1) Are mental health and mental illness the same thing?

Many people use the terms mental health and mental illness interchangeably, but they are in fact two different things.

Mental health reflects our emotional, psychological, and social well-being. It is one’s ability to thrive, enjoy life, have a sense of purpose, and the ability to manage life’s highs and lows. Our mental health affects how we think, feel, and act. It has a strong impact on how we interact with others, handle problems, and make decisions. Mental health is also key to relationships, personal and emotional well-being, and contributing to community and society. Just like our physical health, we need to continuously work on our mental health to stay healthy.  

There is still a large stigma for mental illness, many people who have a mental illness are not comfortable talking about it openly. Mental illness is nothing to be ashamed of, it is a medical condition just like diabetes or heart disease. Mental health conditions are treatable. We are continually expanding our understanding of the human brain, and treatments to help people successfully manage mental health conditions (American Psychiatric Association, 2021).

Mental illness is described as conditions involving changes in emotion, thinking, or behaviour (or a combination of these). Mental illnesses are associated with distress and/or with day-to-day functioning, including problems in social, work or family activities (American Psychiatric Association, 2021).

Examples of mental illnesses include:

• Depressive disorders
• Anxiety disorders
• Bipolar and related disorders
• Obsessive-compulsive disorder
• Schizophrenia 
  

One in five people in Canada will experience a mental health problem or illness in any given year. But five in five of us have mental health (CMHA National, 2020). Mental health is not the absence of mental illness. If you have a mental illness, you can still have good mental health (CMHA National, 2020).

2) What is schizophrenia?

“Schizophrenia is a complex mental illness that affects how a person thinks, feels, behaves and relates to others. This illness affects a person’s ability to determine what is reality and what is not. It is as though the brain sends perceptions along the wrong path, leading to the wrong conclusion. People with schizophrenia are affected by delusions (fixed false beliefs that can be terrifying to the person experiencing them), hallucinations (sensory experiences, such as hearing voices talking about them when there is no one there), social withdrawal and disturbed thinking” (CMHA National, 2020).

Who does it affect?

“Schizophrenia occurs in both men and women, but it is slightly more common in men. On set can typically occur in the late teens to early twenties. The illness can also be developed later in life. As many as one person out of 100 may experience schizophrenia” (CMHA National, 2020).

What can the onset of schizophrenia look like?

“At the beginning of an episode, people may feel that things around them seem different or strange. They may start to experience problems concentrating, thinking or communicating clearly, or taking part in their usual activities. At the height of the episode, people may experience breaks from reality called psychosis. These could be hallucinations (sensations, like voices, that aren’t real) and delusions (strong beliefs that aren’t true, like the belief that they have superpowers). Some people feel ‘flat’ or numb. They may also experience changes in mood, motivation, and the ability to complete tasks. After an episode, signs can continue for some time. People may feel restless, withdraw from others, or have a hard time concentrating” (CMHA National, 2020).

“The exact course and impact of schizophrenia is unique for each person. Some people only experience one episode in their lifetime while others may experience many episodes. Some people experience periods of wellness between episodes while others may experience episodes that last a long time. Some people experience a psychotic episode without warning while others experience many early warning signs. No matter how someone experiences schizophrenia, researchers agree that early treatment can help reduce the impact of episodes in the future” (CMHA National, 2020).

3) What is depression?

Depression is a mental illness that affects negatively affects how a person feels, thinks, and acts. Depression affects a person’s mood. Mood impacts the way people think about themselves, relate to others, and interact with the world. Depression is more than a ‘bad day’ or ‘feeling blue’. Without supports and treatment, depression can last for a long time (CMHA National, 2020 & American Psychiatric Association, 2021).

Depression causes feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home (American Psychiatric Association, 2021).

Who does it affect?

“Depression often starts between the ages of 15 and 30, but it can affect anyone—even teens and younger children” (CMHA National, 2016).

Symptoms of depression can include:

• Feeling sad, worthless, hopeless, guilty or anxious
• Feeling irritable and angry
• Loss of interest or pleasure in activities once enjoyed
• Changes in appetite — weight loss or gain unrelated to dieting
• Trouble sleeping or sleeping too much
• Loss of energy or increased fatigue
• Difficulty thinking, concentrating or making decisions
• Thoughts of death or suicide
• Isolating and withdrawing from others

(CMHA National, 2020 & American Psychiatric Association, 2021).

4) What is bipolar disorder?

Bipolar, like depression, is a mental illness that affects mood. People with bipolar disorder experience episodes of depression and mania. An episode of depression in bipolar disorder is the same as other types of depression. Mania is in an unusually high mood. People may feel as if their thoughts are racing and may feel hyperactive. A person may feel unrealistically confident, powerful, or happy. People often do not sleep much when they are experiencing mania. They may act without thinking or exhibit risk-taking behaviors. People with bipolar disorder generally have neutral moods as well. Bipolar disorder can disrupt a person’s relationships with loved ones and cause difficulty with daily functioning (CMHA National, 2020 & American Psychiatric Association, 2021).

