Melissa Winter carefully takes letters out of a Ziploc bag. They are handwritten on school loose-leaf paper. These are both precious and heartbreaking possessions — keepsakes no mother wants to have.
They are the suicide notes left by her 17-year-old daughter, Jaedra, who died in June 2015. Winter reads one note, which is addressed to no one in particular.
"I've gone to the hospital three times now because of attempts of suicide, and have tried many more times than that. When I sink to my low, sometimes it will never go away. And sometimes they are gone by the next day. It all depends. It's crazy how the brain can think like that, hey?"
The note goes on to say, "Recently I said to a psychiatrist that I needed meds and they should try to discover what's wrong. He said no. I don't think you need them. He didn't even try to check to see how my brain was feeling or working. so here is to prove a point. Get better doctors and people who are actually willing to help."
Jaedra attempted suicide four times in 2½ years. Her mother says she tried to keep her safe, even sleeping beside her for more than a month, but says there wasn't a place for her daughter to be treated.
Locked, long-term inpatient treatment centres — the type of care Winter's wanted for her daughter — don't exist for youth and due to rising demand for mental health services for youth in the province, there are long waiting lists for many treatment options.
A kind, smart overachiever
Jaedra lived in a beautiful but simple country home just outside of Winnipeg shared with her three older siblings and her mom, who is a single parent. She had friends, and loved her home, her family and her dog.
Her mom describes her as an overachiever who made almost every team she ever tried out for, including volleyball, rugby and basketball. She was also kind, her mother said.
"If somebody [on the other team] fell down in basketball, she would pick them up before she would run after the ball," she said.
But she never seemed satisfied with herself.
"I think the problem is that she didn't feel like she was good enough, that she had to be better. She did yoga and ate well. She was in perfect shape, but she also worried about her weight."
Jaedra first attempted to take her life in December 2012, when she was in Grade 8. Her mom got a call that she was acting kind of weird at school. They thought maybe Jaedra had bumped her head, but she hadn't. She had tried to kill herself.
That began a nightmare for the family. Jaedra was taken to the Winnipeg Children's Hospital emergency then admitted to the PY1, the Health Sciences Centre's Child and Adolescent Psychiatric Inpatient Services.
Winter was relieved and hopeful.
"I thought she was going to get this awesome care. She was going in the psych ward; how much better could it get? You think that she's going to have all of the professionals around her to help her."
So it was a surprise to Winter when Jaedra was sent home after four days. The average stay at the locked, 14-bed unit is seven days.
Dr. Laurence Katz, a medical director for child and adolescent mental health at the Health Sciences Centre, says PY1 is only intended as a short-term service to provide a psychiatric assessment and develop a treatment plan for when youth are discharged.
Jaedra was given a prescription for a psychiatric drug, but stopped taking it after about a week, said Winter. There was no counselling, she said.
"We were leaving the hospital with unanswered questions. We took her home and watched her like a hawk and really didn't know what to do with her," Winter said.
"It was awful for everybody. She had no privacy. She was feeling very uncomfortable. It was just making her angry. She just wanted to be left alone. We were scared to leave her alone."
Jaedra worked hard to convince people she was fine. Gradually, she was given more freedoms. Life continued on, as normally as possible. Then a year and a half after her first attempt, she tried again.
Jaedra was in Children's Hospital for a week, and then back to the locked youth psychiatry unit, PY1. Once again, she stayed only a few days.
"She did not want to be in there. It was sort of like a prison being in there; she couldn't do anything," Winter said. "She pretended everything was great, she was happy, so we took her home."
But this time, Winter "spoke a little louder" and demanded that her daughter get outpatient counselling.
Jaedra went along with the counselling, but her heart wasn't in it.
"I heard later from a friend of mine that she was just going just to make everybody happy, to make everybody believe that she's okay."
Needed 24-hour care
Winter says she believes her daughter needed more intensive care.
"I was hoping that she would have a place to stay where she would have 24-hour care. That they could keep an eye on her but also work with her, talk about her feelings, her thoughts," Winter said. "Figure out what kind of medication she needed, what would work and monitor that and not just send her home."
That's the kind of 24-hour care offered at the Manitoba Adolescent Treatment Centre's 14-bed locked unit. But the CEO, Marg Synchyshyn, says the centre is geared toward psycho-social rehabilitation of teens with serious mental illness, such as schizophrenia and bipolar disorder.
According to the province, the other locked centre for treatment of youth mental illness is at Marymound but it's for girls involved with Child and Family services. Jaedra wasn't.
Katz says that kind of locked, in-patient, long-term treatment centre doesn't exist in Manitoba or even in Canada for young patients like Jaedra. There isn't enough research to prove that those types of facilities work for suicidal youth.
