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This section brings together both the young women and the CAMH members of the VALIDITY team to provide insight into how to engage and talk to young women about depression. The VALIDITY team also identified areas where professionals could provide information, understanding and support through the therapeutic relationship. The voices of VALIDITY also include clinicians who helped answer questions that the young women raised.

Hear Me

The medical system, it seems very consumer oriented. You go to see a doctor and . . . the doctor's kind of rushing you to finish whatever and then go off. That's it and you have your medication and that's it . . . You're one case and . . . you're not treated as a real person. Cultural factors or just individual personal factors go into [depression]; you have to take [these] into consideration. It's not . . . just machinery functioning.

I think they should gather, maybe, women who are homeopaths and . . . natural healers, because society does not accept them as doctors.

This one doctor was very patronizing as well. I brought my mother with me . . . she wanted to come. And he was . . . so sexist, so patronizing that we're women, that we didn't know anything! That we had no concept of it! And I would ask him a question and he would ignore it or he would answer it to my mother. And I mean, I'm the one with the problem. Right?

First of all, you gotta hear [young women] out. You gotta try to understand where this whole depression thing is coming from. . . . Don't be judgmental or criticizing.

The levels of hopelessness - you feel that there's just nothing out there for you. . . . You don't think anybody else understands you out there . . . and you cry a lot because you just have all this built-up emotion inside you and nobody will hear you.

Don't look at me as a depressed young woman yet; look at me as a young woman who's going to talk to you, and then we can work together. Don't make assumptions.

Listen and have patience with your client, ask questions, be honest and sincere with them. Acknowledge their feelings. Treat the whole person physically - through diet and vitamins; mentally - through counselling, journaling and by providing reading materials; emotionally - through respite care, massage therapy, holistic healers; and spiritually - through traditional healing, pastor or clergy, walking outside, etc.

It's important for service providers to listen to what we're saying when we're there - to look beyond the situation at hand and find out if there is something external that may be affecting the current situation, such as past events, peers, society.

Understand Me

The young women expressed feelings of fear and of being overwhelmed, and said that reaching out for help was “really scary.” Young women ask us to see each of them as individuals with their own unique stories. By taking the time to listen to the story of young women's current reality, you might pick up clues to issues such as violence, physical/sexual/psychological abuse and other risk factors that might require immediate action. Through this process, you may also determine factors that might contribute to depression, such as: problems with family or other relationships, peer pressure, discrimination, racism, eating disorders, academic pressures, cultural differences and substance misuse.

In Dr. Cheryl van Daalen's article “Living as a chameleon: A feminist analysis of young women's lived experience of anger,” she states that anger brings with it a message: “We cannot adequately partner with girls and young women around the issues of depression without a strong understanding of how they live and experience anger, including what generates it, what they are allowed to do with it, and how it effects their ability to lead authentic lives.” Anger is a part of their story that needs to be understood rather than rejected. Work to build trusting relationships with young women, and invite them to explore all of their emotions.

Support Me

The young women spoke clearly about how they want clinicians to approach them and speak to them about depression. Here are some suggestions.

Is the waiting room and/or your office a welcoming and comfortable place for young women? Here are some ideas:

• Ensure that posters or pictures on the wall show young women of different racial and cultural backgrounds, sexuality and sizes to reflect their reality.
• Display a variety of reading material (e.g., Shameless magazine, written for young women by young women). Avoid too many fashion magazines that show unrealistic images of young women.
• If you have a TV and VCR, make sure there are tapes that provide information on young women's health issues.
• If you have brochure racks, make sure there are materials related to young women (e.g., information on sex, birth control, self-defence, depression, alcohol and other substances, as well as information on prevention resources such as Girls Talk [see Girl-Centred Health  for more information], recreational resources and nutrition).

How do you start talking to young women about depression? Here is what the young women suggest.

• Respect young women's confidentiality. However, no matter what your role is (e.g., doctor, counsellor, teacher), let the young women know under what circumstances confidentiality cannot be kept (i.e., if they indicate that they would harm themselves or others, or if a child is at risk, there is a legal obligation to take action). This should be done at the beginning of a session (whether formally or informally).
• Listen! This might sound obvious, but listening takes time. Young women need to tell their stories, and this is hard to accomplish in just one session. Asking questions from a checklist and not making eye contact come across as insensitive and cold. Instead, find out about the young woman's world by paying attention to the influence and impact of race, culture, socio-economic status, gender identity, sexuality, abilities, family religion, relationships and school issues. As you and the young women explore these stories, you will also hear about interests, hobbies, talents and challenges they have overcome in the past. Asking open-ended questions about these areas will demonstrate respect and interest. As you learn more about the young woman, you will begin to understand her world and gain insight into what interventions or referrals might be appropriate and realistic. Just taking the time to be with the young woman in a way that makes her feel comfortable is a great start and will help keep the door open.
• Young women ask that you use a non-judgmental approach: “We don't want to be stereotyped.” “We're not all the same.” “Don't make assumptions because of the way I dress or look.” When young women express their feelings, they need the “helper” to be caring, sensitive and able to connect emotionally. They do not want to feel rushed or dismissed while talking about their feelings.
• Involve young women. Provide them with options and respect their right to select the therapeutic modality that feels best for them.

Concurrent Disorders

Recognize that co-occurring issues such as substance use and eating disorders may also signal possible underlying depression. The term concurrent disorders (CD) refers to the co-existence of both substance use and mental health disorders. There are likely professionals (e.g., in youth services and addiction agencies) in your community who can offer consultation in these areas. They can be a source of information and assist you in helping and supporting the young woman. Nancy Poole, a research consultant on woman and substance use for the BC Women's Hospital and the BC Centre for Excellence for Women's Health, has written on concurrent disorders in young women:

Poole, N. (2004). Substance use by girls and young women: Taking gender into account in prevention and treatment . Visions: BC's Mental Health and Addictions Journal, 2 (1), 15-16.

Poole, N. (2004). Women's Pain: Working with women concurrently on substance use, experience of trauma and mental health issues. Visions: BC's Mental Health and Addictions Journal, 2 (1), 29-30.

Additional resources on concurrent disorders include:

Skinner, W. (Ed.). (2005). Treating Concurrent Disorders: A Guide for Counsellors . Toronto: CAMH.
This publication is an introduction to identifying, understanding and treating concurrent disorders. It also contains detailed, practical information that will help front-line health care providers to integrate Health Canada's best practice recommendations into their daily work.

Health Canada. (1997). Exploring the Links between Substance Use and Mental Health: An Annotated Bibliography and a Detailed Analysis. Available: http://www.hc-sc.gc.ca/ahc-asc/pubs/drugs-drogues/mental-mentale/index_e.html.

Tupker, E. (Ed.). (2005). Youth & Drugs and Mental Health: A Resource for Professionals . Toronto: CAMH.
This resource provides up-to-date information about addressing substance use and mental health problems among young people. For more information, see A Critical Link - Print and Other Resources .

For resources related to substance use, see: A Critical Link - Referrals and Resources.

For information on eating disorders, visit the web site for Sheena's Place at www.sheenasplace.org or call them at 1 888 743-3627.