Faydra Aldridge: My name is Faydra Aldridge. Welcome to Look Again. Mental Illness Re-examined,
Faydra Aldridge: a podcast brought to you by the BC Schizophrenia Society,
Faydra Aldridge: otherwise known as BCSS, as well as our partner organizations.
S1: Well, I've been tried on eight different medications,
S3: ... a lot of the "hundred yard stare" drugs and "hurt your heart" drugs,
S3: and finally, a doctor tried the Paliperidone, and that has
S3: really worked well for us, so...
S4: Risperidone, with some dosage adjustment, but that worked well for her.
S3: ...on Abilify, and a number of other medications. But he takes that one on a
S3: monthly injection,
S1: ...countless combinations and dosages, and you just end up with
S1: this casserole of medications.
Faydra Aldridge: Some people with serious mental illness don't like the idea
Faydra Aldridge: of taking medication for a variety of reasons, and some
Faydra Aldridge: families of people with mental illness often struggle against the
Faydra Aldridge: need to take medication because they see it as hindering
Faydra Aldridge: a person's quality of life. On today's episode of Look Again,
Faydra Aldridge: we're asking what's at the root of the hesitation around
Faydra Aldridge: using meds to treat serious mental illness? And how do
Faydra Aldridge: the medications used to treat disorders such as schizophrenia actually
Faydra Aldridge: work on the brain? Why is it so important to
Faydra Aldridge: start treatment early? These are just a few of the
Faydra Aldridge: questions we're going to be tackling. Also, we're going to
Faydra Aldridge: be exploring the public perception of what it looks like
Faydra Aldridge: when people are "on" or "off" their meds. Our collective
Faydra Aldridge: literacy with these signs and symptoms is critical to preventing
Faydra Aldridge: negative interactions, both systemic and personal, with people who suffer
Faydra Aldridge: from mental illness. Today, I'm joined by Dr. Fidel Vila-Rodriguez from
Faydra Aldridge: the Department of Psychiatry at UBC. As a clinician-scientist, Fidel
Faydra Aldridge: does research looking at the neurobiology of psychiatric illnesses and
Faydra Aldridge: considers the clinical applications of this knowledge. So in other words,
Faydra Aldridge: he looks at the biology of mental illness and how
Faydra Aldridge: we can actually use that information in a clinical setting
Faydra Aldridge: to actually help people. So, Dr. Rodriguez, we are so
Faydra Aldridge: happy you're here today to not only talk about medication,
Faydra Aldridge: but also about other treatments that work in conjunction with
Faydra Aldridge: medications that can potentially help people who are affected by
Faydra Aldridge: serious mental illness. Fidel, I'm intrigued. I'm excited. Welcome to
Faydra Aldridge: the show.
Dr. Fidel Vila-Rodriguez: Thank you so much, Faydra. It's a great opportunity. And
Dr. Fidel Vila-Rodriguez: I really appreciate being here this afternoon to have this
Dr. Fidel Vila-Rodriguez: conversation about this very important topic.
Faydra Aldridge: So a minute ago, we heard the voices of some
Faydra Aldridge: people with schizophrenia and their families listing off names of
Faydra Aldridge: some of the drugs that they need to take for
Faydra Aldridge: their symptoms. Now, there is a lot of complicated names,
Faydra Aldridge: and it can be really difficult to figure out what
Faydra Aldridge: a drug does. So tell us, what are some of
Faydra Aldridge: the most common medications prescribed for people with schizophrenia?
Dr. Fidel Vila-Rodriguez: Absolutely. And I'd like to take just one minute to
Dr. Fidel Vila-Rodriguez: back up and perhaps make emphasis on why do we
Dr. Fidel Vila-Rodriguez: give medications to treat schizophrenia? And I think it's important
Dr. Fidel Vila-Rodriguez: to emphasize that schizophrenia is an illness that affects the brain.
Dr. Fidel Vila-Rodriguez: And what we know is that the illness affects the
Dr. Fidel Vila-Rodriguez: brain in a way that makes symptoms like voices, hallucinations
Dr. Fidel Vila-Rodriguez: or delusions or these very nagging negative symptoms, which means
Dr. Fidel Vila-Rodriguez: things like a person does not have the strength and
Dr. Fidel Vila-Rodriguez: does not have that drive to do things. So that's
Dr. Fidel Vila-Rodriguez: because the brain is affected by the illness and it's
Dr. Fidel Vila-Rodriguez: not working. Well, one of the key medications that has
Dr. Fidel Vila-Rodriguez: been around now since the 1950s when they were first
Dr. Fidel Vila-Rodriguez: described is called antipsychotics or before they were called neuroleptics.
