Anxiety and fear, especially when confronted with

events or situations that remind you of the trauma

Feeling “on edge,” being easily startled or becoming

overly alert

Crying for no reason, feeling despair and hopelessness

or other symptoms of depression

Memory problems including finding it difficult to

remember parts of the trauma

Feeling scattered and unable to focus on work or daily

activities

Difficulty making decisions

Irritability or agitation

Anger or resentment

Guilt

Emotional numbness or withdrawal

Sudden overprotectiveness and fear for the safety of

loved ones

Avoidance of activities, places or even people that

remind you of the event

Other physical health problems like dizziness, stomach

upset or less ability to fight off sickness or infection

Who does it affect?

While many people will experience a

traumatic event at some point in their

lives, only 8% people will experience posttraumatic

stress disorder in their lifetime.

There are some groups that are at higher risk

of post-traumatic stress disorder than others:

• People in certain occupations — are

at higher risk. A study out of the

University of British Columbia found

that emergency personnel such as

doctors, nurses, paramedics and

firefighters experience post-traumatic

stress at twice the rate of the average

population. In Canada, it is estimated

that up to 10% of war zone veterans

— including war service veterans and

peacekeeping forces — will go on

to experience post-traumatic stress

disorder.

• Women — are twice as likely as men

to be diagnosed with post-traumatic

stress disorder. The reasons for this are

unclear.

• Refugees — are at higher risk for posttraumatic

stress disorder as a result of

the stressful events that forced them to

flee their homeland and the difficulties

involved in moving to a new country.

• Aboriginal people — who attended

residential schools* have reported

experiencing post-traumatic stress

disorder as a result of the abuse

that took place. A small percentage

of residential school survivors have

reported this phenomenon now called

Residential School Syndrome.

*Residential schools were Church-run,

government-funded schools for native children,

set up during the early 1900’s. The schools were

supposed to prepare aboriginal children for life

in white society. Some children who attended

the schools were subjected to physical, sexual

and emotional abuse. The last residential school

didn’t close until 1996.

Primer Primer Fact 2007 Sheets | Post | 2008 Partum | Post-Traumatic Depression Factsheet Stress Disorder | www.heretohelp.bc.ca

| www.heretohelp.bc.ca


What can I do about it?

There are many different treatments for posttraumatic

stress disorder including:

• Cognitive-behavioural therapy (CBT):

A therapist can help teach you better

ways to cope with your anxiety and

work with you to help you change

your harmful thoughts, feelings and

behaviours. CBT can be done one on

one or in a group.

› Exposure therapy is often part of

CBT therapy. In exposure, you are

guided to gradually and carefully relive

parts of the experience to work

through the trauma and face your

fears and responses head-on.

• Support groups: Many people with

post-traumatic stress disorder find

anxiety support groups helpful. They

can help you realize that you’re not

alone and what you are going through

is very understandable.

• Medications: Certain types of

anti-depressants or anti-anxiety

medications can be helpful in

managing some of the symptoms

of post-traumatic stress disorder or

helping prevent relapses.

Eventually, with treatment, most people are

able to feel comfortable in their own skin

again and move on to the point where they

can remember the traumatic event without

reliving it.

Why do some people develop PTSD and others don’t,

even after the same traumatic event?

Human beings are incredibly resilient; they can bounce back and recover from stresses well. But sometimes

our unique makeups can make an event too much for us to bear. Of all the people who will experience a

traumatic event, only about 15% will have a lasting and harmful impact after it. Not all of these responses

would be post-traumatic stress disorder. Why some people develop the disorder and others don’t is complex

and has to do with many factors that are as unique and difficult to figure out as people are. Factors may include

how we’ve faced other challenging or dangerous events in the past, our lifetime of learning how to react to

these kinds of events, and our emotional styles which include genetic factors—plus some of the issues raised

in this fact sheet.

Primer 2007 | Post Primer Fact Partum Sheets Depression | 2008 | Post-Traumatic Factsheet Stress Disorder | | www.heretohelp.bc.ca


www.heretohelp.bc.ca

Where do I go from here?

If you think you or someone you care about

has post-traumatic stress disorder the best

thing to do is talk to your doctor. Together you

can decide which of the above treatments,

if any, would be best for you. In addition to

talking to your family doctor, check out the

resources below for more PTSD information.

Other helfpul resources are:

BC Mental Health Information Line

Call 1-800-661-2121 (toll-free in BC) or

604-669-7600 (in Greater Vancouver) for

information, community resources, or

publications.

AnxietyBC

Visit www.anxietybc.com or call 604-525-

7566 for information and community

resources on anxiety.

BC NurseLine

Call 1-866-215-4700 (toll-free in BC), 604-

215-4700 (in Greater Vancouver) or 1-866-

889-4700 (if you are deaf or hard of hearing).

BC NurseLine provides confidential health

information and advice. If English is not

your first language, say the name of your

preferred language in English to be connected

to an interpreter. More than 100 languages

are available. Anywhere in the province, call

BC NurseLine to speak to a registered nurse

24-hours or a pharmacist from 5 pm to 9 am

every day. Have your CareCard number ready.

