Mental Illnesses

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 this kind of trauma can be overwhelming. After a traumatic event like a car accident or crime, some people continue to relive the experience through flashbacks and other challenges. It can 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 (sometimes just called ‘PTSD’) 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 post-traumatic stress disorder.

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Who does it affect?

While many people will experience a traumatic event at some point in their lives, only 8% people will experience post-traumatic 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 post-traumatic 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 1900s. 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.

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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

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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 overwhelming. 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.

What can I do about it?

There are many different treatments for post-traumatic 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 re-live 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.

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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, available in English only, are:

AnxietyBC
Visit www.anxietybc.com or call 604-525-7566 for information and community resources on anxiety.

BC Partners for Mental Health and Addictions Information
Visit www.heretohelp.bc.ca for info sheets and personal stories about (illness). You’ll also find more information, tips and self-tests to help you understand many different mental health problems.

Resources available in many languages:
*For each service on the right, 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. Learn more at www.victimlinkbc.ca.

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 talk with a pharmacist about medication questions.

Crisis lines aren’t only for people in crisis. You can call for information on local services or if you just need someone to talk to. If you are in distress, call 310-6789 (do not add 604, 778 or 250 before the number) 24 hours a day to connect to a BC crisis line, without a wait or busy signal. The crisis lines linked in through 310-6789 have received advanced training in mental health issues and services by members of the BC Partners for Mental Health and Addictions Information.

© 2013

This info sheet was prepared by CMHA BC Division on behalf of the BC Partners for Mental Health and Addictions Information and HeretoHelp. Funding was provided by BC Mental Health and Substance Use Services, an agency of the Provincial Health Services Authority. For more resources visit HeretoHelp.bc.ca.

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Postpartum Depression

You’ve just had a new baby and this is supposed to be the happiest time of your life. Everyone expects you to be the glowing new mother who experiences joy at each giggle or coo, but what if that joy doesn’t come so easily? What if you feel scared and overwhelmed by all these new responsibilities? What if instead of feeling adoration toward your baby, you feel resentful and inadequate? Does this make you a horrible mother? A horrible person? Absolutely not—what you may be experiencing is postpartum depression. (Postpartum depression is also known as postnatal depression.)

What is it?

Postpartum depression is a form of depression that a mother can experience within the first few weeks, months or even up to a year after having a baby. Ten to 16% of women with postpartum depression begin experiencing symptoms during pregnancy. If left untreated, this depression can last for months or even years after the baby is born. The longer an episode of depression goes untreated, the longer the recovery and the higher the risk of suicide. It’s true that it’s normal for many new mothers to feel a bit down after childbirth, but if these “baby blues” last more than two weeks and affect your ability to take care of yourself and your baby, you may have postpartum depression.

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Who does it affect?

Postpartum depression is more common than you may think, affecting 8–12% of mothers. First-time mothers aren’t the only ones who experience this depression. It can also affect mothers who have already had children as well as adoptive mothers. Some studies have shown that partners can also experience postpartum depression

While postpartum depression can affect anyone, there are some factors that may put you at higher risk:

History of mood or anxiety problems
Family history of major depression or mental illness
Hormonal changes
Sleep deprivation
Recent stressful life events, e.g. death of a parent or moving
Expectations of yourself or your partner’s expectation of you
Lack of support from family or friends
Experience of abuse or violence
Social inequalities like poor housing or inadequate income
Isolation
Medical complications for you or your baby

Other stresses may increase these risks such as:

Emotional stress: After giving birth, women may feel overwhelmed with responsibility, less attractive physically and sexually, anxious from changes in routine or lifestyle, and guilty because of social pressures to be a “perfect” mother
Physical stress: In addition to hormonal changes, common physical changes after labour include weight changes, exhaustion and soreness

Stressors such as tension in a marriage, loss of a job or a lack of support system can also play a role. Even though adoptive mothers, partners and fathers can experience postpartum depression, hormonal changes during pregnancy and after birth are thought to contribute to postpartum depression in some women.

Postpartum anxiety

While anxiety is often considered a symptom of postpartum depression, anxiety disorders that develop during or after pregnancy are a different set of illnesses altogether. Women often have both postpartum anxiety and postpartum depression at the same time. Recent research suggests that pregnancy and the early days after giving birth may be a time in a woman’s life when she is more vulnerable to developing an anxiety disorder.

See the self-help workbook listed in the ‘Where do I go from here’ section of this sheet for more information on postpartum anxiety.

Source: Adapted from BC Women’s Self Care Guide

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Could I have postpartum depression?

I feel extremely sad and depressed
I’m having crying spells for no apparent reason
I’m having guilty thoughts or feelings of worthlessness or hopelessness
I’m having thoughts of ending my life or other frightening thoughts
I’m feeling inadequate and I’m resenting my baby and other family members
I’ve noticed changes in my sleep or appetite
I feel restlessness, out of control, or have no energy
I’m having difficulty concentrating
I find myself withdrawing from family, friends and social situations

Some women may have more physical symptoms such as:

Feeling weak or feeling flushed
Gas, constipation or diarrhea
Headaches or heaviness in the head

It isn’t uncommon for women experiencing postpartum depression to have scary thoughts about harming their babies even though it’s the last thing they’d want to do. While we have all heard stories of women harming their newborns, it happens very rarely. In these cases women who harm their babies usually experience psychosis. Postpartum psychosis (psychosis in the weeks and months after childbirth) affects only one out of 1000 new mothers. Even mothers experiencing postpartum psychosis very rarely harm their children.

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What can I do about it?

While postpartum depression may seem like a never-ending struggle, there are things you can do to help:

Counselling: Group therapy, individual therapy and/or marriage or family counseling with a qualified therapist can help you get back on track and help you realize that you aren’t alone and this isn’t your fault.
- Many women find they benefit from a type of counselling called cognitive-behavioural therapy. In this kind of therapy, you work with your counsellor to change the thoughts, feelings and behaviours that are harming your mental health.
- There is also a type of counselling called interpersonal therapy that deals with the way you interact with others and identifies any problems in your relationships that may be contributing to your depression
Medication: Some women find antidepressants or other appropriate medications may help, especially if their depression is moderate to severe. Always be sure to talk to your doctor to discuss the risks and benefits of taking medications while pregnant or breast-feeding.
Light therapy: Some mothers with postpartum depression have experienced improvement in their symptoms after exposure to special kinds of bright, artificial light for only 30 minutes per day.
Self-help: In addition to professional help, there are things you can do at home to help prevent or lessen the symptoms of postpartum depression. See “How you can help yourself” in the box on the right for some tips.

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How you can help yourself

Get as close to eight hours of sleep a day as you can
Maintain a well-balanced diet
Try your best to find time to exercise
Practice relaxation, even if it’s a few minutes with your feet up or a quick breath of fresh air
Be gentle with yourself and your feelings
Find support from family and other loved ones
Have time for yourself away from the baby
Educate yourself!

How dads and other supporters can help

Encourage her to talk to you about how she feels
Help remind her that it’s not her fault and she’s not a bad mother
Remind her how much you care
Share in home and child-care responsibilities
Accept help from friends and family
If she’s not ready for sex again yet, be physically affectionate and maintain intimacy in other ways
Take care of yourself. Find time out for yourself (other than at work), find someone to talk to, continue to follow some of your own interests, and be aware of your own needs.

