Before I start explaining how to begin mental health treatment, I want you all to know that the following guide is built from my personal experience. I have personally gone through the system for 9 years (and counting…) with time spent in outpatient therapy, groups, & several day-programs. I’ve also spent time in crisis home admissions, inpatient emergency units, adolescent & adult psych units, long-term inpatient, rehabilitation, high-security units, isolation, and mental health institutions. I personally suffer from Borderline Personality Disorder (BPD) & Post Traumatic Stress Disorder (PTSD) and have a history of many co-occupant disorders such as Bulimia and Addiction. The past two years of my life have strictly been outpatient with a few crisis home admissions. Throughout all this time I’ve accumulated 3 years in a hospital bed. The beginning of my journey started as a 13-year-old when I began taking psych medication. Some of my tips may be a bit biased towards BPD treatment since that is my primary diagnoses but since I have such a long history with these institutions and have an immense amount of information on several types of treatment I thought I would share my personal tips on how to get started…
I often get asked, “how can I get admitted to the hospital? What did you do?” THIS QUESTION is one that I will NOT answer. As much as I hate the healthcare system I do have faith in the emergency room staff admitting those who are in need. Being admitted to the hospital is not “cool” it doesn’t make you “crazy“ and being admitted for 24hrs isn’t something to go and brag about with your friends. Of course, talk about mental health but please respect those in the system who are severely struggling to the point that we wouldn’t be alive today without the system, medication, and treatment. Please respect the souls who are committed, being in an institution is all they know and saying that their lifestyle is “unbearable” or “crazy” is just offensive and rude. People die because of the overflowing admissions in hospital psych units, therefore, the hospital should be a last resort. It’s not somewhere to have a vacation from life…it’s strictly for your safety.
How do I know if something is wrong?
Spotting a mental health problem or mental illness can be tricky. I remember having my first therapy booklet where almost every question included doing something ‘too much‘ or ‘too little‘ which I found to be redundant thinking that everyone had to do the same thing at the same amount but I soon realized that the phrase “everything in moderation” reflects mental health symptoms quite accurately.
Are you sleeping too much or too little?
Sleeping is a very individual thing. Many people need a longer sleep while others only need a quick rest. People on sedation pills or heavy psychiatric medication often need more sleep and adapt quickly to this change in need. Some of my medicine cocktail is heavy sedation pills, therefore, I need a heavier and longer sleep than most. Personally, I need around 8-10hrs of sleep a night while the average for people my age is 6-8hrs. You can notice something is wrong with your sleeping schedule when you are constantly tired, if several weeks go by and it takes you longer than 20 minutes to fall asleep, or, you sleep past 12+hrs a night.
If you are seriously thinking that you could be suffering from a mental health problem, you probably are. Some warning signs include…
Thoughts: of self-harm, intrusive sexual or violent thoughts, compulsive needs for repetitive movements, poor self-confidence, self-destruction, and degrading personal comments, intrusive anxiety-provoking thoughts, suicidal thoughts, romanticizing suicide, or suicidal ideation.*
Expressions: someone is telling you that you have ‘changed’ recently in a negative format, someone expressing worry about you, someone expressing fear of or for you, feeling like your safety is in danger or that you ‘deserve‘ what is happening, crying for no reason, not crying at all, feeling ‘numb’, refusal to take responsibility for one’s own actions
Loss: of appetite, libido or impotence, sleep, concentration, start skipping; appointments, school, work or regular daily activities, loss of enjoyment of previously mood enhancing activities, isolation, avoiding friends and family, avoidance of daily functioning activities such as hygiene practices (brushing hair, teeth, showering, etc.)
Overindulging: drugs, medication, alcohol, weed, cigarettes, shopping, clubbing, sleep, food, sex, porn, internet, gaming, gambling, exercising, coffee, or overindulging in anything previously enjoyed in moderation
Emotions: avoidance of responsibilities, codependency, feeling too strongly or not strong enough for situations such as a death, lack of independence, fear of intimacy, emotions not matching the current situation, emptiness, fear of going outside or ongoing regular anxiety, persistent depression, dissociation, inappropriate laughter, mania
**These are all subject to change, different for every person, and not limited to these specific terms. If you experience something different and think it is a problem please contact your doctor and please feel free to add it to a comment below!
