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1. Ready

What are school resources?

Schools are an ideal place for mental health promotion, mental illness prevention, and early intervention In Ontario, schools provide a continuum of mental health support, also called a “Multi-Tiered System of Support”, which covers three different levels of care:

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Tier 1: Good for all
Tier 1 provides a universal level of mental health supports that are concerned with promoting wellbeing through the creation of welcoming and inclusive environments that foster student engagement, and by helping students build their understanding and knowledge of mental health to promote healthy habits and develop self-care skills. Tier 1 school services often involve community partnerships and collaboration by getting families, teachers, faculty, and students involved. Most of the mental health work in schools is at Tier 1. Beecuz’ programming is a Tier 1 support service because it focuses on proactively helping students develop the knowledge, tools, and skills needed to face adversity and thrive.
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Tier 2: Necessary for some
Tier 2 provides structured, prevention, and early intervention services for students who may need additional support. School mental health professionals such as guidance counselors, social workers, or psychologists prevent the development or progression of mental health challenges through early intervention services, like structured psychotherapy. Teachers support struggling students by offering ongoing classroom support, such as removing barriers to learning. And mental health education programs continue to bolster the student by building resilience, positive coping, and cognitive skills.
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Tier 3: Essential for few
Tier 3 services are for students who require intensive assessment and intervention services. Although the necessary treatment interventions are normally accessed and provided through the community, schools need to provide some level of Tier 3 support for students who either cannot or will not access community services. At this level, schools are responsible for helping students access community care, rather than providing care. Students may approach teachers, guidance counsellors or social workers, who can then help the student access the appropriate community or health services and ensure that the student is feeling safe and supported while they are at school.

What are community resources?

Community resources are generally Tier 3 services that provide intensive, tailored intervention services for people who have a mental illness diagnosis or serious mental health challenge. Similar to school services, community support is also provided at different “levels” corresponding to different intensities and degrees of care. In general, out-patient, in-patient and residential services are available.

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Outpatient treatment programs
Outpatient or community mental health services are where a person continues to live at home and receives treatment by going into an office, clinic, or counselling center. Outpatient services generally involve meeting with a therapist, social worker, or larger care team regularly (ex. once a week). This level of care aims to keep people participating in their everyday life and is best for people who feel capable of managing their day-to-day mental health challenges but need support to set and achieve goals, make progress, and thrive. Out-patient services can also include group therapy sessions offered through a community organization such as the local CMHA branch, or hospital. These therapy sessions normally concern themselves with a specific psychotherapy technique, such as dialectical behaviour therapy (DBT), cognitive behaviour therapy (CBT), or acceptance and commitment therapy (ACT), and can be a helpful way to build a peer-support network.
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Inpatient treatment programs
Inpatient mental health care is a more intensive service that involves hospital admission. People can admit themselves to a hospital psychiatric care unit if they are feeling unsafe or unable to cope with a mental illness. These hospital stays usually involve individual and group therapy sessions. A specialized health care team will work with the client to determine treatment options that best support and maintain recovery (ex. outpatient series, medication, etc.). Treatment teams will also help their client create a transition plan back to the community. Hospital stays can range from a couple of days to a couple of weeks, depending on the person’s mental state upon arrival, willingness to comply, and desire to recover. Seeking in-patient support services can be a difficult, but sometimes necessary step.
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Residential treatment programs
Residential treatment is the most intensive treatment option that focuses on providing long-term (several months to a year) programs that are less clinical than in-patient hospital programs. Residential treatment tends to involve “homier” accommodations and the programming is focused on long-term success in everyday life (in-patient programs are more focused on medical stabilization). Residences are generally not capable of providing medical stabilization and are accessed by people who are not at immediate risk to themselves or others. There are few residential mental health facilities in Canada, and many are not Government-funded, making residential treatment expensive, difficult to access, and a kind of “last resort”.

What are online resources?

