tag:theconversation.com,2011:/id/topics/youth-mental-illness-6118/articlesYouth mental illness – The Conversation2023-08-16T12:28:50Ztag:theconversation.com,2011:article/2074762023-08-16T12:28:50Z2023-08-16T12:28:50ZAs the mental health crisis in children and teens worsens, the dire shortage of mental health providers is preventing young people from getting the help they need<figure><img src="https://images.theconversation.com/files/534699/original/file-20230628-23-9wa1lm.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5584%2C3731&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Anxiety, depression and suicide among U.S. teens continue to increase. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/young-girl-in-trouble-feeling-sad-and-depressed-royalty-free-image/1135281941?phrase=distressed+teenager&adppopup=true">Paolo Cordoni/iStock via Getty Images Plus</a></span></figcaption></figure><p>The hospital where I practice recently admitted a 14-year-old girl with <a href="https://www.samhsa.gov/mental-health/post-traumatic-stress-disorder#">post-traumatic stress disorder</a>, or PTSD, to our outpatient program. She was referred to us six months earlier, in October 2022, but at the time we were at capacity. Although we tried to refer her to several other hospitals, they too were full. During that six-month wait, she attempted suicide. </p>
<p>Unfortunately, this is an all-too-common story for young people with mental health issues. A 2021 survey of 88 children’s hospitals reported that they <a href="https://www.cdc.gov/nchs/products/databriefs/db471.htm">admit, on average, four teens per day</a> to inpatient programs. At many of these hospitals, more children await help, but there are simply not enough services or psychiatric beds for them. </p>
<p>So these children languish, sometimes for days or even a week, in hospital emergency departments. This is not a good place for a young person coping with grave mental health issues and perhaps considering suicide. Waiting at home is not a good option either – the family is often unable or unwilling to deal with a child who is distraught or violent. </p>
<p>I am a <a href="https://som.cuanschutz.edu/Profiles/Faculty/Profile/28534">professor of psychiatry and pediatrics</a> at the University of Colorado, where I founded and direct the <a href="https://medschool.cuanschutz.edu/psychiatry/PatientCare/STARTcenter">Stress, Trauma, Adversity Research and Treatment Center</a>. For 30 years, my practice has focused on youth stress and trauma. </p>
<p>Over those years, I have noticed that these young patients have become more aggressive and suicidal. They are sicker when compared to years past. And the <a href="https://blogs.cdc.gov/nchs/2023/06/15/7396/#">data backs up my observation</a>: From 2007 through 2021, suicide rates among young people ages 10 to 24 increased by 62%. From 2014 to 2021, homicide rates rose by 60%. The situation is so grim that in October 2021, health care professionals <a href="https://www.aap.org/en/advocacy/child-and-adolescent-healthy-mental-development/aap-aacap-cha-declaration-of-a-national-emergency-in-child-and-adolescent-mental-health/">declared a national emergency</a> in child mental health. </p>
<p>Since then, the crisis has not abated; it’s only gotten worse.
But there are <a href="https://www.commonwealthfund.org/publications/explainer/2023/may/understanding-us-behavioral-health-workforce-shortage#">not enough mental health professionals</a> to meet the need. </p>
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<figcaption><span class="caption">How school bullying led to tragedy.</span></figcaption>
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<h2>The numbers behind the suffering</h2>
<p>The American Academy of Child and Adolescent Psychiatry reported in May 2023 that there is a <a href="https://www.aacap.org/aacap/zLatest_News/Severe_Shortage_Child_Adolescent_Psychiatrists_Illustrated_AACAP_Workforce_Maps.aspx">drastic shortage of child and adolescent psychiatrists</a> across the U.S. </p>
<p>For every 100,000 children in the U.S. – with 1 in 5 of those children having a mental, emotional or behavioral disorder in a given year – there are only 14 child and adolescent psychiatrists available to treat them, <a href="https://www.aacap.org/aacap/Advocacy/Federal_and_State_Initiatives/Workforce_Maps/Home.aspx">according to the American Academy of Child and Adolescent Psychiatry</a>. At least three times as many are needed. </p>
<p>There is also a significant shortage of child therapists – social workers, psychologists, licensed professional counselors – as well. This is particularly the case in <a href="https://doi.org/10.1001/jamapediatrics.2018.5399">rural areas across the country</a>. </p>
<p>Studies show that young people in the U.S. are <a href="https://www.pewresearch.org/social-trends/2019/02/20/most-u-s-teens-see-anxiety-and-depression-as-a-major-problem-among-their-peers/">increasingly stressed and traumatized</a>. The <a href="https://www.mayoclinic.org/healthy-lifestyle/tween-and-teen-health/in-depth/teens-and-social-media-use/art-20474437#">constant barrage of information</a> via social media and the demand to participate in it is complex, and interactions can be harmful to a child’s mental health. </p>
<p>Young people deal with <a href="https://cyberbullying.org/cyberbullying-statistics-age-gender-sexual-orientation-race">cyberbullying</a> and endless exposure to social media content <a href="https://theconversation.com/mounting-research-documents-the-harmful-effects-of-social-media-use-on-mental-health-including-body-image-and-development-of-eating-disorders-206170">focused on body image</a>.</p>
<p>But what children and adolescents see online is not the only problem. Much of life still happens offline, and a lot of it is not good. Millions of young people deal every day with <a href="https://ncsacw.acf.hhs.gov/research/child-welfare-and-treatment-statistics.aspx#">alcoholic, drug-abusing or neglectful parents</a>; peers who <a href="https://drugabusestatistics.org/teen-drug-use/">drink, vape and use drugs</a>; violence at <a href="https://www.cdc.gov/violenceprevention/communityviolence/index.html">their schools or in their streets</a>; and overwhelmed caregivers – whether parents or others – preoccupied with financial or other personal problems. </p>
<p>For an adolescent already struggling to make sense of the world, any one of these issues can be overwhelming. </p>
<h2>Not enough time or money</h2>
<p>The U.S. health care system does very little to support these children or their families. This pattern begins at the moment of birth, and it is baked into the system. </p>
<p>Ideally, prospective parents or those who are pregnant would receive parenting classes that continue through the child’s developmental phases. That generally <a href="https://www.gse.harvard.edu/ideas/ed-magazine/19/08/parent-approved">does not happen</a>. Then, many new parents do not have <a href="https://www.americanprogress.org/article/universal-home-visiting-models-can-support-newborns-families/">nursing and maternal care visits</a> or <a href="https://www.pewresearch.org/short-reads/2019/12/16/u-s-lacks-mandated-paid-parental-leave/">paid parental leave</a>. And for those families struggling financially, there is <a href="https://doi.org/10.1007/s10826-022-02322-0">not an adequate safety net</a>. </p>
<p>Nor can some families afford mental health treatment to support their children’s needs. <a href="https://www.nami.org/Support-Education/Publications-Reports/Public-Policy-Reports/The-Doctor-is-Out/DoctorIsOut">Many mental health providers don’t take insurance</a> and instead opt for out-of-pocket payments from patients. This is due to the low reimbursement rates from most insurers, which makes it very difficult to sustain a practice. Depending on the service, the cost could be anywhere from US$100 to $600 per session. </p>
<p>To see providers that do take insurance, there are usually co-pays – typically between $20 to $50 a week. But it can often be challenging for the insured to find a suitable in-network provider to meet a child’s needs.</p>
<p>The payments add up, particularly when mental health treatment takes many months, and sometimes years, to have an effect. There is a reason why it takes so long. Unlike medical doctors, mental health professionals do not simply make a diagnosis and provide medication or surgery. Instead, for treatments to work and to change the outcome for young people who are struggling, an ongoing – and lengthy – <a href="https://www.apa.org/monitor/2019/11/ce-corner-relationships">relationship between the therapist and the patient is needed</a>. </p>
<p>Treating a child is significantly more difficult than treating an adult. That is, in part, because children are constantly developing and changing. But perhaps the most formidable challenges are the <a href="https://doi.org/10.1186/s40723-021-00094-6">multiple entities</a> a child therapist may have to work with: caregivers, the school system, the courts and child welfare agencies. What’s more, getting a diagnosis, treatment or both often involves working with multiple providers, such as a primary care doctor, individual therapist, family-focused therapist and psychiatrist. </p>
<p>In the institute where I work, the psychiatry department loses money on almost every patient we treat. If it weren’t for fundraising and fostering relationships with donors, the department could only provide care to a select few. </p>
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<figcaption><span class="caption">Emotional abuse by parents includes threats, bullying, humiliation and insults.</span></figcaption>
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<h2>Possible solutions</h2>
<p>Struggling children and teens in the U.S. need earlier interventions. Although schools are ideal places to teach social skills, they still do not offer enough activities to help young people <a href="https://raisingchildren.net.au/school-age/behaviour/understanding-behaviour/resilience-how-to-build-it-in-children-3-8-years">develop resilience to cope with adversity</a>. </p>
<p>Sometimes, young patients see primary care doctors who don’t have enough training in this area. Telephone hotline programs, which offer these doctors free consultations from mental health professionals to help assess problems in young patients, should be available throughout the U.S. But right now, <a href="https://www.rand.org/news/press/2019/07/15.html">only 19 states have such programs</a>. One bright spot: The <a href="https://theconversation.com/as-suicides-rise-in-the-us-the-988-hotline-offers-hope-but-most-americans-arent-aware-of-it-210356">988 Suicide and Crisis Lifeline</a>, which launched in July 2022, is available 24/7. </p>
<p>When a young person needs treatment, parents should prioritize finding a mental health provider right away. Asking the child’s primary doctor and school counselors for a reference is a good start. If the child is already on a waiting list, a parent or guardian should call the provider weekly to check in and make sure the child is not forgotten. </p>
