By: Cheryl Murphy

1
By Cheryl Murphy 100138330
2
Types of Depression
1.Dysthymia is chronic ongoing mild depression
and occurs when a child f
eels a little down most of the time for a year or
more. 2. Major depression is an illness in w
hich a person has a severely depressed
mood and no longer enjoys
his life. 3. Depression associated with bi-pol
ar disorder (also called manic-depressive
disorder) have moods with
extreme ups and downs.
Government of South Australia website. Teenage
Depression. http//www.cyh.com/HealthTopics/Heal
thTopicDetails.aspx?p114np141id1751
3
Facts About Depression

• Major depression has been estimated at 1 to 3
  in young children and between 3 and 9 in
  adolescents. These estimates
  
• are higher when young people with minor
  depression are included.

http//www.bchealthguide.org/kbase/topic/major/ty4
640/course.htm
4
Symptoms of Dysthymia

• A person with dysthymia may
• gradually lose interest in things they have
  enjoyed doing and appear to be more down most
  of the time
  
• have less energy and find it difficult to
  concentrate
  
• have trouble with eating and sleeping patterns
• the most common factor is feeling bad about
  themselves and having less confidence and
  enjoyment in their lives
  
• Dysthymia is more serious than just a depressed
  mood alone and may need professional assessment
  

Government of South Australia Teenage
Depression http//www.cyh.com/HealthTopics/Healt
hTopicDetails.aspx?p114np141id1751
5
Symptoms of Major DepressionAdolescents with
depression may display some of the following signs

• being angry or irritable a lot of the time
• temper tantrums and shortness of temper
• negative attitude a lot of the time
• overreaction to criticism, irritability
• excessive worry about physical health
• unexplained aches and pains, such as headaches or
  stomach pain
  
• difficulty thinking and making decisions
• problems with sleeping or sleeping too much
• changes in eating habits that lead to weight gain
  or loss or not making expected weight gains
  
• low self-esteem
• feelings of guilt and hopelessness
• constant tiredness or lack of energy
• feeling that nothing is worth the effort
• social withdrawal, such as lack of interest in
  friends and not wanting to go out
  

• loss of interest or enjoyment in his usual
  activities quitting favorite activities
  
• poor concentration with school work or other
  things
  
• missed school, poor school performance and/or a
  sudden decline in grades
  
• being sad or tearful
• anxious worrying and intrusive upsetting
  thoughts
  
• feeling guilty and to blame for things going
  wrong
  
• increasing drug and alcohol use
• not taking care of how he looks or of hygiene
• pains
• carelessness about physical safety
• behaviour problems and delinquency
• having thoughts about being better off dead or
  that life is not worth living
  
• preoccupation with death and suicide.

Compiled from 1) Help Guide.org Teen Depressi
on 2) Government of Sou
th Australia Teenage Depression
3) Psychology
Information Online Depression in Teenagers
6
Causes of Depression in Teens

• Stress
• Loss
• Major disappointment
• Chemical imbalance
• Genetic disposition
• Some medications (i.e. narcotics, steroids) may
  trigger depression
  
• Traumatic events (violence, abuse, neglect)
• Social problems
• Unresolved family conflict

http//www.bchealthguide.org/kbase/topic/major/t
y4640/course.htm
7
Diagnosis

• If your child or teen has mild or moderate
  depression, he or she may be diagnosed and
  treated by your family doctor, general
  practitioner, or pediatrician and a therapist or
  psychologist. A doctor who specializes in the
  diagnosis and treatment of mental health problems
  (psychiatrist) may be helpful for severe
  depression or other mental health problems that
  occur with depression.
• Sometimes a stay in the hospital may be needed if
  the child or teen has suicidal thoughts and is
  likely to act on them or has other health
  conditions, such as a long-term disease, an
  eating disorder, or another mood disorder.

Government of British Columbia- B.C. Health
Guide Depression in Childhood and Adolescence
http//www.bchealthguide.org/kbase/topic/major/ty4
640/course.htm
8

• Automatically, when the disorder depression is
  mentioned normally one directly associates it
  with sorrow. But it is significant to note that
  even if in adults, sorrow characterizes much of
  the depressed experience, in teenagers or those
  younger, depression does not necessarily emerge
  as sorrow. Feelings of anger may actually be
  manifested in hostile or defiant behavior in
  teenagers, as a way of expressing their
  depression. A bad temper may also serve as a sign
  of depression.
• If your child becomes depressed, he/ she is
  unlikely to talk about it. Your first warning
  signs will probably be changes in behaviour that
  may suggest a troubled and unhappy state of mind.

