Attitudes about depression have shifted in recent years, with more recognizing that those with suicidal thoughts need urgent and immediate help. But in some cases, those requests for help are not always heard.

Last month, 54-year-old Mike Coxhead told his family he was so depressed he wanted to end his life. His daughter, Jillian Attwell, decided to take him to his local hospital in Nova Scotia's Annapolis Valley. Attwell knew the situation was serious, as Coxhead had attempted suicide twice before .

"He had a detailed plan on how he was going to take his life and he wanted to be kept at the hospital," she says.

Instead, she says ER staff said he could not be admitted and sent him home, asking him to design his own "safety plan" -- a guide for what to do if he felt suicidal again. They also gave him a card with a crisis hotline number.

"She told him there were no beds and told him if he needed to call, if he needed anybody to speak with, that he could call the emergency number that was on the card and he would be able to speak to somebody," Attwell recalls.

The next day, the RCMP phoned Attwell to tell her that Coxhead had shot himself in the chest. They also mentioned that the crisis hotline details he had been given was a wrong number.

Coxhead was transferred to hospital in Halifax where he remained on life support for two weeks before dying on Nov. 29.

"The fact is that my father went in there and sought help ... He cried for help. He did not , he did not want to die," she says. "He wanted help and (suicide was) his only way out, because nobody gave him the time of day."

Annapolis Valley Health which runs the hospital where Coxhead sought help says it can't comment on his case due to privacy concerns, but it says it has "reached out to the family to offer support" and "a review of the case will be conducted."

'They should have just done their jobs'

Miranda Norman agrees there's a problem.

Her 17-year-old brother Greg confided to her that he was planning his suicide. In fact, police in Halifax took him three times to the emergency department at his local hospital between October and November. He had struggled with mental illness for some time and was cutting himself and taking drugs.

Norman herself called Nova Scotia's Mental Health Mobile Crisis Line on Oct. 24, saying her brother was suicidal. The crisis-line staff are supposed to assess each call for imminent risk, but in Greg's case, no one was dispatched to offer an assessment.

"They said they were not going to help him. Why? Because it was 'a phase.' It's a phase that kids go through," she says they told her. "Thoughts of suicide is apparently a 'phase' to mental health."

Greg killed himself on Nov. 19. Norman says the experience has left her angry.

"For them to just sit there and tell me that my brother is just going through a phase; they should just come out and assess it and then they can make their opinions. But they didn't even bother to do that," she says. "They should have come out. They should have just done their jobs."

The managers of Mental Health Mobile Crisis line refused to comment on Norman's case, but said it too was reviewing the incident.

Jackie Quinn, in nearby Parrsboro, N.S., is also bitter.

Her son Ryan was a promising athlete who suffered from depression, but the medications he had been prescribed by a doctor weren't working. Last June, he told her he wanted to kill himself.

She says she did the only thing she could: she brought him to Amherst Hospital, part of the Cumberland Regional Health Care Centre, where she asked that he be admitted for care.

"I brought my son on emergency basis. I said he needs to see someone. And that's when I was told to sit in the red chairs."

They waited two hours, but were never called.Distressed, Ryan gave up. Two weeks later, he was dead by his own hand.

Quinn says there seems to be all kinds of awareness about suicide and mental health, but not much awareness about those who seek help and who don't get it.

She wonders what more she could have done for her son. "You are told to take your child there if they are suffering from depression and suicidal thoughts. And you do and you don't get the help."

The Cumberland Health Authority, which provides health care services in Parrsboro, said it too can't comment on specific cases.

Cases not unique, say mental health advocates

The Canadian Psychiatric Association says, ideally, when a patient goes to an emergency department with suicidal thoughts, they would by assessed by an emergency room physician, who could then refer the patient to a psychiatric emergency service for additional assessment.

If a patient is not admitted, they are typically given a card with the details for contacting a 24-hour crisis service and told if the situation worsens, they should come back.

While all three of these recent cases were in Nova Scotia, they are not isolated, says Phil Upshall, of the Mood Disorders Society of Canada. His offices receives calls from people across the country who have turned to hospitals and crisis lines for help and received little support.

"For each of those we are talking about today, there are hundreds and hundreds across the country having the same experience," he says.

The first problem, he believes, is stigma. Many in the medical profession still think depression and mental illness aren't as serious as they are and promote a "pull up your socks" approach.

As well, doctors and nurses may not have complete training on how to handle someone in a suicidal crisis.

Often, there are not be enough resources -- either counsellors or beds -- for mental health services. He also advocates for better-designed ER triage for those with suicidal thoughts.

"It's very hard to keep someone with depression or another illness sitting waiting in an ER room. In some cases, people with mental illnesses wait for six to 10 hours, and then get up and walk out."

Patients suffering from mental disorders need compassion and warm, caring staff who will listen and are able to stabilize patients and ensure they get follow-up care the next day.

"Well over 4,000 Canadians kill themselves each year. We need a national strategy on suicide," says Upshall, adding that the majority of cases can be treated.

Miranda Norman says if more is going to be done to prevent suicides like her brother's, the first step is acknowledging that the current system is not working well.

"If people are not aware that change needs to be made," she says, "it will never be made."

With a report from CTV medical specialist Avis Favaro and producer Elizabeth St. Philip

If you or someone you know needs to connect to a suicide hotline, please call a local distress or crisis centre listed here.

If you have a family member who experienced similar problems while suicidal, please follow this link to write to us.