October 16, 2014 9:58 am
Updated: October 16, 2014 1:59 pm

Mental illness: How do I find treatment, and what happens next?

A view of one of the corridors near the reception in Toronto's Centre for Addiciton and Mental Health.

Fernando Morales/The Globe and Mail
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Deciding to come forward and seek help for a mental illness is tough; it can be tougher still if navigating the treatment system’s a struggle.

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To accompany the personal stories of  Canadians with mental illness, we spoke with Dr. Donna Ferguson, a psychologist in the Work, Stress and Health program at the Centre for Addiction and Mental Health, about how to seek treatment, how to talk to family and friends and what barriers remain to getting better.

Do you have a mental illness story you want to share? Tell us.

How do people access treatment? What do people do if they think there’s something wrong?

It often begins in your general practitioner’s office, Ferguson says. Ideally, a GP will refer a patient who may have serious mental illness to a psychiatrist. But sometimes, Ferguson says, family doctors may try to treat something out of their depth.

“There are a lot of GPs who don’t have a lot of experience with PTSD or other forms of mental illness, so they may not know how to diagnose. … [Patients] may not always get the appropriate diagnosis and they may not always get the appropriate medication,” she said.

Family doctors “do the best they can, but …  if they know they don’t have the specific experience in that area, they should definitely refer to a psychiatrist first, or a psychologist.”

Ideally, a psychiatrist will be able to diagnose a patient, prescribe treatment – pharmacological or otherwise – and treat a patient on an ongoing basis, as needed.

What if I don’t have extended benefits?

You still have a right to mental health care – but your choice when it comes to that care could be curtailed. For example, in many cases psychologists aren’t covered by provincial benefits. That can diminish a person’s options in terms of the medical expertise they seek out and can mean a longer wait for in-demand psychiatrists.

But there are other services that can connect individuals to treatment, Ferguson said. In Ontario, that includes Family Services and Health Care Connects, as well as CAMH itself.

Some of the people we spoke with recommended Calgary’s Potential Place and Self Help.

Will I be able to see someone right away?

Maybe. But probably not.

“There’s a waiting list for psychiatrists … it could be months,” Ferguson said.

She chalks it up to a lack of psychiatrists and a lack of free psychiatrist hours, especially when many already have a full roster of patients they’re seeing on an ongoing basis.

What if I don’t have a GP?

It can be tougher to get an appointment with a psychiatrist.

“I think it’s easier if your family doctor refers you,” Ferguson said. “It might be difficult if you’re just cold-calling people.”

And even if you find  a psychiatrist, she or he may want a referral from a GP – at least from a walk-in clinic if you really don’t have a family doctor of your own, Ferguson said.

When would someone get inpatient care?

There are two basic scenarios that would make you a likely inpatient: One is an inability to function at the most basic level; the other is posing an immediate danger to yourself or others.

“If they’re unable to get out of bed, they can’t really care for themselves … they can’t work, they don’t have interpersonal relationships, then that’s someone who might need either an inpatient program or a day treatment program where you have a structured program,” Ferguson said.

“If it’s more crisis-related, if someone’s at risk of harming themselves or harming someone else, they should be an inpatient.”

In some cases, a person in crisis will go to hospital of his or her own accord; in other cases, medical professionals may make the legal determination that someone should be hospitalized against her or his will for a short period of time until the crisis abates.

When does someone move from inpatient to outpatient care?

Ideally, when your symptoms have stabilized – you can look after yourself, you can function and you don’t pose an immediate risk to yourself or anyone else.

“That can be a tough transition,” Ferguson said. It can be made tougher because, often, the determining factor is who else needs your bed.

“There’s always an issue with beds,” she said. “They have to look at other patient waiting lists. … You do the best you can, but all resources are limited in one way or another.”

What do I tell my friends and family?

Depends how comfortable you feel.

Before she recommends a patient tell – or not tell – his or her family and friends about a condition, “you really want to know what the relationships are like. … and how supportive people are,” she said.

“You never want them to tell people and feel ashamed or criticized or ostracized.”

Assuming the patient trusts and feels comfortable with his or her family and friends, Ferguson recommends telling them about the condition “little by little.”

“Just slowly connect with people – even if it’s one-on-one – just talk about the fact that you’ve been having these symptoms.”

And there’s no need to get into specifics, she notes: “You can say, ‘I’m dealing with some issues from a mental health perspective and I am seeking treatment and I hope I’ll be able to function with this much better.

“You don’t have to give people too much before you’re ready.”

What do I tell my boss?

Nothing – unless you really, really want to.

“I honestly don’t think it’s employers’ business,” Ferguson said.

“If you’re off on a medical leave, you’re off on a medical leave. Or if you’re at work still, and things are not going well, some people feel comfortable saying to their direct superrvisor, ‘I’m having some symptoms.’ And I think if you don’t, don’t. You don’t have to. You’re not obligated.”

What’s more, your boss isn’t even allowed to ask.

“They can’t ask you why you’re off, they can’t ask if you’re getting treatment,” Ferguson said. “If you’re off, they’ll know. And it’s between you and HR.

“It’s personal. It’s private. It’s confidential.”

Mental illness: Your stories

What’s the biggest remaining barrier to treatment?

Despite what could be a long wait to see a psychiatrist, Ferguson says the biggest factor preventing people from seeking help is a fear the repercussions of admitting they have an illness will be worse than the illness itself.

People feel uncomfortable. People feel like [they’d be] ostracized, really worrying about whether they’re going to lose their job, worrying about how they’re going to be looked at by their boss and their colleagues. And that’s one of the biggest barriers to people coming forward.

“They just continue to go because … they feel they’re not strong enough” to seek treatment. “So they don’t come forward.” And the illness gets worse.

Tell us your story: Do you, or does someone you love, have a personal experience with mental illness you want to share? We’d love to hear it.

Note: Unless you tell us otherwise we may publish what you send us in this or subsequent stories.

If you are, or someone you know is, in crisis and needs help, visit suicideprevention.ca  for a list of resources. In case of an emergency, please call 911.

 

 

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