Who does it affect?

Bipolar disorder commonly runs in families, 80 to 90 percent of individuals with bipolar disorder have a relative with bipolar disorder or depression. Environmental factors such as stress, sleep disruption, and drugs and alcohol may trigger mood episodes in vulnerable people. The average age of onset is 25 years old (American Psychiatric Association, 2021).

Symptoms of manic episodes:

During manic episodes, people with bipolar disorders experience an extreme increase in energy and may feel on top of the world or uncomfortably irritable in mood.

• Decreased need for sleep (e.g., feeling energetic despite significantly less sleep than usual
• Increased or faster speech
• Uncontrollable racing thoughts or quickly changing ideas or topics when speaking
• Distractibility
• Increased activity (e.g., restlessness, working on several projects at once)
• Increased risky behavior (e.g., reckless driving, spending sprees)

(American Psychiatric Association, 2021)

5) What are anxiety disorders?

“Anxiety is an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure. People with anxiety disorders usually have recurring intrusive thoughts or concerns. They may avoid certain situations out of worry. They may also have physical symptoms such as sweating, trembling, dizziness or a rapid heartbeat” (American Psychiatric Association, 2021).

“People with anxiety disorders may feel anxious most of the time or for brief intense episodes, which may occur for no apparent reason. They may have anxious feelings that are so uncomfortable that they avoid daily routines and activities that might cause these feelings. Some people have occasional anxiety attacks so intense that they are terrified or immobilized” (Centre for Mental Health and Addiction, 2021).

Signs & Symptoms

 Each of the below anxiety disorders are distinct in some ways, but they all share the common symptoms:

• Irrational and excessive fear
• Apprehensive and tense feelings
• Difficulty managing daily tasks and/or distress related to these tasks.

Cognitive, behavioral and physical symptoms include:

• Anxious thoughts (e.g., “I’m losing control” )
• Anxious predictions (e.g., “I’m going to fumble my words and humiliate myself”)
• Anxious beliefs (e.g., “Only weak people get anxious”)
• Avoidance of feared situations (e.g., driving)
• Avoidance of activities that elicit sensations similar to those experienced when anxious (e.g., exercise)
• Subtle avoidances (behaviors that aim to distract the person, e.g., talking more during periods of anxiety)
• Safety behaviors (habits to minimize anxiety and feel “safer,” e.g., always having a cell phone on hand to call for help)
• Excessive physical reactions relative to the context (e.g., heart racing and feeling short of breath in response to being at the mall).
  
  The physical symptoms of anxiety may be mistaken for symptoms of a physical illness, such as a heart attack.

(Centre for Mental Health and Addiction, 2021).

Who does it affect?

“Anxiety disorders can affect anyone at any age, and they are the most common mental health problem” (CMHA National, 2016).

Causes & Risk Factors

Like most mental health problems, anxiety disorders appear to be caused by a combination of biological factors, psychological factors and challenging life experiences, including:

• Stressful or traumatic life event
• Family history of anxiety disorders
• Childhood development issues
• Alcohol, medications or illegal substances
• Other medical or psychiatric problems

The main categories of anxiety disorders are:

• Specific phobias  
• Panic disorder  
• Agoraphobia
• Generalized anxiety disorder 
• Social anxiety disorder
• Selective mutism
• Separation anxiety disorder

Phobias

“A phobia is an intense fear around a specific thing like an object, animal, or situation. Most of us are scared of something, but these feelings don’t disrupt our lives. With phobias, people change the way they live in order to avoid the feared object or situation” (CMHA National, 2020).

Panic disorder

“Panic disorder involves repeated and unexpected panic attacks. A panic attack is a feeling of sudden and intense fear that lasts for a short period of time. It causes a lot of physical feelings like a racing heart, shortness of breath, or nausea. Panic attacks can be a normal reaction to a stressful situation, or a part of other anxiety disorders. With panic disorder, panic attacks seem to happen for no reason. People who experience panic disorder fear more panic attacks and may worry that something bad will happen as a result of the panic attack. Some people change their routine to avoid triggering more panic attacks” (CMHA National, 2020).

Agoraphobia

“Agoraphobia is fear of being in a situation where a person cannot escape or find help if they experience a panic attack or other feelings of anxiety. A person with agoraphobia may avoid public places or even avoid leaving their homes” (CMHA National, 2020).

Social anxiety disorder

“Social anxiety disorder involves intense fear of being embarrassed or evaluated negatively by others. As a result, people avoid social situations. Social anxiety disorder is more than shyness, it can have a big impact on work or school performance and relationships” (CMHA National, 2020).