Dr. Fidel Vila-Rodriguez: They described generically the same class of medications. These are
Dr. Fidel Vila-Rodriguez: medications that when we take them, they go to the
Dr. Fidel Vila-Rodriguez: brain and their mechanism of action is on something called
Dr. Fidel Vila-Rodriguez: dopamine receptors. One of the mechanisms and one of the
Dr. Fidel Vila-Rodriguez: things that happens when someone is suffering schizophrenia and having
Dr. Fidel Vila-Rodriguez: delusions or hallucinations is that there is a state of,
Dr. Fidel Vila-Rodriguez: so to speak, too much dopamine acting in the brain.
Dr. Fidel Vila-Rodriguez: And so what these medications do is work on the
Dr. Fidel Vila-Rodriguez: dopamine receptors to allow this "too much dopamine" in the brain to go down,
Dr. Fidel Vila-Rodriguez: and treating the symptoms. So antipsychotics are one of these medications.
Faydra Aldridge: When do you decide that a person does, in fact,
Faydra Aldridge: require this antipsychotic medication?
Dr. Fidel Vila-Rodriguez: That's an excellent question. And while there are times when
Dr. Fidel Vila-Rodriguez: it might not be entirely clear that medications are needed
Dr. Fidel Vila-Rodriguez: or not, the majority of the times when someone gets
Dr. Fidel Vila-Rodriguez: to a point that they need to seek help and
Dr. Fidel Vila-Rodriguez: they need to see a physician, a mental health professional,
Dr. Fidel Vila-Rodriguez: it means that what drives that need is some sort
Dr. Fidel Vila-Rodriguez: of impact on their lives. So I think that's very
Dr. Fidel Vila-Rodriguez: important to emphasize as well. This illness, schizophrenia, this illness
Dr. Fidel Vila-Rodriguez: of the brain affects people in such a profound way
Dr. Fidel Vila-Rodriguez: that it gets in the way in life. And that
Dr. Fidel Vila-Rodriguez: can look different ways. It can look, a person does
Dr. Fidel Vila-Rodriguez: not do well at school (when they were doing fine)
Dr. Fidel Vila-Rodriguez: and struggles a lot. A person starts not seeing their friends,
Dr. Fidel Vila-Rodriguez: not socializing when they before were doing that, they might
Dr. Fidel Vila-Rodriguez: not be able to perform at work, or all of
Dr. Fidel Vila-Rodriguez: the above. So there's an "impact on functioning" that we call it.
Dr. Fidel Vila-Rodriguez: So the symptoms, the delusions, the hallucinations, the negative symptoms
Dr. Fidel Vila-Rodriguez: get in the way in life. And that's what we
Dr. Fidel Vila-Rodriguez: assess when I see a person who's struggling and the
Dr. Fidel Vila-Rodriguez: person shares with me that they are having these symptoms, and
Dr. Fidel Vila-Rodriguez: I ask them whether they are getting in the way. If it
Dr. Fidel Vila-Rodriguez: becomes obvious that they are getting in the way in
Dr. Fidel Vila-Rodriguez: a big way, they're interfering a lot with their functioning,
Dr. Fidel Vila-Rodriguez: it becomes clear that we need to do something to
Dr. Fidel Vila-Rodriguez: treat the symptoms.
Faydra Aldridge: So what is the response that you typically get when
Faydra Aldridge: you have to tell an individual or a family that
Faydra Aldridge: they do require medication?
