The Christmas Tag

I’ve been in a writing funk lately, but two of my favourite bloggers both tagged me in this fun holiday tag. With just a couple of weeks before Christmas, I thought I would give this a go! Some of you will know that I am quite anxious and can feel low at Christmas. Nevertheless, I do love this holiday!

Many thanks to Peter and Lindsay for each tagging me in The Christmas Tag created by Nicole. I welcome this opportunity to focus on the things I enjoy about my favourite holiday.

Now for the questions.

1. Do you prefer giving or receiving gifts?

I enjoy both, but I would give the edge to giving gifts. I love seeing a friend or family member’s face light up when they open up a gift that I’ve chosen for them. Choosing the right gift is something I put a lot of effort in to, out of joy rather than pressure. My loved ones are incredible and I love having the opportunity to spoil them. That said, my family and friends would also be the first to point out that I am quite the enthusiastic recipient of gifts too!

2. Do you make and stick to New Year’s resolutions?

No, I don’t. I think goal setting and self-improvement are meaningful, but I don’t like the added pressure of New Year’s resolutions.

3. Have you ever made a snowman?

Many times! I’ve never been very good at it though; my brothers have always made much better snowmen than me.

4. Is your Christmas tree real or fake, and what theme do you prefer?

I always get a real Christmas tree, but my parents all use artificial trees now. This year our tree is an oddball, it’s uneven and a bit strange looking. I think I might like it all the more for its quirks though! We don’t have a theme, though we enjoy getting fun ornaments. Last year we found a set of Harry Potter ornaments with Harry, Ron and Hermione, this year I’m adding Belle from Beauty and the Beast to the tree too.

5. Most memorable holiday moment?

One of my many favourites would be my first Christmas living with Tom. We were renting an apartment and didn’t have space for a big tree, but it was still important to us to have a Christmas tree. We found these real mini trees at our grocery store. The one we picked out was only about 2 feet tall. Starting the Christmas tradition of decorating our tree together was special, and still is.

6. What holiday traditions are you looking forward to this year?

I’m not sure to what extent I’ll get to celebrate the holidays this year. For the sake of this question I’ll take an optimistic view of things. Every year I look forward to dinner at my dad’s house, taking our annual picture at my mom’s house and playing games with my in-laws.

At my dad’s house we gather together in the evening. We exchange gifts and then have the best of all the Christmas meals. My dad is a fantastic cook and pulls out all the stops with his traditional Quebecois recipes. Sometimes after dinner we will play a round of Monopoly. My eldest brother and I enjoy teaming up against my sister-in-law, who is far too skilled at Monopoly.

At my mom’s house we typically have a dinner and sleep over for our Christmas eve, then wake up the next morning to open gifts and eat my mom’s famous oatmeal pancakes. My favourite part at my mom’s house is that my mom and stepdad always take a photo on Christmas morning of my siblings and I. It’s loads of fun flipping through Christmas photos from past years and seeing how much we have all changed. We’re all much groggier on Christmas morning as adults!

I love Christmas at my in-laws’ house too. There is always freshly baked bread at dinner and our gift exchange is a blast, especially with our dog running around trying to steal all the wrapping paper. But my favourite part of celebrating with my in-laws is definitely that we always play tons of board games over Christmas. Some years we also get to join in on Christmas celebrations with the extended family too, it’s always a load of fun seeing Tom’s grandma, aunts, uncles, cousins and their kids.

7. What is the best Christmas present you have ever received?

I can’t choose! Each Christmas present is the best because they are given with care from people I love.

8. What are your favourite holiday foods?

I am a food person, so this is another hard question to answer! I love my dad’s tarte au sucre (and doughnuts, sucre à la crème, etc.), my mom’s pancakes, my mother-in-law’s homemade bread, President’s Choice brand candy cane ice cream and the Irish soda bread that Tom makes. I like to cook a lot during the holidays too, last year I made a vegetarian mushroom-walnut roast with gravy and cranberry sauce, which was out of this world. I’ll have to make it again this year.

