Sina Health Centre

Mental Health Resources for Adults

Mental Health Act

British Columbia’s Mental Health Act allows us to admit and treat people with serious mental health issues who are a risk to themselves and/or others. People who are certified under the Mental Health Act can be treated involuntarily for a mental disorder.

What does it mean to be certified under the Mental Health Act
Someone who is certified under the Mental Health Act can receive treatment for a mental disorder involuntarily, or against their will. Typically, people are certified only as a last resort. To be certified for involuntary mental health treatment, a person must meet four requirements:
  – Has a mental health disorder that seriously impairs their ability to live in the community.
  – Requires psychiatric treatment in a designated facility.
  – Requires care and supervision to prevent deterioration or protect themselves or others.
  – Cannot safely or adequately be treated in a community-based facility.

Who can certify people under the Mental Health Act?
Only medical doctors can certify people, and only after seeing and assessing them. The courts or police can assist by apprehending or transporting someone to an involuntary mental health assessment, but only a physician can provide the assessment.

If you’ve been certified as an involuntary patient under the Mental Health Act, you still have rights.
You have the right:
  – To know where you are.
  – To know why you’ve been certified.
  – To be examined by a doctor to see if you still need to be in the hospital.
  – To ask for a review panel hearing to challenge your certification.
  – To ask for a second medical opinion from another doctor about your psychiatric treatment.
  – To speak with a lawyer.

Depression

Depression is a mental health condition that causes you to feel sad, lose interest in activities that you used to enjoy, withdraw from others, and have little energy. It’s different from normal feelings of sadness, grief, or low energy. Depression can also cause people to feel hopeless about the future and to even think about suicide. Depression is very common. It affects people of all ages. If you think you may be depressed, tell your doctor.

What causes it?

When you have depression, there may be problems with activity levels in certain parts of your brain. Or chemicals in your brain called neurotransmitters may be out of balance. Most experts believe that a combination of family history and stressful life events may cause depression. Certain medicines, such as steroids and opioids can cause depression. If you stop using the medicine, the depression may go away.

What increases your risk?

  – Someone in your family has had depression. You may have inherited a trait that makes you more likely to have depression.
  – You have had depression before.
  – You have another mental health problem, such as post traumatic stress disorder (PTSD), substance use disorder, or anxiety.

Other things that can increase your risk of depression include getting older, having a chronic health problem, and having a history of physical or sexual abuse. Some people become depressed after a stressful life event, like losing a job or getting a divorce. Sometimes even happy life events, like getting married or a promotion, can trigger depression. This is because of the stress that comes with change.

You also may get depressed even if there is no reason you can think of.

What are the symptoms?

One of the most common symptoms of depression is feeling sad, hopeless, or tearful. The other is losing interest in daily activities you used to enjoy. If you have had these symptoms nearly every day for at least 2 weeks, you might have depression. A serious symptom of depression is thinking about death and suicide. If you or someone you know talks about suicide or feeling hopeless, get help right away.

You also may:
  – Lose or gain weight.
  – Sleep too much or not enough almost every day.
  – Feel restless and not be able to sit still.
  – Sit quietly and feel that moving takes great effort.
  – Feel tired or as if you have no energy almost every day.
  – Feel unworthy or guilty nearly every day.
  – Have low self-esteem and worry that people don’t like you.
  – Find it hard to focus, remember things, or make decisions nearly every day.
  – Feel anxious or worried about things.

Depression can:
  – Affect your physical health. You may have headaches or other aches and pains. Or you may have digestive problems such as constipation or
    diarrhea. You may have trouble having sex or may lose interest in it.
  – Make older adults confused or forgetful or cause them to stop seeing friends and doing things. It can be confused with problems
    like dementia.

How is it diagnosed?

If your doctor thinks you are depressed, he or she will ask you questions about your health and feelings, and they may:
  – Do a physical examination.
  – Do tests to make sure your depression isn’t caused by a disease such as an underactive thyroid (hypothyroidism) or anemia. Depending on
     your history and risk factors, your doctor may order other tests.
  – Ask if you’ve had any thoughts of self-harm or suicide.
  – Ask if you have symptoms of bipolar disorder.
  – Ask you about symptoms of seasonal affective disorder.
  – Ask you if you have recently lost a loved one.
  – Ask about your drug and alcohol use.

