A self-care program for youth
Reprinted from "Treatment for Young People" issue of Visions Journal, 2006, 3 (1), p. 24-25
It has been estimated that 3.5% of children and adolescents, or about 35,000 British Columbia youth, suffer from depression in any given year.1 This rate increases signiﬁ cantly during adolescence, particularly for girls. It is even higher if we include those youth with ‘low mood’ or who have depression in addition to family, social or school difﬁ culties, or who have depression along with another physical or psychiatric disorder. The lifetime burden of depression is huge for the affected individuals, their families and society at large. Episodes of depression repeat for many people and, for some, may be a chronic disease.
So, there is a strong argument for providing early, accessible and effective assessment and treatment for depressed youth. There are two types of treatments that have proven to be helpful for such teens: medication and psychological treatments (cognitive-behavioural therapy and/or interpersonal therapy). Medications have been the primary treatment to date, but concerns have recently been raised about their safety and side effects. Psychological treatments do not have these safety issues, but are not easily available within the public health care system for most teens.
In response to this situation, the Child and Youth Mental Health Branch, Ministry of Children and Family Development, looked for innovative ways of improving access to care for depressed youth. One approach that has been very useful in providing care for a number of concerns, including mental health disorders, is called self care.
Taking aim with self care
A self-care approach means providing consumers with information, about the management of their particular health condition, that is:
based on the best available evidence on effective assessment and treatment strategies
timely, so it can be available to individuals who are at risk for, or in the early stages of, a mental disorder.
accessible to everyone, especially those who may not use conventional health services
complementary to, or supportive of, other psychological or medical intervention
available for free, or at low cost, in multiple ways, including print and on the Web
Fortunately, such a program existed for depressed adults: the Antidepressant Skills Workbook. We used this as a framework and developed a guide for teens based on up-to-date scientiﬁ c literature about what is most useful for helping depressed youth. The challenge was to adapt this format for youth, recognizing that child and youth mental health needs, issues and expectations are unique.
We wanted to make sure that the content, examples, illustrations, format and style were appropriate. We recognized that we were not the best judges of that, so went to those who are: teenagers. We held a series of meetings with both depressed and non-depressed youth, gave them draft copies of a guide, and asked them about its clarity, appearance and usefulness. We also met with parents, school counsellors, mental health practitioners, physicians and other concerned adults to get their input, as we recognized that they would be important in supporting youth to access and use the guide.
Antidepressant skills for teens
The result of this process is Dealing with Depression: Antidepressant Skills for Teens. It provides useful information and skills about managing mood for teenagers between ages 13 and 17. It is not intended to diagnose depression or to be a substitute for medical or psychological mental health treatment, but may complement such care when it is required. It is probably most appropriate for youth experiencing low mood or mild depression.
Dealing with Depression talks about the difference between depression and feeling sad and provides a model of depression that emphasizes the relationship between thoughts, feelings, emotions, actions and our physical state. Three core skills are then described: realistic thinking, problem solving and goal setting. These are accompanied by worksheets and brief stories about teens effectively using the skills. Finally, the guide provides suggestions to enhance motivation to change, manage lifestyle issues and deal with possible relapse.
The creation of Dealing with Depression was accompanied by a set of recommendations to ensure that the guide would be accessible and useful for as many youth, their families and concerned adults as possible.
These recommendations included:
providing free electronic and print copies
distributing to mental health, education and other governmental agencies concerned with children
forming partnerships with professional, private sector and public sector organizations to help promote the guide
translating the guide into different languages
transcribing the guide into a ‘talking book’ for youth who have difﬁ culties with reading
publicizing the guide at appropriate public and professional conferences and media events
developing brief workshops for parents and professionals on how best to introduce the guide to youth, and how to support them appropriately as they go through it
Dealing with Depression is unique, but is nevertheless only one component in a broad response to the challenge of addressing the mental health needs of children, teens and families. It was produced because of the efforts and support of government and professionals, but came alive because of the honest input from those involved—youth and families. We hope that this effort will reach those who need it, and help them to build and sustain their psychological health and well-being.
Print copies of Dealing with Depression can be obtained from the Child and Youth Mental Health Branch, Ministry of Children and Family Development, by calling 250-387-9749, or e-mailing [email protected]
The guide is also available for download in French and English—including a ‘writable’ version that allows users to complete the exercises on their computer—at the Centre for Applied Research in Mental Health and Addictions website at www.carmha.ca
About the Author
Merv is a psychologist who provides clinical and consultation services to individuals and families, government and the private sector, and he works at BC Children’s Hospital
Waddell, C., Offord, D., Shepherd, C. et al. (2002). Child psychiatric epidemiology and Canadian public policy-making: The state of the science and the art of the possible. Canadian Journal of Psychiatry, 47, 825–832
Bilsker, D. & Paterson, R. (2005). Antidepressant skills workbook (2nd ed.). Vancouver, BC: Centre for Applied Research in Mental Health and Addiction, Simon Fraser University.
Bilsker, D., Gilbert, M., Worling, D. & Garland, J. (2004). Dealing with depression: Antidepressant skills for teens. Vancouver, BC: Mental Health Evaluation and Community Consultation Unit, University of British Columbia.