Precontemplation is a stage that almost everyone who struggles with mental illness goes through. It’s the stage of denial and refusal to accept what is happening. Precontemplation is very popular in those who struggle with eating disorders or drug use. I experienced pre-contemplation at the beginning of my benzodiazepine addiction. As a kid in the hospital, I was often given Ativan to calm me down or help me sleep since the major use for benzodiazepines are a muscle relaxant often used to relax a patient before surgery or help someone suffering from insomnia. I started regularly using Ativan, Valium, Clonazepam, & Xanax for 7 years. In my 8th year, I was taken off of benzodiazepines and I went through the narcotic system to get my hands on what I thought I needed. I never thought I had a benzodiazepine addiction because I was prescribed these medications. The fact is, I had a terrible psychiatrist as a child and since I was constantly being taken in and out of the system transporting to several different hospitals, I would often switch to an entirely different treatment team who wouldn’t know my history with these drugs. It is 100% possible to get addicted to drugs that you are prescribed to by a licensed doctor.
Being honest, there isn’t really a cure for the pre-contemplation stage of treatment. You can educate the person on the short and long-term consequences of their illness but more often than not they will shrug it off or become defensive. ‘Interventions’ are very popular after the TV series was aired but real interventions are more than often not effective. The person will feel bombarded and attacked if put into that situation. What the people in pre-contemplation stage need is care and sympathy so they will know they are cared for. This does not mean you should enable them with money or other resources. A point I always make for people in precompilation stage is that we can hear everything being said to us, we are often not listening but every single word you tell this person – they hear and some part of them will retain. I can promise you that. These people are in denial and need to know they are cared for and that they deserve a chance at a happy and healthy life.
Who do I contact first?
If you are starting from the absolute beginning of your treatment plan the first person you should contact is your general practitioner (GP). Your doctor should have open referrals, access to different treatments, information, education on symptoms, and access to medication (*I personally advocate to wait until you see a professional psychiatrist (or talk to a psychologist) before going on psychiatric medication, especially since most of them can increase suicidal tendencies and your GP is usually for minor physical problems). Tell your doctor the details and how you feel without leaving anything out, they will then lead you to the next step which is usually a referral to see a local psychiatrist, therapist, or psychologist.
Types of Treatment…
Cognitive Behaviour Therapy (CBT)
Dialectical Behaviour Therapy (DBT) / Intensive Dialectical Behavior Therapy (1YearLengthProgram)
Crisis & Group Homes
- I want to put a quick note here that through all the treatment centres I’ve been a part of…outpaitent therapy was by far the most effective.
IEP Day Program: for students in high school struggling with mental health. It provides an opportunity for 3-6 month outpatient intensive treatment while continuing the student’s high school education (GED).
Day Program: A day program is for adults who struggle with their mental health in daily life. This is an intensive outpatient treatment. Since it is intensive treatment the patient (usually) has to take sabbatical from work. This is a great place to get resources for daily life after the program.
Eating Disorders Day Treatment: Toronto General Hospital (TGH) offers an intensive eating disorders treatment program with an 8hr day program with group and individual therapy along with weight gain and support. This is technically known as inpatient treatment but each patient* can go home at night. I put a * at the end of that sentence because it depends on the case if you can go home at night during treatment. There is a separate inpatient treatment program however the day program and the inpatient program can be combined if the person is struggling to the point of needing observation.
Drug Intervention Detox Treatment: There are also detox programs around the country for people suffering from addiction. It usually takes around 5 days to get a drug out of the persons system so this is utilized for people going through withdrawal and is a great place to find resources for continuing outpatient treatment.
Crisis Intervention: if you are in a crisis and are in need of immediate help call 911 or visit your local emergency room.
Hospital intervention is not just for after-the-fact because sometimes that’s too late. If you are experiencing suicidal thoughts to the point that you no longer feel safe at home or have a plan in place call 911 or visit your local emergency room. Please remember that in Canada there are usually waiting lists to get put onto a psych unit and the average waiting time to see the crisis team is 8hrs. This is the reason that I emphasise the hospital as a last resort and inpatient should ONLY be utilized for safety. Sometimes being put in a room for several days as you wait for a bed can be more damaging to your mental health than if you stayed at home. That is not to say that you shouldn’t go to the hospital if you in a crisis, having an anxiety attack, or need to talk to someone because there is the crisis intervention team (ask for them at triage) that can help. It is the admissions to the psych unit that have long waiting lists and the intensive psych units usually do not accept patient unless they are a heavy threat to themselves or others and need to be restrained or put into isolation.