<p>The process can be discouraging and daunting, but in our current environment, which provides limited support, that’s the way it is. And without a heavy lift from parents, the child remains at great risk.</p><img src="https://counter.theconversation.com/content/207476/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Steven Berkowitz is affiliated with Sensye, inc. I am a consultant to Senseye, Inc. a startup developing a device to make objective psychiatric diagnoses</span></em></p>Millions of young people in the US are suffering, whether from abuse at home, pressure from social media or exposure to violence. But navigating the mental health care system can be disheartening.Steven Berkowitz, Professor of Psychiatry, University of Colorado Anschutz Medical CampusLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1937002023-01-17T13:33:06Z2023-01-17T13:33:06ZParents in the US had alarmingly high rates of anxiety and depression during the COVID-19 pandemic – and that has a direct effect on kids<figure><img src="https://images.theconversation.com/files/500562/original/file-20221212-913-u7oobq.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5653%2C3722&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The mental health of parents and children are often intertwined.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/unhappy-with-their-arguments-royalty-free-image/169962903?phrase=ANGRY%20PARENT%20SCREAMING%20AT%20CHILD&adppopup=true">Goodboy Picture Company/E+ via Getty Images</a></span></figcaption></figure><p>It’s no secret that the COVID-19 pandemic has taken a heavy toll on the mental health of kids and parents alike.</p>
<p>In a 2020 survey, 71% of parents said they believed the pandemic had <a href="https://www.apa.org/monitor/2022/01/special-childrens-mental-health">hurt their children’s mental health</a>. The American Academy of Pediatrics declared <a href="https://www.aap.org/en/advocacy/child-and-adolescent-healthy-mental-development/aap-aacap-cha-declaration-of-a-national-emergency-in-child-and-adolescent-mental-health/">a national emergency in child mental health</a> in October 2021, citing “soaring” rates of child mental health challenges. </p>
<p>In 2022, the Biden administration developed a comprehensive strategy and <a href="https://www.whitehouse.gov/briefing-room/statements-releases/2022/07/29/fact-sheet-biden-harris-administration-announces-two-new-actions-to-address-youth-mental-health-crisis/">committed a substantial amount of money</a>, including US$300 million secured through a bipartisan agreement, to a national response to the children’s mental health crisis through multiple sources.</p>
<p>But what is often missing from this national conversation is the importance of recognizing parents’ mental health and the effect that parents’ mental well-being has on that of their children. Decades of research clearly demonstrate that the mental health of parents and their children are inextricably linked.</p>
<p>As an <a href="https://mpsi.wayne.edu/profile/Du4864">assistant professor of child and family development</a> whose research focuses on <a href="https://scholar.google.com/citations?user=tDjq_esAAAAJ&hl=en">parenting and child mental health</a>, I see too often that the mental health of parents – or other caregivers who act in the role of parents, such as grandparents or foster parents – is overlooked when trying to support children’s mental health. Until that gap is addressed, efforts to address the mental health crisis in kids and teens will likely fall short.</p>
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<figcaption><span class="caption">Even after a child shows symptoms of a mental health issue, many parents still don’t reach out for help.</span></figcaption>
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<h2>The pandemic’s toll on parents</h2>
<p>The work of multiple researchers, including my own group, shows that parents reported alarmingly high rates of mental health challenges <a href="https://doi.org/10.3390%2Fijerph182212080">during the COVID-19 pandemic</a>.</p>
<p>In my own work on the subject, a <a href="https://doi.org/10.1037/spq0000467">2021 study found that</a> 34% of parents <a href="https://theconversation.com/how-schools-can-reduce-parents-anxiety-during-the-pandemic-147334">reported elevated anxiety symptoms</a>, and approximately 28% of them reported depression symptoms that were at a point of clinical concern. </p>
<p>These rates were similar to other reports, and they suggest that parents had higher levels of mental health needs than <a href="https://doi.org/10.1007/s42844-021-00037-7">before the pandemic</a>. The preponderance of research into the pandemic’s toll on parents’ and children’s mental health took place in 2020 and 2021, so it’s not yet clear whether mental health needs have lessened as the pandemic has waned or not.</p>
<h2>Passing on the pain</h2>
<p>Parents’ psychological health is important in its own right, since they often experience stress and need support. But research is also clear that the well-being of parents is <a href="https://www.cdc.gov/childrensmentalhealth/features/mental-health-children-and-parents.html">closely linked to that of their child</a>. <a href="https://doi.org/10.1007/s10567-015-0191-9">Parents who are experiencing mental health challenges</a> often have children with mental health challenges, and <a href="https://doi.org/10.1007/s42844-021-00037-7">vice versa</a>. </p>
<p>This interplay is complex and varied and includes both genetics and environmental factors such as exposure to stress or trauma. Parents’ well-being directly affects the overall structure and functioning of the home environment, such as following daily routines, and the quality of the relationship between parent and child.</p>
<p>For example, when parents experience depression, they often express more negative emotions – such as anger and irritability – with their children. They are also less consistent in discipline and <a href="https://www.ncbi.nlm.nih.gov/books/NBK215128/">less engaged in the parent-child relationship</a>. As a result of these stresses at home, their children may also <a href="https://doi.org/10.1007/s10567-010-0080-1">develop depression as well as other challenges</a>, such as anxiety or behavioral problems.</p>
<p>Children of parents with high levels of anxiety are at risk for both anxiety and depression, which themselves are associated with <a href="https://doi.org/10.1007/s10608-013-9569-5">attention-deficit/hyperactivity disorder</a>. And ADHD is known to be highly hereditary: One study found that approximately 50% of children with ADHD also <a href="https://doi.org/10.1007/s10802-010-9415-0">had a parent with ADHD</a>.</p>
<p>Parents’ mental well-being is influenced by the <a href="https://doi.org/10.1089/jwh.2010.2657">amount of stress</a> they experience, such as economic difficulties, insufficient child care and competing pressures from work and family. When parents have <a href="https://doi.org/10.1089/jwh.2007.CDC10">social support</a> from family, friends, their community <a href="https://theconversation.com/how-schools-can-reduce-parents-anxiety-during-the-pandemic-147334">or the school system</a>, studies show they are less likely to struggle with anxiety or depression. </p>
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<figcaption><span class="caption">Children whose parents have mental health challenges can struggle with anxiety and tend to self-isolate.</span></figcaption>
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<h2>Treatment for parents also helps kids</h2>
<p>In a recent review on parental depression, researchers reported that children who are receiving mental health care <a href="https://doi.org/10.1007/s00737-022-01272-2">often have parents with depression</a>, and many times the parents’ depression is not being treated. Importantly, the review also found that when parents are treated for depression and see their depressive symptoms improve, their children’s psychiatric symptoms abate and overall functioning improves. It also concluded that the treatment of parent and child mental health challenges is rarely integrated. </p>
<p>There are, however, emerging approaches for bringing the two together, including screening for and treating both parent and child mental health challenges in <a href="https://link.springer.com/article/10.1007/s00737-022-01272-2">pediatric primary care</a>. While this approach to identifying and treating psychiatric conditions is new, studies show it is promising for reducing depression symptoms in both parents and children simultaneously. </p>
<p>When parents are not able to receive effective treatment for their psychiatric conditions because of their busy schedules, inability to afford it, stigma against mental health care or the <a href="https://www.ijam-web.org/article.asp?issn=2455-5568;year=2017;volume=3;issue=1;spage=5;epage=9;aulast=Butryn">mental health provider shortage</a>, children are put at risk for mental health challenges too. On the flip side, when <a href="https://doi.org/10.1007/s00737-022-01272-2">parents receive evidence-based mental health care</a>, <a href="https://theconversation.com/cbt-dbt-psychodynamic-what-type-of-therapy-is-right-for-me-171101">such as cognitive behavioral therapy</a>, children also benefit. </p>
<p>Research also shows that a <a href="https://doi.org/10.1007/s00737-022-01272-2">family-based approach</a> to mental health care that considers parents’ needs, the family context and the parent-child relationship may best support <a href="https://doi.org/10.1111/j.1467-6427.2010.00529.x">both children and their parents</a>.</p>
<h2>Prioritizing parents</h2>
<p>So often, parents feel they need to take a back seat to what they perceive as the more important needs of their children. But just as when airline flight attendants instruct adults at the start of every flight to put their own safety mask on first, parents should know the importance of prioritizing their own well-being to promote the health of their children. </p>
<p>One concrete action that parents can take is to seek out family-based treatments. This may be a challenging process, but talking with their child’s pediatrician about specific referrals for this kind of care can be a good place to start. If those options are not available, parents should ensure that they are involved in their child’s mental health care and incorporate what is learned in treatment into their family’s day-to-day life. They should also seek referrals for their own mental health care as needed. </p>
<p>Ultimately, the children’s mental health crisis cannot be solved without also prioritizing parents. The British psychiatrist John Bowlby is widely recognized as the father of attachment theory, the study of the importance of early relationships between infants and their caregivers. Bowlby often expressed the sentiment that “a society that values its children <a href="https://doi.org/10.1002/cad.20454">should cherish their parents</a>.”</p><img src="https://counter.theconversation.com/content/193700/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lucy (Kathleen) McGoron receives funding from the Michigan Health Endowment Fund and the Michigan Department of Health and Human Services. </span></em></p>One way to prevent mental health challenges in children: Recognize and treat the mental health issues of their parents.Lucy (Kathleen) McGoron, Assistant Professor of Child and Family Development, Wayne State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1729802021-12-15T03:28:59Z2021-12-15T03:28:59ZHeadspace services for early psychosis have some benefits but aren’t cost-effective<figure><img src="https://images.theconversation.com/files/435813/original/file-20211206-21-rjkm3i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/depressed-sad-young-female-standing-dark-1186386553">Shutterstock</a></span></figcaption></figure><p>Adolescence and early adulthood is a time for people to become more independent, complete their education, enter the workforce, form key relationships and develop lifelong health habits. </p>
<p>It’s also a period where mental health problems often first appear, which can disrupt the person’s development and potentially have a life-long impact.</p>
<p>Many experts argue <a href="https://www.mja.com.au/journal/2007/187/7/investing-youth-mental-health-best-buy">early intervention</a> for emerging mental health problems can prevent or reduce these disruptions.</p>
<p>But while the concept of early intervention during youth makes a lot of sense, the mental health outcomes from young people accessing Australia’s Headspace centres have been disappointing. </p>