In the last decade, mental health apps, phone, text, or chat services, and other online services have grown in popularity. These online or mobile resources include crisis support services, information and knowledge building programs, counselling and therapy, as well as consultation, assessment, and peer support. Online resources are a great way to get immediate support and connect with someone anonymously. In many cases, these resources are a stepping stone for face-to-face services because they help build trust, confidence, and hope. Some of the most popular online resources for children and adolescents include:

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Kids Help Phone
Canada’s largest mental health helpline for children and youth. Kids Help Phone provides professional counselling, information, and referrals for mental health, addictions, and wellbeing. Their services are available 24 hours a day, 7 days a week, and can take the form of a phone conversation, online web post, or live chat. All services are free, anonymous, and confidential. To speak with a professional counsellor, call 1-800-668-6868.
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Crisis Services Canada
A nationally available, regionally delivered service to anyone thinking about or affected by suicide. Every caller or texter is connected with a Crisis Responder. If you are experiencing a crisis, call 1-833-456-4566 anytime or text 45645 from 4 PM-Midnight.
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Mental Health Helpline
A phone helpline that provides information about counselling and community support services for people of all ages in Ontario. The Mental Health Helpline team strives to help individuals access information about the health care and support services they need at the right time, and the right place. All conversations are confidential, free, and available 24 hours a day, 7 days a week. Call 1-866-531-2600.
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Mindyourmind
An online space where youth can get information, resources, and tools to manage stress, crisis, and mental health related problems for themselves or their friends.
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Youthspace.ca
An online crisis and emotional support chat that is available 365 days a year from 6 PM-Midnight for Canadians under the age of 30. A diverse team of trained volunteers will listen to how things are going and provide support. All chats are confidential and anonymous.
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Big White Wall (BWW)
A vibrant peer-to-peer community support platform, helping people with mild to moderate mental health challenges get better together. The Big White Wall is monitored 24/7 by trained practitioners who keep their members safe and facilitate the process of people helping people in an online environment. People can access BWW at www.bigwhitewall.ca

When is it time to ask for help?

Many people continue to believe that you have to be “crazy” or in the depths of despair before seeking professional mental health support, like going to a therapist. If that were the case, then many mental health professionals would be out of a job! The truth is that most people can benefit from therapy at some point in their lives and, in more recent years, countless voices are speaking about the benefits of therapy for everyone (even happy people). But let’s not get ahead of ourselves.

Dr. David Sack Sack, D. (2013, March 18). 5 Signs It’s Time to Seek Therapy. Psychology Today.
names five signs that it’s time to seek therapy, even before you or someone you know has reached rock bottom:
  1. Feeling sad, angry, or otherwise “not yourself”.
  2. Abusing drugs, alcohol, food, or sex to cope.
  3. Losing someone or something important to you.
  4. Experiencing or witnessing something traumatic.
  5. A lack of interest, motivation, or energy to do the things you like to do.

What gets in the way of asking for help?

Humans are social beings, with cooperation lying at the heart of our lives and society. Like other primates, humans evolved to need the support of family and tribes to survive. Why then, is it so hard to ask for help? Well, in accordance with this need to belong, humans also developed psychological responses, similar to pain, that indicate when we might be at risk of social rejection or expulsion. This psychological response is
triggered Staley, O. (2018, May 15). The reason why it’s so hard to ask for help. Quartz at Work.
“by a variety of threats to our social standing, including the fear of losing status, the fear of being treated unfairly, the fear of uncertainty, and the fear of rejection”. Asking for help is so uncomfortable because it is a social threat. It makes us feel weak, threatens our social status, brings about uncertainty, and invites the possibility of rejection. This is true for anything, from asking for help with a math assignment, to asking for help with mental health challenges. Asking for help makes us vulnerable. In an earlier lesson, the most common vulnerability myths were debunked, one of which was the idea that we can “go at it alone”. We can’t. Humans are wired to depend on and support each other.

