Mental health disorders spike in post-high school transitions

The teenage and early adult years, particularly the transition from home to college or a job, can bring on greater incidence of anxiety and other, more serious disorders, doctors say. Many colleges and universities are aware of the situation, but individual advocacy is still important.

Colleges increasingly aware of the problem, but patient advocacy still important

Jason Novick has seen the darkness that mental health disorders can create.

The 27-year-old Toronto man has also seen how advocacy — by himself and by others — has been vital in helping him cope with bipolar disorder, general anxiety disorder, mania and depression, particular during the stressful transition from his teenage years to leaving home for post-secondary school.

Jason Novick says advocacy by yourself and others is important while coping with a mental health disorder. (Courtesy Jason Novick)

"Mental health awareness … is still an issue that’s largely misunderstood," he said in a recent interview.

"There’s a lot of [post-secondary] administrative workers and professors and program co-ordinators and what have you who won’t know the first thing about such issues, so your best ally is probably going to be yourself a lot of the time."

Another ally can also be a caring friend or family member who steps up to help others understand the larger situation. Novick remembers going with his mother to "set the record straight" with a college professor.

They wanted to explain to the instructor that it was his mental health that was his problem, not any lack of interest in the course.

"It was my mental health that was causing me to be so withdrawn, that was causing me to be so unmotivated. I was passionate about the subject, but I was not passionate about life and living."

Novick, who says he contemplated suicide at one point and has been in closed hospital wards three times because of his disorders, is much more passionate about life and living now, particularly after having completed an inpatient program at the Centre for Addiction and Mental Health in Toronto.

This week CBC Toronto focuses on mental health in Canada's universities and colleges. Listen to Metro Morning and watch CBC Toronto for more stories like this in our Off Course On Campus series.

Tough transition

But he knows from personal experience how difficult coping with a mental health disorder can be, particularly for young people as they make the transition from life at home to being on their own and facing the pressures of school or work.

"The incidence in terms of new cases per year … certainly rises between roughly ages 16 to 24," says Dr. David Wolfe, a psychologist, senior scientist and director of CAMH’s Centre for Prevention Science in London, Ont.

Bipolar disorders, schizophrenia, anxiety and depression often become much more apparent during that period.

"Prior to that, there may have been signs of it because a lot of these do originate in childhood," says Wolfe. "But they emerge once the person is in a more stressful situation such as the military, university, college or job, and they don’t have the ability to cope as well."

Figures from Statistics Canada show that in 2009, 87,859 young people aged 12 to 19 were diagnosed with a mood disorder such as depression, bipolar disorder, mania or dysthymia (persistent depressive disorder). In 2012, that number had risen to 111,930.

Many of the disorders are treatable.- Dr. David Wolfe

Other 2012 figures from Statistics Canada show that 315,928 Canadians aged 15 to 24 had a major depressive episode within the previous 12 months. For bipolar disorder, that number stood at 109,967. 

Not everyone with a mental health disorder will be diagnosed, or will need to be diagnosed — some people may find the support they need on their own, Wolfe said.

But overall, Wolfe suggests, the key is early diagnosis of these disorders, which results from recognizing a pattern of behaviour and the difference between a normal response to a stressful situation and an abnormal one.

"Typically," said Wolfe, "it’s when it impedes on everyday function" — such as someone not being able to get out of bed or go to work or school — that help is needed.

Learning to manage

"If they get help, then of course they can learn to manage, typically. Many of the disorders are treatable. They’re not curable, but they’re treatable and allow the person to get back to work or school."

Dr. David Wolfe says there are many more entry points into the mental health system now. (Centre for Addiction and Mental Health)

Novick was diagnosed with bipolar disorder when he was 16. He was later diagnosed with general anxiety disorder. He also experienced mania and depression. He saw a social worker. A psychiatrist, too. There were many medications — some with difficult side effects.

He was hospitalized for the first time at 18. The second hospitalization came just days before he was set to start studying journalism at Humber College.

"The anxiety just built up so much that even before my college career began, mental health took its toll. I didn’t even have to go to a class," Novick said.

Society, he suggests, puts "“so much importance on degrees and diplomas, and I think the pressure of that really got to me. "

There’s also the whole new social world that post-secondary life offers up, the need to meet new people and make new friends.

