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Tag: mental health

Carrying the burden

Mental health issues are taking a terrible toll on our teens.

But it’s time we also acknowledged the damaging ripple effect carrying the burden of worrying about their suffering friends may be having on their peers too. Because while it’s encouraging that young people are asking each other “are you OK?”, if the answer to that question happens to be “no”, what are kids meant to do with this information?

Make no mistake, there are plenty of young people out there currently serving as inexperienced, unqualified counsellors to their highly vulnerable mates. In fact, a struggling adolescent is actually more likely to first talk about their problems with a close friend before reaching out to their own family. And often, the conversation will be couched as one expected to be kept private; “Please don’t tell anyone but …”

For teens on the receiving end of a disclosure that a friend is struggling, there may well be a reluctance to pass on their worries to an adult for fear of being accused of betraying a confidence; secrets are a particularly powerful form of social currency for teenagers and often shared to solidify friendships.

Teens are taking on the burden of friends’ mental health struggles. (Pic: iStock)

Through my work in schools, I have in fact noted a generation burdened with feelings of responsibility for the mental health and safety of their inner circle. In a misguided attempt to maintain their friend’s confidence, often teens acting as a support person will struggle alone. “I guess the best I can do is just to be there for her, ” one 15-year-old girl told me. And thanks to the always-on social media world our teens inhabit, the support is often delivered 24/7. She concluded: “Whenever she feel like hurting herself, she calls me first and I talk her through those feelings. It actually is really stressing me out, but I can’t let her down. She told me if it wasn’t for me, she’d want to end it. I am so scared something bad will happen to her if I don’t respond to her messages.”

Some young people are, however, at least reaching out anonymously to seek direction in knowing how to support friends they are worried about.

Kids Help Line, a telephone counselling service for young people, recorded almost one thousand calls in 2017 alone from kids concerned over the mental health of someone they know. Over half of these related to concern that their friend was suicidal (Kids Help Line are in fact so highly aware of how prevalent this concern is that they offer downloadable resources on this topic, front and centre on their website’s homepage).

Jaelea Skehan, director of Every Mind (one of the organisations behind the latest mental health #youcantalk campaign) explains: “There’s a lot of young people holding heavy stuff for others. Being a good friend is about reaching out and checking in on our friends, but it is also about recognising when we aren’t equipped to manage complex issues and involving professionals who do have those skills.”

Jaelea Skehan is the director of Every Mind, who are behind the #youcantalk campaign. (Pic: Peter Lorimer)

We need to very clear. Yes, we can talk. However, young people urgently need to be reassured that reporting concerns they hear to trusted adults is vital — and isn’t a betrayal of their friend’s trust.

How can we break this message down for them?

I teach teens that we should never keep dark secrets for people. When a young person begins talking to me and says something to the effect, “I want to tell you something but you must promise not to tell anyone.” I respond with the following; “You may tell me anything. And I will listen with my whole heart. But if you have been hurt, or could be hurt, I want you to know that I care too much about you not to do something about that.”

All young people need to know that reporting concerns to trusted adults is not a betrayal. Rather, it shows the depth of their compassion and bravery.

Tools to know how to best manage the conversations they are having are also important to share with our kids. They don’t need to solve complex issues, but simply acknowledge their friend’s feelings and tell them they care. They can also gently point out the consequences of their friend’s actions, for both themselves and the people that care for them. And if their friend has been hurt, or could be hurt? They can support their mate to get the professional help they deserve.

Teens should also be encouraged to take care of themselves during this process. They can reach out and debrief with a trusted adult if they are feeling overwhelmed or anxious by what they’ve been told (this is particularly important as we know that suicide can have a contagion effect on vulnerable youth).

By caring for themselves too, these accidental counsellors will be modelling for their mates that while sharing with those closest to us is a helpful first step, healing comes from also talking with professionals.

This OpEd was first published by The Daily Telegraph, 11/8/18

Why students are packing Prozac in their lunch boxes

This post was first published by RendezView, 31/1/16

Screen shot 2016-02-05 at 7.40.02 AM

Laptop? Check. Lunch box? Check. Prozac? Check.

For more and more young people, the preparation for back to school this year will include making sure they have their anti-depressants close at hand.

Australia has one of the highest rates of use of these medications in the world and a recent University of Sydney study found that there has been a particularly marked increase in the use of these drugs in children and adolescents.

In fact, over the four-year period from 2009-2012, researchers found that the largest increase in use was amongst children aged between 10-14 years.