9. What is your favourite Christmas film?

I have two favourites, Miracle on 34th Street (1947 version) and The Muppet Christmas Carol. Tom and I started watching Christmas movies a few weeks back, we have a whole binder full and like to spend the weeks leading up to Christmas watching as many of them as we can!

10. What is your favourite Christmas song?

I have a lot of favourites. The one that’s stuck in my head right now is, “One More Sleep ‘Til Christmas” from The Muppet Christmas Carol. What I’m saying is, you must watch The Muppet Christmas Carol! Michael Cane as a singing Scrooge, Kermit the Frog as Bob Cratchit… It’s simply the best! If you haven’t seen this classic yet then you are missing out.

11. What is your favourite thing about Christmas?

Spending time with the people I love. I’m not a religious person, so the meaning of Christmas to me has always been being present with the people who matter most to me.

12. What would be your dream place to visit at Christmas time?

At Christmas time, there’s no place like home. (Tom cracked a joke that,”of course it is, you’re agoraphobic!”)

13. Who do you spend Christmas with?

Tom and I have several families to visit, so we have several Christmases. We have one celebration with his parents and his brother. We have one Christmas with my dad, my two older brothers and my sisters-in-law. And another Christmas with my mom, stepdad, step brother and step sister, and one of my older brothers, as well as all my siblings’ partners. Every year who we spend the 25th with changes. Each Christmas has its own traditions and is special in its own way.

14. When do you start getting excited about Christmas?

Probably in mid-November! Excitement and anxiety, battling it out until the holidays are past.

15. You have one Christmas wish – what will it be?

That all my family and friends have a healthy and happy 2019.

I’m tagging…

I’m not sure who celebrates Christmas and whether any of you have already been tagged, but I’m tagging Elizabeth, Joan, Khadra and Nicole. Happy Holidays!

Take care and Happy Holidays!


Photo by Toni Cuenca on Unsplash


Pick Me Up Playlist

My friend Tiara over at Muted Mouthful tagged me to share my Pick Me Up Playlist. The Pick Me Up Playlist tag was created by Laura from Laura Spoonie Blogs last month for World Mental Health Day. It’s a way for us to share the music that lifts us up. I’ve not completed any blog awards or challenges in a while now, I’m struggling to gather any concentration. Music is an important part of my life, though, so I didn’t want to let this tag slip by me!

Tiara’s blog, Muted Mouthful, is the perfect site to feel at home for anyone who is socially anxious and introverted. Among other topics, Tiara blogs about mental health in a way that can make us all feel appreciated and understood. Take a look at her recent post, “10 Everyday Victories for your Mental Health”.


From Laura Spoonie Blogs

  1. Link back to ‘Pick Me Up Playlist’ creator – Laura Spoonie
  2. Tag the blogger who nominated you
  3. Mention how music helps your Mental Health
  4. List 10 songs that you would consider to be a part of your ‘Pick Me Up Playlist’ (optional: mention a little bit why each song is on your list)
  5. Tag 10 other bloggers to join in with the ‘Pick Me Up Playlist’ Challenge

I’ve Got the Music in Me

I listen to music when I am low and need a pick me up. I listen to music when I need to calm down. There are songs for every mood and every experience. I’ve always loved to sing, and much to the detriment of my family’s eardrums, I’ve tried to learn to play the guitar and keyboard. Music is part of what makes me, me. In my teens, I was heavily involved in community musical theatre productions. I took singing lessons every week and performed as often as anyone would let me. I’m out of practice, but I still sing most every day. Both listening to music and making music are important strategies for me to cope with mental illness and maintain my mental health. Music can help us express ourselves and make us feel understood. It can rouse us and get us moving, it can also tear us apart. Music is as powerful, beautiful and important to me as anything.

My Pick Me Up Playlist

Here are ten of the tunes that seldom fail to bring a smile to my face or get me moving. I listen to them when I’m celebrating and I listen to them when I need a moment of relief from bad times.

I Heard It Through the Grapevine – Marvin Gaye

As a kid, it became a kind of tradition that every so often when I couldn’t wake up my dad would blast this Marvin Gaye classic and dance around to get me out of bed. On my grumpier mornings, I wasn’t always a fan of this tactic, but I have always loved this song and the memories it brings back for me.