Dr. Fidel Vila-Rodriguez: It varies. And there's obviously a range of responses. Sometimes
Dr. Fidel Vila-Rodriguez: there's a reaction of disbelief. It could be in both
Dr. Fidel Vila-Rodriguez: families and the person in trying to come to terms
Dr. Fidel Vila-Rodriguez: with the diagnosis. It's a normal, understandable reaction from families,
Dr. Fidel Vila-Rodriguez: from the person suffering the symptoms. And the task at
Dr. Fidel Vila-Rodriguez: hand is to really go over the impact that those
Dr. Fidel Vila-Rodriguez: symptoms are having and together work through, really realizing, look,
Dr. Fidel Vila-Rodriguez: this goes beyond really what you would expect from this breakup,
Dr. Fidel Vila-Rodriguez: from this stress at work, and it's really interfering in
Dr. Fidel Vila-Rodriguez: your life. We need to treat. Now for people suffering
Dr. Fidel Vila-Rodriguez: from this schizophrenia, there is a particular symptom that is
Dr. Fidel Vila-Rodriguez: very challenging. We call it "lack of insight." It can
Dr. Fidel Vila-Rodriguez: be understood as lack of awareness. We take for granted
Dr. Fidel Vila-Rodriguez: a lot of the things that our brains do for
Dr. Fidel Vila-Rodriguez: us from walking from paying attention to things, from speaking.
Dr. Fidel Vila-Rodriguez: One of the things that our brain does is it
Dr. Fidel Vila-Rodriguez: allows us to be aware of our environment, of how
Dr. Fidel Vila-Rodriguez: we are doing, where we are thirsty, whether we are hungry.
Dr. Fidel Vila-Rodriguez: It also makes us aware whether we are struggling with
Dr. Fidel Vila-Rodriguez: pain or with any other symptoms. In schizophrenia, it's difficult
Dr. Fidel Vila-Rodriguez: to realize that they are struggling with a medical illness.
Dr. Fidel Vila-Rodriguez: That's the lack of insight. So what follows is if
Dr. Fidel Vila-Rodriguez: a person has difficulty to realize that they are suffering
Dr. Fidel Vila-Rodriguez: an illness, why would they need treatment? And so that
Dr. Fidel Vila-Rodriguez: is a very challenging situation.
Faydra Aldridge: What you said there is that it's something inherent in
Faydra Aldridge: the illness itself. And that's what would make it so difficult, because,
Faydra Aldridge: as you said, how could somebody say and put up
Faydra Aldridge: their hand and say, I need help, I need treatment, if
Faydra Aldridge: they don't realize that they're even ill? They don't, if they no
Faydra Aldridge: longer have the ability to recognize that they have an illness.
Dr. Fidel Vila-Rodriguez: And the other aspect is the symptoms that the illness
Dr. Fidel Vila-Rodriguez: causes generate an experience in the person that is suffering them.
Dr. Fidel Vila-Rodriguez: And their experience is real. It's what they are experiencing.
Dr. Fidel Vila-Rodriguez: It's like pain. You can't explain to someone else what
Dr. Fidel Vila-Rodriguez: you are feeling. You feel the pain all the people
Dr. Fidel Vila-Rodriguez: might understand, but they don't really feel it.
Faydra Aldridge: So now let's talk about other treatments. And I know
Faydra Aldridge: that some of your research focuses on non-invasive neurostimulation therapies.
Faydra Aldridge: That's quite a mouthful. So can you tell us a
Faydra Aldridge: little bit about this type of treatment?
Dr. Fidel Vila-Rodriguez: Absolutely. So the mouthful -- what it means -- is that there
Dr. Fidel Vila-Rodriguez: are ways of treating medical illnesses, illnesses of the brain,
Dr. Fidel Vila-Rodriguez: that do not involve using a chemical like a medication.
Dr. Fidel Vila-Rodriguez: The brain is similar to the heart in that it's
Dr. Fidel Vila-Rodriguez: an electrical organ. When we generate thoughts, when we walk,
Dr. Fidel Vila-Rodriguez: when we do anything that our brain is involved in, it
Dr. Fidel Vila-Rodriguez: generates tiny little current. And what these non-invasive neurostimulation therapies do,
Dr. Fidel Vila-Rodriguez: is leverage that principle of electricity and use currents to
Dr. Fidel Vila-Rodriguez: stimulate the brain. And they can do this in different ways.
Dr. Fidel Vila-Rodriguez: One of the treatments that's been around for a long
Dr. Fidel Vila-Rodriguez: time and that, still to this date, unfortunately, is still controversial,
Dr. Fidel Vila-Rodriguez: is called electroconvulsive therapy or ECT. And it's still to
Dr. Fidel Vila-Rodriguez: this date, the most effective treatment we've got for depression.