If you do not have a CareCard or don’t want to

give your CareCard number, you can still get

service.

BC Partners for Mental Health and

Addictions Information

Visit www.heretohelp.bc.ca for our Anxiety

Disorders Toolkit, message board, more fact

sheets, and personal stories and articles about

post-traumatic stress disorder. The Toolkit is

full of information, tips and self-tests to help

you understand your anxiety disorder.

Resources available in many languages:

*For each service below, if English is not your

first language, say the name of your preferred

language in English to be connected to an

interpreter. More than 100 languages are

available.

VictimLink

If your trauma is a result of crimes like rape

or relationship violence, assault or burglary,

call 1-800-563-0808 (toll-free in BC and

Yukon) 24 hours a day.

The BC Partners are a group of nonprofit agencies working together to help

individuals and families manage mental health and substance use problems,

with the help of good quality information. We represent Anxiety Disorders

Association of BC, BC Schizophrenia Society, Canadian Mental Health

Association’s BC Division, Centre for Addiction Research of BC, FORCE

Society for Kid’s Mental Health, Jessie’s Hope Society, and Mood Disorders

Association of BC. The BC Partners are funded by BC Mental Health and

Addiction Services, an agency of the Provincial Health Services Authority.


Learn about...

Suicide

It isn’t a topic most people want to talk

about; but odds are you know someone who

has attempted or died by suicide. Maybe

you’ve even lost a friend, family member

or coworker to suicide. At last count, 3613

people in Canada took their own lives. That’s

more lives lost than from traffic accidents

and murders combined that year. Suicide has

been called a “hidden epidemic,” it’s time to

take it out of the shadows.

Who does it affect?

Studies show that up to 90% of people

who take their own lives have depression,

substance use problems or another mental

disorder—whether diagnosed or not—at

the time of their suicide. Most people who

attempt or complete suicide don’t necessarily

want to die; rather they want to escape their

overwhelming emotional pain. Ten to 15%

of people with a mental illness will end up

taking their own lives.

There are a number of other factors that can

put someone at higher risk of completing

suicide:

• Age:

› Canadian seniors make up 12% of

all suicides. In BC, the suicide rate

for all men averages out to 17.5

deaths per 100,000 people; men

over 85 have double that rate. A

shrinking circle of friends, the death

of a spouse or a major illness can all

lead to depression and in turn lead

to suicide. Aboriginal elders are an

exception to this trend.

› Suicide is the second leading cause

of death among young people in BC,

Canada and worldwide. About 7%

of BC teenagers said they attempted

suicide in the past year. Stress,

loneliness, fighting with family or

friends, feelings of “not measuring

up” and a loss of hope for the future

can all contribute to youth feeling

overwhelmed, and may lead them to

consider suicide as a way out.

• Gender: In Canada, for every female

death by suicide there are three

male suicides. However women are

more likely than men to attempt

suicide. Women tend to choose less

violent forms of suicide, leaving more

opportunity for rescue. They also

tend to seek help from friends and

professionals more often.

Most people who attempt or complete

suicide don’t necessarily want to

die; rather they want to escape their

overwhelming emotional pain.

Primer Fact Sheets | 2008 | Suicide | www.heretohelp.bc.ca


Suicide fast facts

In BC, 346 people took their own life in 2006; that’s almost

one person every day.

• In 2006, British Columbians were at least 14 times

more likely to die from suicide than to be the victim

of a homicide.

• In the last 45 years suicide rates have increased by

60% worldwide. Suicide is now among the three

leading causes of death among those aged 15-44

years (both sexes); these figures do not include suicide

attempts which are up to 20 times more frequent

than completed suicides.

• Both the stigma attached to suicide and the likelihood

that some deaths classified as “accidents” are actually

suicides contribute to an overall underestimate of the

true number of suicides each year.

• Social and cultural factors:

› While many Aboriginal communities

have rates of suicide that are much

higher than the general population,

some Aboriginal communities have

rates of suicide that are very low or

zero. Those communities with low

rates of suicide are those that are

working towards self-governance,

are actively engaged in settling

their land claims, have recovered

many traditional practices and enjoy

greater control over the delivery of

local services.

› Studies on the rate of suicide in the

Canadian immigrant population

have had conflicting results. While

one Canadian study found that the

suicide rate in immigrants was closer

to the rate of suicide in Canada,

another found that the suicide rate

was closer to the immigrant group’s

home country. There is likely extreme

under-reporting of suicides in the

immigrant population because in

many cultures suicide is considered

shameful. What is agreed on is that

personal factors such as learning to

speak the host country language,

ethnic pride and a positive attitude

toward the new country’s culture can

reduce stress. Social resources, such

as family and ethnic community

support and a warm welcome by the

new country can also reduce stress,

leading to more positive mental

health. There has been very little

research done on the suicide rates in

Canada’s refugee population.

Primer Primer Fact 2007 Sheets | Post | 2008 Partum | Suicide Depression | www.heretohelp.bc.ca

Factsheet | www.heretohelp.bc.ca


What can I do about it?