Source: Pacific Post Partum Support Society

Where do I go from here?

If you feel like you or someone you care about is experiencing postpartum depression talk to your doctor immediately. They can help you decide which of the above treatments, if any, is right for you. In addition to talking to your family doctor, check out the resources below for more information on postpartum depression.

Some resources available in English only are:

Reproductive Mental Health Program at BC Women’s Hospital
Call BC Women’s Hospital at 1-888-300-3088 ext. 2025 (toll-free in BC) or call 604-875-2025 (in Greater Vancouver) to find out how to see a specialist in postpartum depression or anxiety. You can also visit www.bcmhas.ca/ProgramsServices/ChildYouthMentalHealth/ProgramsServices/Reproductive+Mental+Health. You must have a referral to the Reproductive Mental Health Program from your doctor. To get referral forms, doctors may call the numbers above. In addition to issues related to pregnancy, this program can also be helpful for other times in a woman’s reproductive cycle where mental health problems can happen such as the pre-menstrual period, menopause, after a miscarriage, or while experiencing infertility.

Coping with Depression in Pregnancy: A cognitive behaviour therapy-based self-management guide for women
The workbook from the Reproductive Mental Health Program helps you build self-help tools and strategies to use before and after birth. To download the workbook, visit www.heretohelp.bc.ca/workbook/coping-with-depression-in-pregnancy.

Pacific Post Partum Support Society
Visit www.postpartum.org for resources and information about support groups. Pacific Post Partum Support Society also offers telephone for women and families across BC. It’s available Monday to Friday from 10:00 am to 4:00 pm and on Saturday on-call from 12:00 am to 4:00 pm. For more call, 1-855-255-7999 or 604-255-7999 (in the Lower Mainland).

Mood Disorders Association of BC
Visit www.mdabc.net or call 604-873-0103 (in the Lower Mainland) or 1-855-282-7979 (in the rest of BC) for resources and information on mood disorders. You’ll also find more information on support groups around the province.

Resources available in many languages:
*For the 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.

© 2013

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Preventing Suicide

Suicide. It’s a difficult topic to bring up. However, when someone talks about suicide or brings up concern for a loved one, it’s important to take action and seek help quickly.

What is suicide?

Suicide means that someone ends their life on purpose. However, people who die by suicide or attempt suicide may not really want to end their life. Suicide may seem like the only way to deal with difficult feelings or situations.

Who does it affect?

About 4000 Canadians die by suicide every year. Suicide is the second-most common cause of death among young people, but men in their 40s and 50s have the highest rate of suicide. While women are three to four times more likely to attempt suicide than men, men are three times more likely to die by suicide than women.

Suicide is a complicated issue. People who die by suicide or attempt suicide usually feel overwhelmed, hopeless, helpless, desperate, and alone. In some rare cases, people who experience psychosis (losing touch with reality) may hear voices that tell them to end their life.

Many different situations and experiences can lead someone to consider suicide. Known risk factors for suicide include:

A previous suicide attempt
Family history of suicidal behaviour
A serious physical or mental illness
Problems with drugs or alcohol
A major loss, such as the death of a loved one, unemployment, or divorce
Major life changes or transitions, like those experienced by teenagers and seniors
Social isolation or lack of a support network
Family violence
Access to the means of suicide

While we often think of suicide in relation to depression, anxiety, and substance use problems, any mental illness may increase the risk of suicide. Its also important to remember that suicide may not be related to any mental illness.

What are the warning signs?

Major warning signs of suicide spell IS PATH WARM:

Ideation: thinking about suicide
Substance use: problems with drugs or alcohol

Purposelessness: feeling like there is no purpose in life or reason for living
Anxiety: feeling intense anxiety or feeling overwhelmed and unable to cope
Trapped: feeling trapped or feeling like there is no way out of a situation
Hopelessness or Helplessness: feeling no hope for the future, feeling like things will never get better

Withdrawal: avoiding family, friends, or activities
Anger: feeling unreasonable anger
Recklessness: engaging in risky or harmful activities normally avoided
Mood change: a significant change in mood

How can I reduce the risk of suicide?

Though not all suicides can be prevented, some strategies can help reduce the risk. All of these factors are linked to well-being. These strategies include:

Seeking treatment, care and support for mental health concernsand building a good relationship with a doctor or other health professionals
Building social support networks, such as family, friends, a peer support or support group, or connections with a cultural or faith community
Learning good coping skills to deal with problems, and trusting in coping abilities

When a person receives treatment for a mental illness, it can still take time for thoughts of suicide to become manageable and stop. Good treatment is very important, but it may not immediately eliminate the risk of suicide. Its important to stay connected with a care team, monitor for thoughts of suicide, and seek extra help if its needed. Community-based programs that help people manage stress or other daily challenges can also be very helpful.

What can I do if I experience thoughts of suicide?

Thoughts of suicide are distressing. Its important to talk about your experiences with your doctor, mental health care team, or any other person you trust. They can help you learn skills to cope and connect you to useful groups or resources. Some people find it helpful to schedule frequent appointments with care providers or request phone support. Other things that you can do include:

Calling a crisis telephone support line
Connecting with family, friends, or a support group. It can be helpful to talk with others who have experienced thoughts of suicide to learn about their coping strategies

If youre in crisis and arent sure what to do, you can always call 9-1-1 or go to your local emergency room.

Some people find a safety plan useful. A safety plan is a list of personal strategies to use if you think you are at risk of hurting or ending your life. You can create a plan on your own, with a loved one, or with your mental health care team. Your plan may include:

Activities that calm you or take your mind off your thoughts
Your own reasons for living
Key people to call if youre worried about your safety
Phone numbers for local crisis or suicide prevention helplines
A list of safe places to go if you dont feel safe at home

How can I help a loved one?

If youre concerned about someone else, talk with them. Ask them directly if theyre thinking about suicide. Talking about suicide wont give them the idea. If someone is seriously considering suicide, they may be relieved that they can talk about it.

If someone you love says that theyre thinking about ending their life, its important to ask them if they have a plan. If they have a plan and intend to end their life soon, connect with crisis services or supports right away. Many areas have a crisis, distress, or suicide helpline, but you can always call 9-1-1 if you dont know who to call. Stay with your loved one while you make the call, and dont leave until the crisis line or emergency responders say you can leave.

The two most important things you can do are listen and help them connect with mental health services.

Listening

Here are tips for talking with a loved one:

Find a private place and let your loved one take as much time as they need.
Take your loved one seriously and listen without judgementtheir feelings are very real.
Keep your worddont make promise you cant keep or dont intend to keep.
Tell your loved one that they are important and that you care about them.

Supports

If your loved one already sees a doctor or other mental health service provider, its important that they tell their service provider about any thoughts of suicide they may have been having. Depending on your relationship, you can offer to helpby helping your loved one schedule appointments or by taking them to their appointments, for example.

If your loved one doesnt see a mental health service provider, you can give them the phone number for a local crisis line and encourage them to see their doctor. Your loved one may also be able to access services through their school, workplace, cultural or faith community.