I Have Confidence – The Sound of Music

Another song that brings back happy childhood memories is this anthem to overcoming self-doubt from The Sound of Music. My mom and I have shared a love of the movie adaptation of The Sound of Music for as long as I can remember. I love how over the course of this song, Maria is giving herself a pep-talk, continuously having to reassure herself of her own confidence. Singing along to this song ahead of challenging days has helped me prepare for job interviews, presentations and difficult appointments. In a musical full of amazing music, this song may be my favourite.

Don’t Stop Me Now – Queen

It’s the perfect song for keeping up a good momentum!

Heaven on Their Minds – Jesus Christ Superstar

I think what gets me the most with this song is the urgency and intensity of emotion – a good cocktail for most any song from a musical. Andrew Lloyd Webber may have sold out in recent years, but the man’s a genius. Jesus Christ Superstar has an incredible score, the accompanying album for the 1973 film adaptation is one of my favourite CDs.

Thunderstruck – ACDC

ACDC has otherworldly powers to get me air drumming and head-bopping. This song hooks me in at the first “thunder!”

I’ll Cover You – Rent

Rent is full of heart-wrenching stories and songs, which I feel make the happy moments that much more captivating. I have yet to avoid singing along to this song when I hear it, I’ll have to refrain when I finally get to see a live production of Rent.

I Feel the Earth Move – Carole King

An infinitely danceable tune with relatable lyrics by one of my favourite artists.

Feed Me – Little Shop of Horrors

Yeah, maybe it’s about a blood-thirsty plant egging poor Seymour into murder so that it can have a tasty snack… But it’s SO catchy. High on my list of favourite showtunes of all time, Feed Me is a necessary inclusion on my Pick Me Up Playlist.

Hallelujah I Love Her So – Ray Charles

I couldn’t choose whether to include a song by Ray Charles, The Beatles or Stevie Wonder, so I’m including a song that’s been performed by all three! There’s a reason why this song has been covered time and time again – it’s catchy and joyous.

Your Turn!

I’m tagging the folks I think might enjoy this the most. However, please don’t feel pressured to participate!

AndrewThe Phoenix Narrative

Brian & ChelseaTwo of a Mind

Cara Cara’s Corner

ElizabethUncustomary Housewife

FoxThe Patchwork Fox

LindsaySeeds in the Wasteland

My Simple Mind (blog)

NicoleNavigating Darkness

PeterLiving with Anxiety

That’s all for today!

Take care,


The Flawesome Award

Image from Sophia Ismaa

I was nominated by Elizabeth for the Flawesome Award. Elizabeth blogs about mental health and lifestyle topics over on The Uncustomary Housewife. She is one of my absolute favourite bloggers. I hope you will all go follow her and read her work. Elizabeth, I think you are fantastic and it means a lot to me that you thought of me for this award. Thank you.

About the Award

Sophia Ismaa created the Flawesome Award. I could paraphrase, but she said it best:

“It’s time to celebrate the flaws that make you awesome. How many times do we see an award that celebrates all things bright and shiny and sunny in a person? How often do we forget that our weaknesses can be a strength? Our flaws make us human, our flaws tell us more about who we are, and in turn we turn those flaws into awesome strengths. In short, our flaws make us #flawesome.”

( From: )

I believe we learn a lot from what we perceive as flaws, so I think this award is pretty amazing.

Rules of the Flawesome Award

  1. Link back to the creator – Sophia Ismaa Writes
  2. Display the award
  3. List 3 flaws and turn it into a strength
  4. Tag 10 other people

My Flaws & Strengths

I have difficulty discussing my strengths, so this wasn’t easy for me. I decided that given this is a mental health blog, I would take this opportunity to focus on ways in which my mental illnesses have created strengths in me. Bear with me because I don’t want anyone to think that I believe illnesses reflect badly on those who have them. Having an illness doesn’t mean you are flawed. I think illnesses are a part of life. My grandma used to always say, “everything happens for a reason”. I wouldn’t go that far, but I do think we learn things and adapt from hard times. I am going to focus on ways that mental illness negatively impacts my life that have brought about positive lessons for me.

