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machado: how can we treat and prevent an illness that hides stealthily under our skin?

we don't always see mental illness, but if we keep talking about it, continue to reach out and make it easier to connect to help, we can remove the shroud of dangerous invisibility that can lead to disastrous consequences.

we're fighting an invisible opponent
despite the growing spotlight on mental illness, there has been a 13 per cent increase in mental health conditions and substance use disorders in the last decade. getty
warning: this story mentions self-harm and suicide. if you or someone you love is experiencing thoughts of suicide, self-harm or other mental health distress, call or text 9-8-8.
last year, i opened my front door to see one of my closest friends standing on the porch with tears in her eyes, her white denim jacket hanging off of one shoulder. she fell into me, her arms wrapped tightly around my neck, as my brain rushed through the possibilities of what could have had her so upset — maybe she was sick, or something terrible had happened to her kids or her husband.
once she was settled on my couch with a cup of tea, she said that she needed to tell me something, something that she was really worried about. she explained she had been cutting herself, for months. she used the pink razor that she kept in her shower, she said. the cuts were long and deep from one side of her right thigh to the other side of the left. it hurt, she said, a lot. but it felt better than what she had been feeling in her head and her heart — something she described as dark and heavy and awful.
to say that all of this was unexpected would have been an understatement. this was my beautiful friend, the one who laughed easily and danced in my kitchen as she hummed her favourite song. she had lots of great friends — the kind who she could call at 3 a.m. and who would come over with a sundae, no questions asked. her hair was shiny, she always smelled good and loved a good vintage store. she was also smart, with no shortage of dreams and goals and little doubt that she would achieve them. she was the one that those around her would say had her future more or less figured out.

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except on that day.
just the week before, the son of a mutual friend — a teenager we had seen recently, who seemed so excited about university and his new girlfriend — sent a text in the middle of the night telling his mom and dad where they would find his body in the morning. luckily, his dad was awakened by the buzzing of his phone and raced off in the snow and in his car wearing just jeans and a t-shirt to find his son sitting at the edge of the roof of an abandoned eight-floor building. months before this, a neighbour called her partner from toronto’s camh saying that he was her one call before being admitted to what turned out to be a month-long program of mental health therapy and counselling with no contact with the outside world.

her partner was her “one” call before admitting herself to camh

no one would have described these people as sad or disturbed or as having mental illness — not by their friends, not even by those with whom they were closest. in fact, every single one of them appeared to be doing well in their lives, getting out of bed every day, showing up and doing what they needed to do, all with a smile.
but they were also hurting themselves, sitting on the edges of buildings and admitting themselves to hospital for help — to the complete and utter surprise of those around them, who were left to shake their heads and utter some version of “how could i have missed it?” over and over at a lonely kitchen table.

worrying is the fact that it’s not like we don’t talk about mental illness and emotional distress. generally, our society has come a long way from where we have been in history in terms of how we perceive and understand mental health. in years past, we shunned those with mental illness, linked emotional distress with the supernatural, and used asylums as “treatment” facilities. today, schools and workplaces alike are urged to talk about mental health and make emotional wellness programs easy to access, all with the goal of not only getting help to those who need it, but also reducing the stigma that has dogged mental illness and figuring out effective treatment for centuries.

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in fact, a quick check of social media will even find “fun” references to mental illness, like stressed out people who post about “taking a g rippy sock vacation” — which refers to time spent in a psychiatric hospital, where patients are given socks with sticky rubber grips on the bottoms — feeling “stressy depressy,” having a “menty b,” (mental breakdown) and making references to suicide using the word “suey.” and while some of this stems from the fact that cute language allows posts about mental illness and self-harm to avoid being deleted by mental illness-aware platforms, some experts, like dr. nicholas westers, also say it’s good, maybe helping to destigmatize mental illness and give people the nudge they need to seek help. but westers, a clinical psychologist at children’s health in dallas, told cnn health he is also concerned that we have gone too far to the lighter side, making it easier for people who are struggling to distance themselves from their mental distress and delay getting help.