Supporting a loved one can be a difficult experience for anyone, so its important to take care of your own mental health during this time and seek support if you need it.

Do you need more help?

Contact a community organization like the Canadian Mental Health Association to learn more about support and resources in your area.

Founded in 1918, The Canadian Mental Health Association (CMHA) is a national charity that helps maintain and improve mental health for all Canadians. As the nation-wide leader and champion for mental health, CMHA helps people access the community resources they need to build resilience and support recovery from mental illness.

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Psychosis

What do you think of when you hear the word “psychotic?” Some people are scared of psychosis because of the way it’s shown on TV or in the movies. In real life, though, psychosis is a serious and disabling mental health condition—but it is treatable and many people recover after only one episode when they get proper treatment.

What is it?

Psychosis is often described as a “loss of reality” or a “break from reality” because it makes you experience or believe things that aren’t real. It can change the way you think, act, feel or sense things. Psychosis can be very scary and confusing, and it can significantly disrupt your life. In fact, the World Health Organization (WHO) ranks psychosis as the third-most disabling medical condition in the world.

Psychosis is a syndrome or group of symptoms. Psychosis itself isn’t a disease or disorder—it’s usually a sign that something else is wrong.

You may experience vague warning signs before the symptoms of psychosis begin. Warning signs can include depression, anxiety, feeling “different” or feeling like your thoughts have sped up or slowed down.

There are two different kinds of psychosis symptoms: positive symptoms and negative symptoms.

Positive symptoms “add” things like thoughts or behaviours.

Delusions are a strong belief in something that isn’t true. A common delusion is the belief that someone is following you or watching you.
Hallucinations are things you sense that aren’t really there. You can experience a hallucination with any of the five senses (hearing, sight, taste, touch, smell). The most common hallucination is hearing another voice talking that others can’t hear.
Speech is so jumbled or illogical that no one can understand it.
You have a hard time organizing or completing tasks, or you don’t act the way you used to. You might have a hard time with daily tasks like cooking or getting dressed, or you might suddenly laugh when someone tells a sad story.
Your movements are very slow, awkward and rigid or are very fast.

Negative symptoms take something away. You might not being able to show emotions, talk much (or at all) or be motivated to do anything. Negative symptoms often aren’t as distinct as positive symptoms, and they can look like symptoms of a mood disorder like depression or the side effects of medication.

The symptoms of psychosis generally depend on the cause of psychosis, so different people may have very different symptoms. Someone living with schizophrenia may experience many positive and negative symptoms while someone living with a brain injury may only experience hallucinations or delusions. The most important thing to remember is that all symptoms are treatable.

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Who does it affect?

About 3% of the population will experience psychosis at some point. Psychosis usually starts to affect people in their late teens and early twenties. It affects men and women equally, though men usually experience symptoms at a slightly earlier age than women. Risk of psychosis seems to run in families, and people seem to be more vulnerable if a family member has a psychotic disorder like schizophrenia or a personality disorder like paranoid personality disorder.

Mental illness—Schizophrenia is the most common cause of psychosis. Other psychotic disorders include schizoaffective disorder. People with severe mood disorders like depression or bipolar disorder may also experience psychosis.
Substance use—Some substances cause psychosis. Cocaine, amphetamines (speed), marijuana, PCP, hallucinogens and sedatives can cause psychosis when you use those substances. Alcohol, sedatives and hypnotics (sleep medication) can cause psychosis when you suddenly stop using them. Most regular methamphetamine (meth) users experience psychosis at some point.
Other health problems—Certain physical injuries, diseases or health conditions such as brain injury or lupus can cause psychosis.
Stress—Intense stress can cause psychosis. In this particular cause, there may be no other conditions or diseases involved. This kind of psychosis lasts for less than one month. Stress can also trigger symptoms in people who are particularly at risk for psychotic disorders.

Could I have psychosis?

While psychosis looks different from person to person, it always causes changes in your abilities and personality. Because it is so different in each person, you may experience some or all of the symptoms below.

I’m hearing voices that other people don’t hear
My thoughts take a long time to form, come too fast together, or don’t form at all
I’m convinced I’m being followed
I’m having trouble remembering things, concentrating and making decisions
I act differently or I have a hard time completing basic tasks
I don’t feel like talking much anymore, or people say they can’t understand what I’m saying
I get confused easily

If you are experiencing any of these symptoms it’s important that you talk to your doctor. These symptoms could also be signs of other mental or physical health problems, and your doctor can help figure out what is causing them. Often, people living with psychosis also experience symptoms of anxiety and depression.

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What can I do about it?

Psychosis is much easier to treat if it’s treated early. People who receive treatment during their first episode of psychosis often recover faster, experience fewer related problems like depression, spend less time in the hospital and have fewer school, work or social problems. With treatment, many people never experience psychosis again after they recover from their first episode.

Treatment for psychosis usually includes medication and counselling. Some people need to stay in the hospital for assessment or treatment.

Medications—Most people with psychosis can be treated with medications called antipsychotics. Antipsychotics have improved in the last few years. They are more effective and have fewer side-effects than they used to. These newer antipsychotics are also called ‘atypical antipsychotics.’ Other medication like antidepressants or mood stabilizers may help mood problems that go along with psychosis.
Counselling—Supportive counselling can offer emotional support. Cognitive-behavioural therapy (CBT) is a promising type of counselling for psychosis. It teaches how behaviours and thoughts affect mood. Family therapy may help the entire family cope with a family member’s psychosis.
Education—Education is a very import part of a psychosis treatment plan and it should include patients and their families. Helpful psychosis education explains what psychosis is and what we know about it, treatment options and coping skills, how to avoid relapse and how to access services.
Stress management—Stress can worsen symptoms, make it harder to function and even trigger a relapse, so it’s important to learn positive ways to deal with stress. This might include learning problem-solving skills, coping skills and relaxation skills.
Self-care—Self-care strategies like eating well, getting enough sleep and keeping in touch with family and friends can also help.
Social and life skills support— Someone living with psychosis might need help with skills like finding a job and managing their finances. A professional like an occupational therapist or social worker can help with day-to-day living and connect people with community services or government programs.

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Where do I go from here?

In addition to talking to your family doctor, check out the resources below for more information about psychosis:

Early Psychosis Intervention (EPI)

EPI programs help people who have recently started to experience psychosis symptoms. The Early Psychosis website can help you find services or programs in BC. They also offer information about psychosis, assessments, managing psychosis, and supporting someone who experiences psychosis. For more, visit www.earlypsychosis.ca

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 schizophrenia and psychosis.

Kelty Mental Health

Contact Kelty Mental Health at www.keltymentalhealth.ca or 1-800-665-1822 (toll-free in BC) or 604-875-2084 (in Greater Vancouver) for information, referrals and support for children, youth and their families in all areas of mental health and addictions.

BC Partners for Mental Health and Addictions Information
Visit www.heretohelp.bc.ca for info sheets, and personal stories about psychosis. You’ll find more information, tips and self-tests to help you understand many different mental health problems.

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.