Parenting Advice for Troubled Teens
Misdiagnosis of Depression http//www.troubledte
ensinfo.com/Mental_Health_Problems/Teen_Depression
/Misdiagnosis_of_Depression_in_Troubled_Teens/
9
Consider..

• It was once thought that only adults developed
  depression and that children and teens could
  not.
  
• Symptoms of depression in children and teens can
  be difficult to recognize.
  
• Mood swings and other emotional changes caused by
  depression may be overlooked as unimportant or as
  a normal part of growing up.
  
• At one time it was a common belief that
  depression is "all in the mind" and that a
  depressed person should be able to snap out of
  it. We now know that depression is an illness
  that requires treatmentnot a character flaw or
  weakness.
• Prolonged or severe depression can lead to
  problems making and keeping friends, difficulty
  in school, substance abuse, suicidal behaviour,
  and other problems that may carry into adulthood.

Government of British Columbia- B.C. Health
Guide Depression in Childhood and Adolescence
http//www.bchealthguide.org/kbase/topic/major/ty4
640/course.htm
10
Myths About Depression

• Myths about depression often prevent people
  from doing the right thing. Some common myths
  are
  
• Myth It's normal for teenagers to be moody
  teens dont suffer from real depression. FACT
  Depression is more than just being moody, and it
  can affect people at any age, including
  teenagers.
• Myth Telling an adult that a friend might be
  depressed is betraying a trust. If someone wants
  help, he or she will get it. FACT Depression,
  which saps energy and self-esteem, interferes
  with a person's ability or wish to get help. It
  is an act of true friendship to share your
  concerns with an adult who can help.
• Myth Talking about depression only makes it
  worse. FACT Talking through feelings with a good
  friend is often a helpful first step. Friendship,
  concern, and support can provide the
  encouragement to talk to a parent or other
  trusted adult about getting evaluated for
  depression.

Psychology Information Online Depression in
Teenagers http//www.psychologyinfo.com/depressi
on/teens.htmMyths
11
Remember.

• Having depression doesn't mean that a person is
  weak, or a failure, or isn't really trying...it
  means they need treatment.1
  
• By getting to the root of a teens depression the
  likelihood of it resulting in suicide is greatly
  reduced, if not eliminated.2
  
• Do not wait and hope that symptoms will go away
  on their own.3
  
• Parents need to recognize when their adolescent
  is distressed. They must be careful not to
  disregard real emotional difficulties and
  mistakenly assume that these are due to physical
  changes associated with adolescence.4

1.Advance Behaviorial Consultants Lets talk
About Teen Depression http//www.healthsurvey.com
/teendepression.htm 2, Help for Troubled Teens
Identifying Teen Depression http//www.troubledte
ensinfo.com/Mental_Health_Problems/Teen_Depression
/Identifying_Teen_Depression/ 3. HelpGuide.ordTe
en Depression http//www.helpguide.org/mental/dep
ression_teen.htmsymptoms 4.Health Canada Attach
ment to Parents and Adjustments in Adolescence
http//www.phac-aspc.gc.ca/dca-dea/publications/pd
f/attachment_e.pdf
12
How is Teenage Depression Treated?

• Depression is commonly treated with therapy or
  with therapy and medication. A combination of
  approaches is usually most effective
  
• Cognitive-behavioral therapy focuses on the
  causes of the depression and helps change
  negative thought patterns.
  
• Group therapy is often very helpful for teens,
  because it breaks down the feelings of isolation
  that many adolescents experience (sometimes it
  helps just to know that "I'm not the only one who
  feels this way").
• Family therapy as an adjunct to individual
  therapy can address patterns of communication and
  ways the family can restructure itself to support
  each member, and can help the teenager feel like
  others share the responsibility for what happens
  in the family.

• Physical exercise is helpful in lifting
  depression, as it causes the brain's chemistry to
  create more endorphins and serotonin, which
  change mood.
• Creative expression through drama, art or music
  is often a positive outlet for the strong
  emotions of adolescents.
  
