Challenges & Choices: Finding mental health services in Ontario
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What is an emergency or crisis?
A crisis is a time of danger or great difficulty. Generally, you will know you are in crisis if you feel like you can't cope and are not in control. For instance, you may be having difficulty sleeping, eating, paying attention or carrying on your normal routine at home, work or school. Or you may have had a serious setback or be wondering if you can keep going. Acting on thoughts of suicide--for example, cutting your wrists--is an emergency.
A crisis could result from losing your housing, problems with money, worries about your child's well-being, or a problem or difficult situation that is not cleared up and becomes more serious over time. What is a difficult situation for one person may be a crisis for another, depending on the person's support system, and how he or she interprets and copes with the problem.
Some people show no signs when they are in crisis. In other people, it is obvious when they are having a hard time. They may behave differently and may not think clearly.
Some people may have thoughts of suicide or have even made suicide attempts. They may feel so hopeless and despairing about their lives that they see dying as the only way out of their difficulties.
More women attempt suicide than men. But more men actually die as a result of suicide because the methods men use are more likely to cause death. Suicide also tends to be more common among people with serious depression, bipolar disorder (formerly called manic depression), schizophrenia; people with substance use problems; people with few social supports; Inuit living in the North; and youth who are lesbian, gay, bisexual, transsexual or transgendered who may be struggling with gender identity issues, and experiencing prejudice and discrimination.
Crisis intervention -- stepping in to help a person in crisis--involves providing treatment and support as soon as possible after you know the person is in distress. (For information on preparing a crisis plan and having someone admitted to a hospital, see Take Action, in Section 12
In an emergency, call 911.
Types of crisis services
Here are some ways to get help in a crisis.
Emergency departments of hospitals
You can go to the emergency department of a hospital for help. However, unless you are a danger to yourself or others, the health care professional (e.g., doctor, nurse) at the hospital may suggest you return home or stay with a friend or family member as long as you have someone with you for support.
Choosing to be admitted to the hospital is a personal decision. Some people find it stressful to be in a hospital where they are separated from their usual supports and must follow rules and regulations and structured programs. (For more information about getting an assessment in emergency departments of hospitals, in Section 3
Question: When is it necessary for someone to be hospitalized?
Answer: Hospitalization is usually only recommended when outpatient services cannot adequately meet the care needs of a person's condition or the person's challenges of daily living.
You may prefer to be in the hospital, surrounded by a support system and away from your day-to-day responsibilities where your need for medication can be assessed--or if you are already using medication, you can be observed for possible side-effects.
However, if you have supports in the community, it may be better for you not to be in the hospital as long as you feel safe. Being in the hospital can be very disruptive to your life; for example, it may be difficult to keep up social contacts or deal with financial or housing issues. However, you can be forced into hospital in certain situations. (See Appendix C
Outpatients have a variety of programs available to them. Having regular, pre-set appointments are often helpful during a difficult time.
Question: If I am hospitalized, how long will it last?
Answer: With fewer hospital beds available across the province and greater efforts to offer supports within the community, generally people are only hospitalized for serious problems and for a short time. Usually, hospital stays are for two weeks or less.
Mobile crisis units and services
A mobile crisis unit can provide help in a crisis over the phone or at a person's home. A worker will assess the situation, help to lessen the present crisis and decide on the best way to deal with the problem. Both new and existing clients receive a psychiatric consultation if needed. They are assessed and treated on the spot and connected with other useful services.
Like many other health care services, mobile crisis units are more likely to be found in cities and larger communities.
However, a greater number of these units are now operating, with some variations, to provide more service to rural areas.
To reach a mobile crisis unit, call 911, or contact your local hospital, community mental health agency or a community care access centre.
Distress and crisis lines
Distress or crisis phone lines are open 24 hours a day if you need to talk to someone. Crisis hotlines offer free, anonymous telephone counselling and information. The counsellors must keep everything you say confidential. Trained volunteers usually run these phone support services.
There are different types of hotlines; for example, assaulted women or rape crisis hotlines, suicide lines and kids' help lines. Distress lines outside of cities are a major source of support and can link you to local services.
You can find emergency numbers at the front of your phone book or through a local community information centre. For the phone number of a community information centre or distress line near you, call 211 in Toronto or (416) 397-4636 if you are outside of Toronto. (For a list of hotlines, see Appendix A
Safe houses and shelters
Shelters offer a safe, temporary place to live during a crisis where workers can give you advice and support. Shelters and safe houses often provide services to specific groups of people; for example, women only, women and children, men only or youth. They may offer housing services, counselling and other supports along with providing a bed and a meal. (See Housing, in Section 11
Note: Some shelters or safe houses have policies that exclude people with mental health or substance use problems.
For a list of shelters in your area for women who have been abused, view the Web site www.shelternet.ca
Food and shelter
The Out of the Cold program was started up in Toronto more than 15 years ago to help provide shelter, food and warm clothing for people without homes and people with low incomes. The program provides people with meals and shelter during the colder months and, in some cases, year-round. Toronto has about 40 Out of the Cold overnight programs and more than 20 meal programs. The program also runs in about seven other Ontario cities.
Food banks, community kitchens and other food services are also available in some communities for people who need them.
To find the location of an Out of the Cold program in Toronto, call (416) 782-0122 or view their Web site at www.ootcrc.com
Challenges & Choices: Finding Mental Health Services in Ontario