© 2013

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Schizophrenia

Schizophrenia can be a frightening experience on its own. Unfortunately, it’s often misunderstood, in part due to sensational stories in the news and other media. Some people assume that people who experience schizophrenia are dangerous or believe that people who experience schizophrenia should be treated without respect for their rights and dignity. These public perceptions can leave people scared to talk about their experiences and seek help. The truth is that many people learn how to manage schizophrenia with the right tools and supports. It’s time to learn the facts about schizophrenia and see it for what it is: a treatable illness.

What is it?

Schizophrenia is a mental illness. It causes people to lose touch with reality and sometimes makes it difficult for them to think and speak in an organized way. (This loss of touch with reality is called psychosis. Psychosis is a part of schizophrenia, but may also be seen on its own. For more on psychosis, see “a look at the terms” below.) It isn’t known exactly what causes schizophrenia, but it’s likely a combination of several factors, such as the way your body works, your family history, your environment, and your life experiences.

Schizophrenia myths and facts

Schizophrenia is not caused by bad parenting, childhood trauma, poverty, street drugs or alcohol
Schizophrenia is not contagious
Schizophrenia is very different from dissociative disorder (what used to be called split or multiple personality disorder)
Schizophrenia is no one’s fault
People who experience schizophrenia have a higher risk of suicide. In one study, 20-40% of people with schizophrenia attempted suicide and 5% of people with schizophrenia completed suicide, so all talk of suicide should be taken seriously

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Who does it affect?

Schizophrenia affects about 1% of Canadians—that’s about 40,000 people in British Columbia. While scientists are still working hard to figure out what causes schizophrenia, we do know that it affects:

Young people: Schizophrenia usually first shows up between the ages of 18 and 25 in men and between 25 and 35 in women.
Men and women: Schizophrenia affects men and women equally as often. Men usually start to experience symptoms at an earlier age than women.
Families: Schizophrenia seems to run in families. If a close family member (like a parent or sibling) experiences schizophrenia, you may experience an increased risk of schizophrenia. However, it’s important to remember that there is much more to schizophrenia than your genes—genes are one of several risk factors.

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Could I have schizophrenia?

While schizophrenia looks different from person to person, it always causes changes in your abilities and personality. Because it is so different in each person, you may experience some or all of the symptoms below.

I’m hearing voices other people tell me they can’t hear
I’m seeing things that other people tell me they can’t see
My thoughts take a long time to form, come too fast together, or don’t form at all
I’m convinced I’m being followed
I feel immune to any kind of danger; I believe I can save the world
I sometimes feel like I’m not actually in my body, that I’m floating
I used to like being around other people, but now I’d rather just be by myself
I want to end my life or harm myself
I’m having trouble remembering things, concentrating and making decisions
I’m getting confused easily

If you are experiencing any of these symptoms it’s important to talk to your doctor. People who experience schizophrenia often experience symptoms of anxiety and depression, too.

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A look at the terms

Below are the definitions of a few words that you might hear associated with schizophrenia.

Psychosis: A group of symptoms related to the way you understand the world around you. It includes hallucinations, delusions, and confusing thinking. Hallucinations are things you sense that aren’t real. The most common hallucination is hearing voices. Delusions are strong beliefs that can’t be true. Common delusions include believing that someone is following you or watching you, or believing that you have special powers. Confused thinking can make it difficult to speak in ways that others understand, concentrate, or complete daily tasks. Psychosis is a major part of schizophrenia. It can be caused by other health problems, too: another mental illness, substance use or substance withdrawal, brain injury, and other health problems. To learn more about psychosis, see our “Psychosis” info sheet at www.heretohelp.bc.ca.
Schizoaffective disorder: A mental illness that includes symptoms of both schizophrenia and a mood disorder.
Negative symptoms: Symptoms that “take away.” With schizophrenia, this may be loss of interest in things you used to enjoy, loss of emotions, or loss of concentration.
Positive symptoms: Symptoms that “add.” With schizophrenia, this may be hallucination, delusions, or strange thoughts.

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What can I do about it?

Schizophrenia is treatable. While there is no cure, you can learn how to effectively manage schizophrenia. An important part of recovery is seeking help early. Many people are scared to tell others about their experiences because they worry about what others will think or do. However, early treatment can help you recovery faster and more completely. As schizophrenia usually starts when you’re a teen or young adult, it can interfere in your development and interrupt your goals in school or work. Early treatment can help you get back on track with fewer delays. Of course, it’s also never too late to seek help. There are many different things you can try—talk with your doctor to see what might be right for you.

Medication: Most people with schizophrenia can be treated with medications called antipsychotics. New types of antipsychotics (also called atypical antipsychotics) may have fewer side effects than older types, but the important part is finding a strategy that works best for you. It may take time to find the right medication and the right dose, so it’s important to be patient during this process. Whenever you start a new medication, it’s a good idea to talk to your doctor about what to expect and what you can do to reduce side effects.
Counselling: Counselling is a very important part of treatment for schizophrenia. A counsellor can help you learn new skills, cope with challenges you experience, and support you on your own path to recovery. Extra supports around job skills, financial management and social skills may also be helpful. You often find these supports in local mental health teams. A type of talk therapy called cognitive-behavioural therapy can help with symptoms like confused thinking, and a type called metacognitive training (MCT) teaches you about thought patterns involved in psychosis.
Counselling is also important for families and loved ones because it can help them learn more about schizophrenia, what to expect, navigating the system, and supporting someone. They can learn what they can do to help their loved one, especially during relapses or crisis.
Hospitalization and follow-up: If you become extremely ill with schizophrenia, you may need to go the hospital. Once you are out of the hospital, regular check-ups with your doctor and/or community mental health team are a good idea. (See our ‘Getting Help for Mental Illnesses’ sheet for more about mental health teams). The BC Schizophrenia Society has helpful worksheets to help you plan your release from hospital and transition back into your regular routine.
Support groups: You are not alone. Support groups, for both people with the illness and loved ones, are a great way to share your experiences and learn from the experiences of others.
Self-help: During and after treatment, 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, keeping in touch with your spirituality, and minimizing the use of alcohol and other drugs can help keep your symptoms 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.

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Where do I go from here?

In addition to talking to your family doctor, check out the resources below for more information on schizophrenia:

Helpful resources available in English only are:

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 schizophrenia and psychosis, including family support groups, respite care, support for children with a parent with a mental illness, and education courses for persons with schizophrenia and their families.

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 illness.

BC Partners for Mental Health and Addictions Information
Visit www.heretohelp.bc.ca for our Managing Mental Illnesses series of info sheets, more information, and personal stories about schizophrenia. You’ll also find tips and self-tests to help you take control of your mental health.

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.

© 2014

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Seasonal Affective Disorder

Have you ever noticed how different you feel when the sun is shining on your face? How about when it’s rainy and dreary here in BC? How do you feel then? Everyone’s mood can be affected by the weather. It dictates what we wear, when we travel and what activities we choose to do. But when the seasons change, bringing long term changes in the weather, temperature and length of day, some people are affected in other ways. The seasonal changes can affect their entire sense of well-being. If you find that you feel like a completely different person depending on the season, you may have a mental illness called seasonal affective disorder.

What is it?