• Volunteer work is sometimes helpful for
  adolescents. Helping someone else whose problems
  are greater than one's own offers a perspective
  and also an opportunity to be helpful, which can
  increase one's sense of purpose and meaning.
• Medication for depression should be used with
  great caution, and only under careful
  supervision. Recent studies by both the UK
  government and the FDA have led to warnings that
  not all psychiatric drugs may be appropriate for
  teenagers and children. Seek a physician who
  works specifically with teenagers.
• Hospitalization may be necessary in situations
  where a teen needs constant observation and care
  to prevent self-destructive behavior. Hospital
  adolescent treatment programs usually include
  individual, group and family counseling as well
  as medications.

Helpguide.org Teen Depression
http//www.helpguide.org/mental/depression_teen.ht
msymptoms
13

• Special schools, wilderness challenges, or "boot
  camps" are sometimes recommended for troubled
  teens. These alternatives are intended to help
  adolescents learn coping skills, develop
  confidence, learn to trust and work with others,
  improve academics and/or deal with negative
  behaviors. Whether or not they are good options
  largely depends on the staff running the program.
  In many cases, they are not trained mental health
  professionals and may use confrontation,
  humiliation and punitive measures designed to
  break down resistance rather than build up
  internal strengths. Sometimes these programs do
  more harm than good, and can even result in worse
  outcomes for adolescents. Before considering such
  alternatives, do careful research on their
  philosophy, methods, and the background of their
  employees.

Helpguide.org Teen Depression
http//www.helpguide.org/mental/depression_teen.ht
msymptoms

14
What parents can do for their teen

• Respond with love, kindness, and support.
• Repeatedly let your child know that you are
  there, whenever she or he needs you
  
• Be gentle but persistent if your adolescent shuts
  you out (depressed teenagers do not want to feel
  patronized or crowded). Do not ask a lot of
  questions, but make known your concern and your
  willingness to listen.
• Do not criticize or pass judgment once the
  adolescent begins to talk (the important thing is
  that he or she is talking and communicating
  feelings).
• Encourage activity and praise efforts to
  socialize and be active.
  
• Seek help from a doctor or mental health
  professional if the adolescent's depressed
  feeling doesn't pass with time. Be prepared to
  list behaviors, note how long and how often they
  have been occurring, and how severe they seem.
• Do not wait and hope that symptoms will go away
  on their own. When depression is severeif
  adolescents are thinking about hurting themselves
  or about suicideseek professional help as soon
  as possible.

Helpguide.org Teen Depression
http//www.helpguide.org/mental/depression_teen.ht
msymptoms
15

• Never treat depression as if it is simply teenage
  'blues' - always take
  
• it seriously.
• Encourage your child to seek help by providing a
  list of contacts for her to choose from.
  
• If your teenager won't go for help and you are
  really worried, go by yourself first and get some
  advice about how to best handle the situation.
  
• Show love and concern - this doesn't mean that
  you have to agree with everything your child does
  or wants to do, but young people need to know
  that you still love them no matter who they are
  or what they do.
• Take time to listen when your teenager wants to
  talk about her feelings.
  
• Show her that you are available without being
  'pushy'.
  
• Encourage her to do things you know she enjoys.
• Notice the little things she does that you
  approve of.
  
• Make sure that you do not keep a gun in your home
  or shed. (Farmers need to be very careful about
  where they store guns because this is the method
  often used in youth suicides in country areas.)
• Take seriously any talk about suicide and actions
  such as giving away special things. Do whatever
  is needed to protect your child's safety - even
  if it is against her wishes.

Government of South Australia Teenage
Depression http//www.cyh.com/HealthTopics/Healt
hTopicDetails.aspx?p114np141id1751
16
More helpful actions.

• The first thing to do is to help your teenager
  set realistic short-term goals. Ask him for
  suggestions on how he would like to improve his
  life. Then help him identify some simple steps he
  can take to achieve these goals. Remember not to
  set goals, which are unattainable, as this will
  just reinforce his belief that he is a failure.
  On the other hand, do not aim for things that are
  easily attainable. The whole idea is that your
  teenager must feel that he has been equal to the
  challenge. 
• Make sure that you encourage him at every step
  and help him in every way possible without
  actually doing his work for him. For instance, if
  he wants to audition for a play, help him
  rehearse and boost his confidence without giving
  him false hope.
• If he fails to reach his set goals, do not try to
  sweep it under the carpet and smooth it over with
  inanities like "you'll do better next time."
  Acknowledge his failure and discuss why it
  happened. Maybe he gave up too easily or didn't
  study hard enough or had a panic attack. It's
  important to get this out in the open so that you
  know what your teenager attributes his failure to
  and correct any misconceptions that he may have.