<h2>Remind me, what is Headspace?</h2>
<p>Funded by the Commonwealth government, Headspace began in 2006 with ten centres, which are <a href="https://headspace.org.au/about-us/who-we-are/">described as</a>:</p>
<blockquote>
<p>a one-stop shop for young people who need help with mental health, physical health (including sexual health), alcohol and other drugs or work and study support.</p>
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<p>It has since expanded to more than 100 centres nationally and has been influential internationally.</p>
<h2>What do the evaluations say?</h2>
<p>An <a href="https://headspace.org.au/assets/Uploads/Evaluation-of-headspace-program.pdf">independent evaluation</a> in 2015 found the effects on mental health were “relatively weak”. </p>
<p>One of the <a href="https://theconversation.com/is-headspace-really-improving-young-peoples-mental-health-46398">explanations for this</a> was many Headspace clients received only one to two sessions of treatment, which was too little to be effective. </p>
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Read more:
<a href="https://theconversation.com/is-headspace-really-improving-young-peoples-mental-health-46398">Is 'headspace' really improving young people's mental health?</a>
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<p>However, a <a href="https://www.mja.com.au/journal/2021/216/2/social-and-occupational-outcomes-young-people-who-attend-early-intervention">more recent study</a> looked at the outcomes for young people who received two years of early intervention from Headspace. </p>
<p>This study found most of these young people showed no or only temporary improvement, suggesting other approaches are needed.</p>
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<h2>Another layer of services for more complex problems?</h2>
<p>Headspace services appear insufficient for young people with complex mental health problems. So <a href="https://www.mja.com.au/journal/2021/216/2/reality-mental-health-care-young-people-and-urgent-need-solutions">one suggestion</a> is to add a layer of more intensive mental health services for such young people. </p>
<p>These services would be modelled on early intervention services for young people with psychosis: a more severe mental illness in which the person loses contact with reality.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/budget-funding-for-beyond-blue-and-headspace-is-welcome-but-it-may-not-help-those-who-need-it-most-147661">Budget funding for Beyond Blue and Headspace is welcome. But it may not help those who need it most</a>
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<p>But the Commonwealth government has already set up a number of <a href="https://headspace.org.au/our-services/earlypsychosis/headspace-early-psychosis/">Headspace early psychosis youth services</a>.</p>
<p>So the outcomes of these services need to be examined before youth services are expanded in this direction. </p>
<p>Although an independent evaluation of these services was completed in August 2020, it has only recently been <a href="https://www.health.gov.au/resources/foi-disclosure-log">released to the public under a Freedom of Information request</a>.</p>
<h2>What did the review find?</h2>
<p>The Headspace early psychosis program started in 2014 and has provided care in six locations across Australia to young people aged 12–25 who were experiencing a first episode of psychosis or were at very high risk of becoming psychotic. </p>
<p>The services are more intensive than provided to regular Headspace clients. They include a mobile assessment and treatment team, a continuing care team, a functional recovery program, group and family programs, and a peer support program.</p>
<p>The evaluation found the early psychosis youth program “was effective in achieving improved outcomes for some young people”. However, the services were not cost-effective. </p>
<figure class="align-center ">
<img alt="Young man sits with a therapist." src="https://images.theconversation.com/files/435815/original/file-20211206-13-wqpb4f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/435815/original/file-20211206-13-wqpb4f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/435815/original/file-20211206-13-wqpb4f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/435815/original/file-20211206-13-wqpb4f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/435815/original/file-20211206-13-wqpb4f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/435815/original/file-20211206-13-wqpb4f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/435815/original/file-20211206-13-wqpb4f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The Headspace early psychosis program improved outcomes for some young people.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-asian-man-male-has-mental-1888913212">Shutterstock</a></span>
</figcaption>
</figure>
<p>To assess cost-effectiveness, health economists often estimate the cost of giving a client an additional year of good quality life – <a href="https://www.pocog.org.au/qolfaq.aspx?question=24">a Quality Adjusted Life Year (or QALY)</a>. </p>
<p>A cost of up to A$50,000 to A$70,000 per QALY gained is generally considered a “good buy”. However, the Headspace program cost A$318,954 per QALY gained, which is way above this threshold. </p>
<p>The Headspace early psychosis services were also found to be less cost-effective than mental health services provided by state governments, where <a href="https://www1.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-p-mono-toc%7Emental-pubs-p-mono-bas%7Emental-pubs-p-mono-bas-acc%7Emental-pubs-p-mono-bas-acc-cas">case managers</a> link young people with psychosis to services and provide support.</p>
<h2>Benefits appear short-lived</h2>
<p>It was hoped intensive early intervention programs might “bend the curve” and change the lifetime trajectory of illnesses such as schizophrenia. </p>
<p>The peak disability for schizophrenia occurs in mid-life. If intensive youth programs changed the trajectory of the illness, it was expected they might substantially improve mid-life outcomes and reduce the lifetime health and social costs. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-causes-schizophrenia-what-we-know-dont-know-and-suspect-102651">What causes schizophrenia? What we know, don't know and suspect</a>
</strong>
</em>
</p>
<hr>
<p>It is becoming clearer these early hopes were misplaced. The benefits of early intervention for psychosis are mostly short-lived. The long-term <a href="https://www.tandfonline.com/doi/abs/10.1080/09540261.2019.1643704">follow-up studies reveal</a> a dilution of the beneficial impact after the early intervention service ends, usually at two years. </p>
<p>After this time, young people who received the more expensive early intervention program <a href="https://academic.oup.com/schizophreniabulletin/article/44/6/1362/4823040">fare no better</a> than those who received “treatment as usual”, for example, the care provided by state governments for people with psychosis.</p>
<p>Studies are underway comparing longer treatment (up to five years) with standard treatment (up to three years) by early intervention teams, to find out if the early gains are maintained. </p>
<p>So far, these trials have <a href="https://www.cochrane.org/CD013287/SCHIZ_extending-treatment-time-specialist-mental-health-teams-better-people-recent-onset-psychosis">not found an improvement</a> in the numbers of people who recover, nor a reduction in hospitalisation. But more trials are needed.</p>
<h2>Where to next?</h2>
<p>If the outcomes of the Headspace early psychosis program are no better than state government mental services after a couple of years, and the costs of the Headspace program are proving unsustainable, the program will likely be wound back at some point in the future. </p>
<p>In the meantime, Commonwealth and state governments must develop a sustainable model of care that still achieves the best possible long-term outcomes. </p>
<p>This could mean <a href="https://www.alfredhealth.org.au/services/headspace">integrating Headspace services into existing state-based hospital mental health services</a>, to provide more coordinated care and case management, as <a href="https://www.newsweek.com/best-hospitals-2021/australia">Alfred Health</a> in Melbourne has done, with great success.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/youth-anxiety-and-depression-are-at-record-levels-mental-health-hubs-could-be-the-answer-154722">Youth anxiety and depression are at record levels. Mental health hubs could be the answer</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/172980/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anthony Jorm receives funding from the National Health and Medical Research Council. He is a Director of Mental Health First Aid International. He is Editor-in-Chief of Mental Health & Prevention. It is a member of the Alliance for the Prevention of Mental Disorders and the Association for Psychological Science. Anthony Jorm worked at Orygen Youth Health Research Centre from 2005-2012.</span></em></p><p class="fine-print"><em><span>Stephen Allison is a past clinical director of a state government regional child and youth mental health service.</span></em></p>It was hoped intensive early intervention programs might ‘bend the curve’ and change the lifetime trajectory of illnesses such as schizophrenia. But that doesn’t appear to be the case.Anthony Jorm, Professor emeritus, The University of MelbourneStephen Allison, Assoc. Professor of Child and Youth Psychiatry, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1697292021-10-20T07:25:47Z2021-10-20T07:25:47ZTreating a child’s mental illness sometimes means getting the whole family involved<figure><img src="https://images.theconversation.com/files/427440/original/file-20211020-13-4eqe9r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/child-psychology-174171269">Shutterstock</a></span></figcaption></figure><p>Half of all adult mental health issues emerge before the age of 14, with 14% of Australian children aged four to 17 currently <a href="https://www.mentalhealthcommission.gov.au/mental-health-reform/childrens-mental-health-and-wellbeing-strategy">impacted by poor mental health</a>. </p>
<p>These are the drivers for the first National Children’s Mental Health and Well-being strategy, developed by the National Mental Health Commission and released by the government last week. </p>
<p>The strategy suggests viewing children’s mental health and well-being along a continuum of well–coping–struggling–unwell, and recommends focusing on support, prevention and early intervention before mental illness occurs. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/427457/original/file-20211020-20-qcq04n.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/427457/original/file-20211020-20-qcq04n.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=279&fit=crop&dpr=1 600w, https://images.theconversation.com/files/427457/original/file-20211020-20-qcq04n.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=279&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/427457/original/file-20211020-20-qcq04n.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=279&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/427457/original/file-20211020-20-qcq04n.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=350&fit=crop&dpr=1 754w, https://images.theconversation.com/files/427457/original/file-20211020-20-qcq04n.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=350&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/427457/original/file-20211020-20-qcq04n.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=350&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://www.mentalhealthcommission.gov.au/getmedia/5b7112be-6402-4b23-919d-8fb9b6027506/National-Children%E2%80%99s-Mental-Health-and-Wellbeing-Strategy-%E2%80%93-Report">The National Children’s Mental Health and Wellbeing Strategy</a></span>