If you think someone you know is

considering suicide:


Remind yourself that all talk of suicide

must be taken seriously

• Say to the person:

› “You are really important to me”

› “I don’t want you to die”

› “It’s reasonable to feel like you

do, but I can help you find other

solutions”

• If you are concerned that someone

you know may be considering suicide,

ask a direct question like “Are you

thinking about suicide?”. You won’t

be putting the idea in the person’s

head; chances are if they are thinking

about it, they will be relieved to tell

someone. Consult the “Where do I go

from here?” section on the next page

so you know what to do if they answer

“yes” when you ask.

• Call the Distress Line Network of BC at

1-800-SUICIDE, that’s 1-800-784-2433 or

310-6789 (no area code needed). Help is

available 24 hours a day.

• Seeing a doctor or mental health

professional is often the next step for

the person. Remember to maintain your

support if the person is getting help for a

mental illness like depression. The early

days of treatment, before the person

feels like themselves again but when

they may feel well enough to carry out a

plan, is the time professionals, family and

friends should still monitor warning signs

carefully.

Is someone you know thinking about suicide?

Most people who take their own lives show some noticeable signs that they are thinking about it beforehand.

Thankfully, if these signs are recognized, immediate action taken and support given, many lives can be saved.

There are ten warning signs that experts suggest you should watch out for. To help you remember them, they

spell out IS PATH WARM?

Has someone you know:

Talked about or threatened to hurt or kill themselves, or looked for ways to do it? [I = Ideation]

Increased their use of alcohol or other drugs? [S = Substance use ]

Mentioned having no reason to live or no purpose in life? [P = Purposelessness]

Showed increased anxiety and changes in sleep patterns? [A = Anxiety]

Talk about feeling trapped, like there’s no way out? [T = Trapped]

Expressed feeling hopeless about the future? [H = Hopelessness]

Withdrawn from friends, family members or activities they enjoy? [W = Withdrawal]

Shown uncontrolled anger or say they want to seek revenge? [A = Anger]

Engaged in risky activities, seemingly without thinking? [R = Recklessness]

Experienced dramatic changes in their mood? [M = Mood change]

If you see several of these behaviours, especially the first one, it is important to take them seriously and get

help right away.

Primer 2007 | Post Partum Depression Primer Fact Sheets Factsheet | 2008 | Suicide | | www.heretohelp.bc.ca


www.heretohelp.bc.ca

Where do I go from here?

If you or someone you know is thinking

about suicide the best thing to do is contact

your local crisis line first. Trained suicide

prevention volunteers can help you or

your loved one, plus connect you to local

emergency mental health services if you need

them. Confidentiality can be waived in life

or death situations. Even if you have doubts

about you or your loved one’s chances of

actually attempting suicide, it is always best

to call.

Other helpful resources are:

1-800-SUICIDE

If you are in distress or are worried

about someone in distress who may hurt

themselves, call 1-800-SUICIDE 24 hours a

day to connect to a BC crisis line, without a

wait or busy signal. That’s 1-800-784-2433.

If English is not your first language, say the

name of your preferred language in English to

be connected to an interpreter. More than 100

languages are available.

Youth in BC

Visit www.youthinbc.com for youth resources

or chat with a counselor online. You can also

call 1-866-661-3311 (toll-free in BC) 24 hours

a day.

Centre for Suicide Prevention

Visit www.suicideinfo.ca for information,

research and links to national distress

websites.

The BC Partners are a group of nonprofit agencies working together to help

individuals and families manage mental health and substance use problems,

with the help of good quality information. We represent Anxiety Disorders

Association of BC, BC Schizophrenia Society, Canadian Mental Health

Association’s BC Division, Centre for Addiction Research of BC, FORCE

Society for Kid’s Mental Health, Jessie’s Hope Society, and Mood Disorders

Association of BC. The BC Partners are funded by BC Mental Health and

Addiction Services, an agency of the Provincial Health Services Authority.


MENTAL HEALTH, HIV/AIDS AND HCV COINFECTION

Adding Life to Years: Depression and HIV

CMHA National has entered into a collaborative initiative as one of five

sponsoring organizations of a project called Adding Life to Years:

Phase II - A Collaborative Response to HIV and Depression. The

funder for this project is the Public Health Agency of Canada; the lead

organization is St. Michael's Hospital, with Sean B. Rourke, Ph.D. as the

project leader.

The goal of the project is to improve the mental health and well being of

people living with HIV, adding life to years, by building and sustaining the

capacity of community-based organizations and people who are HIV

positive to identify and respond to depression issues. There are three

target groups for the project: support workers and volunteers working in

community-based AIDS organizations, and in other organizations, that

provide services for people with HIV; mental health support workers

working in Canadian Mental Health Association branches and other

community-based mental health services; and people with HIV/AIDS who

may not be aware that depression is a treatable illness.

Depression is an issue for people living with HIV and the organizations

that serve them in all parts of Canada. To ensure the entire country has

the opportunity to benefit from this project, the Canadian Mental Health

Association has been added as a new national partner.

Adding Years to Life is available as:

A SELF DIRECTED TRAINING MANUAL

AN ON-LINE COURSE

Connect with OAN to learn more.

Located at: http://www.ontarioaidsnetwork.on.ca/hivdepression/

109

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