How is depression treated?

Doctors usually treat depression with counselling or medication. Often a combination of the two works best. But some people do not get better without treatment. In many cases, counselling can work as well as medication to treat mild to moderate depression. Counselling is done by licensed mental health providers. Antidepressant medicines can improve the symptoms of depression in 1 to 3 weeks. But it can take 6 to 8 weeks to see more improvement. Your doctor will likely have you keep taking these medicines for at least 6 months. If depression is caused by a medical problem, treating that problem may also help relieve the depression.

Counselling

Counselling is an important part of treatment for depression. You will work with a mental health professional such as a psychologist, clinical social worker, or psychiatrist. Together you will develop an action plan to treat depression.

Therapies that are helpful for people with depression include:
  – Cognitive-behavioral therapy (CBT). CBT teaches you how to change the ways you think and behave. This can help you stop thinking bad
    thoughts about yourself and your life. You can take part in CBT with a therapist or in a group setting.
  – Interpersonal therapy. This therapy looks at your social and personal relationships and related problems.
  – Acceptance and commitment therapy (ACT). In ACT, you work with a therapist to learn to accept your negative feelings but not let them run
    your life. You learn to make choices and to act based on your personal values, not negative feelings.
  – Mindfulness-based therapies. Examples include mindfulness-based stress reduction and mindfulness-based cognitive therapy. These
    treatments help you to focus your attention on what is happening at the moment without trying to change it. They teach you to let go of
    past regrets and not worry about the future. For people who have had more than one episode of depression, mindfulness-based cognitive
    therapy may help reduce the risk of relapse.

Other treatments that may be helpful include:
  – Problem-solving therapy. This looks at your current problems and helps you solve them.
  – Family-therapy. This brings you and your family together to discuss your relationships and depression.

How long will you need counselling?

How long your treatment lasts depends on how severe your depression is and how well your treatment goes. Short-term counselling usually lasts from 10 to 20 weeks. You usually see a counsellor once a week but may need to meet with him or her more often or for a longer time.

Medication

Antidepressant medications may improve or completely relieve the symptoms of depression. But they work in different ways. No antidepressant works better than another. But different ones work better or worse for different people. The side effects of these medications are different and may lead you to choose one instead of another. You may have to try different medications or take more than one to help your symptoms. Many people find a medication that works within a few tries. They may need to take the antidepressant and another type of medication, such as an anti-seizure, mood stabilizer, antipsychotic, or anti-anxiety medicine.

How long will you need to take antidepressants?

If you take antidepressants, it’s best to take them for at least 6 months after you start to feel better. This can help prevent you from feeling depressed again (relapse). You may start to feel better within 1 to 3 weeks after you start taking antidepressant medicine. But it can take as many as 6 to 8 weeks to see improvement. Some people need to take medicine for several months to years. Others will need medicine long-term.

Lifestyle changes

You can do many things to help yourself when you feel depressed or are waiting for your medication to work. These things include being active, getting enough sleep, and eating a balanced diet.

Other treatment

Brain stimulation. This includes:
  – Electroconvulsive therapy (ECT). Electrodes that produce a brief electrical stimulation to the brain are placed on the head. The stimulation produces a short seizure that is thought to balance brain chemicals.

  – Deep brain stimulation. A device that uses electricity to stimulate the brain is put in your head. It is used for Parkinson’s disease. But it has not been well studied for depression.

  – Vagus nerve stimulation. A generator the size of a pocket watch is placed in your chest. Wires go up from the generator to the vagus nerve in your neck. The generator sends tiny electric shocks through the vagus nerve to the brain.

  – Transcranial magnetic stimulation. An electromagnet is placed on your head. It sends magnetic pulses that stimulate your brain.

  – Complementary therapies. They include:
                 * Massage therapy, yoga, and other relaxation exercises.
                 * Fish oil containing omega-3 fatty acids.
                 * SAM-e (S-adenosylmethionine).

Help is available 24 hours a day, 7 days a week.

If you or someone you know talks about suicide, self-harm, a mental health crisis, a substance use crisis, or any other kind of emotional distress, get help right away.
  – Call Talk Suicide Canada: 1-833-456-4566 or text 45645 (4 p.m. to midnight ET).
  – Kids or teens can call Kids Help Phone: 1-800-668-6868 or text CONNECT to 686868.
  – Go to the Talk Suicide Canada website at https://talksuicide.ca or the Kids Help Phone website at https://kidshelpphone.ca for more
     information.