Generalized anxiety disorders

“Generalized anxiety disorder is excessive worry around a number of everyday problems for more than six months. This anxiety is often far greater than expected—for example, intense anxiety over a minor concern. Many people experience physical symptoms too, including muscle tension and sleep problems” (CMHA National, 2020).

Some mental illnesses are no longer classified as anxiety disorders, though anxiety or fear is a major part of the illnesses:

Obsessive Compulsive Disorder

“Obsessive-compulsive disorder is made up of unwanted thoughts, images, or urges that cause anxiety (obsessions) or repeated actions meant to reduce that anxiety (compulsions). Obsessions or compulsions usually take a lot of time and cause a lot of distress” (CMHA National, 2020).

Post-traumatic stress disorder

“Post-traumatic stress disorder can occur after a very scary or traumatic event, such as abuse, an accident, or a natural disaster. Symptoms of PTSD include reliving the event through nightmares or flashbacks, avoiding reminders of the traumatic event, and feeling unsafe in the world, even when a person isn’t in danger” (CMHA National, 2020).

6) What is suicide?

“Suicide is the act of intentionally causing one’s own death, and is often related to complex stressors and health issues. Suicide occurs across all ages, incomes, ethnicities and social factors” (CAMH, 2021). “People who die by suicide or attempt suicide may not really want to end their life. Suicide may seem like the only way to deal with difficult feelings or situations” (CMHA National, 2016).

Who does it affect?

“About 4000 Canadians die by suicide every year. Suicide is the second-most common cause of death among young people, but men in their 40s and 50s have the highest rate of suicide. While women are three to four times more likely to attempt suicide than men, men are three times more likely to die by suicide than women” (CMHA, 2016).

“Suicide is a complicated issue. People who die by suicide or attempt suicide usually feel overwhelmed, hopeless, helpless, desperate, and alone. In some rare cases, people who experience psychosis (losing touch with reality) may hear voices that tell them to end their life” (CMHA, 2016).

Known risk factors for suicide include:

• A previous suicide attempt
• Family history of suicidal behaviour
• A serious physical or mental illness
• Problems with drugs or alcohol
• A major loss, such as the death of a loved one, unemployment, or divorce
• Major life changes or transitions, like those experienced by teenagers and seniors
• Social isolation or lack of a support network
• Family violence
• Access to the means of suicide

 (CMHA, 2016)

While we often think of suicide in relation to depression, anxiety, and substance use problems, any mental illness may increase the risk of suicide. It’s also important to remember that suicide may not be related to any mental illness (CMHA, 2016).

Signs & Symptoms

People who are at risk for suicide may:

• Show a sudden change in mood or behavior
• Show a sense of hopelessness and helplessness
• Express the wish to die or end their life
• Increase substance use
• Withdraw from people and activities that they previously enjoyed
• Experience changes in sleeping patterns
• Have a decreased appetite
• Give away prized possessions or make preparations for their death (for example, creating a will).

(CAMH, 2021)

Major warning signs of suicide spell IS PATH WARM:

I—Ideation: thinking about suicide
S—Substance use: problems with drugs or alcohol

P—Purposelessness: feeling like there is no purpose in life or reason for living
A—Anxiety: feeling intense anxiety or feeling overwhelmed and unable to cope
T—Trapped: feeling trapped or feeling like there is no way out of a situation
H—Hopelessness or Helplessness: feeling no hope for the future, feeling like things will never get better

W—Withdrawal: avoiding family, friends, or activities
A—Anger: feeling unreasonable anger
R—Recklessness: engaging in risky or harmful activities normally avoided
M—Mood change: a significant change in mood

(CMHA National, 2016)

How can I help someone who is at risk for suicide?

• Listen to them and take them seriously. Don’t judge or minimize their feelings. Be positive and hopeful, and remember that suicide can be prevented.
• Ask them if they are having thoughts of suicide. Don’t be afraid that you will put the idea in their head. It may be a relief for them to talk about it.
• Ask if they have a plan. Depending on their answer you may want to limit their access to lethal means, such as medication, knives or firearms.
• Ask them to rate their suicidal feelings on a scale of one to 10. Regularly ask them to tell you where they are on the scale, so you can assess if things are getting worse.
• Let them know help is available and that the cause of their suicidal thoughts can be successfully treated.
• Encourage them to talk about how they are feeling.
• Encourage them to seek help from a doctor or mental health provider, and offer to help with this if they would like.
• Make a safety plan with them. Who will they call if their feelings get stronger? Who can stay with them to keep them safe? Make a list of phone numbers of people and services they can call if they feel unsafe. Avoid leaving the person alone if they are in crisis.
• Seek support for yourself. It is important that you don’t carry this burden alone.