India Parenting Pvt. Ltd. Helping you Teenager
Overcome Depression http//www.indiaparenting.co
m/raisingchild/data/raisingchild058.shtml
17

• Do not compare your teenager to his peers and
  find him wanting. Don't say things like "why
  can't you be like that?" You will just be
  reinforcing his belief that he's not good enough
  the way he is, even for you. You have to teach
  him that he can admire others without necessarily
  envying them. If he comments in an envious tone
  about another teenager's attributes, admit that
  the other child is good, but point out something
  that your teenager is good at.
• Depressed teenagers tend to vacillate over every
  decision. This is because they don't trust their
  own judgement and need to be constantly reassured
  that they are doing the 'right thing.' You have
  to help your teenager make decisions in a way
  that he will learn to trust his own judgement. It
  is also important that you insist that once he
  has made a choice, he must go through with it and
  cope with the consequences, whatever they are.
• Short-term measures like buying your teenager
  tickets to a concert or taking him for a holiday
  are not going to alleviate his depression. You
  are going to have to sit down and talk to him
  about what exactly it is that bothers him and how
  he can overcome it. You have to take steps to
  make him feel empowered so that he feels that he
  can effectively accomplish the things he sets out
  to do.

India Parenting Pvt. Ltd. Helping you Teenager
Overcome Depression http//www.indiaparenting.co
m/raisingchild/data/raisingchild058.shtml
18

• Encourage your child to
• Get regular exercise, such as swimming, walking,
• or playing vigorously every day.
• Avoid alcohol and illegal drugs, non-prescription
  medications, herbal therapies, and medications
  that have not been prescribed (because they may
  interfere with the medications used to treat
  depression).
• Get enough sleep. If your child has problems
  sleeping, he or she might try
  
• Going to bed at the same time every night.
• Keeping the bedroom dark and quiet.
• Not exercising after 500 p.m.
• Eat a balanced diet. If your child lacks an
  appetite, try to get him or her to eat small
  snacks rather than large meals.
  
• Be hopeful about feeling better. Positive
  thinking is very important in recovering from
  depression. It is difficult to be hopeful when
  you feel depressed, but remind your child that
  improvement occurs gradually and takes time.

Government of British Columbia- B.C. Health
Guide Depression in Childhood and Adolescence
http//www.bchealthguide.org/kbase/topic/major/ty4
640/course.htm
19
Parenting a teenager who is under severe stress
or suffering depression can be
very stressful. At times it may seem as if your
child is deliberately not trying or misbehaving
. When you find yourself feeling angry or frustra
ted (and you will!)
Government of South Australia Teenage
Depression http//www.cyh.com/HealthTopics/Healt
hTopicDetails.aspx?p114np141id1751
20

• Take a step back and think about what is
  happening before you react.
  
• Remember to hang in there, your child needs your
  love even if she seems to reject it.
  
• Think about your own views
• Are you wondering "Why should I have to put up
  with this terrible behaviour?" This thinking will
  make the situation worse.
  
• Are you thinking "Something must be wrong for my
  child to be behaving like this"? This thinking
  will lead to a search for the cause.
  

• Ask people close to you for support.
• Ask someone the young person is close to (eg
  another relative) to help provide support - but
  make sure your child knows that you're not
  rejecting her.
• Make sure you do things for yourself - you need
  to take care of your own needs if you're to help
  your child.
  
• Get professional help for yourself if you feel
  you are struggling.

Government of South Australia Teenage
Depression http//www.cyh.com/HealthTopics/Healt
hTopicDetails.aspx?p114np141id1751
21

• Recognize your own feelings about your child's
  depression. you might find that you are feeling
  guilty or frustrated. Without wanting to, you may
  let your child know this and make him / her feel
  rejected and misunderstood.
• You should also be honest with brothers and
  sisters, and other family members about your
  depressed child's needs. That way, he / she will
  have several sources of support and
  understanding.