Call 9-1-1 or other emergency services immediately if:
  – You or someone you know is thinking seriously of suicide or has recently tried suicide. Serious signs include these thoughts:
                 * You have decided on how to kill yourself, such as with a weapon or medicines.
                 * You have set a time and place to do it.
                 * You think there is no other way to solve the problem or end the pain.
                 * You feel you can’t stop from hurting yourself or someone else.

Call a doctor now if:
  – You hear voices.
  – You have been thinking about death or suicide a lot, but you don’t have a plan to harm yourself.
  – You are worried that your feelings of depression or thoughts of suicide aren’t going away.

Seek care soon if you are:
  – Feeling sad or hopeless.
  –
Not enjoying anything.
  – Having trouble with sleep.
  – Feeling guilty or worthless.
  – Feeling anxious or worried.
  – Been treated for depression for more than 3 weeks, but you are not getting better.

Self care

Things to think about:
  – Be realistic. Set goals you can meet. If you have a big task to do, break it up into smaller steps you
    can handle. Don’t take on more than you can handle. Be realistic in what you expect and what you can do.
  – Don’t blame yourself or others for your depression. Build your self-esteem and try to keep a positive attitude.
  – Think about putting off big decisions until your depression has lifted. Wait a bit on making decisions about marriage, divorce, or jobs. Talk it
    over with friends and loved ones who can help you look at the whole picture.
  – Think positively. How you think can affect how you feel. Challenge negative thoughts with statements such as “I am hopeful,” “Things
    will get better,” and “I can ask for the help I need.” Write down these statements and read them often, even if you don’t believe them yet.

Things to do

  – Get regular exercise. Even something as easy as walking can help you feel better.
  – Eat a balanced diet. Include plenty of fresh vegetables and fruits, whole grain foods, and protein foods. If you have lost your appetite, eat
    small snacks rather than large meals.
  – Get enough sleep. A good night’s sleep can help mood and stress levels. Avoid sleeping pills unless your doctor prescribes them.
  – Find ways to cope with stress. Too much stress may trigger depression. Using positive coping skills, such as listening to music or talking things
    over with a friend, can help you with your stress level.
  – Avoid drinking alcohol or using drugs. Also avoid taking medicines that have not been prescribed to you. Having a substance use problem
    makes treating depression harder.
  – Be thankful.
                 * Thank people for the small and big things they do for you.
                 * Be thankful for big things like having a home, family, and friends.
                 * Be thankful for little things like making people laugh, enjoying a piece of music, or finding warm gloves for the winter.
  – Do things with others. Try to be part of spiritual, social, holiday, or other activities. Help others who are not as well off as you are.
  – Get support from others. Let your family and friends help you. Find someone you can trust and confide in and talk to that person. This
    includes telling people you trust about depression.

Anxiety

Feeling worried or nervous is a normal part of everyday life. Mild to moderate anxiety can help you focus your attention, energy, and motivation. If anxiety is severe, you may have feelings of helplessness, confusion, and extreme worry that are out of proportion with the actual seriousness or likelihood of the feared event. Overwhelming anxiety that interferes with daily life is not normal. This type of anxiety may be a symptom of generalized anxiety disorder, or it may be a symptom of another problem, such as depression.  

Symptoms

Anxiety can cause physical and emotional symptoms. A specific situation or fear can cause some or all of these symptoms for a short time. When the situation passes, the symptoms usually go away.

Physical symptoms of anxiety include:
  – Trembling, twitching, or shaking.
  – A feeling of fullness in the throat or chest.
  – Breathlessness or a rapid heartbeat.
  – Light-headedness or dizziness.
  –
Sweaty or cold, clammy hands.
  – Feeling jumpy.
  – Muscle tension, aches, or soreness (myalgias).
  – Extreme tiredness.
  – Sleep problems, such as not being able to fall asleep or stay asleep, early waking, or feeling restless (not feeling rested when you wake up).