Barriers to Help-Seeking Behaviour for Mental Health

After reviewing twenty-two published studies of perceived barriers and facilitators of mental health help-seeking behaviour in adolescents and young adults,
researchers concluded Griffiths K. M., Gulliver A., & Christensen H. (2010). Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry, 10(1), 113.
that the biggest barriers to asking for help include “perceived stigma and embarrassment, problems recognizing symptoms (poor mental health literacy), and a preference for self-reliance”. In Ontario,
63% of youth Ontario Centre of Excellence for Child and Youth Mental Health (2012). Evidence In-Sight: Effective Stigma Reduction Strategies in Child and Youth Mental Health.
point to stigma as being the most likely reason not to seek help for mental health challenges. For boys and men,
social norms and expectations Möller-Leimkühler, A. (2002). Barriers to help-seeking by men: a review of sociocultural and clinical literature with particular reference to depression. Journal of Affective Disorders, 71(1-3), 1–9.
to be “tough”, “strong and independent”, as well as “unemotional”, make it even harder to ask for help and receive professional care.
Cultural, ethnic, and contextual factors Cauce, A. M., Domenech-Rodríguez, M., Paradise, M., Cochran, B. N., Shea, J. M., Srebnik, D., & Baydar, N. (2002). Cultural and contextual influences in mental health help seeking: A focus on ethnic minority youth. Journal of Consulting and Clinical Psychology, 70(1), 44–55.
also profoundly “affect ethnic minority adolescents’ pathways into mental health services”. For example, different cultures have
different opinions Cauce, A. M., Domenech-Rodríguez, M., Paradise, M., Cochran, B. N., Shea, J. M., Srebnik, D., & Baydar, N. (2002). Cultural and contextual influences in mental health help seeking: A focus on ethnic minority youth. Journal of Consulting and Clinical Psychology, 70(1), 44–55.
about concepts “as basic as what is perceived to be a mental health problem”, as well as how acceptable it is to experience mental health challenges or ask for help, and the amount of social support (ex. from friends and family) that remains after a mental illness diagnosis.

Studies Griffiths K. M., Gulliver A., & Christensen H. (2010). Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry, 10(1), 113.
have found that adolescents and young adults are more likely to ask for help if they have had positive past experiences with asking for mental health support, and if they have support or encouragement to seek care from friends and family.

Where can I learn more?

School Mental Health Ontario

Canadian Mental Health Association – Mental Health Resources in Schools

nprEd – Mental Health in Schools: A Hidden Crisis Affecting Millions of Students

Mind – Seeking help for a mental health problem

Healthline – 10 Ways to reach out in a mental health crisis

What will students learn?

By the end of this lesson, students will be able to:

  • Understand that everyone needs help at some point in their life  
  • Identify people, organizations and resources in the school and the broader community that support mental health
  • Know when and how they can seek help
  • Call the Kids Help Phone line and understand the services they offer
References
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Cauce, A. M., Domenech-Rodríguez, M., Paradise, M., Cochran, B. N., Shea, J. M., Srebnik, D., & Baydar, N. (2002). Cultural and contextual influences in mental health help seeking: A focus on ethnic minority youth. Journal of Consulting and Clinical Psychology, 70(1), 44–55.

Griffiths K. M., Gulliver A., & Christensen H. (2010). Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry, 10(1), 113.

Möller-Leimkühler, A. (2002). Barriers to help-seeking by men: a review of sociocultural and clinical literature with particular reference to depression. Journal of Affective Disorders, 71(1-3), 1–9.

Ontario Centre of Excellence for Child and Youth Mental Health (2012). Evidence In-Sight: Effective Stigma Reduction Strategies in Child and Youth Mental Health.

Sack, D. (2013, March 18). 5 Signs It’s Time to Seek Therapy. Psychology Today.

School Mental Health Ontario (n.d.). Think in Tiers and Focus on the Positive. School Mental Health Ontario.

Staley, O. (2018, May 15). The reason why it’s so hard to ask for help. Quartz at Work.

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