"It's a dilemma," Katz says. "I completely understand a parent and a family's anxiety and concern ... and how difficult it is to manage."
More research is needed, he says. Still, he notes that current evidence suggests treatment outside of long-term, locked centres is the best practice, though there are waiting lists for it.
There's been a "profound" increase in demand for youth mental health services in Manitoba, said Katz.
In the past 17 years, there's been a five-fold increase in the annual number of psychiatric consults requested at the Children's Hospital emergency room to 1,350 in the last fiscal year from 250 in 1998, said Katz.
'Mental health is the orphan in the health system. And child and adolescent mental health is kind of the orphan of the orphan.' - Marg Synchyshyn
As a result, the Children's Hospital has increased the number of hours that psychiatrists and psychiatric residents spend in the ER, the doctor said.
But the need is also evident on waiting lists for outpatient care and community care.
It takes about six to eight months to get into the Anxiety Disorders Services for Children and Youth, while the wait for an assessment with the Intensive Child and Adolescent Treatment Service is four to eight weeks, plus a similar wait for treatments, said Katz.
To get into dialectical behavioural therapy (DBT), a proven treatment for suicidal teens, can take a few months.
Katz said the system is looking for creative ways to deal with the waits, such as adding more group sessions for DBT therapy, rather than one-on-one sessions, to try to get more youth involved.
The increase in demand and the lengthening wait times aren't unique to Manitoba, but rather an international phenomenon. Studies out of the U.S. cite more and more children in distress. The reasons aren't clear, but it's likely work being done to reduce stigma means more kids and families are seeking help.
Whatever the reasons, more funding would be welcome, said Katz.
"Clearly, the demand is substantial," he says.
According to numbers provided by the provincial government, it currently spends about five percent of the total health budget on mental health.
Synchyshyn, who is also the Winnipeg Regional Health Authority's director for child and adolescent mental health services, says more needs to be done.
"Mental health is the orphan in the health system. And child and adolescent mental health is kind of the orphan of the orphan," says Synchyshyn, who spent seven years on the child and youth advisory committee for the Mental Health Commission of Canada.
Great work has been done on reducing stigma, but she said resources haven't kept up.
A sign of things to come
Winter says a therapist she spoke with early on in Jaedra's journey told her something that seemed to foreshadow what was to come.
"She told me there was lots of good help, but she said unfortunately there were lots of people who needed it," Winter said.
Jaedra never had a clear diagnosis, she said, but they believed she might have had a borderline personality disorder.
After being placed on a waiting list, Jaedra was finally accepted into a dialectical behavioural therapy course at Health Sciences Centre. The therapy teaches patients a number of coping skills, including mindfulness, emotion regulation, interpersonal effectiveness and distress tolerance.
Winter thought it was a good fit, but she and Jaedra only got a taste of it because of the long waiting list.
"I wish we could have continued that, because I think it would have been very helpful," Winter said.
Two days after finally getting into the class, Jaedra had her third attempt. It left her with a brain injury.
After a month at Children's Hospital (not in the psychiatry ward), Jaedra was sent home in November of 2014, she said. They had to wait until January to see her psychiatrist. Other supports, such as occupational therapy, never materialized.
The entire family was on alert at home.
"For the first month that she was home from the hospital, she slept with me in my bed. I couldn't even take a shower without finishing it and coming outside to make sure she was still sleeping," said Winter, who works from home.
She only left the house with trusted friends or family. Everyone pulled together to try to keep her safe. But it wasn't enough.
Jaedra died on June 19, 2015. The pain is searing for the whole family.
"We all have suffered PTSD. When we hear sirens or ambulances or even police cars driving by, we get uptight," Winter said, her voice breaking.
Jaedra's doctor and one of her psychologists were among the 1,300 mourners who attended the funeral.
"They were very, very distraught. I think they were very shocked," said Winter. "They're not just doing their job. It really affects them as well."
She wishes she knew more about grassroots organizations — like the Mood Disorders Association of Manitoba, which offers outreach programs to youth, such as drop-in discussions and camps — that might have helped her navigate the system.
She didn't learn about the group until friends of the family organized a day of mental health awareness in memory of Jaedra. The event called "She Wore Flowers in her Hair" drew more than 500 people, most of them youth. Some of them reached out for help that day and were pointed in the right direction.
Winter plans to make it an annual event.
"I think that it's going to be good," Winter said, smiling. "And these people eventually are going to get the help that they're looking for as well."
If you suspect you are in crisis, or you know someone who is, contact the Mood Disorders Association of Manitoba at 204-786-0987 or toll-free 1-800-263-1460, or go to its website.
You can also contact the Klinic Crisis Line at 204-786-8686 or the Manitoba Suicide Prevention and Support Line toll-free at 1-877-435-7170. Both operate 24 hours a day, seven days a week.