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We call it "the most wonderful time of the year," and many of us eagerly look forward to a festive winter season with family and friends. But joy and celebration can unfortunately become elusive for some during the holidays. Increased expectations may leave them feeling overwhelmed or confronting a number of mental health challenges.
"It's so emotionally loaded," says Dr. Susan Abbey, Psychiatrist-in-Chief and Program Medical Director at UHN's Centre for Mental Health. "Some had very happy holidays as kids and now struggle to recreate that, while others had horrible holidays and are tormented by their memories.
"And then there are those not part of this dominant holiday tradition who may feel alone and othered at this time of year."
The elements and traditions many find enjoyment in – social engagements, gift buying, meal preparation, to name a few – can unintentionally generate stress for others.
"The holidays can be a very triggering time for people, especially those who have existing mental health issues," says Dr. Suze Berkhout, clinician-investigator and psychiatrist at the Centre for Mental Health, who notes that Emergency Departments typically see a spike in mental health-related patients.
UHN News spoke with Drs. Abbey and Berkhout for some strategies on how to keep the holidays the positive experience they should be.
Q. Expectations for the holidays don't always line up with reality. What is a helpful approach to take?
Whether you have a large family of dependents or are flying solo this season, we all expect to have a terrific winter holiday. It's natural for your expectations to expand as the season draws near, but it is important that they not reach unrealistic levels, say Drs. Abbey and Berkhout.
"Some people over anticipate all the kinds of problems that might happen and then end up feeling stressed in the lead up to an event and not enjoying the thing itself," says Dr. Berkhout. "When things don't go according to plan or when it is over they can feel let down and depressed."
"The holidays should be about you and what matters to you," says Dr. Abbey, who advises taking a mindful approach. "The experience will be what it will be – give yourself permission to accept your emotional response."
Q. What is the best way to manage stress during the holiday season?
Be kind to yourself. Self-care is the foundation of mental and physical health. Increased feelings of anxiety or depression can trigger unhelpful physical, emotional or behavioural problems.
Stress evokes a fight-or-flight response. Dr. Abbey advises a "tend-and-befriend" approach instead: either tending to yourself or those around you and/or befriending others by reaching out to social connections for support.
"Scientific literature shows that being more nurturing towards yourself and the world can provide stress relief and healing," says Dr. Abbey. "So maybe the thing to do is to stay in your bed binge watching a show all day or maybe it is to volunteer this year at a soup kitchen."
Indulgence – whether that's overeating or the consumption of substances like alcohol or drugs – is often a way for us to manage stress and feel that we are more relaxed and festive, says Dr. Berkhout, but it can ultimately backfire. She underlines the importance of moderation and getting adequate sleep, eating nutritiously and physical activity.
Both Drs. Abbey and Berkhout stress the importance of structure and routine. They help to minimize unpredictability or uncertainty and will reduce potential stressors.
Q. Feelings of isolation or loss are common during the holiday season. What approach should someone follow who finds themselves in such a situation?
The cultural messages we send around the holidays about kinship and community are not the reality for everyone. Some may be alone, experiencing the holidays without loved ones for the first time or be separated from their family by COVID-19 restrictions or other reasons.
To combat isolation, Drs. Abbey and Berkhout encourage people to create new traditions in their lives and find a sense of connection – whether that's exploring nature or spirituality, celebrating with a tight-knit group of friends rather than family, or getting outside and around others like skating at an outdoor rink.
"What I think people really end up struggling with is being part of something bigger than yourself," says Dr. Berkhout. "That is really at the heart of what the holidays are trying to do."
Q. How can staff members working during the holidays best prepare for mental health challenges?
The holidays can be particularly demanding. They land right as flu season is picking up and because of the pandemic there is not a lot of capacity in the system right now. Patients tend to be particularly disappointed to not be at home at that time of year.
A number of TeamUHN members offer to take shifts in the hospital during this period knowing how helpful their presence can be for colleagues and patients, and for their own mental health as well.
"In some ways the holidays are about celebrating life in the midst of the darkness of winter," says Dr. Abbey. "It helps to put ourselves in the context of what the bigger meaning of the holidays are and what the bigger meaning of our role as healthcare providers is."
Some units recognize the holidays with decorations or Christmas trees. In years past, holiday treats were exchanged adding to a festive spirit.
"Making things special and meaningful and not so hard for the patients can be helpful and bring a sense of camaraderie," says Dr. Berkhout. "It can counterbalance some of the challenges that are there."
Q. From a mental health perspective, are New Year's resolutions a positive step to take?
"Taking stock of where you've been, what you've done and where you're going is a great direction to follow," says Dr. Berkhout, "whether you celebrate the New Year on Jan. 1st or another time during the year."
But for a healthy reflection process to be successful both Drs. Abbey and Berkhout stress the importance of SMART goals – Specific, Measurable, Attainable, Relevant, Time-based. Realistic resolutions will prevent you from falling into the trap of chasing goals that are either too challenging to accomplish or require an unattainable level of perfection.
Dr. Abbey suggests giving yourself the option of starting on Jan. 15.
"It's probably not the best day to start a diet on Jan. 1st if you're dining at your mother-in-law's when you'll be tempted to stress eat her chocolate chip cookies," she says.
As for a resolution recommendation this New Year's?
"It's been a long and hard two years and having some kind of self-compassion resolution is probably a good goal for everyone to have," says Dr. Berkhout.
If you or someone you know is in distress and in need of urgent help with a mental health emergency please call 911, go to the nearest Emergency Department of your local hospital, or call a local distress centre or crisis centre.