"I was not in a place where that was very easy," says Novick.

"I was still severely depressed. I was still self-harming and I was still prone to bouts of mania and all of that just created a perfect storm of mental health problems that imploded a few days before I was supposed to start, and I wound up back in Sunnybrook [hospital] for the second time.”

More time in hospital

Novick did eventually enrol at Humber, and has good things to say about many staff members he encountered who offered him help and support.

But ultimately, he says, he found that his major was "no longer within my capability," particularly because he recognized that his difficulties with memory and recall would not serve him well as a journalist.

"I think it’s important to keep family and close friends in the loop about your mental health.- Jason Novick

Later, there was a second, ill-fated, post-secondary experience and another hospitalization. Still later, in the spring of 2012, with help and support from his mother, he checked himself into the Centre for Addiction and Mental Health. He was recommended for CAMH’s Alternate Inpatient Milieu program, a 28-day service for individuals with mood and anxiety disorders.

"That is the program that changed me," Novick said.

"It was magnificent. It emphasizes cognitive behavioural therapy very heavily, which I took to very quickly, and the outpatient programs that followed were also in that vein. I loved them."

Since then, Novick has been in therapy, and completed a CAMH outpatient program. He’s also volunteering in the mental health field, "working with people who have been in my situation."

For those who find themselves in a similar situation, he suggests it is vital to tell as many people as they can.

"I think it’s important to keep family and close friends in the loop about your mental health, if you are comfortable with that, because if you do then I find you feel less isolated and you have more support around you."

More help now

He also suggests that students with a mental health problem should make sure they get assessed as a student with a disability at their post-secondary institutions as soon as possible. That assessment is something that can clear the way for extensions on tests and assignments, or other assistance.

Wolfe also notes how help is available on campuses, much more so than in the past.

"There’s a lot more entry points into the mental health system today than there were even a decade ago," he says.

"College campuses, universities, all have counselling centres and my understanding is they’re very busy these days because there is more news that they’re available."

Some people suggest there is more of an epidemic of cases, says Wolfe, while others suggest the situation is more reflective of increased awareness and people being more knowledgable about getting help.

"It’s hard to say what it is, but there is help there and it doesn’t have to be a tragedy or a crisis in order to get it….

"That’s good. You have to have a system that people can enter into without a crisis."

Mental health disorders

What is bipolar disorder?

Everyone has ups and downs in mood. Bipolar disorder, or manic-depressive illness, is a serious medical condition that causes people to have extreme mood swings. Bipolar disorder typically consists of three states:

  • a high state, called mania
  • a low state, called depression
  • a well state, during which the person feels normal and functions well.

In adolescents and young adults, the symptoms may be less typical and may be mistaken for teenage distress or rebellion.

What is depression?

Clinical depression, sometimes called major depression, is a complex mood disorder caused by many factors, including genetic predisposition, personality, stress and brain chemistry. While it can suddenly go into remission, depression is not something that people can "get over" by their own effort.

Types of depression:

  • Seasonal affective disorder: This type of depression is usually affected by the weather and time of the year.
  • Postpartum depression: This occurs in women, following the birth of a child. About 13 per cent of women will experience it.
  • Depression with psychosis: In some cases, depression may become so severe that a person loses touch with reality and experiences hallucinations (hearing voices or seeing people or objects that are not really there) or delusions (beliefs that have no basis in reality).
  • Dysthymia: This is a chronically low mood with moderate symptoms of depression.

What is schizophrenia?

Schizophrenia is a long-term mental health problem. People with schizophrenia can have a range of symptoms including periods when they cannot tell the difference between what is real and what is imagined. Schizophrenia seriously disturbs the way people think, feel and relate to others.

What are anxiety disorders?

Everyone experiences symptoms of anxiety but they are generally occasional and short-lived, and do not cause problems. But when the cognitive, physical and behavioural symptoms of anxiety are persistent and severe, and anxiety causes distress in a person’s life to the point that it negatively affects his or her ability to work or study, socialize and manage daily tasks, it may be beyond the normal range.

Types of anxiety disorders:

  • phobias
  • panic disorder (with or without agoraphobia)
  • generalized anxiety disorder
  • obsessive-compulsive disorder
  • acute stress disorder
  • post-traumatic stress disorder

Source: Centre for Addiction and Mental Health


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