Anxiety affects the part of the brain that helps control how you communicate. This makes it harder to express yourself creatively or function well in relationships. Emotional symptoms of anxiety include:
  – Feeling restless, grouchy, or on edge or keyed up.
  – Worrying too much.
  – Fearing that something bad is going to happen. You may feel doomed.
  – Not being able to concentrate. You may feel like your mind goes blank.

Anxiety disorders

Anxiety disorders occur when people have both physical and emotional symptoms. These disorders interfere with how a person gets along with others. They also affect daily activities. Women are twice as likely as men to have problems with anxiety disorders. Examples include panic attacks, phobias, and generalized anxiety disorder.

When you have generalized anxiety disorder, you feel worried and stressed about many everyday events and activities. Often the cause of anxiety disorders is not known. Many people with an anxiety disorder say they have felt nervous and anxious all their lives. This problem can occur at any age. Children who have at least one parent with the diagnosis of depression are more likely to have an anxiety disorder than other children. Anxiety disorders often occur with other problems, such as:
  – Mental health problems, like depression.
  – Substance use problems.
  – A physical problem, like heart or lung disease.

Panic attacks

A panic attack is a sudden feeling of extreme anxiety or intense fear without a clear cause or when there is no danger. Panic attacks are common. They sometimes occur in otherwise healthy people. An attack starts suddenly and usually lasts from 5 to 20 minutes but may last even longer. You have the most anxiety about 10 minutes after the attack starts. Symptoms include feeling like you’re dying or losing control of yourself, rapid breathing (hyperventilation), numbness or tingling of the hands or lips, and a racing heart. You may feel dizzy, sweaty, or shaky. Other symptoms include trouble breathing, chest pain or tightness, and an irregular heartbeat. These symptoms come on suddenly and without warning. Sometimes symptoms of a panic attack are so intense that you may fear that you’re having a heart attack. Many of the symptoms of a panic attack can occur with other illnesses, such as hyperthyroidism, coronary artery disease, or COPD. People who have repeated unexpected panic attacks and worry about the attacks are said to have a panic disorder.  

Phobias

Phobias are extreme and irrational fears that interfere with daily life. People with phobias have fears that are out of proportion to real danger. They’re not able to control the fears. Phobias are common. They sometimes occur with other conditions, such as panic disorder or Tourette’s disorder. Most people deal with phobias by avoiding the situation or object that causes them to feel panic. This is called avoidance behaviour. A phobic disorder occurs when the avoidance behavior becomes so extreme that it interferes with your daily activities. There are three main types of phobic disorders:
  – Fear of being alone or in public places where help might not be available, or escape is impossible (agoraphobia).
  – Fear of situations where you might be exposed to criticism by others (social phobia).
  – Fear of specific things (specific phobia).

Self care

Home treatment, combined with professional treatment, can help relieve anxiety.

  – Know your anxiety.
                 * Recognize and accept your anxiety about specific fears or situations. Then make a plan for dealing with it. For example, if you are
                    always worrying about finances, set up a budget or savings plan.

  – Don’t dwell on past problems.
                 * Change what you can to help you feel more comfortable with present concerns. But let go of past problems or things you can’t
                    change.

  – Be kind to your body.
                 * Relieve tension with exercise or massage.
                 * Try stress-relief techniques that focus on relaxing your mind and your body.
                 * Get enough rest.
                 * Practice healthy thinking and stop negative thoughts. Choose helpful thoughts to replace the unhelpful ones.
                 * Avoid alcohol, caffeine, chocolate, and nicotine. They may make you more anxious. Some drugs, such as cocaine, crack, and speed
                   (amphetamines), also can cause anxiety.

  – Engage your mind.
                 * Get out and do something you enjoy. For example, go to a funny movie or take a walk or hike.
                 * Plan your day. Having too much or too little to do can make you more anxious.
                 * Keep a diary of your symptoms. Or discuss your fears with a good friend. Confiding in others sometimes relieves stress.

  – Do things with others.
                 * Get involved in social groups, or volunteer to help others. Being alone can make things seem worse than they are.

  – Get support.
                 * Talk with your human resources officer about counselling benefits that may be available through your employee assistance program.
                 * Check with your provincial health plan or private health insurance company to see what mental health benefits are available.
                 * Contact your public health unit for information on community mental health programs.

