As we rebuild the State’s social and economic infrastructure, we have a great opportunity to take a new approach to managing the emotional and mental health and wellbeing of our children and young people.
Our pragmatism and community spirit kicked in earlier this year, with the benefits of living in a small State coming to the fore via rapid cross agency work and staff deployment. These quick actions led to previously unimagined ways of doing business here in SA; from introducing contact tracing and online learning platforms, to providing shelter for the homeless and prison visits via skype.
So why does it feel as though we’ve slipped back into doing things the way we’ve always done them when it comes to children’s mental health? The urgency there was to mobilise resources and expertise, to find ways to breakdown institutional walls and brick up service doors that lead nowhere, appears to have gone?
It must mean it’s time to reignite this urgency and build a whole community approach to children’s emotional health and wellbeing starting with “what can I do” to help an SA child feel loved, cared for and hopeful about their future.
According to recent figures, 13% of Australian primary school children (aged 4 to 11 years) meet the criteria for a mental health disorder. This figure is even higher for Indigenous children and those from other at risk groups.
If left untreated the long term implications for these children can extend across their lifetime.
Prioritising the treatment of South Australian children who have mental health issues while they are still young is exponentially more effective in reducing the incidence and severity of their mental health problems into adulthood. As well as impacting positively on their parent’s wellbeing, it will have a significant positive impact on health outcomes for the whole population, thereby creating a double-positive outcome.
Our State mental health resources are largely targeted at the severe end and are predominantly based in metropolitan Adelaide. There is a lack of accessible services designed for children with ongoing mental health issues across all sectors, and a particularly severe shortage of psychologists working with 5 to 12 year olds. This is causing lengthy wait times in major metropolitan areas, while outside Adelaide very few options exist.
Many children and young people in our community come from complex families characterised by mental illness, drug and alcohol misuse, or domestic violence. Sometimes children live in families who have a combination of all three. In these families, children are often forced to look after themselves from an early age, and as a result generally ‘grow up’ much more quickly than their peers. As a result of their home situations they may have experienced a lack of boundaries, poor adult supervision, and limited positive parental role modelling. This can mean they come to the attention of police and youth justice services as either victims of crime, or for their own offending behaviour.
Others may present at hospital emergency departments with mental distress and self-harming injuries. Though rarely admitted, when they are, they are often discharged with a referral to a mental health service where they will probably wait for a considerable length of time to be seen.
With little or no appropriate support, children in these situations describe their experiences as being ‘on a treadmill that goes nowhere’. They say the experience of asking for help, not getting help, and being ‘moved on’ is one of ‘repeated rejection’. Consistent rejection by adults who are ‘supposed to care’ is a common occurrence for these children.
Living in families with complex issues often also impacts on a child’s ability to make positive, safe life choices. Their challenging home situation can exacerbate their own mental and physical health, leading to difficulty developing positive friendships, participating in community activities, or finding work opportunities.
Many children and young people with critical mental health needs are unable to receive services due to the chaotic nature of their parents/carers lives. They frequently miss appointments or can’t access them at all. Regrettably this can lead to the labelling of families as ‘not engaging’ or being ‘too challenging’, with the consequence sometimes being a referral to Child Protection.
I am also aware of children in hospital who are being discharged and re-admitted frequently, with only a follow up visit guaranteed for their post hospital release. It’s pretty clear from the patterns being seen by health professionals, that these children need ongoing support.
Then there are those children with emotional and behavioural challenges arising from multiple adverse experiences, who the mental health system say do not have ‘a mental disorder’. They’re often kids who present as being highly distressed, unable to live healthy and safe lives, and who cannot participate in their educational or recreational activities. Whether their issues are deemed as chronic or as an acute mental health episode is not nearly as important as whether they receive treatment and support for those things impacting them beyond their control.
We know our post-COVID recovery process will be characterised by severe economic downturn and that this will inevitably lead to higher levels of unemployment, increased domestic violence, and greater substance abuse amongst parents and carers. Equally then, we can anticipate increased levels of distress among children and young people coming into contact with more stressed adults.
With the same urgency with which we approached the COVID crisis, let’s design and implement a “What Can I Do” response that will give kids in these complex home situations a real chance.
Like all children across our community, they deserve, and indeed have a right, to enjoy a successful life that provides them with the basics; someone to love, somewhere to live, someone to care about them, something purposeful to do, and something to wish for.
Helen Connolly is Commissioner for Children and Young People
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