Adolescent suicide has been in the news recently: Parents have called for more discussion and community awareness on the subject.
The National Children’s Commissioner has just called for submissions to examine “intentional self-harm and suicidal behaviour in children” across the whole country.
In South Australia a recent Coroner’s report on the death of 15 year old school girl Michaela Mundy has been critical of the assessment and treatment service offered to the young girl and her family.
The problem is big. Let’s be realistic about that. Large proportions of our young people now talk about suicide and self-harm as a known and routine topic of conversation. They know of peers who engage in such behaviours. In my experience as a mental health counsellor, it is human nature to be more likely to try something that we know others have done before us.
The Children’s Commissioner’s ‘Call for Submissions’ reports that from 2011-12 intentional self-harm was the leading cause of death for young people aged 15 to 24. Australian hospital statistics record that 10,000 young people in the same age range presented with incidents involving intentional self-harm. This does not include children aged 5 to 14. Kids Helpline (a phone counselling service) recorded 16,000 contacts from ‘kids’ aged 5 to 25 who talked about self-injury and self-harming.
Nationally services are Lifeline, Kids Help Line, Reachout (on the phone and online) and Headspace. The latter is a nationally funded face-to-face counselling program. The Medicare Locals, which are currently threatened to be disbanded in the federal budget, also provide some counselling response under the ATAPS (Access to Allied Psychological Services) program. A GP referral through the Better Access to Mental Health Care Program also allows some adolescents and families to get support. All of these programs do good work.
Each suicidal young person who is seen needs to be seen at least weekly initially and probably for a year or more overall. There are hundreds of kids and too few counsellors to meet the demand.
The State Government provides its response through Child and Adolescent Mental Health Services (CAMHS).
There are a number of difficulties for this service to provide enough support to all those families who request help.
While the numbers of adolescents presenting is about a third of all people with mental health issues seeking state services, adolescent services get only a 10 per cent share of the budget. There has been no significant increase in funding to CAMHS in the last decade.
My own experience of trying to help families get a CAMHS appointment confirms there are long waiting lists of children and adolescents. And not with minor issues – there are plenty of suicidal adolescents waiting to be seen.
A quick response in these cases is obviously needed and helps success enormously. There is usually only a small window of opportunity. If families have battled to get an adolescent to the CAMHS office only to be told there is a waiting list, a crucial opportunity is lost. Each suicidal young person who is seen needs to be seen at least weekly initially and probably for a year or more overall. There are hundreds of kids and too few counsellors to meet the demand.
Experience also says that CAMHS are referred the most difficult, most risky cases. A family may have accessed one of the other services initially, but if the young person fails to engage and people are still worried, a referral is made to CAMHS. It is the last option; to pass the risk and responsibility to “the state”.
The CAMHS staff live constantly with the weight of knowing they cannot offer timely services to all who ask for it. Even when a first appointment is set up, it is often extremely difficult to engage that young person in treatment.
The term ‘mental health’ has a stigma for them. Peer ridicule is uppermost in their minds at this age. As a counsellor you have one session to find a way to connect. How do you do that? Certainly counsellors have more knowledge, skills and techniques to use. But they cannot work miracles. Faced with a teenager sitting stony-faced in front of you in silence, or spitting out they don’t want to be there, or swearing, or getting up and walking out the door – what can you do?
You can try to talk in their language, but it has to be genuine. You can talk out loud about the sorts of issues you know young people like themselves have and what can be done, in the hope they take in some of it and feel you do understand. You can try to boost their self-esteem in the session by all sorts of respectful and caring gestures. But it is a big ‘ask’ to succeed with that first connection.
Is it all the responsibility of government? What else can the families and community do to help prevent young people feel this miserable?
In my view the community needs to do more to engage with children all the way through.
Preventing children feeling isolated, ignored, unimportant, or not sure of their place, is the best option. This must begin in families themselves. Families need to talk to their children about difficult issues and events in their lives in simple age appropriate terms, rather than avoid them and just hope for the best.
Kids tend to blame themselves for everything that goes wrong unless reassured and told otherwise. Families need to encourage and coach their kids in how to develop self-confidence. Schools then need to support and reinforce good relationships, but they cannot do it alone. But if any of us sees a child who is withdrawn, separate, uninvolved or trying too hard to be accepted, we can and should do something.
The state adolescent mental health services are struggling badly to meet the demand. There is only so much in the state money purse.
What priority are we as a community going to give to supporting adolescents who feel so bad they self-harm, or consider ending it all?
It makes logical sense to put more money into adolescent mental health services; into the prevention of so much grief, and of later adult mental health problems requiring services. Let’s think about it.
Mary Hood is the president of the South Australian branch of the Australian Association of Social Workers. She is an Accredited Mental Health Social Worker.
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