</figcaption>
</figure>
<p>The strategy also calls for “integrated child and family well-being services to better support families”. This means focusing on <em>all</em> the environments in which a child lives, learns and plays. </p>
<p>So what does the strategy recommend? And why is it important to get family involved in children’s mental health care?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/preventive-measures-are-as-important-to-the-mental-health-pandemic-as-they-are-to-covid-19-160082">Preventive measures are as important to the mental health pandemic as they are to COVID-19</a>
</strong>
</em>
</p>
<hr>
<h2>Supporting the child’s family, school and community</h2>
<p>The strategy recommends focusing on four key areas to improve Australian children’s mental health and well-being:</p>
<p><strong>1. Empowering families to play a role.</strong></p>
<p>This means having access to mental health information and education, and allowing parents to better identify the signs of poor mental health in their child. Families should be supported to access services in the community before their child becomes significantly unwell, potentially <a href="https://emergingminds.com.au/our-work/guiding-principles/prevention-early-intervention/">decreasing the need</a> for more acute support. </p>
<p><strong>2. Closing the gaps in access.</strong></p>
<p>More than 50% of children with mental health issues are not receiving professional support, highlighting a <a href="https://www.mentalhealthcommission.gov.au/getmedia/9ccb3072-3ec1-4cf4-95e4-7b1b91c21ff6/National-Children%E2%80%99s-Mental-Health-and-Wellbeing-Strategy-%E2%80%93-At-a-Glance">significant gap in access</a>. The strategy notes ways for services to better support families, including: </p>
<ul>
<li>improvements in system navigation so families can find the right help at the right time</li>
<li>building the system to support children with complex care needs, for example, by providing support to engage with multiple government agencies</li>
<li>upskilling the existing workforce to increase capacity. </li>
</ul>
<p><strong>3. Increasing the role for schools in supporting children’s well-being and mental health.</strong></p>
<p>This includes:</p>
<ul>
<li>creating a culture within schools where well-being is nurtured</li>
<li>providing targeted responses for at-risk youth</li>
<li>supporting the development of educators that are trained and equipped to deliver well-being support. </li>
</ul>
<p>While some of this work is <a href="https://education.nsw.gov.au/student-wellbeing/whole-school-approach/wellbeing-framework-for-schools">already underway</a>, the impacts of the COVID-19 pandemic, extended school absence and facial coverings on children cannot be underestimated.</p>
<p><strong>4. Use treatments based on evidence.</strong></p>
<p>Therapeutic treatments and supports should be based on scientific evidence from high quality research. </p>
<h2>Why involve the family?</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/427450/original/file-20211020-14-b5zxiz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/427450/original/file-20211020-14-b5zxiz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/427450/original/file-20211020-14-b5zxiz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/427450/original/file-20211020-14-b5zxiz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/427450/original/file-20211020-14-b5zxiz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/427450/original/file-20211020-14-b5zxiz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/427450/original/file-20211020-14-b5zxiz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Therapies are increasing involving parents and other family members.</span>
<span class="attribution"><a class="source" href="https://theconversation.com/preventive-measures-are-as-important-to-the-mental-health-pandemic-as-they-are-to-covid-19-160082">Shutterstock</a></span>
</figcaption>
</figure>
<p>While therapies for children vary according to the issue of concern, more and more are integrating families at various stages to increase their effectiveness. </p>
<p>Guidelines for the treatment of <a href="https://www.dovepress.com/oppositional-defiant-disorder-current-insight-peer-reviewed-fulltext-article-PRBM">oppositional defiant disorder</a> and <a href="https://www.nice.org.uk/guidance/ng69/chapter/Recommendations#treating-anorexia-nervosa">anorexia nervosa</a>, for example, typically include either parent management training or family therapy, or both.</p>
<p>So how do they work? Let’s take a closer look at these examples. </p>
<h2>Oppositional defiant disorder</h2>
<p>Young people with oppositional defiant disorder display a <a href="https://raisingchildren.net.au/guides/a-z-health-reference/odd">frequent and persistent pattern</a> of anger, irritability, arguing and defiance towards authority figures. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/more-than-just-a-tantrum-heres-what-to-do-if-your-child-has-oppositional-defiant-disorder-96014">More than just a tantrum: here's what to do if your child has oppositional defiant disorder</a>
</strong>
</em>
</p>
<hr>
<p><a href="https://www.dovepress.com/oppositional-defiant-disorder-current-insight-peer-reviewed-fulltext-article-PRBM">Parent management training</a> for the disorder focuses on spending quality time with your child, providing <a href="https://www.triplep-parenting.net.au/vic-uken/triple-p/">positive reinforcement</a> (such as praise) for desired behaviour and setting consistent limits for undesirable behaviour. </p>
<p>Family therapies vary, but typically ask all household members to attend sessions together. Discussion points may include understanding each family member’s views of the concern, identifying family strengths, exploring challenges and conflicts, encouraging consistency between parents and strengthening family bonds. </p>
<p><a href="https://www.wjgnet.com/2219-2808/full/v7/i1/9.htm">Research</a> combined with our own clinical experience suggests including parents and/or family members in treatment results in better outcomes for children that are maintained longer, and typically in fewer sessions. </p>
<h2>Anorexia nervosa</h2>
<p>Family support is the <a href="http://cedd.org.au/wordpress/wp-content/uploads/2014/09/Clinical-Practice-Guidelines-for-the-Treatment-of-Eating-Disorders-Developed-by-Royal-Australian-and-New-Zealand-College-of-Psychiatrists-RANZCP-2014.pdf">gold standard</a> in the <a href="https://www.nice.org.uk/guidance/ng69/chapter/Recommendations#treating-anorexia-nervosa">treatment</a> of anorexia nervosa and other eating disorders.</p>
<p>Anorexia nervosa is a psychological illness that results in low body weight and body image distortion. Young people with anorexia nervosa restrict the types and amount of food they eat and will often engage in extreme forms of weight loss, such as excessive exercise. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/anorexia-spiked-during-the-pandemic-as-adolescents-felt-the-impact-of-covid-restrictions-169466">Anorexia spiked during the pandemic, as adolescents felt the impact of COVID restrictions</a>
</strong>
</em>
</p>
<hr>
<p>Family-based therapy for anorexia nervosa supports treatment of the young person in their community, <a href="https://ceed.org.au/wp-content/uploads/2020/04/Family-Based-Treatment-FBT.pdf">rather than relying solely on hospital admission</a>. </p>
<p>Outcomes for young people tend to improve when their parent(s) are supported to better understand and manage the symptoms of the eating disorder.</p>
<h2>It’s about consistency and support</h2>
<p>Families are sometimes anxious about joining therapy, often due to fears regarding perceived blame. In reality, clinicians understand most families are doing the best they can with the resources they have. </p>
<p>By integrating parents and other family members in therapy, it is hoped young people will have consistent support between the therapy space and their home environment. Family members can also be important advocates and cheerleaders for their children, as well as challenging symptoms of concern. </p>
<p>Children’s lives and obligations are much broader than ever before. They typically spend a significant time outside of their family and school such as sporting groups, church, social activities and the online space. To provide truly targeted, child-centred care, services will need to consider all domains of the young persons’ world.</p><img src="https://counter.theconversation.com/content/169729/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Associate Professor Jade Sheen has received research grants from the Australian Government and Victorian Government.</span></em></p><p class="fine-print"><em><span>Amanda Dudley does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>By integrating parents and other family members in therapy, young people will have more consistent support between the therapist’s office and their home.Jade Sheen, Associate Professor, School of Psychology, Deakin UniversityAmanda Dudley, Psychologist and Lecturer, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1627502021-08-09T17:55:35Z2021-08-09T17:55:35ZChild and youth mental health problems have doubled during COVID-19<figure><img src="https://images.theconversation.com/files/412969/original/file-20210724-19-ojjyym.jpg?ixlib=rb-1.1.0&rect=393%2C48%2C4568%2C3516&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Not only did youth mental health difficulties increase during COVID-19, but they became more prevalent as the pandemic persisted.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>For most children and adolescents, the past year has been a shadow of a typical childhood. Instead, there have been strict stay-at-home orders, repeated opening and closures of schools, social distancing from peers and other supports, limited or no access to sport and extracurricular activities, and many missed milestones such as graduation. </p>
<p>During this time, the family unit has been in crisis as well, with financial instability as well as <a href="https://doi.org/10.1016/S2215-0366(21)00074-2">increased psychological stress for caregivers</a>. Independently and collectively, these events can catalyze mental health difficulties in children and youth. </p>
<p>At the beginning of the pandemic, children and adolescents were the <a href="https://www.cdc.gov/coronavirus/2019-ncov/hcp/pediatric-hcp.html">lowest-risk group with regards to medical concerns and complications</a> from COVID-19. Now, over a year into the pandemic, they have emerged as the invisible casualties of this global crisis. </p>
<h2>Sounding the alarm to a youth mental health crisis</h2>
<p>Many clinicians and child-health practitioners are calling attention to a youth <a href="https://ottawacitizen.com/news/local-news/kids-are-not-doing-well-pediatricians-raise-alarm-bells-about-impact-of-pandemic-on-children">mental health crisis</a>. Recently, national children’s charity Children First Canada declared a <a href="https://childrenfirstcanada.org/campaign/code-pink/">#codePINK</a>, a term commonly used in health-care settings to indicate a pediatric emergency.</p>
<p>Many pediatric hospitals have <a href="https://childrenfirstcanada.org/code-pink/kids-are-in-crisis-canadas-top-advocates-and-experts-unite-to-declare-codepink/">reported a 100-per-cent increase in admissions for mental health problems</a>, upwards of a 200-per-cent increase in admissions for substance use and suicide attempts, and report that <a href="https://doi.org/10.1007/s00787-021-01744-3">70 per cent of children and youth</a> have indicated that the pandemic has affected their mental health. </p>