I can be withdrawn

The flaw: My depression and anxiety disorders often lead me to withdraw from my life. I can seclude myself, not seeing anyone for months. This can negatively impact my relationships with friends and family. It also leads me to feel lonelier and more isolated which causes my depression and anxiety symptoms to worsen.

The strength: I value my friends and family above all else. I have always been someone who cares deeply about the people in my life, but my seclusion further emphasizes the importance of my social connections. I am hyper-aware of how much my loved ones mean to me. In a world where we can sometimes veer towards selfishness, I see this focus on others as a strength.

I worry excessively

The flaw: I spend much of my time anxious and worried. My anxiety is severe and impedes my functioning in very real ways. My head is always spinning with “what ifs” and worst case scenarios. I can react negatively to events, information or stimuli I am not expecting. My worry has affected my mental and physical health, and many aspects of my life.

The strength: I am organized and prepared. My files are in order, I know where most of my belongings are, I have checklists for everything and I keep an updated calendar. I worry about all sorts of possibilities arising, and I often work hard to prepare for things. This means when I go on road trips I have a binder full of directions, restaurant menus, festivals and events, addresses and phone numbers. Being organized and prepared is a coping mechanism I need to stay afloat when I am anxious. Organization and preparedness help me avoid surprises and be ready for things that come my way.

I’m not where I thought I would be

The flaw: Some of my plans for my life haven’t worked out. As a result of my mental illnesses, I am low functioning at the moment. I am 26 years old but I’m not able to work, I’m very dependent on others and some aspects of my personal life have been put on hold. I am not able to contribute financially to my family. I’m not currently able to take care of myself independently.

The strength: It took me a long time to accept that I might have to let go of things I had always planned for. I have had to re-evaluate some of my preconceptions about life. I have come to accept that it is okay to rely on others, we all do sometimes. We don’t exist independent of the help we are granted. Independence remains important, gaining further independence is a major goal of mine. But I no longer think it’s a flaw to need help or ask for it. Likewise, I used to think that ambition was a universally important character trait. I now realize that ambition sometimes comes at the expense of happiness. We can become lost in our ambitions, I’m sure I have. I have an appreciation for prioritizing the things I find most important and I’m no longer judgemental of anyone who is taking time to find their footing. It is okay to just be. There is a lot to be said for a life of balance.

My nominees

These are the bloggers who I want to recognize for their work. I hope you will go visit them on social media and check out their blogs.

To the bloggers: I’m sure many of you have already received this award. There’s no pressure to keep it going, I just think you are wonderful.

Ain’t No Atlas


Dr. Ashley

The Panicked Foodie


Brian & Chelsea

Two of a Mind

@Brian_ToaM & @Chels_ToaM


Carys Emma Blog



The Fractured Light



My Best Friend Adeline



The Good The Human



Seeds in the Wasteland



Navigating Darkness



Mentally Speaking



Thanks again to Elizabeth for nominating me. It turned out to be a great exercise for me to identify strengths and lessons I have gained.

Take care,


Blogger Recognition Award

Photo by Jess Waters on Unsplash

I’m very touched to have been nominated for another blogger award. Nicole from Navigating Darkness has nominated me for the Blogger Recognition Award. This award is given between bloggers in recognition of each other’s work. It means a lot to me that my writing is being read and appreciated by amazing people like Nicole.

Nicole not only blogs candidly about her mental health, she is also always coming up with ways to bring the mental health blogging community together in advocacy and awareness initiatives. I believe she is still accepting submissions for her post series “Taking Care of Your Mental Health During the Holiday Season” which I will be contributing to. She has also created The Mental Health Awareness Project (MHAP). The MHAP launches in 2019 and aims to raise awareness through monthly mental health topics which bloggers can contribute pieces to. You can also find both Nicole and the MHAP on Twitter at @ItsNicoleCarman and @OfficialMHAP.

How the Blogger Recognition Award works

  1. Write a post to showcase your award
    2. Give a brief story of how your blog started.
    3. Give two pieces of advice for new bloggers.
    4. Thank those that nominated you and link their blog
    5. Select other blogs to give the award to.