Seasonal affective disorder, or SAD, is a kind of depression that appears at certain times of the year. It usually begins in the fall when the days get shorter and lasts through the winter. SAD doesn’t only happen in the colder months though. A less common form of seasonal affective disorder affects people in the summer months and usually starts in the spring. It isn’t really clear what causes SAD, but it’s thought that winter SAD may be caused by lack of sunlight. But this may not be the whole answer, as it’s also thought to run in families: 13–17% of people who develop SAD have an immediate family member with the disorder.

Could I have SAD?

I feel like sleeping all the time, or I’m having trouble getting a good night’s sleep
I’m tired all the time, it makes it hard for me to carry out daily tasks
My appetite has changed, particularly more cravings for sugary and starchy foods
I’m gaining weight
I feel sad, guilty and down on myself
I feel hopeless
I’m irritable
I’m avoiding people or activities I used to enjoy
I feel tense and stressed
I’ve lost interest in sex and other physical contact

If some of these feelings seem to happen each year, have a real impact on your life, and improve during certain seasons, talk to your doctor.

It is very important not to diagnose yourself without speaking to your doctor because there may be other causes for these symptoms. And even if it does turn out to be depression, it may not be the SAD form of depression.

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Who does it affect?

About 2 to 3% of Canadians will experience SAD in their lifetime. Another 15% will experience a milder form of SAD that leaves them only slightly depressed, but still able to live their life without major disruptions. People with seasonal affective disorder make up about 10% of all depression cases. There are some groups of people who are at higher risk of seasonal affective disorder.

Adults—are at higher risk of SAD than children and teenagers. After the age of 50, the risk of SAD starts to decline. Researchers aren’t yet sure why.
Women—may be more likely to experience SAD. Some research found that women may be up to nine times more likely to be diagnosed than men.
People in more northern countries or cities—are more likely to experience SAD than those who live close to the equator. The amount of daylight you receive changes as you move north, and that change is thought to be part of SAD.

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What can I do about it?

If you think you might have seasonal affective disorder, talk to your doctor. Your doctor can help rule out any other causes for your symptoms, like thyroid problems or other types of depression. Some common treatments for SAD include:

Light therapy—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. The intense artificial light causes a chemical change in the brain that improves mood and helps relieve SAD symptoms. Light therapy should not be done without first consulting your doctor because there are side-effects to this treatment. Sixty to 80 per cent of people with SAD find substantial relief from light therapy.
Medication—can be helpful for treating all kinds of depression, including SAD. Different kinds of medication work in different ways. Talk to your doctor to find out if medication is right for you and how you should use it.
Counselling—such as an approach known as cognitive-behavioural therapy (CBT), is effective for depression. 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. CBT may be used alongside other treatments like light therapy or medication.
Self-help—can help you feel better. Regular exercise, a healthy diet, good sleep habits, staying connected to others, balanced thinking techniques, and managing stress have all been shown to reduce the symptoms of depression. These are helpful if you have only mild changes in your mood that follow a seasonal pattern. Doing these things can also help alongside treatment for more moderate or severe symptoms.

Although there are many alternative therapies for depression, there is less evidence available that they actually work. Some people find that certain herbal remedies help with their mild depression symptoms like those experienced with SAD. 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 and make sure they know all the different treatments you are trying.

Tips to Ease Your Winter SAD Symptoms

Spend more time outdoors during the day
Try to arrange the spaces you spend time in to maximize sunlight exposure
Keep curtains open during the day
Trim tree branches or hedges that may be blocking some of the light from getting into your home
Move furniture so that you sit near a window or, if you exercise indoors, set up your exercise equipment by a window
Install skylights and add lamps
Build physical activity into your lifestyle preferably before SAD symptoms take hold. Physical activity relieves stress, builds energy and increases both your physical and mental well-being and resilience
Make a habit of taking a daily noon-hour walk, particularly if you commute to school or work in the dark hours of the day
When all else fails, try a winter vacation in sunny climates—if the pocketbook and work schedule allow. Keep in mind that the symptoms will recur after you return home
Try to resist the carbohydrate and sleep cravings that come with SAD

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Where do I go from here?

If you have SAD, 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 seasonal depression, it’s also important to see a doctor first to rule out other explanations for your symptoms. In addition to talking to your family doctor, check out the resources below for more seasonal affective disorder information:

Resources, available in English only, are:

BC Partners for Mental Health and Addictions Information
Visit www.heretohelp.bc.ca for info sheets and personal stories about seasonal affective disorder. You’ll also find more information, tips and self-tests to help you understand many different mental health problems.

© 2013

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Self-harm

People go to great lengths to protect themselves from pain and injury. But some people hurt themselves on purpose to help them deal with bad feelings or thoughts. This is called self-harm. People who self-harm don’t do it to end their life—instead, self-harm may be the best way they know to survive.

What is it?

Self-harm means that you hurt yourself on purpose, but you don’t intend to die as a result. It isn’t a mental illness—and in many cases, it isn’t a sign that someone has a mental illness. Instead, self-harm is usually a way to deal with difficult feelings or show distress.

When you self-harm, you cause some kind of damage to your body. The most common ways to do this are cutting or burning the skin, scratching that breaks the skin, hitting to the point of bruising or breaking bones, biting or falling. Some people also take a minor overdose of a substance (for example, they take more than the recommended dose, but not a lethal dose, of an over-the-counter medication) to harm themselves. Acts of self-harm are sometimes done on impulse, and sometimes they’re planned. Certain people who self-harm say that don’t feel pain when they hurt themselves, or that they do it to feel physical pain.

Why do people self-harm?

To deal with uncomfortable or unwanted feelings like anxiety or depression
To cope with grief, loss, violence or chronic illness
To punish themselves or to express self-hatred or self-anger, or feelings of failure
To make their emotional pain feel like physical pain
To feel “real”, feel anything or to cope with feelings of emptiness or numbness
To regain control over their body
To just feel better

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Who does it affect?

Teens—Self-harm affects 1% to 4% of the population, but rates of self-harm among teens range from 14% to 39%. Some teens may feel extreme emotions. They may have more conflicts with adults and may have to deal with loneliness and peer pressure.
People with certain ways of coping or thinking about themselves—Self-harm seems to be more common in people who feel poorly about themselves. It’s also more common in people who feel like they can’t express their feelings or who have a hard time dealing with negative events or emotions. Self-harm may also be a way to deal with abuse.
People living with a mental illness—Sometimes self-harm is a sign of a mental illness. It’s seen with a few different illnesses, including eating disorders, depression, anxiety disorders, substance use disorders and some personality disorders.

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What can I do about it?

It’s important to talk to someone about self-harm because it can result in a serious injury or become a habit.¹⁶ Self-harm may also be a risk factor for future suicide attempts.¹⁷

What can I do about self-harm injuries?

In an emergency—As in any health emergency, call 911 or go to the nearest emergency room.
At home—Care for any injuries properly. It’s always a good idea to see your doctor if you’re not sure what to do. In BC, you can also call 811 and talk to a registered nurse.

What can I do about self-harm behaviours?

Many people who self-harm don’t have a mental illness. But some people self-harm as a result of a mental illness. That’s why it’s important to tell your doctor if you’re experiencing any other symptoms, like troubling thoughts or feelings. If self-harm is related to an illness, treating that illness can reduce the thoughts or feelings that lead to self-harm.