<p>Our child psychology research team sought to better understand the current state of children’s mental health globally, one year into the pandemic. This <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2782796">research summary, published in <em>JAMA Pediatrics</em></a>, shows that globally, one in four young people is experiencing clinically elevated depressive symptoms, while one in five is experiencing clinically elevated anxiety symptoms. </p>
<p>These rates are all the more alarming when compared to pre-pandemic estimates, which were closer to one in 10 youth having clinically elevated anxiety and depression. This indicates that youth mental health difficulties have likely doubled during COVID-19. </p>
<h2>Child and youth mental health distress may be sustained long term</h2>
<p>When we looked deeper into which youth were struggling the most globally, we found that — consistent with <a href="https://doi.org/10.1016/j.yfrne.2014.05.004">pre-pandemic data</a> — females and older youth were at greater risk for both depression and anxiety difficulties. </p>
<p>We also found that mental health difficulties were more prevalent as the pandemic persisted. This suggests that as the length of the pandemic continued, along with <a href="https://theconversation.com/with-covid-19s-third-wave-were-far-from-all-in-this-together-159178">public health safety measures such as school closures and social distancing</a>, clinically significant anxiety and depression symptoms also increased. This indicates that children and youth globally are struggling with mental health difficulties, and their symptoms are worsening as the pandemic continues. </p>
<h2>What can be done to help children and youth?</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/410728/original/file-20210712-17-8uosx1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Long rows of lockers in an empty school hallway" src="https://images.theconversation.com/files/410728/original/file-20210712-17-8uosx1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/410728/original/file-20210712-17-8uosx1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=387&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410728/original/file-20210712-17-8uosx1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=387&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410728/original/file-20210712-17-8uosx1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=387&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410728/original/file-20210712-17-8uosx1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=486&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410728/original/file-20210712-17-8uosx1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=486&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410728/original/file-20210712-17-8uosx1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=486&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The pandemic and measures such as school closures and social distancing from friends can catalyze mental health difficulties in children and youth.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Jonathan Hayward</span></span>
</figcaption>
</figure>
<p>As researchers and psychologists, we are left wondering whether mental health difficulties in youth will continue to persist for years to come. Will their mental health deterioration be one of the most profound impacts of the COVID-19 pandemic? We think so. </p>
<p>Children and adolescents who endured the various disruptions and emotional and physical consequences of the pandemic are the future of our society. To help foster their well-being and our prosperity as a society, now is the time to act to protect the next generation. We have identified three primary objectives for pandemic recovery efforts aimed at improving child and youth mental health. </p>
<h2>1. Take action now</h2>
<p>We can’t wait to make services available to children who are suffering emotionally. We must act now to address a near doubling in mental health difficulties for children and youth during the pandemic. There is a need for government to develop urgent and strategic plans to address the mental health of youth and ensure the provision of accessible and equitable resources to support this initiative. </p>
<h2>2. Return to routine</h2>
<p>Decades of research on child development has shown that <a href="https://depts.washington.edu/isei/iyc/20.4_spagnola.pdf">children thrive in the context of clear and consistent routines and structure</a>. Many of the strategies used to reduce the spread of COVID-19 have forced children and adolescents to stay indoors, resulting in disrupted routines, increased <a href="https://doi.org/10.1111/apa.15966">sedentary time</a> (for example, more screen time, less physical activity) and a reduction in structured activities such as sports, camps and extracurriculars. </p>
<p>Keeping schools open and <a href="https://doi.org/10.1016/j.ynstr.2020.100291">maintaining family routines</a> during the pandemic can protect children’s mental health. It will also be critical to support families by ensuring they have the material and psychological resources needed to help their children. </p>
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Read more:
<a href="https://theconversation.com/covid-19-stress-toll-is-a-family-affair-4-ways-to-support-mothers-mental-health-155862">COVID-19 stress toll is a family affair: 4 ways to support mothers' mental health</a>
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<h2>3. Mental health supports for children</h2>
<p>To address this ongoing crisis, there is a need for equitable mental health services that are accessible to all children and youth. Investing in new models of care that can be adapted to increase scalability should be prioritized. This includes group and individual <a href="http://dx.doi.org/10.1037/cap0000259">telemental health services</a> (mental health services delivered by phone, texting or videoconference) and brief intervention approaches. Emerging research awaiting peer review suggests that single-session interventions for adolescent depression during COVID-19 <a href="https://doi.org/10.31234/osf.io/ved4p">can effectively reduce feelings of depression and hopelessness among youth</a>. Increased access to, and availability of, mental health resources are critical. </p>
<p>Children and youth represent our largest investment in the future. The mental health implications of COVID-19 have been particularly dire. Although there have been some COVID-19 recovery initiatives <a href="https://pm.gc.ca/en/news/news-releases/2021/04/28/investing-young-canadians">targeted at this group</a>, we need clear and actionable items to move forward with a mental health recovery plan that will address the increased severity of mental illness in children and adolescents and the rising need for services. </p>
<p>Ultimately, the policy choices we make now will have long-lasting effects on the prosperity of the next generation of youth. There is an urgent and rising demand for child and youth mental health services in Canada. Parents, practitioners, allies and policy-makers need to come together to develop methods of mental health service delivery with widespread impact to meet this demand.</p><img src="https://counter.theconversation.com/content/162750/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brae Anne McArthur receives funding from Alberta Children's Hospital Research Institute, the Social Sciences and Humanities Research Council, the Canadian Institutes of Health Research, and the Children and Screens Institute of Social Media and Child Development. She is affiliated with the Family Psychology Place. </span></em></p><p class="fine-print"><em><span>Nicole Racine receives funding from the Social Sciences and Humanities Research Council, Alberta Innovates, the Canadian Institutes of Health Research, and the Children and Screens Institute of Social Media and Child development. She is affiliated with the Family Psychology Place and Strong Minds, Strong Kids.</span></em></p><p class="fine-print"><em><span>Sheri Madigan receives funding from the Social Sciences and Humanities Research Council, the Canadian Institutes of Health Research, the Alberta Children's Hospital Foundation, the Canada Research Chairs program, and Children and Screens: Institute of Digital Media and Child Development.</span></em></p>New research shows the dire effects of the pandemic on the mental health of children and youth, with as many as 25 per cent of young people affected. Immediate action can help address this distress.Brae Anne McArthur, Postdoctoral Research Fellow, Determinants of Child Development Lab, University of CalgaryNicole Racine, Postdoctoral Research Fellow, Psychology, University of CalgarySheri Madigan, Associate Professor, Canada Research Chair in Determinants of Child Development, Owerko Centre at the Alberta Children’s Hospital Research Institute, University of CalgaryLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1422642020-07-29T18:33:05Z2020-07-29T18:33:05ZPolice encounters reveal a mental health system in distress<figure><img src="https://images.theconversation.com/files/349915/original/file-20200728-13-1gkpusv.JPG?ixlib=rb-1.1.0&rect=0%2C0%2C3000%2C1931&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The family of D’Andre Campbell, a Black man in a mental health crisis who was shot and killed by Peel police in April in his home in Brampton, is pictured outside their lawyer's office in Toronto. Left to right: Sister Michelle Campbell, mother Yvonne Campbell and brother Dajour Campbell.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Carlos Osorio</span></span></figcaption></figure><p>Too many Canadians in mental health distress die at the hands of police after <a href="https://globalnews.ca/news/7092621/police-wellness-checks-experts-change/">calling for help</a>. The case of <a href="https://www.cbc.ca/news/canada/toronto/d-andre-campbell-black-police-1.5607750">D'Andre Campbell</a> is just the latest example; he was fatally shot by police in April after calling them to his home for help in Brampton, Ont.</p>
<p>These deaths justify a deeper look at the societal response to those with episodic mental health and substance use issues.</p>
<p>Seventy per cent of 460 Canadians who died in police encounters from 2000 to 2017 reportedly suffered from <a href="https://www.cbc.ca/news/investigates/most-canadians-killed-in-police-encounters-since-2000-had-mental-health-or-substance-abuse-issues-1.4602916">mental health or substance use issues</a>. Racial minorities <a href="https://www.cbc.ca/news/canada/toronto/police-deaths-blacks-data-1.4599215">were over-represented</a>.</p>
<p>Canadian and Ontario chiefs of police argue insufficient investment in community mental health care has made police “<a href="https://globalnews.ca/news/1472443/dont-want-cops-to-be-psychiatrists-in-blue-fund-mental-health-services/">psychiatrists in blue</a>.” More than 30 per cent of people with serious mental illness who were turned away from emergency departments as they tried to access care experienced <a href="https://cmha.bc.ca/wp-content/uploads/2016/07/policereport.pdf">police encounters</a>, according to a study by the Canadian Mental Health Association (CMHA). </p>
<p>But while police budgets increase annually, research I helped conduct has found that investments in mental health <a href="https://doi.org/10.1016/j.socscimed.2020.113007">declined from 2000 to 2014</a> compared to other health-care areas. Savings from psychiatric hospital closures were shifted to other sectors, even though funding community supports <a href="https://doi.org/10.1111/j.1754-7121.2005.tb00231.x">could avert mental-health crises</a>. This holdover of what’s known as “<a href="https://www.mentalhealthcommission.ca/English/structural-stigma">structural stigma</a>” enables systemic neglect.</p>
<h2>Mental health system in distress</h2>
