'The father just didn't understand how his suicidal son could feel so stressed'
Educating parents will be key to solving our children's mental health crisis
The young man always stands out in Dr Gillian O'Brien's memory. "He was just 19 at the time of his suicide attempt, a really serious overdose, and he'd ended up in hospital in Dublin," O'Brien, a clinical psychologist, recalls.
"The dad told me about getting the call to say the son was in hospital. He said he couldn't believe it. 'I raced to my son's bedside and held his hand and when he woke up, I said to him, son how could you do this yourself?' The son replied, 'I'm just so stressed about things' and the dad said: 'You? Stressed? Listen to me, when you have a mortgage, a wife and kids to deal with, come back to me and talk about stress'. He totally dismissed the experience, and believe me, that man really did love his son."
For O'Brien, the clinical director of Jigsaw, a mental health charity for young people, this anecdote seemed to exemplify the difficulties that still exists when it comes to Irish parents and children having open conversations about mental health. "A lot of parents don't know where the line is between a real problem and adolescent growing pains," she explains. "A lot will ask, is this thing that's happening to my son or daughter 'normal'? When does staying in bed all day become a problem, for instance? We run a lot of training and workshops for parents, where we try to give answers to questions like that. In my experience, when a lot of people come to us, they might disclose what's really going on with them and when we say, 'have you told your mum or dad', they say no. We communicate to parents that they're not to lose their head, no matter what they are told."
If Ireland has cultural issues to do with openness around mental health, there are also serious structural problems that impede delivery of services. Staffing is a huge issue - we recently saw the resignation of three psychiatrists in the south east, with Dr Kieran Moore, a specialist consultant paediatric psychiatrist, describing staff as "burnt out" and "struggling to provide a service".
Nurses and other staff who work in the mental health system are going abroad in search of better pay and conditions. And there are also issues around the way the services are structured. "Jigsaw deals with young people in the 12-25 age range but the rest of the system is birth to 18," O'Brien explains. "Mental health needs are greatest around adolescence and early adulthood, where we tend to introduce this big break in services as someone moves from what is classed as childhood to adulthood. We need to redesign the services around the needs of young people."
Jigsaw receives some funding from the HSE and is also dependent on private donations. But is outsourcing the serious issue of mental health in young people to a charity really another symptom of a broader Irish issue: that the more vulnerable the group (the homeless, the young), the more likely it is that the Government will leave its management to the voluntary sector?
"That's an interesting question. That does tend to happen a lot and we have a history of that in Ireland. Outsourcing is one way to look at it. The HSE has to be a big, more slowly moving entity because of its scale. Youth mental health has only really become a discipline in itself in the last 10-15 years so back when Tony Bates founded Headstrong he saw that gap and other charities came along. Whether or not it's an appropriate way to deal with things going forward, I don't know if I'm the right person to comment on that. There is a whole suite of statutory services too, and the vast majority of mental health services are still delivered by the system."
O'Brien, who grew up in Dublin, is highly qualified - she is a clinical psychologist, with a primary degree from Trinity and a doctorate from Queen's University, Belfast. She as worked in Saint John of God Hospital as well as gathering "very formative" experience working as child psychologist in an orphanage in Guatemala.
That level of expertise and experience is often not available to the person on the street, however, and another huge issue in the field of mental health is the lack of professional standards in certain areas, such as psychotherapy.
"It's a real issue for the sector that we don't have statutory registration for everyone who works in the sector, there already is for some, but not all," O'Brien explains. "Minister Harris is moving toward regulation for psychotherapists. It's important the public has trust in the professionals working in the area. A lot of people in counselling and psychotherapy tend to work privately."
Jigsaw has lofty goals with ambitious plans to do with reforming views around mental health in what O'Brien calls "the entire community and wider society". She also says that educating parents will be one of the most important keys to solving our children's mental health crisis, however. "We're all a product of our environments and the family is the most formative environment for a child," she explains. "Parents might not fully understand what to say, like in the example I gave, but they can also be such a huge and powerful support to a young person. Helping them to be that support is what we are about too."