The following treatments may be helpful on their own or as part of your treatment plan:

Cognitive-behavioural therapy (CBT): CBT teaches you how your thoughts and behaviours affect your mood. This may be particularly helpful for people who self-harm because it may reduce the feelings that trigger self-harm. CBT may improve anxiety, depression, self-esteem, problem-solving skills and coping skills in people who self-harm.
Dialectical behaviour therapy (DBT): DBT teaches you how to replace extreme and rigid ways of thinking with more open and flexible ways of thinking. It also teaches skills like acceptance and problem-solving, and can teach you how to cope with uncomfortable or difficult thoughts, feelings and situations.
Self-help: Regular exercise, eating well, getting enough sleep, staying in touch with family and friends, joining a support group and doing things you enjoy are some things that are good for everyone’s mental health. If you’re struggling with self-harm, it may be helpful to find other healthier ways to cope that work for you, like talking to friends, writing in a journal or practicing relaxation exercises. It’s also a good idea to avoid any media (like TV shows or movies) that makes self-harm look glamorous or ‘cool.’

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How do I know if someone I love is self-harming?

It may be hard to tell if someone self-harms, and someone who self-harms may try to cover up their injuries because they’re embarrassed or ashamed. While people may hurt themselves in different ways, here are a few warning signs:

They often have unexplainable wounds like cuts, burns or bruises
They have many unexplainable scars
They often say that they’re “accident-prone” or have many accidents
They cover their body, even during warm weather

Remember, someone who self-harms doesn’t want to die. But if you aren’t sure if someone you love self-harms or feels suicidal, it’s best to be cautious and get help immediately.

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What can I do if someone I love self-harms?

It’s natural to feel shocked, angry, frustrated, confused or guilty if you find out that someone you love self-harms. But it’s important to remember that self-harm is a sign that someone you love is in distress. A compassionate approach is the best way to help. While everyone’s situation is different, here are some general things you can do to help:

Educate yourself about self-harm
Avoid anger and judgment. Your loved one isn’t trying to hurt you, make you feel guilty or get attention
Focus on your loved one’s concerns or issues, not the act of self-harm
Encourage positive, healthy coping methods. It takes time to learn the positive coping skills that can replace harmful coping skills. Don’t demand that your loved one stop self-harming immediately
Let your loved one know that you’re willing to listen, but don’t force them to talk
Encourage your loved one to seek professional help

Helping someone you love can be hard. It’s important to take care of yourself, too. For example, do things you enjoy, talk with a friend about your own feelings and/or set boundaries for how much you can help the person you love. If you’re having a hard time coping with loved one’s self-harm, extra support from a mental health professional or support group may be helpful.

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Where do I go from here?

Note: If you hurt yourself badly, or see that someone you care about has, call 911 or go to the nearest emergency room. If you ever feel like ending your life, talk to someone and get help right away. If you need help or think that someone you love needs help, call 1-800-SUICIDE.

In addition to talking to your doctor or mental health professional, check out these resources for more information about self-harm:

BC Partners for Mental Health and Addictions Information
Visit www.heretohelp.bc.ca for info sheets and personal stories about self-harm. You’ll also find more information, tips and self-tests to help you understand many different mental health problems.

Kelty Mental Health
Contact Kelty Mental Health at www.keltymentalhealth.ca or 1-800-665-1822 (toll-free in BC) or 604-875-2084 (in Greater Vancouver) for information, referrals and support for children, youth and their families in all areas of mental health and addictions.

INSYNC (Interdisciplinary National Self-Injury in Youth Network Canada)
Visit www.insync-group.ca to learn more about self-injury and find links to other websites for youth who self-injure, as well as information and links for families and friends.

1-800-SUICIDE
If you’re not sure if self-harm is a suicide attempt, call 1-800-SUICIDE (1-800-784-2433) to get help right away, any time of day or night. It’s a free call.

© 2013

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Social Anxiety Disorder

Amal is a young man in his 20s. When he was a child, everyone thought he was very shy. Now that he’s in university, he’s having a hard time fitting in. He rarely joins class discussions, and he avoids talking to his classmates. He lives in constant fear of doing or saying the wrong thing. He thinks that other people will judge him or laugh at him. When he does talk to others, he feels shaky and nauseous. Amal has always been a good student, but his grades are starting to slip. His teachers notice that he doesn’t asks questions or participate—in fact, he’s been missing more and more classes as the school year goes on.

We can all feel nervous in social situations like job interviews or when we’re giving presentations. But if you’re so scared of interacting with others that it affects your relationships with other people or it affects your work or school performance, you may have something called social anxiety disorder.

What is It?

Social anxiety disorder, also known as social phobia, is a mental illness. It belongs to a group of mental illnesses called anxiety disorders. People with social anxiety disorder feel very nervous and uncomfortable in social situations like meeting new people. Or they might feel very anxious when they have to do something in front of other people, like talking in a meeting. Some people feel very anxious in both situations.

People with social anxiety disorder often feel like they will say or do the wrong thing. Or they might think that other people will look down on them and think poorly of them because they’re “strange” or “stupid.” It’s important to know that adults with social anxiety disorder recognize that they feel too anxious, but they may not be able to control it.

Some people may have a panic attack or feel some physical signs of anxiety when they’re facing a social situation. Common physical signs of anxiety include stomach aches, shallow breathing, sweating or feeling hot flashes, feeling like your heart is racing, feeling tightness in your chest, feeling tense and feeling shaky.

Social anxiety disorder can have a very negative effect on your well-being and quality of life. The illness can cause a lot of problems in your relationships with partners, family and friends. It can also seriously affect your school or work life. You may avoid certain careers or fields of study, avoid contributing your ideas, turn down promotions, drop out of school or take many days off because you feel so anxious. Some people with social anxiety disorder fear one or just a few specific social situations. Others fear a wide range of social situations.

Could I have social anxiety disorder?

It’s normal to feel a bit nervous or anxious when you have to give a speech or when you’re meeting people for the first time. But with social anxiety disorder, your anxiety is so intense that it affects many parts of your life. It might affect your school or work life, relationships, things you do for fun or your day-to-day life.

These are some other signs you might have social anxiety disorder:

I’m scared other people will think I’m stupid or strange if I say something wrong
I’m scared to do things like join in during meetings at work or discussions at school or give presentations in front of a group of people
When I’m in an uncomfortable social situation, I think other people can see how anxious I feel
I go out of my way to avoid social situations that make me anxious, and I dread situations I can’t avoid
I drink a lot or use other substances to lower my anxiety before I to go to a social event

If you agree with some or all of the above statements, the best thing to do is talk to your doctor.

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Who Does It Affect?

Social anxiety disorder is one of the most common types of anxiety disorders, and one of the most common mental illnesses. About 8% of people will experience symptoms of social anxiety disorder at some point in their life. Without treatment, social anxiety disorder can last for a long time. Unfortunately, many people never seek help for social anxiety disorder.

There are some groups of people at higher risk of experiencing social anxiety disorder:

Age—Social anxiety disorder often starts sometime between childhood and teenage years. The majority of people with social anxiety disorder say that their symptoms started before they were 18
Women—Women are more likely to experience social anxiety disorder than men
Other mental illnesses or substance use disorder—Many people with social anxiety disorder have other mental illness like depression, panic disorder, bulimia nervosa (an eating disorder) and substance use disorders. However, social anxiety seems to appear before other mental illnesses.