Canadian Mental Health Association Children and
Depression http//www.cmha.ca/bins/content_page.
asp?cid3-86-87-90lang1
22
Suicide

• Most people who are depressed do not commit
  suicide. But depression increases the risk for
  suicide or suicide attempts.

Psychology Information Online Depression in
Teenagers http//www.psychologyinfo.com/depressi
on/teens.htmMyths

23
Myths about Suicide

• People who talk about suicide won't do it. Almost
  everyone who commits suicide gives some clue or
  warning.
  
• Anyone who tries to commit suicide must be
  crazy. It isn't as simple as this. Suicidal
  thinking isn't necessarily a sign of mental
  illness. In young people depression is almost
  always behind suicidal thinking. Often no one has
  realized that the young person was depressed.
• If people really want to kill themselves nothing
  will stop them. What they usually want is for the
  pain to stop. The feeling of wanting to end it
  all doesn't last forever. In fact, sometimes it
  doesn't last for long at all, particularly if
  things in the person's life change.
• People who complete suicide don't seek help
  before their death. More than half of the people
  who commit suicide have been to their doctor for
  help in the six months before their death, though
  they may not tell their doctor they are thinking
  of suicide.
• Talking/asking about suicide may give someone the
  idea. The opposite is true. Discussing suicide
  openly helps people talk about their feelings and
  to look for other ways to stop the pain.

Government of South Australia website. Teenage
Depression. http//www.cyh.com/HealthTopics/Heal
thTopicDetails.aspx?p114np141id1751
24
Facts about Suicide

• Teens with depression are at particularly high
  risk for suicide and suicide attempts.
  
• In Canada, approximately 400 teens commit
  suicide each year.
  
• While teen girls attempt suicide almost twice as
  often as teen boys, boys are more likely to
  succeed because girls usually use less lethal
  means and survive the attempt.
• Suicide attempts in children younger than age 12
  are uncommon.
  

Government of South Australia Teenage
Depression http//www.cyh.com/HealthTopics/Healt
hTopicDetails.aspx?p114np141id1751
25

• Suicide is the leading cause of death among youth
  in British Columbia and the 2nd leading cause of
  death among youth overall (ages 15-24) in Canada
  
• Teen/youth suicide rates have tripled since
  1970.
  
• Approximately one-third of teens who die by
  suicide have made a previous suicide attempt.

The Kelty Patrick Dennehy Foundation
http//www.thekeltyfoundation.org/index.html
26

• Nine out of ten suicides take place in the home.
  
  
• For every completed suicide there are an
  estimated 30 to 50 attempts.
  
• 70 of suicides occur between the hours of 3
  p.m. to midnight (when they could be saved).
  
• Males complete suicide 4 times more often than
  females.
  
• Females account for 75 of the attempted suicides
  (mainly with drug overdoses).

The Kelty Patrick Dennehy Foundation
http//www.thekeltyfoundation.org/index.html
27

• Approximately one-third of teens who die by
  suicide have made a previous suicide attempt.
  
• Males use more violent means, e.g. guns,
  hanging.
  
• Only 33 to 50 were identified by their doctors
  as having a mental illness at the time of their
  death and only 15 percent of suicide victims were
  in treatment at the time of their death.

The Kelty Patrick Dennehy Foundation
http//www.thekeltyfoundation.org/index.html
28

• Spring and fall are the months of highest risk.
• An estimated 80 of all those who commit suicide
  give some warning of their intentions or mention
  their feelings to a friend or family member.
  
• In 1996, more teenagers and young adults died of
  suicide than from cancer, heart disease, AIDS,
  birth defects, stroke, pneumonia and influenza,
  and chronic lung disease combined.

The Kelty Patrick Dennehy Foundation
http//www.thekeltyfoundation.org/index.html
29
Risk Factors for Suicide

• Current suicidal thoughts.
• Other mental health or disruptive disorders, such
  as conduct disorder.
  
• Impulsive or aggressive behaviours.
• Feelings of hopelessness.
• A history of past suicide attempts.
• A family history of suicidal behaviour or mood
  disorders.
  
• A history of being exposed to family violence or
  abuse.
  
• Access to firearms or other potentially lethal
  means.
  