Dr Emily Karanges, now a research fellow in the Medicines Policy Unit at the University of NSW and lead author of the paper based on the study’s findings, suspects the rates of usage would be even higher amongst those who are school-aged today: “There is no reason to think this trend would have reversed. Given the steep upward trajectory in the rate of antidepressant use at the time of our research, especially among young people, I’d expect the figures now would be significantly higher again.”

Yet the therapeutic guidelines from the US, UK and Australia recommend that psychological therapies rather than medication be used to manage depression and anxiety of a mild or moderate severity, and that anti-depressants should only be used for severe disorders or when all other treatments have first proved ineffective. This is because these drugs are often less effective in depressed children and adolescents than in adults, and come with increased risk of self-harm and suicidal thinking.

Karanges also advocates for caution as: “The brain is still developing up to the age of 25 and antidepressants are a pretty blunt instrument. We know very little about how they might be changing the development of the brain and whether they might have long-term effects into adulthood.”

So what is driving this eagerness to medicate kids who need support?

Although counsellors and psychologists can’t prescribe medication, many are quick to suggest young people visit a GP to access these (it is not uncommon for this to be suggested as a solution even during an introductory counselling session). Concerned parents may then go to their GP specifically requesting drugs.

And many time-poor GPs report feeling ill equipped to treat mental health issues; according to the Black Dog Institute, in Australia GPs don’t have to have any specific training in mental health to practice.

Karanges points out that these types of medications are also heavily marketed to the medical community: “It is perhaps no coincidence that the anti-depressants that were most rapidly increasing in use were also the newest ones and the ones most likely to be advertised to doctors.”

GP’s may also have the misguided view these types of medications are relatively safe. A Danish study published in The British Medical Journey this week found that the harms reported in antidepressant trials were often seriously misrepresented and underreported, this included suicide attempts and suicidal idealation being coded in reports by pharmaceutical companies as “emotional lability” or “worsening depression”.

Reports issued by drug companies were, the authors said, “even more unreliable than we previously suspected”. The study concluded by recommending “minimal use of antidepressants in children, adolescents, and young adults, as the serious harms seem to be greater, and as their effect seems to be below what is clinically relevant”.

Instead, treatments such as psychotherapy and exercise were suggested.

It may also be that culturally, we are not always comfortable with the full spectrum of human emotions and are too eager to seek a quick fix.

Psychologist Jacqui Manning says she would be reluctant to suggest medication, particularly with a young person, until a range of other strategies had been tried first.

“I may see teens during highly stressful life events like the HSC exams or a breakdown or death in the family,” she said.

“Sometimes parents will say, ‘my child isn’t coping — do you think they need meds?’ I’ll respond that there are many things we can try first and that their son or daughter’s feelings are a normal human response to an extremely stressful situation.”

Whilst it is important not to stigmatise or alienate those young people who do genuinely need medication, Iain McGregor, Professor of Psychopharmacology at the University of Sydney, has called for time out on making medication our default response when supporting children and teens in crisis.

“We need to have a national debate about what is driving this phenomenon,” he said.

“Why are we so reliant on pills for the mental wellbeing of our young people?”

And what is happening that is making our kids feel so desperately sad in the first place?

Girls in crisis: self-harm, and what you can do to help

Increasingly I am being asked by concerned parents and girls about the issue of self-harm, so this week I’m bringing you an abridged version of the section in my book The Butterfly Effect that looks at what drives some girls to hurt themselves, the warning signs to look out for, and what we can do to help girls in crisis.

Trigger warning: The following post contains references to self-harm that may be a trigger for some people.

What is self-harm?

Self-harm is when a girl purposely injures herself, usually in secret. There are many different ways that a girl might do this, including cutting, burning, biting or branding her skin; hitting herself or banging her head; pulling her hair out; picking and pulling at her skin; or picking at old sores to open them up again.

Self-harm warning signs

  • Cuts – especially small shallow parallel cuts on the arms or legs – for which there is no adequate explanation
  • Other frequent and unexplained injuries, such as burns or bruises
  • Starting to wear long sleeves or pants all the time, even in warm weather
  • Sudden aversion to going swimming or getting changed in front of other girls
  • Hair missing, where it has been deliberately pulled out
  • Mood changes, depression, anxiety
  • Spending a lot of time alone
  • Notable difficulty dealing with stressful or emotional situations
  • A drop in school performance

Why do girls self-harm?