Social anxiety disorder in children

Young children usually don’t know that they are experiencing anxiety. They just know that they have stomach aches, headaches or other physical symptoms of anxiety. Children also know that they just don’t want to do certain activities. So children might express their anxiety by complaining about physical discomfort, avoiding social activities, refusing to go to school or acting out.

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What can I do about it?

There are a few different things you can do:

Counselling—Many people with social anxiety disorder benefit from a form of counselling called cognitive-behavioural therapy or CBT. A mental health professional trained in CBT can help you work through the thoughts or beliefs and behaviours that lead to or maintain your social anxiety. CBT helps you cope with social anxiety by teaching you skills to build confidence in social situations. You can also learn how to interact with people and maintain relationships. CBT is usually a short-term treatment. You can get the most out of treatment by regularly practicing CBT skills.
Exposure—Exposure (sometimes called desensitization) helps you “unlearn” anxiety associated with a situation or thing. With the guidance and support of a qualified professional, you gradually take small, planned steps towards a situation you fear until you no longer feel overwhelmed by that situation. It can be a very effective treatment for many different phobias, including social phobia. Exposure is an important part of CBT treatment for social anxiety.
Medication—Anti-anxiety medications or antidepressants can be used in combination with counselling or exposure to reduce your body’s response to anxiety.
Support groups—You are not alone. Anxiety disorder support groups in person or online are a great way to share your experiences and learn from the experiences of others.
Self-help—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 anxiety from getting worse. 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.

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Where do I go from here?

In addition to talking to your family doctor, check out the resources below for more information about social anxiety disorder:

AnxietyBC
Visit www.anxietybc.com or call 604-525-7566 for self-help information and community resources.

BC Partners for Mental Health and Addictions Information
Visit www.heretohelp.bc.ca for info sheets and personal stories about social anxiety disorder. You’ll also find more information, tips and self-tests to help you understand many different mental health problems.

Resources available in many languages:
* 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.

© 2013

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Supporting a Friend or Family Member

It can be scary when someone you love is sick. It can be especially scary if they’re diagnosed with a mental illness. It’s hard to see someone you love in pain and it’s confusing when someone you know well is not acting like themselves. You know how you would take care of them if they had a cold or flu, but what do you do for a mental illness? Like any other health problem, someone with a mental illness needs extra love and support. You may not be able to see the illness, but it doesn’t mean that you’re powerless to help.

How can I help?

Research confirms that support from family and friends is a key part of helping someone who is going through a mental illness. This support provides a network of practical and emotional help. These networks can be made up of parents, children, siblings, spouses or partners, extended families, close friends and others who care about us like neighbours, coworkers, coaches and teachers. Some people have larger networks than others, but most of us have at least a few people who are there for us when we need them.

There are a number of major ways that family and friends can help in someone’s journey of recovery from a mental illness:

Knowing when something is wrong—or right: Getting help early is an important part of treating mental illness. Family and friends are often the first ones to notice that something is wrong. See “How do I know when to help?” on the next page for signs to watch for. Finding a treatment that works is often a process of trial and error, so family members may also be the first to see signs of improvement.

How do I do this?

TIP: Learn more about the signs and symptoms of different mental illnesses. Also learn more about how treatments work so that you know what side effects you may see, when to look for improvements and which ones to look for first. A recent review found that when the family is educated about the illness, the rates of relapse in their loved ones were reduced by half in the first year.

Seeking help: Families and friends can be important advocates to help loved ones get through those hard, early stages of having a mental illness. They can help their loved one find out what treatment is best for them. They can also be key in letting professionals know what’s going on, filling in parts of the picture that the person who’s ill may not be well enough to describe on their own.

How do I do this?

TIP: Offer to make those first appointments with a family doctor to find out what’s wrong or accompany your loved one to the doctor—these steps can be hard if your loved one doesn’t have much energy or experiences problems with concentration. If you do accompany the person, work with them to write down any notes or questions either of you have in advance so that you cover all the major points. If your loved one wants to do it on their own, show them your support and ask them if there’s anything you could do to help.
TIP: You can’t always prevent a mental health crisis from happening. If your loved one needs to go to hospital, try and encourage them to go on their own. If you’re concerned that your loved one is at risk of harm, they may receive treatment under BC’s Mental Health Act. It may be necessary in certain cases, but involuntary treatment can be complicated and traumatic for everyone. To learn more about the Mental Health Act, see the “Coping with Mental Health Crises and Emergencies” info sheet.

Helping with medications, appointments and treatments: If you spend a lot of time around your loved ones, you can help them remember to take their medications. You may also be able to help tell a doctor why medications aren’t being taken as they should be. Similarly, you may be involved in reminding your loved one to do their counselling homework or use their light therapy treatment each morning, or reminding your loved one to make or keep appointments for treatment.

How do I do this?

TIP: If you notice that your loved one is having trouble taking their medication, you can encourage them to talk to their doctor or pharmacist. They can suggest ways to make pill taking easier. If there are other problems with taking medicine, such as side effects, encourage your loved one to write down their concerns and questions and talk to their doctor. If they don’t have a good relationship with their doctor, help them find a new one. If cost is a barrier, learn about BC’s no-charge psychiatric medication coverage called Plan G.

Supporting a healthy lifestyle: Families can also help with day-to-day factors such as finances, problem solving, housing, nutrition, recreation and exercise, and proper sleeping habits.

How do I do this?

TIP: See our Wellness Modules at www.heretohelp.bc.ca for practical tips on how to have a healthy lifestyle for both you and your loved one. Case managers and peer support workers at mental health centres in your community may be able to help with life skills training as well as connections to income and housing.

Providing emotional support: You can play an important role in helping someone who’s not feeling well feel less alone and ashamed. They are not to blame for their illness, but they may feel that they are, or may be getting that message from others. You can help encourage hope.

How do I do this?

TIP: Try to be as supportive, understanding and patient as possible. See our “Where do I go from here?” section for resources on how to be a good communicator.
TIP: Taking care of an ill family member or friend can be stressful. Remember that you need emotional support, too. Consider joining a support group for family members of people with mental illness. There, you can connect with other people going through the same things and they can help you work through your own emotions. It’s very important to make sure you are taking care of your own mental health as well.

How do I know when to help?

Some signs that a friend or family member may have a mental illness and could need your help are:

They suddenly no longer have interest in hobbies and other interests they used to love
They seem to feel angry or sad for little or no reason
They don’t seem to enjoy anything anymore
They have told you about or seem to be hearing strange voices or having unsettling thoughts
They seem emotionally numb, like they don’t feel anything anymore
They used to be healthy, but now they’re always saying they feel a bit sick
They eat a lot more or less than they used to
Their sleep patterns have changed
They seem to be anxious or terrified about situations or objects in life that seem normal to you and to others
They’ve been missing more and more time from work or school
They’ve been drinking heavily and/or using drugs to cope
They are talking about taking their life or feeling hopeless
They are avoiding their close friends and family members

“Tom’s recovery has been an exercise in patience, love and understanding. We take one step forward and stumble two steps back; baby steps—small increments of success, tiny improvements of things we would ordinarily take for granted—are things we celebrate. When Tom smiles, cracks a joke or declares that he wants to go for a run, they are positive, encouraging signs: baby steps forward.”
—Family member from Family Toolkit

“The most important thing [families] have to do is accept you completely, with all your faults. Families can help by saying ‘You’re okay, we love you, and you’ll get better”
—Mariam, 31 in recovery from clinical depression

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Where do I go from here?

