Saturday 19 January 2019

Brendan O'Connor: Listen to these 7,000 kids now, not when it's too late

We are great at talking about mental health these days, but not so great at providing vulnerable children with the help they need, writes Brendan O'Connor

Help: Children often ‘need the opportunity to tell their story
Help: Children often ‘need the opportunity to tell their story
Brendan O'Connor

Brendan O'Connor

A very well-spoken and efficient sounding lady from the HSE came onto Morning Ireland to tell us that everything was fine. In fact the figures suggesting we had the fourth highest rate of teen suicide were out of date, and the Government is now pumping €5m into loads of new assistant psychologists for young people.

But Anne O'Connor did not dispute the fact 7,000 children are waiting for psychological services in the primary care area, and one third of those have been waiting for more than a year. The people who sit on these lists, she said, are not urgent cases. Though she did concede that early intervention is key in this area. Non-urgent cases can, of course, very easily become urgent cases. They can certainly become urgent in a year.

We pride ourselves on being great at talking about mental health in this country these days. And compared to how we used to be, we certainly are. Most of this change has come about not from anything the Government did, but from people in various leadership or prominent positions in the community speaking out to break the stigma around mental health.

Some will say all the talk about anxiety and so forth focuses on 'mental illness lite' and does not really address the nature of really messy, really awful, full-blown mental illness that prevents people from functioning at all. But this openness certainly represents some improvement from previous generations who suffered from nerves and took to the bed.

We are great, too, at talking about the dangers facing our children in the challenging, competitive, complicated world we live in. We wring our hands a lot about the internet, social media, bullying in school and even exam pressure, about apparent epidemics of anxiety, depression and self-harm among our kids.

Talking about things and lifestyle advice are great ways of helping people who are experiencing distress from tipping over the edge into a situation where their mental and emotional well-being becomes a serious problem.

And it's nice that we have these feel-good factors around minding our mental health, and around it being OK, as they say, not to be OK.

But the reality is that none of this really matters a damn unless those who are in trouble get access to professional help - and get it early on, because the later the help comes, the more it will cost in terms of resources and disruption to lives.

We can talk all we want about how great we are around mental illness but unless we prioritise helping people, it's all just so much hot air.

Tanya Ward of the Children's Rights Alliance, who brought the shocking figures on waiting lists to light last week, says that the experience on the ground is that when children who have attempted suicide are brought into hospitals there is often no one to refer them onto.

Terri Morrissey, chief executive of the Psychological Society of Ireland, points out another interesting aspect of this lack of services. She says a shortage of skilled professionals to deal with children in crisis leads to over-prescription and over-labelling of children. So instead of being dealt with as individuals, as human beings in crisis, these kids are dealt with as a label, or a syndrome, or a medical condition to be cured with tables.

Morrissey echoes concerns that run through an important new book by Dr Mike Shooter, an eminent UK child psychiatrist. Shooter's book Growing Pains is causing quite a stir and is a book that every parent should read.

The book is mainly composed of stories about many of the kids Shooter has dealt with down the years, but throughout he riffs on our whole system of treating young people in crisis, and indeed the reasons why so many of our young people are unhappy, lonely or distressed.

He also talks about the notion of labelling and medicalising young people in crisis.

"I do despair of the way diagnosis has swept the board," he writes. "Children's problems have been bundled into categories for treatment and their broader identities have been swept under the medical carpet in the process."

Shooter is one of those very humane, wise people you find yourself wishing was your doctor. He explains that labelling or diagnosing is often more to feed the demands of parents and doctors than the children themselves. In terms of families, he believes some kind of label, like ADHD or even ASD, both of which he thinks are overdiagnosed, can almost be a badge of pride and take away certain responsibilities.

In terms of doctors, he points out that psychiatrists and psychologists want to feel more like real doctors who deal with real illnesses, so they like a diagnosis or a label, and then managers like numbers, so they can tick off how many were diagnosed and how many were treated. And that's what the system views as success.

Incidentally, health economist Professor Alan Maynard, who died this month and was something of a maverick, once scandalised medics by suggesting that a better measure of whether a system was working was to ask the actual patient whether their treatment was a success. Don't think that ever caught on!

Mike Shooter has a lot to say that is pertinent to our situation in Ireland. While he agrees that self-harm, anxiety and depression do seem to be a growing problem among young people, he uses very human terms when he talks about the reasons behind it.

For example, he points out that we are always failing our kids at something, so maybe we need to look at our academic system. He also talks a lot about the role of the family and society, the lack of togetherness and community in the world now.

He puts much of the family strife that causes childhood emotional issues down to "the problems of living in a more competitive, unequal, lonely and stressful society".

In terms of how the system is dealing with this, he says: "Children and their carers are languishing on ever-lengthening waiting lists or are not referred for help at all. If they finally get there, their behaviour will be turned into a diagnosis for treatment or dismissed as a social problem for which the doctor behind the desk has nothing to offer. And their stories will never be heard."

Stories are central to Shooter's world view. His book uses people's stories to make its point and he believes passionately that many kids, rather than being labelled or medicated or bounced deeper into the mental health system, can be helped by "the opportunity to tell their story, to someone they trust, who will listen to them with patience and respect, who will recognise that this may be the first time they have found the courage to share it with anyone".

"Some of the children I worked with were clinically depressed and needed to be treated as such," he concedes. But, he adds, "The pressures in their lives were just as important and required guidance, not a pill. Indeed, most of them were beset with problems that had nothing to do with illness - family breakdown, bullying, abuse and the like. Their lives were in a mess. They needed my help and they got it, not some invented diagnosis that would be more comfortable for everyone concerned, or a rejection because they had no psychiatric diagnosis."

So perhaps what we take from this is that those 7,000 children who are not yet urgent cases need someone to tell their stories to, and they need to do that in a timely fashion, because the alternative for many of them is for their crisis to blow up, or for them to become medicalised, labelled, for their lives to be ruined and for them to cost society a lot more in the long term.

Sunday Independent

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