Getting help, Lessons learned

Lesson #8: What to do while waiting for help to help

What to do while waiting for help is one of the most important lessons to learn in parenting depression, because it’s on you, the parent. Whatever happens, however easy or difficult it is to lead your child to safety, it’s on you to keep going.

I am so fortunate with a family doctor and means for private therapy. I live in a big city with specialized services. Through my work, I have health insurance and through my family, connections to people working for big mental health organizations.

So while I’d read about the gaps in Canada’s mental health care system, I didn’t expect to encounter them. I also wasn’t prepared for the job. I didn’t know the right questions to ask, what constituted a mental health “crisis”, or how quickly depression could escalate.

With that in mind, here’s what I think you should know when waiting for help.

Ontarians wait an average of 20.3 weeks for services.
Photo by Slava Bowman on Unsplash
Canada has a shortage of psychiatrists

When my daughter first told me she felt depressed, I did what I think most parents do. I took her to her family doctor, who did a thyroid hormone test, and referred her to a therapist.

What I didn’t do then, was ask for a referral to a psychiatrist.If I had, I would have discovered early on that there aren’t enough psychiatrists in Canada.

The Coalition of Ontario Psychiatrists released a report quantifying the problem in August 2018.

In Vancouver, only six of 230 clinically active psychiatrists were readily able to accept referrals with wait times ranging from 4 to 55 days.

“In Ontario, there are fewer than 100 active child psychiatrists: only 26 of these psychiatrists practice in Toronto, with areas of the province entirely unserved.”

London Free Press

Ontarians, according to the report, wait an average of 20.3 weeks for services. The shortage has resulted in a 53% increase in visits to the emergency department and a 56% increase in hospitalization., a directory of mental health services in Ontario, has addressed the shortage with a big yellow warning at the top of the page that says: Looking for a psychiatrist? There’s a shortage. Consider seeing a psychologist instead, but note they can’t treat patients with medication.

But what do you do when those psychologists recommend a psychiatrist and medication?

Like the snakes and ladders board game, we’d inched our way up only to hit a snake that sent us back to square one. Meanwhile, my daughter’s mental health was rapidly declining.

What to do while waiting for help

In response to prolonged wait times for youth mental health services, the Children’s Hospital of Eastern Ontario (CHEO) developed a guide to what to do while waiting for help.

It recommends things like quality time with your child, reduced screen time, healthy eating habits and a good night sleep. It points you to alternative or private health services and has a number to call if you’re in a crisis.

But what if your child is too depressed to try therapy. Or won’t or can’t get a good night sleep, exercise, give up their phone, or let you hug them?

What if they come to you crying, asking how long until the next appointment? Or what if they tell you they’re cutting themselves, not because they want to kill themselves, but because it makes them feel better.

How bad do things have to be before you head to emergency?

As we sat in the gap between therapy and psychiatry, I thought I was doing the right thing.

I spoke to her therapist about the cutting. I spoke with my daughter frequently about suicide and whether we should go to the hospital. It seemed ludicrous, to both of us, I think, to go to emergency. I didn’t know, it was in fact, the legitimate, next step in our quest for help.

I now know better. It’s kind of like learning a new level in a video game. The more you do it, you get a better sense of when to jump or pivot or hunker down and hoard resources.

Additional tips for what to do while waiting for help

1. Keep a journal.

Start it as soon as you’re aware your child is having problems because details and dates become fuzzy. Record changes in behaviour, frequency and duration of episodes. It’s also helpful to record medications and doses. Take it to appointments and be sure to also get the names and contact information of any professionals you’ve been in touch with, particularly in emergency, because I can guarantee you, these things will get lost in the moment.

2. Consider the person as well as the illness when judging severity.

My daughter has always been very high functioning, even when she’s severely depressed. I know this now. I didn’t at first and so I missed signs of depression in her for months. While online guides and doctors can tell you how depression usually manifests itself, I need to constantly remind myself who I’m dealing with. While you can use checklists as guideposts, keep your child’s unique nature at the centre of the things.

3. Seek different levels of help at the same time. 

As CHEO puts it, don’t put all your eggs in one basket. Talk therapy is great, but it may not be enough. Rather than wait to find out if antidepressants are necessary, I’d request a referral to a psychiatrist immediately after testing thyroid hormone levels.
If you find you don’t need their services in the end, you can easily remove your name from the waitlist. You might also look to alternate services such as the What’s Up Walk-In Clinics to fill the gaps between appointments.

4. vocal about any change in your child’s mental health.

As you ping-pong from one trained professional to another make sure you connect the dots by updating all the professionals you’ve seen on your progress. Your updates may prompt them to try to move you up the list or suggest an alternate solution. They may also see something you don’t.

5. Learn how to use the Columbia Protocol. 

While I was asking my daughter if she felt at risk to herself, I shoudl have been asking more specific questions. The Columbia Suicide Severity Rating Scale can help you identify a potentially life-threatening situation. There are six questions. If your child answers yes to questions 4, 5 and 6, take them to emergency. The Association for Children’s Mental Health in Michigan also has a good guide to identifying and handling a crisis situation.

6. Build a support system.

When you first seek help for your child’s depression, a lot of health professionals will reassure you that depression can be helped. That things will get better. They’re not lying. My daughter is a thousand times better than she was three years ago. But things got worse before they got better and I wish I’d been more prepared.

Start talking to parents who have been through the experience. There is a fantastic, closed Facebook Group for parents of teenagers who have depression and anxiety. You’d be amazed at the number of common experiences. Also, start thinking about who might be able to help at home if suddenly you need to stop doing everything else to focus on caring for your child. Go on date with your spouse to shore up your marriage. Arm yourself with information. Consider your own mental health needs and make room for daily self-care.

7. Speak out.

Our kids can’t fix Canada’s mental health care system, so just as it’s important for them to speak up and ask adults for help, it’s important for us parents to tell our story. It’s not right what’s happening. It’s not economically sound for us as a country. And our inability to focus on mental wellness as opposed to managing mental illness is just exacerbating the problem.

Things are getting worse, not better:
  • According to Unicef, Canada ranks 25th out of 41 rich countries on the Index of Child and Youth Well-being and Sustainability.
  • CAMH reports half of all cases of mental illness begin by age 14 and three-quarters by age 24
  • The 2018 Annual Auditor General’s Report says the Ontario Ministry of Children, Community and Social Services provided $460 million in 2017/18 transfer payments through it’s child and youth mental health program ($438 million in 2015/16). It also says the four child and youth mental health agencies they audited have made little progress on over 76% of the recommended actions.

For the past nine years, Canadians have taken to social media to tweet #BellLetsTalk to help eliminate stigma around mental health. Part of me is thrilled. Without #BellLetsTalk, my daughter might not have had the courage to speak up.

But having struggled to get help to keep my teenager from killing herself –even with all the privileges in the world compared to so many others reliant on public systems–it’s beginning to feel a bit like lip service.

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