<p>From an international perspective, Canada lags in addressing mental health. Only one in five children receive the care <a href="https://cmha.ca/fast-facts-about-mental-illness">they require</a>, enduring wait-lists of a year or more, according to the CMHA. Although mental illness and substance use account for 23 per cent of <a href="https://cmha.ca/ending-health-care-disparity-canada">disease burden</a> — more than 1.5 times that of all cancers combined — they represent only seven per cent of <a href="https://www.camh.ca/en/driving-change/the-crisis-is-real/mental-health-statistics">health-care spending</a>. </p>
<p>The World Health Organization denotes a care gap of 35 to 50 per cent in developed countries, resulting in <a href="https://doi.org/10.1016/S0140-6736(07)61239-2">delayed care</a> and <a href="https://doi.org/10.1001/jama.291.21.2581">treatment failures</a>. Ensuring access to co-ordinated community care, psychotherapy, substance-use rehabilitation, court diversion and housing <a href="https://www.mentalhealthcommission.ca/English/case-for-investing-backgrounder">would prevent hospitalization</a>, employment disability, homelessness, imprisonment and police encounters. </p>
<p>While societal savings from psychotherapy for depression <a href="https://ps.psychiatryonline.org/doi/pdf/10.1176/appi.ps.201600395">are double</a> their cost, they are uninsured unless offered by physicians whose supply is limited, constraining access. </p>
<h2>Insuring psychotherapy</h2>
<p>The United Kingdom and Australia publicly <a href="https://doi.org/10.1016/S2215-0366(15)00082-6">insure psychotherapy</a>, while B.C. and Ontario are expanding access. Early intervention for youth with psychosis can prevent disability and <a href="https://doi.org/10.1017/S0033291703001119">improve recovery</a>, yet youth at risk are often <a href="https://www.sfu.ca/content/dam/sfu/carmha/resources/2017-toward-quality-mh/CARMHA%20REPORT_29%20Aug_Final.pdf">turned away</a> from emergency departments, waiting months for assessment, only to increase the likelihood of committal. </p>
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<img alt="A police officer in full uniform walks with a dark-haired woman in a park with trees in the background." src="https://images.theconversation.com/files/349923/original/file-20200728-17-11k9gb6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/349923/original/file-20200728-17-11k9gb6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=411&fit=crop&dpr=1 600w, https://images.theconversation.com/files/349923/original/file-20200728-17-11k9gb6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=411&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/349923/original/file-20200728-17-11k9gb6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=411&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/349923/original/file-20200728-17-11k9gb6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=517&fit=crop&dpr=1 754w, https://images.theconversation.com/files/349923/original/file-20200728-17-11k9gb6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=517&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/349923/original/file-20200728-17-11k9gb6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=517&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">An RCMP officer in charge of the Surrey RCMP mental health outreach team talks with a registered psychiatric nurse in Surrey, B.C., in June 2020. They are part of a mobile crisis response unit partnership between the Surrey RCMP and Fraser Health Authority that attend calls in Surrey involving mental health issues.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Darryl Dyck</span></span>
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<p>Most psychiatric hospitalizations are <a href="https://doi.org/10.1192/bjo.2017.4">indeed involuntary</a>. Would delays that increase the risk of youth death and disability be accepted for an illness like diabetes?</p>
<p>Enhanced funding for community supports — crisis teams and supportive housing — would reduce the direct and indirect costs of mental illness that represent <a href="https://read.oecd-ilibrary.org/social-issues-migration-health/making-mental-health-count/the-cost-of-mental-illness_9789264208445-5-en#page12">4.4 per cent of GDP</a>; investment of $85 per capita pales in comparison to the $7,068 in health-care expenditures <a href="https://www.statista.com/statistics/436378/total-health-spending-per-capita-canada/#:%7E:text=As%20of%202019%2C%20the%20per,the%201984%20Canadian%20Health%20Act">per Canadian</a>. </p>
<p>Mobilizing greater commitment, however, entails immense political will.</p>
<h2>Why health is a political issue</h2>
<p>Mental health policy is politicized by the federal and provincial governments and contested among professionals and advocates.</p>
<p>Although jurisdiction for health care lies with provinces, Ottawa used its spending power to encourage the provinces to launch medicare. Of the five conditions provinces must meet to secure federal health transfers, <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3662667">comprehensive care</a> was defined as medically necessary <a href="http://accessh.org/wp-content/uploads/2015/02/1802_Mossialos_intl_profiles_2014_v6.pdf#page=21">hospital and physician services</a>. </p>
<p><a href="https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/science-research-data/canada-health-act-infographic/cha-infographic-eng.pdf">The Canada Health Act</a> followed the path of the 1957 <a href="http://uregina.ca/%7Erasmussk/publications/can_pscyhol_article.pdf">Hospital Insurance and Diagnostic Services Act</a> that excluded psychiatric hospitals, non-physician community care and limited psychiatric general hospital beds to 10 per cent, foreshadowing our <a href="https://doi.org/10.1503/cmaj.170738">current dilemma</a>.</p>
<p>While provinces that fail to insure hospital and physician services risk forfeiting federal transfers, they can exclude community care with impunity. Mental health care has therefore focused on clinical, hospital-based services instead of helping people regain their health by insuring community supports that would <a href="https://doi.org/10.1016/j.socscimed.2020.113007">reduce institutional system costs</a>.</p>
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<img alt="A woman bows her head." src="https://images.theconversation.com/files/349914/original/file-20200728-21-1pzmr8l.jpg?ixlib=rb-1.1.0&rect=454%2C696%2C3752%2C2059&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/349914/original/file-20200728-21-1pzmr8l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/349914/original/file-20200728-21-1pzmr8l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/349914/original/file-20200728-21-1pzmr8l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/349914/original/file-20200728-21-1pzmr8l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=425&fit=crop&dpr=1 754w, https://images.theconversation.com/files/349914/original/file-20200728-21-1pzmr8l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=425&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/349914/original/file-20200728-21-1pzmr8l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=425&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Mental illness needs to be treated with the same urgency and seriousness as physical diseases are.</span>
<span class="attribution"><span class="source">(Volkan Olmez/Unsplash)</span></span>
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<p>Federal and provincial government relations and their accommodation of the medical profession further <a href="https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.18.3.114">guide health policy</a>. Given competing demands on provincial budgets, political and professional concerns may overshadow patient needs. Physician strikes that occurred when medicare and the Canada Health Act <a href="https://www.jstor.org/stable/pdf/3228491.pdf">were enacted</a> reflect the contentious nature of policy negotiations. </p>
<p>Exclusion of community-based mental health care from the terms of the Canada Health Act, and the absence of targeted federal funds to address the omission, resulted in fragmented accountability, revealing misaligned strategy as politics ascended policy. </p>
<h2>Addressing structural discrimination</h2>
<p>Canada’s federal structure and intergovernmental dynamics profoundly shaped health policy. The Canada Health Act set the terms for federal health transfers, establishing financial incentives for provincial governments, which have reinforced regressive patterns of medical care.</p>
<p>Although the <a href="https://www.theglobeandmail.com/news/politics/ontario-quebec-alberta-reach-health-deals-with-ottawa/article34264300/">2017 federal health accords</a> targeted funds for mental health, they fell short of the $3.1 billion annual investment required to meet health spending targets recommended by the <a href="https://www.mentalhealthcommission.ca/English/focus-areas/mental-health-strategy-canada">Mental Health Commission of Canada</a>. </p>
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<a href="https://images.theconversation.com/files/349927/original/file-20200728-17-mr8dv5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man gestures while speaking with a report entitled Shape the Future in the foreground." src="https://images.theconversation.com/files/349927/original/file-20200728-17-mr8dv5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/349927/original/file-20200728-17-mr8dv5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=427&fit=crop&dpr=1 600w, https://images.theconversation.com/files/349927/original/file-20200728-17-mr8dv5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=427&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/349927/original/file-20200728-17-mr8dv5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=427&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/349927/original/file-20200728-17-mr8dv5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=536&fit=crop&dpr=1 754w, https://images.theconversation.com/files/349927/original/file-20200728-17-mr8dv5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=536&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/349927/original/file-20200728-17-mr8dv5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=536&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Roy Romanow, head of the commission on health care, speaks during a news conference in Ottawa in February 2002 after releasing his interim report.</span>
<span class="attribution"><span class="source">CP PHOTO/Jonathan Hayward</span></span>
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<p>The 2002 <a href="http://publications.gc.ca/collections/Collection/CP32-85-2002E.pdf">Romanow Commission on the Future of Health Care</a> emphasized federal and provincial co-operation and recommended funding follow patients rather than be tied to institutions. </p>
<p>Enhanced mental health supports would reduce public expenditures and employer productivity loss by <a href="https://doi.org/10.1503/cmaj.170738">$255 billion over 30 years</a>. Failure of governments to adequately fund mental health will only raise societal costs and increase the <a href="https://www.cbc.ca/news/canada/toronto/police-mental-crisis-1.5623907">30,000 mental health crisis calls</a> that Toronto police alone receive annually, and so the time for action is upon us. Were it not for federal incentives, after all, Canadians might not have universal health care today.</p><img src="https://counter.theconversation.com/content/142264/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mary Wiktorowicz receives funding from the Canadian Institutes of Health Research and York University; her research was previously funded by the Canadian Foundation for Healthcare Improvement. She is affiliated with the Dahdaleh Institute for Global Health Research.