While each girl’s situation at home, school, with friends and in the community influences her life in a unique way, there are underlying factors in our culture that are putting more teenage girls at risk than ever before. Being part of society means meeting certain expectations; around adolescence girls begin to be more fully aware of the pressure to fulfil these expectations, which were mapped out before they were even born. Girls can hardly miss the messages about what it takes to be an ideal girl or the ideal woman. Unable to match the ideal no matter how they try, many girls begin to loathe themselves for falling short.

To try to meet the expectations of who they should be, teenage girls may have to tame themselves, blunt themselves. They learn that if they express anger, they will turn people off, because feminine, good girls are agreeable, not cranky. Even though on the surface a girl may appear sad, happy or indifferent, she may really be bottling up rage. Where does girls’ suppressed anger go? For some, it may become depression, drug or alcohol abuse, or self-aggression such as anorexia, bulimia, self-harm or suicide.

In some cases, self-harm is a form of risk-tasking and rebelling, or even of being accepted into a peer group. In others, it is a sign of deep psychological distress, a way of coping with painful, overwhelming feelings. If a girl finds it hard to express emotions such as anger, sadness or grief, marking her body in this way may be her desperate attempt at self-expression. A girl numbed by depression or trauma may self-harm in order to feel something again. It can also be a cry for help. A girl who doesn’t know who to ask for help, or how, may be using her injured body to send a message. And as with eating disorders, there are girls who self-harm because they feel that they are not in control of aspects of their life; for them, self-harm is a way of asserting control.

During the act of hurting herself, a girl may feel as though she is releasing pent-up steam, as if opening the valve on a pressure cooker; the act brings a temporary sense of relief. But self-harm also brings with it guilt, depression, self-loathing, anger, fear, and isolation from friends and family.

Self-harm doesn’t necessarily mean that a girl is suicidal, but all cases of self-harm need to be taken seriously. Self-harm can be related to mental health issues including depression, psychosis, bipolar disorder and borderline personality disorder; to a trauma such as physical or sexual abuse; or to some other source of deep psychological pain. Self-harm may also do lasting physical damage. While girls rarely need hospitalisation because of self-harm, they may give themselves lifelong scarring as well as nerve damage.

What can be done to help?

In the short term, if a girl self-harms she needs to learn ways to cope when the urge strikes. Her therapist is likely to suggest ideas such as counting to ten or waiting 15 minutes, to give the feeling a chance to pass; saying ‘No!’ or ‘Stop!’; relaxation techniques such as yoga; or going for a run or doing some other kind of hard physical exercise. Another accepted short-term solution is to choose an alternative to self-harm, such as squeezing ice cubes between her fingers until they go numb, eating a chilli, standing under a cold shower, having her legs waxed or drawing in red on her body instead of cutting. Crucially, the underlying reasons why she self-harms need to be uncovered and worked through with a professional, who will also help her to develop healthier ways of identifying, coping with and expressing painful emotions.

There is much we can do to help prevent girls finding themselves at crisis point; and no matter how troubled a girl is, she can turn her life around. The key is communication. By strengthening a girl’s connections – to her parents, the rest of her family, her friends, community and school – we can give her the best chance.

Girls regularly tell me that what they want more of is their parents’ time. They want their parents to listen. Sometimes when we ask our daughters what’s wrong, we get a blank gaze or a huff or a slammed door, and we give up. Don’t give up too quickly. Your girl may be sending out all the signals to push you away while actually she needs you to keep asking, giving her attention, showing her you care. Therapist Martha B. Straus urges: ‘When she’s at a loss for words, guess and guess again.’ Many teen girls have a limited vocabulary for expressing their feelings, but we can help them. It can take something as simple as ‘I feel really angry about this – do you?’ to open the floodgates.

One of the most helpful things you can do is allow her to express all her emotions, rather than choking on her darker feelings until they turn into despair. ‘When girls can be angry,’ Straus writes, ‘they can also be reassured they are worth such powerful feelings – there is someone in there worth being mad about.’

Action Plan

  • Seek professional help. A good starting point is your GP, for a referral to a relevant specialist, local adolescent mental health team, counsellor or community health centre.
  • Be consistent. Set consistent boundaries, but also be consistent in your loving. Even if she takes a drastic backslide in her recovery, she needs to know that you still love her.
  • Banish secrecy. Maintaining a shroud of secrecy around a crisis is not helpful to girls.
  • Build networks of support. A girl’s networks may include doctors, therapists, adult mentors, relatives, school counsellors and friends.
  • Celebrate. When a girl is on the path to recovery there may be frustrating and disappointing setbacks, but there will be victories, too. Take heart in them. And celebrate.


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