How Like As The Waves Started

I’ve written about the origins of this blog before and to find out all the details you can visit my post for the Sunshine Blogger Award. It’s worth noting, brevity wasn’t something I aimed for in that particular description.

I began blogging in response to the overwhelming support and encouragement I received from friends and family after beginning to share openly about my mental health on Facebook. I began sharing updates with my loved ones from the hospital in 2017 and the support I received completely floored me. I have always loved to write and wanted an outlet to do so. After my wedding last October I was looking for something meaningful to do with my time. I started Like As The Waves in November 2017 and am so glad I did. I am learning and growing from writing about mental health and mental illness. I am also glad to be connecting with some inspiring and supportive people who I feel privileged to get to know online.

Advice for New Bloggers

It is strange for me to offer advice to new bloggers, given I feel like quite the newbie myself! However, as it is part of the award, here are two things I try to adhere to as a blogger.

  1. Be yourself.

Always be yourself. The blogs I admire most are written by people who write with an authentic voice. Sure, there is a lot of information out there on how to best run a blog, but none of that advice will work for you if it isn’t true to who you are. Write about what feels important or interesting to you in a way that is true to who you are. Your blog will be much more compelling that way. William Shakespeare wrote it best, “this above all: to thine own self be true”. That quote has been my absolute favourite since I read Hamlet many fortnights ago. Honest, I even have a necklace with that quote engraved on it. (Bonus piece of info – did you know my blog title is the opening words to my favourite Shakespearean sonnet? More on that in a blog post soon). Point being, I think blogs are best when they are backed by honesty and passion. The best way to fuel those in to your blog, in my humble opinion, is to be yourself.

  1. Don’t be afraid to share your work

Your blog is probably pretty awesome, make sure others know it exists. I am still painfully bad at promoting my blog, but I do try to always share the pieces I write. I suggest acquainting yourself with Twitter if you haven’t already. While I was pretty excited to write a blog even when my readership was mostly just one person (hi mom) it has been nice to connect with a broader community on Twitter. By sharing my work and seeking out the work of others I have made some great friends and learned a lot.

If you are a mental health blogger starting out on Twitter, the @SickNotWeak and @KeepTalkingMH communities are a great place to start looking for other advocates to engage with. Start using their hashtags #SickNotWeak and #KeepTalkingMH for your own tweets and search out those hashtags for awesome community members to follow and connect with. Nicole’s new project @OfficialMHAP is another great community to connect with on Twitter, use the hashtags #MHAP and #MHBlogFam.

Probably the most gratifying response I receive from my blog is from family and friends. I often feel vulnerable or embarrassed when I share my blog posts on Facebook for them to see, but I try to do it anyways. It’s been great for the people I care about to get to know me better, and has allowed some of them to feel comfortable opening up to me about their own struggles.

My nominees

Here are some of the writers whose blogs I am most grateful for! If you choose to make a blog post about this award, please let me know so that I can read your responses. I would love to hear what advice you have to share for other bloggers.

I hope anyone reading will check out these thoughtful writers and their blogs.


The Calculating Mind


Anja is a mental health advocate living with Bipolar Disorder. She writes from a mixture of personal experience and insight into broader issues. The intersection of research and personal stories makes her blog a favourite of mine. One of her recent pieces, “3 Assumptions Mental Health Providers Should NOT Make”, spoke to me on a very personal level as someone who has been on the receiving end of those harmful assumptions. She is also a great presence on Twitter and perhaps the only other person who I know to have gotten excited at receiving a DSM-5 as a gift.


The Uncustomary Housewife


Elizabeth is a longtime blogger who writes about her Bipolar Disorder, Obsessive Compulsive Disorder and Anxiety, along with other lifestyle topics. I love her blog not only for her own brilliant pieces about mental health, but also for her Not Alone Series which features stories and interviews from other individuals with mental illness. She is also wonderfully geeky and her love of Broadway makes me infinitely happy.


Worn Pages and Ink


Jaaron is a book blogger and close friend of mine. Long before I read any other blogs, I was reading Jaaron’s! She has a knack for relaying the essence of books. After reading her recent review of “Tin Man” by Sarah Winman I wasted no time in running to Amazon to order a copy! I’m forever jealous of her beautiful books organized by colour. Most importantly, she is a beautiful person, amazing friend and talented writer. If you love books (or want to read reviews that are sure to make you love books), hop on over to her blog.