mental health conditions have increased 13 per cent in the last decade

but despite the growing spotlight that has settled on mental illness, it doesn’t feel much like it’s helping to prevent or slow the numbers of people affected. according to the world health organization , there has been a 13 per cent increase in mental health conditions and substance use disorders in the last decade (to 2017); 20 per cent of children globally live with a mental health condition; and suicide is the second leading cause of death among 15 to 29-year-olds. approximately 1,000 older adults are admitted to canadian hospitals each year as a result of intentional self-harm, says the canadian coalition for seniors’ mental health. and in any given year, one in five canadians experiences a mental illness, camh reports. in fact, b y the time canadians reach 40 years of age, one in two have — or have had — a mental illness. it costs our economy $50 billion in absenteeism and disability, and employers $17 billion in lost productivity.

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certainly, there are a whole host of reasons for these stats , with financial insecurity, workplace stress and burnout being just three. another reason is that despite all the talk about mental illness, it’s still largely an unseen disease, which makes it tough to identify, treat and prevent. like conditions such as heart disease, crohn’s disease, lupus, fibromyalgia and arthritis, mental illness is often referred to as being “invisible,” flawlessly capable of hiding itself from others — sometimes even ourselves — deep under our skin, sometimes with disastrous results.

it doesn’t help that many of the non-mental health professionals among us have no idea how to best respond to someone who admits they are cutting themselves to alleviate mental and emotional anguish or are having thoughts of taking their life. there are the typical knee-jerk (and completely natural) responses that involve worry, fear, judgment, taking it as a personal failing, and then there’s simply making a cup of tea and hoping for the best. if my dear friend had sat on my couch sobbing about a realization that her husband was a dink, or that she was worried she would lose her job or couldn’t take the pain of a broken ankle, well, these are things i can work with. i have advice, stories and jokes to lift spirits.

but with feelings of doom and hopelessness that stem from some unknown reason and place, i might stumble over figuring out the best and most gentle way to respond. i would offer hugs, empathy and compassion — all good things, but just a smidge of what she really needed to feel better and be safe. (in case you are wondering, in situations where you are worried about someone’s mental health, camh advises talking about their feelings — talking about suicide or self-harm won’t increase the chances of it happening, but it might make them feel less isolated and scared; encouraging them to seek help from a healthcare professional, even offering to accompany them; taking them to an emergency department if you can safely; and calling 911 if the risk is immediate.)

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what about people who can’t or don’t reach out for help?

it’s also worth noting that my friend was one of the lucky ones who felt that she could talk about what was going on in her brain, like the wife who was feeling desperately hopeless and lost and sought help. what about those who don’t or can’t reach out for help? what about the ones who are hidden by the invisibility of their disease, like the teenager on the roof whose dad got there just in time?

well, we keep trying to reach them. this week, camh launched 9-8-8 , a new three-digit number that people can call or text if they are thinking of suicide or experiencing emotional distress or if they are worried about someone they care about. the service allows anyone in canada to connect to a trained responder who is bilingual and ready to listen without judgment. 

there is also deep responsibility within our communities — all of us doing our best to normalize mental illness, eliminate stigma and make it easier for people to seek help when they are struggling. in our own lives, it means making it a habit to connect with the people we love, check in on them and pay attention to subtle changes in behaviour (such as losing interest in favourite things, sleeping more than usual, and avoiding friends and family) that could indicate they are having a hard time.

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we won’t always see the signs. but if we keep talking about it, continue to reach out, make it easier to connect to help, and ensure that help is effective, we can remove the shroud of dangerous invisibility that hides mental illness. most of all, we can ensure that people who are struggling know there are always options other than the worst.
lisa machado is the executive producer of advocacy & better health. she can be reached at lmachado@postmedia.com.
 
lisa machado
lisa machado

lisa machado began her journalism career as a financial reporter with investor's digest and then rogers media. after a few years editing and writing for a financial magazine, she tried her hand at custom publishing and then left to launch a canadian women's magazine with a colleague. after being diagnosed with a rare blood cancer, lisa founded the canadian cml network and shifted her focus to healthcare advocacy and education.

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