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Q: We are struggling to find a child psychiatrists/team to work with our son and give us a proper diagnosis. We have seen two psychatrists who have totally disagreed with each other’s diagnosis and have prescribed different medications.  We are struggling with the system and just want some timely help.  Are there private child/adolescent psychiatry practices we can seek out?

A: Yes, there are people who work in private practice as well as clinics. However, our recommendation before heading down this road would be to return to your GP and explore some additional referrals with them. In our experience, it's most often a treatment/process issue that is needing to be worked though rather than simply offering another name or two. It is very uncommon to be seen by two psychiatrists that would differ so dramatically in diagnosis, which suggests that they are not in the same program.

This question comes from a parent who is concerned with how their child will maintain or develop their friendships after being diagnosed with a mental illness.

"My daughter, who is presently admited to a adolescent psychiatric unit, is feeling ostracized by her close circle of friends, whom she feels may not understand what is happening with her. As a monther, I have a good relationship with her friends and want to help out. Should I approach the friends or say/do anything?"

Answer: This is a difficult time for you and for your daughter and sometimes either or even both of you may feel a bit overwhelmed.  This means that you will each need support from others, such as other family members or trusted friends.  Regarding your daughter's friends - remember that they are her friends. 

It is not uncommon for a young person to want to spend less time with friends if they are not feeling well.  However, addressing peer relationships should  be part of  her treatment plan. 

My suggestion is to let your daughter have the lead in what she wants to tell or not to tell to her friends. You can support and encourage her.  One important issue that should be sorted out is if your daughter is ok with her friends contacting her when she is on the unit.  This you need to talk about.  If she is ok with that, then you can tell her friends to link directly with her.  If not, you and your daughter together should decide on what specific information you will pass on.  You can be friendly with your daughter's friends and at the same time respectful of her wishes.

Answer: You need to know what your medication is used for before you can tell how well it is working. The best way to tell if a medication is working for you is to come up with a plan for reviewing your symptoms, side effects, and activities before you start a medication. In general, if a medication is helping, your symptoms will start to get better and you should experience fewer problems and in most cases be getting back to your regular activities. How quickly things start to improve can depend on the kind of symptoms you have and how strong they are. Different medications take different lengths of time to work. Some work immediately, others take weeks or even months before the full effects are felt.

It is very important to talk to your prescriber and health providers about how to tell if you are getting better, staying the same, or getting worse while taking medications.

Answer: Medications used to treat mental illnesses work in the brain. Most medications act in different chemical pathways of the brain (for example: serotonin; dopamine) to help them work better or more efficently. There are many different kinds of medications for treating mental illnesses. Many medications can be used to treat several different mental illnesses. As an example, medications for depression can also help people with anxiety disorders.  This can be a bit confusing because it is common to think that a medicine with a specific name (for example: antidepressant) can only be used for the disorder that shares it name.  For this reason, it is important to talk to your doctor and other health providers such as pharmacists about your medications to know how they should work for you.

This question comes to us from a parent that is feeling left out of the loop.

"After a suicide attempt and cutting that got out of control, she wanted to be a place where she felt safe and understood.  After 3 weeks, I receive calls from her daily crying and wanting to come home.  I have not received much info from the unit as they say they are "still conducting assessments".  Is this normal? "

Answer: This is a difficult time for you and for your daughter and sometimes either or even both of you may feel a bit overwhelmed.  This means that you will each need support from others, such as other family members or trusted friends.  Don't forget to take care your yourself while you are taking care of your daughter. 

Regarding the treatment unit.  It is usual practice to have parents involved and active in the treatment process.  This means sharing non-confidential information, consistent treatment staff contact and regular debriefings.  This should be happening.  If it is not, then you should book an appointment with your daughter's psychiatrist and staff leader and discuss. 

Answer: The short answer is not that I know of.  However, persistent self-harm behaviors should be able to be addressed as part of usual mental health services.  In some cases, a group home setting or a residential unit with properly trained staff can be very helpful.

Fact: The main risk factors for mental illness are not bad parenting or personal weakness but rather genetics, severe and prolonged stress (such as physical or sexual abuse), or other environmental influences (such as birth trauma or head injury). It is important to remember that mental illness is a disease like any other physical disease and is not a result of personal weakness. We must remove the misconceptions and myths and the stigma that surround mental disorders.

Fact: It may seem that stress is responsible for mental illness because it is sometimes difficult to untangle whether experiences and symptoms predate or result from the disorder. However, there is no one clear cause of mental illness. Rather, it is a result of complex interactions between psychological, biological, genetic and social factors. Stress, stigma, and lack of support work to exacerbate the impact of these factors on the individual. Stress often causes mental distress, demoralization, emotional upset, frustration, etc. but these understandable and common responses should not be confused with a mental disorder.

Fact: Mental disorders are not rare and affect nearly every Canadian either directly or indirectly. Approximately 1 in 5 adolescents between the ages of 15 and 24 report a mental disorder, substance abuse or learning disability. Between 15 and 20 percent of the Canadian adolescent population suffers from a mental disorder at one time or another.