The Good The Human


Khadra’s blog focusses on mental wellbeing. She is a trained counsellor whose blog is uplifting and informative. She frequently shares insightful advice on maintaining mental health and supporting those who are struggling. Her recent blog “How Would You Respond? Part 2” about responding to self-harm beautifully captures how to be helpful to someone who discloses their self-harm to you. She has also recently co-created the Mental Health Crisis Angels (@MHCrisisAngels on Twitter). The Mental Health Crisis Angels are a group offering peer support through Twitter messages. You can find out more about this amazing initiative here.

Thanks for reading! I hope you will show some love to the amazing blogs I linked to. Thank you again to Nicole for nominating me, it was fun to put this together. I will be back, hopefully later this week, with a new blog entry.

Take care,


Emergency Departments Should Do More for Suicide Prevention

Photo by paulbr75 on Pixabay

Every day, suicidal individuals are sent home from the emergency room with little to no follow up. I believe this to be one of the greatest threats to effective suicide prevention.

Today is World Suicide Prevention Day. I feel the need to add to this important conversation, not only because of my personal relationship with suicide but also because suicide often fails to be recognized for the serious health issue it is. The World Health Organization estimates that about 800,000 people worldwide die by suicide every year. In Canada every day 10 people die by suicide and 200 attempt suicide. In Ontario alone 1327 people died by suicide in 2014. In short, we need to talk about suicide prevention.

Discussions about suicide prevention are not complete without looking at necessary improvements to our hospital mental health systems. While hospitals, doctors and other mental health professionals work tirelessly to support their at-risk patients, there remain major flaws in the availability, accessibility and adequacy of services provided. Not the least of these problems occurs when suicidal patients are denied care in hospital emergency departments.

The Problem

Imagine for a moment that you feel there is no reason to live. You feel that you can’t stand to go on any longer and have made plans of how to kill yourself. Imagine you reluctantly make it to the hospital, perhaps of your own will or perhaps at the urging of someone who cares. With one last shred of hope, you think maybe the hospital will help you, and what do you have to lose? You wait for hours, growing more jaded as time goes on. After sitting in the hospital all night in high emotional distress receiving only cursory information from busy ER nurses, you finally see a doctor. You describe to them that you plan to kill yourself, you explain your plans, describe your hopelessness and pain. Imagine that doctor, after only spending a few minutes with you, sending you home without offering help. Imagine feeling even more worthless and hopeless, because even the system that is in place to save lives turns you away. Imagine feeling as though doctors are telling you that you are not worthy of being saved. You return home, emotions heightened, even more certain than before that your life has no value.

This happens every day. Every day people who have decided to end it all are turned away from the very systems there to protect them. While my experiences with the ER have often been positive, this has happened to me. It is one of the worst feelings imaginable, to be at the end of your rope and have your attempt to access care rejected. Few things have made me feel less worthy of living than being sent home from the emergency room when I am a threat to myself. To add insult to injury there is often no follow up even when follow up is promised. While this is certainly not the intention of the hardworking emergency department medical staff, the message I internalize from these events is loud and clear, “Your life is not important and you do not deserve to be saved.” When in the depths of a suicidal episode even the act of being assessed by a doctor for my risk of suicide feels stigmatizing. Being asked questions with the obvious motive of trying to uncover whether I am “suicidal enough” is humiliating. Shouldn’t it be enough that we are asking for help?

Suicidal patients like myself and our caregivers have been placed in the position of having to advocate for our need for care during crisis. As a suicidal person, it isn’t easy when you do not believe you should live to present yourself to the hospital and advocate for care to keep you alive. In fact, it’s one of the hardest things I have ever done. Caregivers too are placed in difficult positions, often having to advocate for care they feel is desperately needed, sometimes against the wishes of their loved one. My husband has had to advocate me, and I know it hasn’t been easy for him to simultaneously convince me to accept treatment and convince doctors of my need for treatment. I am forever grateful that he has endured that stress, it has saved my life. These self-advocacy measures should not be necessary. We shouldn’t have to convince doctors of our honesty, our intent and our need for treatment, out of fear of being sent home with no answers.