Dr. Fidel Vila-Rodriguez: And it's also very effective to treat schizophrenia. This treatment
Dr. Fidel Vila-Rodriguez: leverage s a very counterintuitive mechanism. What we do is,
Dr. Fidel Vila-Rodriguez: when a person is under general anaesthesia, we trigger a
Dr. Fidel Vila-Rodriguez: seizure in the brain with external current. When that happens,
Dr. Fidel Vila-Rodriguez: when we trigger a controlled seizure, there are a lot
Dr. Fidel Vila-Rodriguez: of good things that happen in the brain. One of them,
Dr. Fidel Vila-Rodriguez: for example, is there's a release and regulation of those
Dr. Fidel Vila-Rodriguez: dopamine levels that we talked about earlier with medication. So
Dr. Fidel Vila-Rodriguez: what ECT accomplishes in the context of treating schizophrenia is
Dr. Fidel Vila-Rodriguez: it helps regulating, as well, the dopamine levels in the brain.
Faydra Aldridge: Tell us about CBT.
Dr. Fidel Vila-Rodriguez: So now we are transitioning from these treatments that leverage
Dr. Fidel Vila-Rodriguez: currents to treatments that rely on talk therapy and traditional
Dr. Fidel Vila-Rodriguez: CBT or cognitive behavioral therapy. The way that CBT usually
Dr. Fidel Vila-Rodriguez: is structured is, the person suffering schizophrenia works with their therapist,
Dr. Fidel Vila-Rodriguez: and they work together to identify these "cognitive biases," meaning
Dr. Fidel Vila-Rodriguez: jumping to conclusions, for example. And so by looking at
Dr. Fidel Vila-Rodriguez: these patterns of thinking and trying to work with the person,
Dr. Fidel Vila-Rodriguez: then identifying how to modify them not only during the session,
Dr. Fidel Vila-Rodriguez: but after the session and in between sessions, doing homework
Dr. Fidel Vila-Rodriguez: and identifying these patterns, eventually it helps the person to
Dr. Fidel Vila-Rodriguez: leverage these tools and catch whenever they go into this
Dr. Fidel Vila-Rodriguez: thinking pattern.
Faydra Aldridge: Now, with CBT, as well as those non-invasive neurostimulation therapies
Faydra Aldridge: that we were just talking about, are they used in
Faydra Aldridge: conjunction with medication then, or are they used instead of medication?
Dr. Fidel Vila-Rodriguez: All the current treatment guidelines for schizophrenia clearly identify that
Dr. Fidel Vila-Rodriguez: the backbone treatment starts with medications, with antipsychotics. In addition,
Dr. Fidel Vila-Rodriguez: we can add CBT, we can add ECT as an
Dr. Fidel Vila-Rodriguez: approved treatment for schizophrenia, and there are other interventions that
Dr. Fidel Vila-Rodriguez: can be used, in addition. But the backbone, when someone
Dr. Fidel Vila-Rodriguez: is suffering from schizophrenia and actively having positive symptoms, delusions
Dr. Fidel Vila-Rodriguez: and hallucinations: medications need to be in place.
Faydra Aldridge: You're listening to LookAgain, Mental Illness Re-examined, a podcast brought to you by
Faydra Aldridge: the BC Schizophrenia Society and BC partner organizations. I'm your host,
Faydra Aldridge: Faydra Aldridge . This podcast would not be possible without the
Faydra Aldridge: support of the entire community. From the bottom of our hearts,
Faydra Aldridge: we want to thank you for caring about mental illness together.
Faydra Aldridge: We truly can make a difference. // So we're back with Dr.
Faydra Aldridge: Fidel Vila-Rodriguez talking about mental illness, medications and treatment.
S3: My son had anosognosia, which means he did not know
S3: he was ill. He was very sick but did not
S3: know it, and "he doesn't need medicine." So "what are
S3: you talking about?" So he was that for sure, all
S3: the way to his death. And so he had to
S3: be on forced injections.
S4: Well, firstly, they don't make him feel very well. And
S4: so the drugs themselves are hard on them. He doesn't
S4: sleep well when he's on the drugs. You know, he-he
S4: doesn't feel well. They can create different health issues, weight gain.
S4: And that's part of it. Part of it is an
S4: acceptance and belief that you have to take them to
S4: be healthy too...
S3: ... other side effects, of course, is, you know, when he
S3: gets his shot that it makes him very slowed down.
S3: He doesn't like to be slowed down.
S1: ...a lot of problems with him staying on it. He kept going
S1: off and back on and off and back on.