Fact: Some mental illnesses include a genetic component, which results in a predisposition or vulnerability toward the illness among children and siblings. While mental disorders often run in families, environment also plays a key role in the determing the outcome of certain conditions. Therefore just because your mother and your uncle or any other family member may have a mental illness, does not necessarily mean that you will too. Mental illness is a result of complex interactions between psychological, biological, genetic and social factors. What it does mean however, if someone in your family has a mental disorder you may be at higher risk. So, if you start to experience the symptoms of a mental disorder it will be important for you to see a health provider as soon as possible to determine if you may have a problem that could be treated. It is also a good idea if there is a mental disorder in your family history to do your best to avoid potential environmental triggers such as drugs and alcohol.

Fact: Once diagnosed, mental illness is treatable. While it is not usually "cured", it can be effectively managed. Most people with mental disorders live productive and positive lives while receiving treatments for their mental illness. As is the case with any illness, individuals with severe or persistent mental disorders that respond poorly to available treatments may require more support and may not function as highly as others.

Fact: While some people who suffer from mental illness do commit antisocial acts, mental illness does not equal criminality or violence - despite the media's tendency to emphasize a suspected link (e.g. psychotic serial killers). In fact, people with mental illness are no more likely to commit violence than the general public, but they are 2.5 times more likely to be victimized and are more likely to inflict violent behaviours on themselves. Furthermore, the general public is more likely to be violently victimized by someone who does not have a mental illness rather than by someone who suffers from mental illness.

Some evidence suggests that certain medications might rarely be associated with aggression, but this doesn't mean there is a link between psychiatric medications and violent behaviour. In fact, the drug that is most often associated with aggressive behaviour is alcohol! Many medications used to treat mental disorders are also helpful in treating violent behaviour. It is important to remember that the best known predictor for future violent behaviour is past violent or criminal behaviour, not mental illness.

Fact: Mental illness is a disease, not a life sentence. Most people with a mental disorder respond well to treatment. Most people with a mental disorder learn to cope with mental health problems and go on to lead very productive and fulfilling lives. While some illnesses can be debilitating, most are treatable. Many prominent members of society, including artists, musicians, and scholars have had a mental illness.

Some examples include:
• Vincent Van Gogh (Dutch Painter)
• Alanis Morrisette (Canadian Singer/Songwriter)
• Jim Carrey (Canadian Comedian/Actor)
• Margaret Trudeau (Wife of former Canadian Prime Minister Pierre Elliot Trudeau)
• Albert Einstein (German physicist)
• Ludwig van Beethoven (German composer and pianist)
• Winston Churchill (British politician)
• Charles Darwin (English naturalist)
• Abraham Lincoln (US President)

Fact: The effectiveness of any treatment depends on a number of factors including the type of mental illness and the particular needs of the individual. Most recent studies suggest that a combination of psychiatric medication and psychotherapy or social interventions are the most effective way to treat mental illnesses. Treatment effectiveness can also be improved if intervention is provided early in the course of the disorder.

Answer: Even before you start a medication it is good to talk about how you feel about taking medications and what you expect to happen with treatment. Your prescriber and other health providers that you work with and trust can help you get the facts about medications and other treatment options.

You and your doctor and other health providers should make a clear plan about how often to meet (e.g. in person at an appointment) or talk (e.g. on the phone) about how you are doing after starting a medication. It is important to keep track of how you feel while taking a medication.

Your doctor and other health providers such as your pharmacist will talk about the good things that happen with taking a medication like improved symptoms and the possible bad things like side effects that can happen.

Most medications for mental illnesses do not usually work right away but gradually over time to help symptoms. Some medications, such as those for ADHD, may have immediate effects. How well a medication works and when it starts to work can depend on the kind of symptoms you have and how strong they are. You should talk to your health providers about when and what kinds of things should improve with medication use. It may take some time before you and your doctor will be able to figure out the correct dose of medication for your body.

Medications may cause side effects and this can happen before your symptoms improve. Keep in mind that not everyone gets side effects. You should talk to your health providers about side effects and how to get help if they happen.

You should expect to visit your doctor and other health providers more often after starting a medication. This can let them see if your medication helps, does nothing, or causes problems.

Answer: Your prescriber (who is usually a doctor) and other health providers such as pharmacists have special training and experience with medications. If you have questions or concerns about your medications talk to these people to get more information.

Answer: Everyone should understand why they are taking a medication. If you are not sure why a medication has been prescribed for you, you should talk to your doctor and health providers to find out why. Medications can be prescribed to help people with symptoms of mental illnesses to get well and stay well.

For some people, the brain is working differently than normal and medications can help the brain to function better. It is the same as when people take medications for other parts of their bodies because they don't work normally. For example, people with asthma use medications when their lungs don't work as they should and people with diabetes can take medications to help control their blood sugar. Medications that treat mental illnesses can help people get back to their regular activities such as working, going to school, hanging out with friends, or playing music or sports.