I believe the result of these interactions with hospital emergency departments can foster a distrust of mental health systems. It is dangerous, I believe, to contribute to a person’s feeling that their suicidal ideation, plans and actions will not be taken seriously. I know many people, myself included, who have at one time or another refused to go to the hospital due to the belief that they will not receive care and their time there will only make things worse. Surely, contributing to that belief is not what hospitals should be doing for suicidal individuals. Emergency departments have a key role in suicide prevention and sadly they are not always up to the task.


Photo by blickpixel on Pixabay

Why I Think This Happens

There are, of course, many reasons why doctors might choose not to admit a suicidal patient to the hospital. A hospital admission isn’t always in the best interest of the patient. For one, there is a broad range of what qualifies as “suicidal” and not everyone who has thoughts of suicide is an immediate risk to their own safety. According to The Suicide Risk Assessment Guide by the Ontario Hospital Association (pg. 25), doctors in emergency settings should assess the risk of suicide by determining the patient’s actual level of intent to die by suicide and evaluating whether the patient is telling the truth about wanting/not wanting to die by suicide. Based on the assessment of risk of suicide, doctors determine the level of care needed and should, ideally, help connect the patient to the appropriate level of care. In Ontario we have a shortage of psychiatrists, hospitals are frequently operating over capacity, wait times for mental health services are long. I imagine that those constraints add an additional level of difficulty in pairing suicidal patients with the treatments they require. However, sending suicidal patients home without follow up care or even a safety plan is irresponsible.

Finding Solutions

Solving this issue isn’t straight forward. This is not about a few stigmatizing doctors who believe their suicidal patients are just attention-seeking (though that is sometimes the case). Often, the capacity to offer timely help to every person who needs it is simply not there. In many places, hospitals don’t have enough rooms or enough beds or enough staff or enough funding to offer immediate support to every suicidal person who comes looking for it. In an ideal world, everyone who has plans to end their life would have a place in the hospital until they are truly safe to go home. Fixing this problem isn’t as simple as admitting every patient who may be at risk to the hospital. As it stands, at least here in Ontario, that just isn’t possible.

There are ways that I believe the emergency departments can contribute to suicide prevention. Information about free community services with low wait lists should be shared. Peer support groups, for example, can be helpful in suicide prevention and often do not have waitlists. Helping the patient create a safety plan can also be beneficial. Follow up from the hospital (calls or appointments) is another way to not only check that patients are okay, but also to reassure patients that they are a priority and have not been forgotten. Doctors should make sure the patient has a mental health professional or family doctor they can follow up with soon. You would think that all of these practices would already be used consistently, but that is not the truth of my experience or the experience of many of the people I have interacted with. The result of a hospital visit due to a suicide attempt or suicidal plans should never be nothing. No suicidal patient wants to feel that they are met with apathy at the hospital. We are failing to prevent suicides by letting suicidal individuals slip through the cracks. When all else fails, compassion from the emergency department medical team can save a life. I should know, it has saved mine.

My own personal experiences with visiting the emergency department when I am suicidal have varied. At times, I am treated with compassion and a level of concern appropriate to the severity of my condition. At other times, I have been sent home without any help, care or follow up. At the worst, I have felt stigmatized and humiliated by the words and actions doctors. My experience is not unique. There are many people who are turned away from the hospital when they truly need help. If you need any evidence of that, I suggest you start looking at the mental health community on Twitter. I see stories every day of people turned away from the emergency room without help, even when they have no other supports in place.

With all that said, I am deeply grateful to the doctors, nurses and administrators at hospital emergency departments who have helped me in the past. I have had some very positive outcomes from ER visits.

Suicide prevention is something I can’t help but care about deeply. Once you have been suicidal, you understand how big the discrepancy is between the need for effective emergency care to help suicidal individuals and what is actually available. We are told to report to our nearest hospital emergency room when we are in crisis, we should be able to expect to receive real help when we do.

Take care,