Steve Lurie is Executive Director of the Canadian Mental Health Association, Toronto and Adjunct Professor, Factor-Inwentash Faculty of Social Work, University of Toronto
</span></em></p>Federal incentives would enhance community support for those with mental illness and would avert police engagement.Mary E. Wiktorowicz, Professor of Global Health Governance and Policy, Dahdaleh Institute for Global Health Research, York University, CanadaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1303712020-01-29T17:46:15Z2020-01-29T17:46:15ZFrom recognition to transformation: How digital technology can reduce mental illness stigma<figure><img src="https://images.theconversation.com/files/312559/original/file-20200129-92987-1k7r3xh.jpg?ixlib=rb-1.1.0&rect=1213%2C25%2C6003%2C3461&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Digital technology may help improve the effectiveness of anti-stigma education programs.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/man-holding-xray-human-brain-his-507958237">(Shutterstock)</a></span></figcaption></figure><p>When those with mental illness experience prejudice and discrimination in the form of stigma, it can make their suffering considerably worse. </p>
<p>Spreading awareness and understanding through education is one of the strategies used to tackle the problem. Years of public education campaigns have helped open the conversation. Yet evidence suggests that stigma against people with mental illness <a href="https://doi.org/10.1017/S1121189X00002669">remains a problem in our health-care system</a>.</p>
<p>Consider what the experience is like for a young person who seeks mental-health care. They may suffer for a long time before they eventually build up the courage to ask for help. When they share this with a family member or a friend, they may be encouraged to look for help, but encounter a <a href="https://doi.org/10.7870/cjcmh-2017-003">long waiting list</a> for treatment. Over time, they continue to struggle and things get worse. If they end up in crisis, they might need to seek emergency care. </p>
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<img alt="" src="https://images.theconversation.com/files/312566/original/file-20200129-92959-5re1rf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/312566/original/file-20200129-92959-5re1rf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/312566/original/file-20200129-92959-5re1rf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/312566/original/file-20200129-92959-5re1rf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/312566/original/file-20200129-92959-5re1rf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/312566/original/file-20200129-92959-5re1rf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/312566/original/file-20200129-92959-5re1rf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">People seeking mental health care may face long waits for treatment.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mental-health-concept-727793356">(Shutterstock)</a></span>
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<p>The doctor, nurse or mental health professional they encounter is probably struggling within a challenging system. Health-care professionals work hard with limited resources, soaking up the suffering of others until they begin to <a href="https://psycnet.apa.org/doi/10.1037/a0030388">detach from their own humanity for self-protection</a>. They might appear rushed. They might seem distant. This can result in the patient feeling dismissed or feeling judged. </p>
<p>As a psychiatrist, I bear witness to a broken system. Mental-health care is chronically underfunded. If a parent has one child with diabetes and one with anxiety or depression and they seek help, the child with diabetes receives world-class care. The child with mental illness is given a sheet of paper and a <a href="https://www.cmho.org/news/6519906-28-000-kids-waiting-for-mental-health-services">12- to 18-month wait</a>.</p>
<h2>Encountering blame and shame</h2>
<p>As a stigma researcher, my team and I found that when individuals seek help for their mental illness in settings like hospitals or emergency departments, they frequently encounter blame and shame. We also found that many health professionals stigmatize without even <a href="http://dx.doi.org/10.1007/s40037-017-0333-5">being aware of it</a>.</p>
<p>We quickly learned that no matter how well-intentioned health professionals may be, they do not always intend to say what their patients and their families hear.</p>
<p><a href="https://link.springer.com/article/10.1007/s10459-018-9816-3">Stigma in health care is automatic</a>. It is embedded within the fabric of the system. Can we really expect training and workshops for health-care workers to solve the problem? </p>
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Read more:
<a href="https://theconversation.com/bell-lets-talk-day-should-i-share-a-mental-health-story-130260">Bell Let's Talk Day: Should I share a mental health story?</a>
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<p>One of the problems with existing stigma reduction education is that it’s delivered through in-class formats that <a href="https://www.cmaj.ca/content/168/6/710">are fairly one-dimensional</a>. Advances in digital and social media may have the potential to challenge traditional approaches to learning and provide real-time delivery of information to a huge audience. For example, medical journals that leverage social media have a much <a href="https://dx.doi.org/10.1503%2Fcmaj.150976">greater impact</a> than those that do not. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/312564/original/file-20200129-92987-1ohjnry.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/312564/original/file-20200129-92987-1ohjnry.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=423&fit=crop&dpr=1 600w, https://images.theconversation.com/files/312564/original/file-20200129-92987-1ohjnry.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=423&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/312564/original/file-20200129-92987-1ohjnry.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=423&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/312564/original/file-20200129-92987-1ohjnry.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=532&fit=crop&dpr=1 754w, https://images.theconversation.com/files/312564/original/file-20200129-92987-1ohjnry.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=532&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/312564/original/file-20200129-92987-1ohjnry.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=532&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Social media can be an effective way to keep health professionals up to date.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/silhouette-man-carrying-large-hashtag-made-291168752">(Shutterstock)</a></span>
</figcaption>
</figure>
<p>Hashtag campaigns on social media are another example. Instead of educating people about mental illness in a classroom, a viral social media post can inspire a social movement. Digital tools like social media, blogs and wikis <a href="https://dx.doi.org/10.1186%2F1472-6920-6-41">provide knowledge</a> for health professionals who can use this technology to learn about a topic while deepening their engagement and promoting collaboration. </p>
<p>Research shows that social media is an <a href="https://doi.org/10.2196/jmir.2138">effective and efficient way</a> to keep health professionals up to date with the latest knowledge to improve the quality of health care for their patients. </p>
<h2>Sharing stigma-reduction tools</h2>
<p>Digital technology also makes stigma-reduction education freely available to everyone. By putting knowledge about stigma in the hands of <a href="https://doi.org/10.1097/j.pain.0000000000001327">patients and caregivers</a>, technology democratizes expertise. </p>
<p>An example of the power of digital technology to improve health care can be found in pediatric pain research. Led by clinical psychologist, Dr. Christine Chambers, #itdoesnthavetohurt is a science-media partnership that brings evidence-based information about children’s pain directly to parents.</p>
<p>Chambers found that numerous eHealth tools for pain assessment and management are developed, yet have a reduced impact because they are rarely made available to <a href="https://doi.org/10.1097/PR9.0000000000000686">patients and families</a>. She and her team targeted their digital strategy directly at caregivers, whom they empowered with knowledge on best practices for managing pediatric pain.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/is-my-child-depressed-being-moody-isnt-a-mental-illness-92789">Is my child depressed? Being moody isn't a mental illness</a>
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</em>
</p>
<hr>
<p>Chambers’s work is a good example of how including the patient (or, in this case, the caregiver) in the solution can improve results. Digital technologies, including social media platforms, provide opportunities <a href="https://link.springer.com/article/10.1186/s13012-017-0696-3">to include</a> people affected by mental health stigma in new solutions to address it. </p>
<p>As stigma researchers, my team and I recognize the potential value in providing stigma-reducing tools directly to patients and caregivers, as well as to the health professionals those tools are targeting. Bringing those groups together may provide better ways to tackle the stigmatizing practices and policies that still exist in health care.</p><img src="https://counter.theconversation.com/content/130371/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Javeed Sukhera receives funding from Associated Medical Services, the Academic Medical Organization of Southwestern Ontario, and Physician Services Incorporated.</span></em></p>People seeking mental health care still encounter stigma, even within the health system. New tools for teaching and sharing information may help address it.Javeed Sukhera, Associate professor, Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1165042019-05-08T22:34:43Z2019-05-08T22:34:43ZHow to stop kids from cutting themselves – advice from an ER doctor<figure><img src="https://images.theconversation.com/files/273499/original/file-20190509-183103-1uobcww.jpg?ixlib=rb-1.1.0&rect=5%2C115%2C3841%2C2451&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many teenagers who self-harm do so to cope with overwhelming thoughts and emotions. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>I recently worked a shift in the emergency room at a Toronto-area hospital and was asked to see a 12-year-old boy who had cut himself for the first time, on his wrist. </p>
<p>Cutting with razors, knives or other sharp objects is a common method of inflicting <a href="https://www.suicideinfo.ca/resource/self-harm-and-suicide">“self-harm”</a> — deliberate attempts to hurt oneself, without conscious suicidal intent. Other methods include burning or hitting oneself. </p>
<p>Hospitalizations from incidents of self-harm are increasing in Canada — <a href="https://www.cihi.ca/web/resource/en/info_child_harm_en.pdf">especially among pre-teen and teenage girls</a> — and <a href="https://www.reuters.com/article/us-self-harm/one-in-12-teenagers-self-harm-study-finds-idUSTRE7AG02520111117">globally</a>. </p>
<p>Over five years from 2009-10 to 2013-14, the rate of <a href="https://www.cihi.ca/web/resource/en/info_child_harm_en.pdf">intentional self-harm-related hospitalizations in girls increased by more than 110 per cent</a> — from 78 to 164 per 100,000 female youth. The rate for boys increased by more than 35 per cent — from 23 to 32 per 100,000 male youth. And this does not include all the cases that do not make it into the hospitals. </p>
<p>Like many, this boy did not know exactly why he did what he did; so I talked it through with him while I repaired his laceration. He left smiling and satisfied. His mom sent me an email today thanking me for taking care of her son.</p>
<h2>Why young people self-harm</h2>
<p>I recall another incident last year, with another 12-year-old boy who had cut himself. This was his third emergency room visit for cutting; the story was that “he began cutting only after having met a female friend who cuts.” </p>
<p>I asked him why he cuts? He looked up briefly and said it’s because “everyone hates me.” I asked him why if others hate him, they aren’t doing the cutting. He looked puzzled. </p>
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<p>I then asked him if it is possible that he is struggling with difficult feelings or thoughts that he can’t stop, and if he is using the pain of cutting to interrupt them. He looked up and held my gaze for the first time and nodded his head. </p>
<p>I asked him what else he does to stop these thoughts and feelings. Does he play video games? He quickly denied it. His mom pointed out that he plays hockey and has no time to waste. So I asked him again what else he does to stop his thoughts. His mom looked surprised when he finally said he punched walls. </p>
<p>I asked him if the pain helps him stop his thoughts and feelings. He said yes. I then asked him what else? He said he banged his head against walls. </p>