If you need advice on how to get your loved one the help they need, there are a number of resources available to you.

Other helpful resources are:

BC Partners for Mental Health and Addictions Information
Visit www.heretohelp.bc.ca for info sheets and personal stories on supporting loved ones. You’ll also find more information, tips and self-tests to help you understand many different mental health problems.

Alzheimer Society of BC
Visit www.alzheimerbc.org or call 1-800-936-6033 (toll-free in BC) for information and community resources for individuals and families with dementia.

AnxietyBC
Visit www.anxietybc.com or call 604-525-7566 for information, tools, and community resources on anxiety.

British Columbia Schizophrenia Society
Visit www.bcss.org or call 1-888-888-0029 (toll-free in BC) or 604-270-7841 (in Greater Vancouver) for information and community resources on schizophrenia and other major mental illnesses and support for families.

FORCE Society for Kids’ Mental Health
Visit.www.forcesociety.com or call 1-855-887-8004 (toll-free in BC) or 604-878-3400 (in the Lower Mainland) for information and resources that support parents of a young person with mental illness.

Jessie’s Legacy at Family Services of the North Shore
Visit www.familyservices.bc.ca or call 1-888-988-5281 ext. 204 (toll-free in BC) or 604-988-5281 ext. 204 (in Greater Vancouver) for information and resources on body image and prevention of eating disorders.

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.

© 2013

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Youth and Self-Injury

People cope with difficult thoughts, feelings, or situations in different ways. Some people cope by injuring themselves on purposeand it may be the only way for them to feel better. Self-injury may seem frightening, but its important to look beyond the injuries and see whats really going on.

What is self-injury? Self-injury means that someone hurts themself on purpose but doesnt intend to end their life. Common acts of self-injury include cutting skin, burning skin, hitting yourself to the point of injury, and preventing wounds from healing. Self-injury itself isnt a mental illness, but may be a sign that someone needs care and support. In some cases, self-injury can be a sign of a mental health problem. People self-injure for many different reasons. Some people self-injure:

To cope with anxiety or depression
To cope with loss, trauma, violence, or other difficult situations
To punish themselves
To turn emotional pain into physical pain
To feel real and counter feelings of emptiness or numbness
To feel euphoria
To regain control of their bodies
To simply feel better

People who self-injure are not trying to end their lives, but they can experience those thoughts. When they self-injure, they are trying to cope with difficult or overwhelming thoughts or feelings.

Warning Signs

People who self-injure often hide the behaviour. They may feel embarrassed or ashamed, and they may avoid talking about it. Warning signs include:

Unexplained frequent injuries, such as cuts and burns
Unexplained scars
Wearing long pants and long-sleeved shirts all the time, even in warm weather
Low self-esteem
Problems handling emotions
Problems with relationships

Who does it affect?

Self-injury can affect anyone, but its more common during the teenage years and among females. Self-injury is also more likely to affect people who have experienced stressful or traumatic life events, people who have a hard time coping with their feelings, and people who experience low self-esteem.

What can I do if I do about it?

If you self-injure, its important to begin talking with someone you trust. This could be a friend, a family member, a teacher, a school counsellor, or anyone you feel comfortable talking with. Your support person can help you work through next steps, like talking with a doctor or other health care professional. If you self-injure, its important to take care of your injuries. If youre worried about an injury, talk to your doctor, go to your local emergency room, or call 9-1-1. You should be treated with respect no matter how you received the injury. Self-injury isnt a mental illness, but in some cases it can be a sign of a mental health problem. Its important to talk with your doctor about self-injury and any other problems youre experiencing. If self-injury is related to a mental illness, treating the mental illness may help you reduce self-injuring behaviours.

Counselling and support

If self-injury isnt related to a mental illness, its still best to talk with a mental health professional or a school counsellor. Your doctor can recommend a counsellor who can help you. They can help you work through the thoughts, feelings, or situations behind self-injury, teach you skills to cope with difficult thoughts and feelings, and help you find alternatives to self-injury. Two types of counselling that may help self-injury are cognitive-behavioural therapy and dialectical behaviour therapy. Cognitive-behavioural therapy (or CBT) helps you understand the relationship between your thoughts, feelings, and actions. It also teaches you skills like problem-solving and stress management. Dialectical behaviour therapy (or DBT) teaches you open and flexible ways of thinking. It also teaches skills like acceptance, problem-solving, and coping with difficult or uncomfortable thoughts, feelings, and situations.

It can be very helpful to connect with support groups. They are a place to share your own experiences and learn from others, and help you connect with people who understand what youre going through. If there isnt a support group in your area, you may find groups online. Self-help strategies that boost your well-being can also help you work through self-injury.

Self-help might include connecting with family, friends, or a support group, eating well, exercising, getting enough sleep, and spending time on things you enjoy. Youll find many of these strategies in counselling, but you can practice them on your own, too.

How can I help a loved one?

If you are concerned about a friend or family member, its okay to ask about self-injury. Talking about self-injury wont make someone start hurting themselves. Its a good idea to learn more about self-injury before you start the conversation. It can be difficult to hear what your loved one has to say. Self-injury may not make sense to you and you may wonder why someone would hurt themself, but your loved ones feelings are very real. Learning more can help you give support that respects your loved ones experiences. Many young people arent sure what they can do to help a friend. Its a good idea to talk to someone you trust, like a teacher or school counsellor. There are also help lines and websites to support young people, like the Kids Help Phone. Here are a few more tips for helping a loved one:

Instead of focusing on your loved ones self-injury behaviours, it may be more helpful to focus on your concern for their well-being.
Dont demand that your loved one immediately stop self-injuring. New healthy behaviours take time to learn. Instead, focus on supporting new behaviours and celebrate your loved ones small steps forward.
Avoid guilt, shame or judgementthese can get in the way of open and trusting relationships.
Seek help or support for yourself, if you need it.

Do you need more help?

Contact a community organization like the Canadian Mental Health Association to learn more about support and resources in your area. Founded in 1918, The Canadian Mental Health Association (CMHA) is a national charity that helps maintain and improve mental health for all Canadians. As the nation-wide leader and champion for mental health, CMHA helps people access the community resources they need to build resilience and support recovery from mental illness.

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Mental Illnesses

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What is it?

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Could I have post-traumatic stress disorder?

Why do some people develop PTSD and others don’t, even after the same traumatic event?

What can I do about it?

Where do I go from here?

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What is it?

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Postpartum anxiety

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Could I have psychosis?

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Schizophrenia myths and facts

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Could I have schizophrenia?

A look at the terms

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Tips to Ease Your Winter SAD Symptoms

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Why do people self-harm?

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What can I do about self-harm injuries?

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What can I do if someone I love self-harms?

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Could I have social anxiety disorder?

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Social anxiety disorder in children

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