A 40-year-old Niverville man tried to end his battle with mental illness in his garage last February.
Trevor, whose wife won't allow their surname to be used because of the stigma, was besieged by depression. He blocked his car's exhaust pipe, closed the garage door and started the vehicle. His partner found him alive.
"She called the RCMP. I was hospitalized for four nights," Trevor said recently. "I really wanted to die."
In the fall of 2011, he had a nervous breakdown at work. He lost control and verbally abused his boss. He was sent home, and when he called later to apologize, he went off again.
"I literally lost my mind," he said. "I've known I had depression for a long time but nothing like this."
Trevor works for a major corporation and credits his employer with dealing with his illness compassionately. He's on disability from his draftsman position and will return to work when he feels ready. If the stress of his current job proves too great, accommodations will be made.
Trevor said it was almost impossible for him to get consistent therapy and support. That's what drove him to attempt suicide after his wife said she could no longer tolerate his moods and their devastating impact on their family.
"I think it's great the government recognizes depression as an illness, but if there's no meat-and-bones programming, what good is it? There is no help out there."
Trevor said he called nine mental health care agencies. None phoned him back. He finally connected with a Steinbach church and is getting help from a support group there.
"How many times do you hear about a suicide? How many times did the person try to get help and fail?"
Peter and Elizabeth Kennedy share Trevor's experience. Elizabeth, 30, suffers severe social anxiety disorder and depression. She's been ill since her early teens. The New Brunswick native slit her wrists for the first time when she was 14. Her husband says she now looks "like she lost a fight with a lawn mower."
The young woman's arms, chest and legs are ribboned with scars. Some cuts are recent and bear signs of stitches. Others are white bands where razor once met flesh. She cuts when she feels overwhelmed by anxiety or life, she says.
"It kind of gives you a nice feeling," she said in a low, dull voice. "It feels like you're floating. It kind of gives you a calm."
Her husband of seven years looked at her steadily. Photos of their son, 8, and daughter, 5, decorate a living room wall. The children have been raised knowing their mother is ill.
"We explained to them in a way they can understand," said Peter. "They know mom has a special kind of sad, and she has to take medication for it. There's times when mom can be very functional and very interactive with them and times when she can't."
Peter and Elizabeth talk about the difficulties they've had accessing mental health care in Manitoba. When Elizabeth is taken to an emergency room and stitched up, she always tells the truth about her injuries. She's usually sent home. On rare occasions she has been admitted to the crisis stabilization unit, a temporary answer that nets her several sessions with a therapist. Her last stay at the CSU was March 14.
"That was because I was struggling and wanted to hurt myself," she said. Peter said he can't count how many times she has cut herself.
"Umpteen times over the years," said Peter. "It's not good. It's horrible. To know someone you love is in that much pain that this was the only way they could escape is heart-wrenching."
These are difficult conversations, as intimate as the details of a sexual relationship. There is so much stigma and pain. She's ashamed and she's tired. She struggles with an eating disorder and other obsessive behaviour. Life overwhelms her.
"Trying to manoeuver my way through the system has been really hard," she said. "We've been trying (for) so long. I hope people start to see all of the holes in the system."
Elizabeth has Peter as an advocate. They wonder how a mentally ill person without support could possibly find help, keep appointments and keep fighting to live another day. Trevor asks the same question.
Elizabeth is scheduled for admission to STAT (Short Term Assessment and Treatment program). It's a Health Sciences Centre program that offers "a higher intensity of service," says Dr. Murray Enns, WRHA medical director of adult mental health services. The program is geared toward patients who are in the midst of an acute mental health care crisis.
The five-week program sees roughly 15 patients at any given time with another 100 or so outpatients seen for short-term follow-up. About 400 referrals are received annually. Roughly 300 patients are accommodated. The program does not keep a waiting list because the program is crisis-focused.
"If we could get everyone the Cadillac service, we would," says Heidi Graham, WRHA director of media relations.
Winnipeggers with severe mental health problems may qualify for a case management worker to provide direct help with everything from housing to work. There are only 23 such workers in Winnipeg.
Provincial health officials say Manitobans with psychiatric concerns are relatively fortunate. As bad as it may be here, it's worse elsewhere in Canada.
Manitoba has a five-year mental health care strategy and will soon open a dedicated mental health crisis response centre.
"There will never be enough," Health Minister Theresa Oswald said in a recent interview. "We will always need to be doing more for people with mental health care issues." Still, she said, "we have made some pretty remarkable strides over the past decade."
Government and mental health care advocates are banking on the $12.5-million crisis centre, which will open early in the new year, to get patients and their families the support they need faster and more efficiently. The Health Sciences Centre building will operate 24/7 and offer screening, assessment, crisis intervention, initial treatment services and psychiatric consultation. It's intended as an easy entry point into the mental health care system.
People in crisis can sit for hours in hospital ERs waiting to be seen. Unless a patient has already harmed themselves, they are usually categorized as a level 5, the least urgent.
"There will be doctors, nurses, social workers," Graham said. "If someone does need to go to the hospital (perhaps because they have harmed themselves) they will."
The centre was a major recommendation from an emergency care task force, made up of individuals and families who have experienced a mental health crisis and service providers.
The WRHA spent $88 million annually on mental health care services, exclusive of fee-for-service psychiatrists and psychologists. That number does not include private counsellors. Overall, the province, through its various regional health authorities, spent $128.9 million in 2010/11.
In Manitoba, more than $400 million was spent in 2007/08 for services that addressed mental health. Those include hospital and community-based services, income assistance and federal disability. It did not include economic costs to other systems, such as schools, workplaces, justice and families.
Oswald said the province's just-launched mental health court is meant to "reset a path for those who are really struggling."
The health minister said there's a push to increase mental health care access to school-age children. Provincial documents show at least 70 per cent of mental health problems and illnesses have their onset in childhood or adolescence. In Manitoba, according to a government report, 20 per cent of five-year-old children have "social and emotional problems".
"I think we're on the right track," said Oswald of Manitoba's health care initiatives.
Mental health care consumers and their families are praying she's right. As Trevor said, no one really knows how people in this problem ended their lives, alone and unable to find the help they needed.