S4: So for him, that's his big negative, is that he
S4: thinks that he can function well enough, independently, enough without them,
S4: that he doesn't need them, that he would be OK.
S1: Slowly, the wheels started turning and they started actually noticing
S1: that he can survive. He can go to work full
S1: time when he's taking his medication.
S4: He doesn't, he hasn't come to the point where he says,
S4: "my life, my quality of life is not good when
S4: I when I'm not being medicated."
S1: But he's much, much better. But I was all for it.
S1: I'm like, oh, Jesus, just please take your medication. I want my son back.
Faydra Aldridge: That was pretty powerful. The last line, I just want
Faydra Aldridge: my son back, I'm sure you hear that a lot, Fidel,
Faydra Aldridge: with your patients and the families that you work with.
Faydra Aldridge: But we also heard families talk about their fear of
Faydra Aldridge: the side effects and the potential resistance to take medications
Faydra Aldridge: when they are told that they are necessary to their treatment.
Faydra Aldridge: What do you say to families or to the individuals
Faydra Aldridge: with schizophrenia and serious mental illness that you work with
Faydra Aldridge: around the need to take medication despite the potential side effects?
Dr. Fidel Vila-Rodriguez: I think the clip that we just heard is a
Dr. Fidel Vila-Rodriguez: very powerful reminder of the testimony of of this suffering
Dr. Fidel Vila-Rodriguez: and the challenges that people who suffer with schizophrenia and
Dr. Fidel Vila-Rodriguez: their families go through. And sometimes the very difficult decisions
Dr. Fidel Vila-Rodriguez: that come on the table, like someone not recognizing they
Dr. Fidel Vila-Rodriguez: need help and professionals need to resort to involuntary treatment.
Dr. Fidel Vila-Rodriguez: Hearing these testimonies from families brought me back to the
Dr. Fidel Vila-Rodriguez: day-to-day work with families and the realization that there are
Dr. Fidel Vila-Rodriguez: times when the illness is so severe that gets in
Dr. Fidel Vila-Rodriguez: the way of the person being able to ask for help.
Dr. Fidel Vila-Rodriguez: And that's a situation where families, professionals, we don't want
Dr. Fidel Vila-Rodriguez: to be in that spot. But when we are, we
Dr. Fidel Vila-Rodriguez: recognize the suffering. Unfortunately, when those situations come to play
Dr. Fidel Vila-Rodriguez: out that way, involuntary treatment might be the last resort.
Dr. Fidel Vila-Rodriguez: But it's the only thing that we can do. That leads me to,
Dr. Fidel Vila-Rodriguez: to your question about side effects. Any treatment, no matter
Dr. Fidel Vila-Rodriguez: what medical condition, has the potential of coming with side effects.
Dr. Fidel Vila-Rodriguez: And the conversation, like in any other field in medicine,
Dr. Fidel Vila-Rodriguez: boils down to carefully gauge how much benefit and how
Dr. Fidel Vila-Rodriguez: much risk we are dealing with here. It's very important
Dr. Fidel Vila-Rodriguez: to carefully describe what are those side effects, what are the
Dr. Fidel Vila-Rodriguez: chances of experiencing them, and very importantly, what can we
Dr. Fidel Vila-Rodriguez: do to minimize the risk of those happening. That last
Dr. Fidel Vila-Rodriguez: point is a very important one, because it is true
Dr. Fidel Vila-Rodriguez: that any medication, any treatment has a potential for side effects.
Dr. Fidel Vila-Rodriguez: But it's also true that we can do things to
Dr. Fidel Vila-Rodriguez: minimize to make that risk as low as possible. It
Dr. Fidel Vila-Rodriguez: doesn't go to zero, but we can do things to
Dr. Fidel Vila-Rodriguez: minimize it.
Faydra Aldridge: So, Fidel, at the beginning we talked about when somebody
Faydra Aldridge: is "on" their meds or "off" their meds, is this
Faydra Aldridge: something that you hear a lot? Do people go on
Faydra Aldridge: and off their medications?
Dr. Fidel Vila-Rodriguez: People with schizophrenia, they sometimes forget a dose. Sometimes there
Dr. Fidel Vila-Rodriguez: are situations when there is a need to increase dose.