• Social isolation/alienation, including because of
  being gay or being bullied
  

Government of British Columbia- B.C. Health
Guide Depression in Childhood and Adolescence
http//www.bchealthguide.org/kbase/topic/major/ty4
640/course.htm
30

• talk or threats of suicide
• hints such as "I won't be a problem for you much
  longer"
  
• previous attempts - especially if the person was
  alone at the time
  
• careless, risk taking, behaviour
• self-destructive behaviour
• sad or angry mood that does not go away
• giving away personal possessions
• suddenly clearing out belongings and getting them
  in order
  
• becoming suddenly cheerful without reason after
  being depressed.
  

Government of South Australia Teenage
Depression http//www.cyh.com/HealthTopics/Healt
hTopicDetails.aspx?p114np141id1751
31
Precipitating Events for Teen Suicide

• Suicidal behavior in adolescents is commonly
  precipitated by events or challenges that the
  teenager finds too difficult to tolerate. Even
  things that seem minor to an adult can be major
  to a young person, who does not have the life
  experience to put them into perspective or the
  coping skills that an adult has honed.

Helpguide.org Teen Depression
http//www.helpguide.org/mental/depression_teen.ht
msymptoms

32
Some common precipitants of suicidal behavior in
teenagers include

• death of a family member or close friend
  (particularly if by suicide)
  
• loss of a romantic relationship or good
  friendship
  
• loss of a parent through divorce or separation
• loss of a pet, treasured object, job or
  opportunity
  
• fear of punishment
• physical, sexual or psychological abuse
• unwanted pregnancy
• poor grades
• fight or argument with family member or loved one
  
  
• belief one has harmed or brought harm to a family
  member or friend
  
• embarrassment or humiliation
• concerns about sexuality
• suicide of a friend, acquaintance, or celebrity
  ("copycat" suicide)
  

Helpguide.org Teen Depression
http//www.helpguide.org/mental/depression_teen.ht
msymptoms

33
If your child exhibits any warning signs

• Call 911

34
Crisis Intervention and Suicide Prevention Centre
of British Columbia

• Greater Vancouver 604-872-3311
• Toll free - Howe Sound Sunshine Coast
  1-866-661-3311
  
• TTY 1-866-872-0113
• BC-wide1-800-SUICIDE (784-2433)
• Help for Youth Online www.YouthInBC.com

35
REMEMBER

• Depression is treatable
• You are not alone, help is available
• Dont delay. If you suspect your child is
  depressed, seek help.
  

36
References

• Advanced Behavioral Consultants Lets Talk
  About Depression retrieved March 5, 2007
  
• http//www.healthsurvey.com/teendepression.htm
• Canadian Mental Health Association Children and
  Depression retrieved February 15, 2007
  
• http//www.cmha.ca/bins/content_page.asp?cid3-86-
  87-90lang1
  
• BC Helpguide Depression in Childhood and
  Adolescence retrieved February 15, 2007
  
• http//www.bchealthguide.org/kbase/topic/major/ty4
  640/cause.htm
  

37
Health Canada Attachment to Parents and Adjstm
ent in Adolescence retrieved April 5, 2007
http//www.phac-aspc.gc.ca/dca-dea/publications/pd
f/attachment_e.pdf Help for Troubled Teens Mi
sdiagnosis of Depression in Troubled Teens
retrieved March 2, 2007 http//www.troubledte
ensinfo.com/Mental_Health_Problems/Teen_Depression
/Misdiagnosis_of_Depression_in_Troubled_Teens/
Helpguide.org Teen Depression retrieved Fe
bruary 15, 2007 http//www.helpguide.org/mental/
depression_teen.htmparents
38
India Parenting Helping your teenager Over
come Depression retrieved March 3, 2007
http//www.indiaparenting.com/raisingchild/data/ra
isingchild058.shtm The Kelty Patrick Dennehy
Foundation Teenage Depression and Suicide-the
Facts retrieved April 8, 2007
http//www.thekeltyfoundation.org/depression-facts
.htm Psychology Information Online Depressi
on in Teenagers retrieved March 2, 2007
http//www.psychologyinfo.com/depression/teens
.htmsuicide South Australia Government Child
ren, Youth and Womens Health Service Teenage
Depression retrieved March 2, 2007
http//www.cyh.com/HealthTopics/HealthTopicDetails
.aspx?p114np141id1751
39

• Crisis Suicide Prevention Centre of British
  Columbia website
  
• http//www.crisiscentre.bc.ca/