Long-term treatment or institutionalization…
Long-term treatment is usually decided when the person is an outpatient and usually needs a certain amount of days of being clean of suicidal thoughts or actions, self-harm, hospitalization, or any type of symptomatic behaviour. I was refused to be put on the waiting list for Homewood Health Centre because I was admitted to the hospital and needed 3 months clean from all admissions so until that mandatory date was filled I had to wait. However, when I was put into long-term inpatient treatment at Ontario Shores, I was hospitalized for 8 months and then transferred to the long-term institution treatment program. It is very depending on what, how, and when you are suffering. Treatment programs vary. Some programs are better as an outpatient because inpatient is too intense and can actually exacerbate the symptoms. However, being committed to inpatient is also sometimes needed, it is extremely rare but it does happen so let’s respect everyone’s journey no matter where they are.
What should when I’m on the waiting list?
If you are a parent wondering how to help your child or an adolescent looking for help please remember that your school has some major and amazing guidance ready for you with no waiting lists. Talk to your guidance counsellor, teacher, principal, vice principal, anyone you trust in the education system to be appointed to a counsellor that can both help you with your education and mental health.
When you’re waiting, as of any age, avoid the internet and self-diagnosing. Many people self-diagnose which takes away the legitimacy of actual mental illnesses. You can’t diagnose yourself with Cancer so why should you be able to diagnose yourself with Depression?
Chapters, Indigo, and many bookstores have dozens of materials to go through when you are waiting for a therapist. There are self-help books, therapy books written by real doctors and psychologists, inspirational texts by people who have suffered, and education on what you’re struggling with. I would stay away from memoirs at the beginning since some of them (especially in symptomatic cases) can be more of a ‘how-to‘. Stick to improving yourself and education, for now, you’ll get the chance to read and even write your own memoir soon.
What should I expect at my first appointment?
You should expect a long appointment for the beginning, especially if you are going for a history and diagnoses appointment. These can take around three hours of going through the details of how you are struggling and your history of symptoms, health, medication, and family health. These can be exhausting so remember to perform some self-care and relax before and after your appointment. Some appointments take less time than others but the first appointment is usually very tiring so be proud of yourself for taking this first step! Bring a notepad and some paper to record what you find to be important and next steps, especially since a lot of us struggle with memory and remembering every detail of these appointments is extremely difficult.
Medication is the last thing I want to touch on before the end of this article. As I said in the earlier paragraphs, I advocate not to go on medication until talking to a professional psychiatrist or psychologist since your GP is more for physical illnesses and are often not educated well enough on the immense amount of drugs and side-effects that go into someone struggling with a mental illness. I often find that GP’s are “pill pushers” especially with benzodiazepines since they are meant as muscle relaxers and insomnia pills. I want to emphasize that you shouldn’t want to be numb. Sometimes people think being numb, even if it’s just in the beginning with medication can help them in the long-run, but it actually does the opposite. As people, we feel, we have emotions, we get sad, we become happy. We shouldn’t shut out feelings no matter how hard…but we can help them with proper medication. Chemical imbalances are both genetic and can be grown within someone’s chemistry and pills can often help this imbalance.
My current psychologist says that having a feeling will never kill you, it’s impossible. It is our actions and behaviours on that feeling that can hurt us. I’ll be honest, I still think it’s bullshit but I see where she is coming from. Like I mentioned before, I was addicted to benzodiazepines for several years and because of this, I became numb to emotions. I learned my whole life that I should distract myself from my emotions because I was never ready to feel them but as an outpatient, I do wish I spent time on learning how to have strong emotions without acting upon them.
Please remember that some psychiatric medications become dangerous when mixed with alcohol and even grapefruit. So talk to your doctor about these complications before taking the medication. You should also be aware of what medication you are on because it is extremely important for your personal knowledge of why you may be experiencing some side-effects, increasing thoughts of suicide, or uncomfortable physical sensations. Psychiatric medication is also a very long journey and often takes a few years to find the proper combination. Most of these medications also do not kick in for 3-weeks so if you don’t feel anything past this 3-week term talk to your doctor. These pills aren’t happy pills and don’t make you smile but they help moderate the chemical imbalances in your brain and help calm thoughts, and intrusive complications.
In conclusion, I hope you read the whole article because there are several points I’ve made that are essential for a healthy, recovered life for either yourself or someone else. Getting help for mental health is not shameful, it doesn’t make you weak, it doesn’t make you crazy, and seeing a “shrink” isn’t something to be embarrassed about. Taking time in your life to improve your health is actually honourable. Going to therapy is just as important as going for a jog. Please comment below with any questions, let me know what you think and if you have experienced any different types of treatments. I have attached links to several community resources, however, I am in Toronto, Canada so I don’t have many links to universal mental health care but these tips are universal. Thanks for reading everyone and I hope this article helped to any degree. Stay safe!