Dr. Fidel Vila-Rodriguez: That dose that we were giving stopped being enough and
Dr. Fidel Vila-Rodriguez: that can lead to symptoms coming back. If someone is
Dr. Fidel Vila-Rodriguez: not taking all the medication that they need, or they don't,
Dr. Fidel Vila-Rodriguez: they don't have enough dose that can lead to symptoms
Dr. Fidel Vila-Rodriguez: coming back. And the way this looks varies a lot
Dr. Fidel Vila-Rodriguez: from person to person. Families are really good at picking
Dr. Fidel Vila-Rodriguez: up the cues.
Faydra Aldridge: So if a person is on medications, should they be
Faydra Aldridge: worried about getting the covid vaccination?
Dr. Fidel Vila-Rodriguez: We know -- and there's research that has recently come out
Dr. Fidel Vila-Rodriguez: about this -- that unfortunately, people who suffer from schizophrenia are
Dr. Fidel Vila-Rodriguez: at higher risk of having Covid and complications from Covid. So
Dr. Fidel Vila-Rodriguez: we know that. So the risk is even higher. So
Dr. Fidel Vila-Rodriguez: the need for getting immunized is even more pressing. The
Dr. Fidel Vila-Rodriguez: vaccine is safe in the general population, as it is
Dr. Fidel Vila-Rodriguez: for people with schizophrenia. The only situation that there's been
Dr. Fidel Vila-Rodriguez: a few case reports and that it's important to pay
Dr. Fidel Vila-Rodriguez: a little bit more attention, is for people who are
Dr. Fidel Vila-Rodriguez: taking one particular antipsychotic called Clozapine. Clozapine is the most
Dr. Fidel Vila-Rodriguez: effective antipsychotic that we have for schizophrenia. But unfortunately, it
Dr. Fidel Vila-Rodriguez: comes with some side effects and sometimes has been can
Dr. Fidel Vila-Rodriguez: be associated with fever... high temperature. Vaccines in anyone can
Dr. Fidel Vila-Rodriguez: cause a transient, very temporary reaction where we have a
Dr. Fidel Vila-Rodriguez: little bit of fever. And what this means is they
Dr. Fidel Vila-Rodriguez: want to make sure to convey, is very clearly, being
Dr. Fidel Vila-Rodriguez: on Clozapine is not a contraindication for a vaccine. The
Dr. Fidel Vila-Rodriguez: vaccine is safe. The benefits of getting the vaccine for
Dr. Fidel Vila-Rodriguez: people with schizophrenia in general far outweigh the potential risk.
Dr. Fidel Vila-Rodriguez: So it is very important to get vaccinated.
Faydra Aldridge: I cannot thank you enough for joining me today, Dr. Rodriguez.
Faydra Aldridge: It has been absolutely fascinating.
Dr. Fidel Vila-Rodriguez: Thank you so much, Faydra.
Faydra Aldridge: So just a reminder to everyone who is listening. Thank
Faydra Aldridge: you for being a part of our show today. We will,
Faydra Aldridge: of course, be posting all of the relevant links for
Faydra Aldridge: this conversation in our show notes and of course, on
Faydra Aldridge: our website www.BCSS.org . I hope you learned as much
Faydra Aldridge: as I did. And coming up on the next episode,
Faydra Aldridge: we're going to be looking at concurrent disorders and perceptions
Faydra Aldridge: around how common serious mental illness is. And trust me.
Faydra Aldridge: Spoiler alert here. It's way more common than what you think.
Faydra Aldridge: Bye for now.
Dr. Fidel Vila-Rodriguez: This podcast is brought to you by the BC Schizophrenia
Dr. Fidel Vila-Rodriguez: Society and the B.C. Partners for Mental Health and Substance
Dr. Fidel Vila-Rodriguez: Use Information, where a group of non-profit agencies providing good
Dr. Fidel Vila-Rodriguez: quality information to help individuals and families maintain or improve
Dr. Fidel Vila-Rodriguez: their mental well-being. The B.C. Partners Members are Anxiety Canada,
Dr. Fidel Vila-Rodriguez: BC Schizophrenia Society, Canadian Institute for Substance Use Research. Canadian
Dr. Fidel Vila-Rodriguez: Mental Health Associations, B.C. Division, Family Smart, Jessie's Legacy, a
Dr. Fidel Vila-Rodriguez: North Shore Family Services Program, and Mood Disorders Association of B.C.,
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Dr. Fidel Vila-Rodriguez: For more information, visit heretohelp.bc.ca