(CAMH, 2021)

What if someone I know shows warning signs for suicide?

• If the person will not go to the hospital or you’re unsure if this is the right thing to do, get help from a health care provider as quickly as possible. You can call the person’s health care team or a crisis line.
• If your loved one is attempting or about to attempt suicide, and you are not at risk, do not leave them alone and call 911.
• Keep yourself safe.

(CAMH, 2021)

How can I reduce the risk for suicide?

Though not all suicides can be prevented, some strategies can help reduce the risk. All of these factors are linked to well-being. These strategies include:

• Seeking treatment, care and support for mental health concerns—and building a good relationship with a doctor or other health professionals
• Building social support networks, such as family, friends, a peer support or support group, or connections with a cultural or faith community
• Learning good coping skills to deal with problems, and trusting in coping abilities

(CMHA National, 2016)

“When a person receives treatment for a mental illness, it can still take time for thoughts of suicide to become manageable and stop. Good treatment is very important, but it may not immediately eliminate the risk of suicide. It’s important to stay connected with a care team, monitor for thoughts of suicide, and seek extra help if it’s needed. Community-based programs that help people manage stress or other daily challenges can also be very helpful” (CMHA National, 2016).

What can I do if I experience thoughts of suicide?

“Thoughts of suicide are distressing. It’s important to talk about your experiences with your doctor, mental health care team, or any other person you trust. They can help you learn skills to cope and connect you to useful groups or resources. Some people find it helpful to schedule frequent appointments with care providers or request phone support” (CMHA National, 2016).

Other things that you can do include

• Calling a crisis telephone support line
• Connecting with family, friends, or a support group. It can be helpful to talk with others who have experienced thoughts of suicide to learn about their coping strategies

(CMHA National, 2016).

If you’re in crisis and aren’t sure what to do, you can always call 9-1-1 or go to your local emergency room.

“Some people find a safety plan useful. A safety plan is a list of personal strategies to use if you think you are at risk of hurting or ending your life. You can create a plan on your own, with a loved one, or with your mental health care team” (CMHA National, 2016).

Your plan may include:

• Activities that calm you or take your mind off your thoughts
• Your own reasons for living
• Key people to call if you’re worried about your safety
• Phone numbers for local crisis or suicide prevention helplines
• A list of safe places to go if you don’t feel safe at home

(CMHA National, 2016).

Supports

“If your loved one already sees a doctor or other mental health service provider, it’s important that they tell their service provider about any thoughts of suicide they may have been having. Depending on your relationship, you can offer to help—by helping your loved one schedule appointments or by taking them to their appointments, for example” (CMHA National, 2016).

“If your loved one doesn’t see a mental health service provider, you can give them the phone number for a local crisis line and encourage them to see their doctor. Your loved one may also be able to access services through their school, workplace, cultural or faith community” (CMHA National, 2016).

“Supporting a loved one can be a difficult experience for anyone, so it’s important to take care of your own mental health during this time and seek support if you need it” (CMHA National, 2016).

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References

American Psychiatric Association (2021). What is depression? https://www.psychiatry.org/patients-families/depression/what-is-depression

American Psychiatric Association (2021). Help with schizophrenia. https://www.psychiatry.org/patients-families/schizophrenia

American Psychiatric Association (2021). Help with bipolar disorder. https://www.psychiatry.org/patients-families/bipolar-disorders

American Psychiatric Association (2021). Warning signs of mental illness. https://www.psychiatry.org/patients-families/warning-signs-of-mental-illness

Centre for Addiction and Mental Health (2021) Anxiety disorders. https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/conditions-and-disorders/anxiety-disorders

Centre for Addiction and Mental Health (2021) Bipolar disorder. https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/conditions-and-disorders/bipolar-disorder

Centre for Addiction and Mental Health (2021). Depression. https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/conditions-and-disorders/depression

Centre for Addiction and Mental Health (2021). Schizophrenia. https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/conditions-and-disorders/schizophrenia

Centre for Addiction and Mental Health (2021) Suicide. https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/conditions-and-disorders/suicide

Canadian Mental Health Association. (2016, February 28). Anxiety disorders. https://cmha.ca/documents/anxiety-disorders

Canadian Mental Health Association (2016, February 27). Mental illnesses. https://cmha.ca/documents/mental-illnesses

Canadian Mental Health Association (2016, February 27). Myths about mental illness. https://cmha.ca/documents/myths-about-mental-illness

Canadian Mental Health Association. Canadian Mental Health Association (2016, February 27). Preventing suicide. https://cmha.ca/documents/preventing-suicide

Canadian Mental Health Association. (2016, February 27). Schizophrenia. https://cmha.ca/documents/schizophrenia