Mental Health Resources BC

Primary Care Network/Mental Health Support Team:

The Primary Care Network works with you and your primary care provider to support your medical, wellness and social needs. The Mental Health Support Team Clinicians (MHST) is made up of trained clinicians. They offer 6-8 sessions of counselling and/or support services. All services are free. They will work with you to identify goals that they can support you with. They can also help to connect people with services, support and resources in the community. If you are interested in counselling, your family practitioner will refer you to the MHST. The MHST will call you within 2 weeks to discuss how they can help support you. Sessions are offered in person or virtually. Including:
  – Life stressors
  – Substance use
  – Grief and loss
  – Caregiver stress
  – Anxiety & depression

VCH Community Resources:
  – Central Intake for Adult Mental Health & Substance Use 604-244-5488
  – Children & Youth: Child & Youth Mental Health 604-207-2511
  – Crisis Response: Mental Health Emergency Services (MHES) 604-244-5562
  – Older Adults with Dementia: Older Adult Mental Health 604-675-3975

Richmond Community Resources:
  – Chimo Community Services 604-279-7077 English Crisis Line: 604-279-7070 chimoservices.com
  – Pathways Clubhouse 604-276-8834 pathwaysclubhouse.com
  – Richmond Addiction Services Society (RASS) 604-270 9220 richmondaddictions.ca
  – Richmond Mental Health Consumer and Friends’ Society (RCFC) 604-675-3977 rcfc-society.org
  – SUCCESS Cantonese Help Line: 604-270-8233 Mandarin Help Line: 604-270-8222 successbc.ca
  – Turning Point Recovery Society 604-279-7169 turningpointrecovery.com

Provincial Resources:
  – Anxiety BC anxietybc.com
  – BC Schizophrenia Society (BCSS) 604-270-7841 bcss.org
  – Monthly Family Support Meetings: bcss.org/monthly-meetings-calendar
  – HealthLink BC Non-emergency Health Line: 811 healthlinkbc.ca
  – Here to Help Distress Line: 310-6789 (no area code needed) heretohelp.bc.ca
  – Institute of Families for Child and Youth Mental Health 604-878-3400 familysmart.ca
  – Kelty Dennehy Mental Health Resource Centre hopementalhealth.ca
  – MindHealthBC mindhealthbc.ca
  – Mood Disorders Association of BC mdabc.net
  – Red Book Online redbookonline.bc211.ca

Alcohol & Drug Information Referral Service (ADIRS):

Provides free, confidential information and referral services to British Columbians in need of support with any kind of substance use issue (alcohol or other drugs). Contact ADIRS toll-free at 1 800 663-1441, or in the lower mainland at 604 660-9382. Free, multilingual telephone assistance is available 24 hours a day, 7 days a week.

Mental Health Crisis Line 310-6789 (no area code):

Provides a toll-free number connecting callers to a BC crisis line, without a wait or busy signal. Offers emotional support, information on appropriate referral options, and a wide range of support relating to mental health concerns.

First Nations and Métis KUU-US Crisis Line 1-800-588-8717:

The KUU-US Crisis Line Society provides a First Nations and Indigenous specific crisis line available 24 hours a day, 7 days a week, toll-free from anywhere in British Columbia. KUU-US Crisis Line can be reached toll-free at 1-800-588-8717. Alternatively, individuals can call direct into the Youth Line at 250-723-2040 or the Adult Line at 250-723-4050. 

Suicide, self-harm, a mental health crisis, a substance use crisis, or any other kind of emotional distress:
  – Call Talk Suicide Canada: 1-833-456-4566 or text 45645 (4 p.m. to midnight ET).
  – Kids or teens can call Kids Help Phone: 1-800-668-6868 or text CONNECT to 686868.
  – Go to the Talk Suicide Canada website at https://talksuicide.caor the Kids Help Phone website at https://kidshelpphone.ca for more
    information.
  – Call 9-1-1 for any emergency situation.

Information Links

Mental Health Act – BC Ministry of Health
health.gov.bc.ca/library/publication/year/2005/MentalHealthGuide.pdf

The Freedom of Information and Protection of Privacy Act (FIPPA) – BC Laws
http://www.bclaws.ca/civix/document/id/consol26/consol26/96165_00Information

Healthy Together is a directory of health and mental health services (in English and Chinese): vch.ca/healthytogether

Mental health links