<p>Like <a href="http://www.arwtraining.com/wp-content/uploads/2015/02/03-Self-Harm-Perspectives-from-Personal-Experience-First-Hand-Experience-Testimonies.pdf">many others who self-harm</a>, this boy is cutting himself in an attempt to cope with events in his life, and the overwhelming emotions and thoughts that arise. </p>
<h2>‘Take Five:’ A mindfulness strategy</h2>
<p>I asked the first boy if I could share with him <a href="https://www.mentalhealthcommission.ca/English/media/4157">a mindfulness-based and painless technique called “Take Five”</a> that may help him deal with difficult thoughts. He looked at me earnestly and agreed. </p>
<p>I instructed him as follows: </p>
<ol>
<li>Hold up one spread hand and hold out the index finger in the other.<br></li>
<li>Slowly trace the outline of the spread hand with the index finger of the opposite hand in the following way. </li>
<li>Wait for the next (preferably involuntary) breath. </li>
<li>Trace up the digit with each inspiration.<br></li>
<li>Trace down the digit with each expiration. </li>
<li>Repeat until the entire spread hand is traced.</li>
</ol>
<p>I explained to him that by intentionally paying attention to the sensation of his breath and the tracing of his hand, he can redirect his attention away from his difficult thoughts and feelings without the the pain and trouble of his current methods. </p>
<p>I encouraged him to practise this new technique at every chance he gets. I suggested that his ability to direct his attention will improve with these regular practices — just like hockey drills improve his play.</p>
<h2>Mental health challenges are common</h2>
<p>According to <a href="https://cmha.ca/about-cmha/fast-facts-about-mental-illness">the Canadian Mental Health Association</a>, around 50 per cent of the population will have experienced mental illness by the age of 40.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/mental-illness-on-campus-really-is-a-thing-94571">Mental illness on campus really is 'a thing'</a>
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</em>
</p>
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<p>The 2016 report of <a href="http://oucha.ca/pdf/2016_NCHA-II_WEB_SPRING_2016_ONTARIO_CANADA_REFERENCE_GROUP_EXECUTIVE_SUMMARY.pdf">an American College Health Association survey in Ontario</a> revealed that 65 per cent of students “reported experiencing overwhelming anxiety in the previous year” and 13 per cent had seriously considered suicide.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/273498/original/file-20190509-183112-1ntd4gj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/273498/original/file-20190509-183112-1ntd4gj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/273498/original/file-20190509-183112-1ntd4gj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/273498/original/file-20190509-183112-1ntd4gj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/273498/original/file-20190509-183112-1ntd4gj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/273498/original/file-20190509-183112-1ntd4gj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/273498/original/file-20190509-183112-1ntd4gj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A technique like Take Five can offer an alternative way of redirecting attention away from difficult thoughts and emotions.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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</figure>
<p>Encouraging <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3383812/#!po=0.505051">preliminary evidence</a> suggests that therapists can foster <a href="http://www.mindfulnessinstitute.ca/mbsr">mindfulness</a>, in a relatively brief period of time and that mindfulness can affect a variety of processes thought to contribute to suicidal behaviour.</p>
<h2>Opportunities for greater understanding</h2>
<p>Before he left, I asked this boy if anyone else in his family suffered difficulty with thoughts and feelings. He said “my twin.” I asked, “who else?” He pointed to his mom. </p>
<p>I asked, “what about when your dad loses his temper and yells at you about hockey?” He thought and began smiling and nodding. So I suggested that he might find an appropriate moment to share his new knowledge and Take Five with his father.</p>
<p>He held my gaze continuously. In my peripheral vision, I noticed he had continued to practise Take Five by tracing his hand.</p>
<p>I suggested to him that many people struggle with these challenges and that he is not alone. I explained that by developing his ability to choose the object of his moment to moment attention, <a href="https://self-compassion.org/wp-content/uploads/publications/Nonsuicidal_selfinjury.pdf">he can develop self-compassion</a> and open many exciting possibilities.</p>
<p>I also pointed out to him that even the Olympic silver medallist may cry for being only the second best; that the “worst” player exhibits great courage for simply being part of the game; and that everyone has the right to be happy.</p>
<p>I directed him to a <a href="https://palousemindfulness.com/">free online mindfulness training program</a> and encouraged his family to check it out.</p>
<p>He then reached out and shook my hand firmly for helping him.</p>
<p><em>If you, or someone you know, is struggling with self-harm or suicidal thoughts, free crisis support is available at Canada’s <a href="https://www.crisistextline.ca">Crisis Text Line</a> and international <a href="http://www.suicide.org/international-suicide-hotlines.html">suicide prevention hotlines</a>.</em></p><img src="https://counter.theconversation.com/content/116504/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Carlos Yu does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A doctor explains how he introduces mindfulness to self-harming youth in the emergency room.Carlos Yu, Assistant Professor, Department of Community and Family Practice, Queen's University, OntarioLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/894052018-01-03T13:06:06Z2018-01-03T13:06:06ZHow perfectionism became a hidden epidemic among young people<figure><img src="https://images.theconversation.com/files/200663/original/file-20180103-26151-w4iomf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/tired-puzzled-woman-sitting-cafe-near-617911967">Shutterstock.</a></span></figcaption></figure><p>In our roles as academics, young people knock on our doors almost every day. They are typically ambitious, bright and hard-working. They have a broad network of friends, and most come from supportive families. Yet no matter how well-adjusted they can appear, we are finding that our students are increasingly likely to seek our support for mental health issues, as well as academic ones.</p>
<p>We are not alone in observing this trend. Student mental illness on UK campuses is at <a href="https://www.ippr.org/files/2017-09/1504645674_not-by-degrees-170905.pdf">record highs</a>. And right across the globe, young people are reporting to clinicians at unprecedented levels with <a href="http://apps.who.int/iris/bitstream/10665/254610/1/WHO-MSD-MER-2017.2-eng.pdf?ua=1">depression, anxiety and suicidal thoughts</a>. </p>
<p>One possible reason for this is that across the US, Canada and the UK, today’s young people are the first generation to grow up in a society based on the principles of neoliberalism championed by the leaders of the late 20th century – Ronald Reagan, Brian Mulroney and Margaret Thatcher respectively. Over the last 50 years, communal interest and civic responsibility have been progressively eroded, replaced by a focus on self-interest and competition in a supposedly free and open market place. </p>
<p>In this new market-based society, young people are evaluated in a host of new ways. Social media, school and university testing and job performance assessments mean young people can be sifted, sorted and ranked by peers, teachers and employers. If young people rank poorly, the logic of our market-based society dictates that they are less deserving – that their inferiority reflects some personal weakness or flaw. </p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/uiGi9wgvRd","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<p>There is, then, enormous pressure on young people to demonstrate their value and outperform their peers. And there is evidence that they are struggling to cope. In particular, emerging epidemics of serious mental illnesses speak to the negative effects of this market-based society, and a culture which is fundamentally changing the way young people think about themselves and others.</p>
<h2>The rise of perfectionism</h2>
<p>Leading psychologists, Paul Hewitt and Gordon Flett <a href="https://journal.thriveglobal.com/heres-the-profound-psychological-shift-that-frees-people-from-perfectionism-290dc09ad73">have suggested</a> that one of the ways in which younger people are acting differently to their older peers is by showing a greater tendency toward perfectionism. </p>
<p>Broadly speaking, perfectionism is an irrational desire for flawlessness, combined with harsh self-criticism. But on a deeper level, what sets a perfectionist apart from someone who is simply diligent or hard-working is a single-minded need to correct their own imperfections. </p>
<p>Perfectionists need to be told that they have achieved the best possible outcomes, whether that’s through scores and metrics, or other peoples’ approval. When this need is not met, they experience psychological turmoil, because they equate mistakes and failure to inner weakness and unworthiness. </p>
<p>We recently published a study in the <a href="http://psycnet.apa.org/record/2017-57603-001">Psychological Bulletin</a>, which shows that levels of perfectionism have risen significantly among young people since 1989. We think that this may, at least in part, be a symptom of the way that young people are attempting to feel safe, connect with others and find self-worth within market-based, neoliberal societies. </p>
<p>Irrational ideals of the perfect self have become desirable – even necessary – in a world where performance, status and image define a person’s usefulness and value. You don’t need to look far to find examples; corporations and their marketers offer all manner of cosmetic and material solutions for the flawed consumer. Meanwhile, Facebook, Instagram and Snapchat provide platforms to exchange curations of the perfect version of oneself and lifestyle with others. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/200660/original/file-20180103-26157-gwax1t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/200660/original/file-20180103-26157-gwax1t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/200660/original/file-20180103-26157-gwax1t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/200660/original/file-20180103-26157-gwax1t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/200660/original/file-20180103-26157-gwax1t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/200660/original/file-20180103-26157-gwax1t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/200660/original/file-20180103-26157-gwax1t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">#instagood?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/beautiful-woman-using-smart-phone-while-785413978?src=aNdU3I89W32QFuif8f3HEw-1-35">Shutterstock.</a></span>
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<p>This is a culture which preys on insecurities and amplifies imperfection, impelling young people to focus on their personal deficiencies. As a result, some young people brood chronically about how they should behave, how they should look, or what they should own. Essentially, agitating to perfect themselves and their lives.</p>
<p>It’s no wonder that there’s substantial evidence indicating that perfectionism is associated with (among other things) <a href="http://onlinelibrary.wiley.com/doi/10.1002/per.2053/full">depression</a>, <a href="http://onlinelibrary.wiley.com/doi/10.1002/1098-108X(199503)17:2%3C147::AID-EAT2260170207%3E3.0.CO;2-X/full">anorexia nervosa</a>, <a href="http://onlinelibrary.wiley.com/doi/10.1111/jopy.12333/abstract">suicide ideation</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/19383652">early death</a>. </p>
<p>We feel a deep sense of sympathy with our students’ struggles. For the first time on record, <a href="https://www.theguardian.com/society/2016/jul/18/millennials-earn-8000-pounds-less-in-their-20s-than-predecessors">young people are expected</a> to be <a href="https://www.theguardian.com/world/2016/mar/07/revealed-30-year-economic-betrayal-dragging-down-generation-y-income">materially less well-off</a> in adulthood than their parents. And it’s not just their material well-being that’s at stake – their mental and physical well-being is threatened by this hidden epidemic of perfectionism. </p>
<p>It’s time for organisations such as schools and universities, as well as the politicians and civil servants who help to shape the way these organisations operate, to take steps to safeguard the welfare of young people. They must resist marketised forms of competition, at the expense of young people’s mental health. They should teach the importance of compassion over competition. If they do not, the rise of perfectionism – and its association with serious mental illness – is likely to continue unabated.</p><img src="https://counter.theconversation.com/content/89405/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There is enormous pressure on young people to strive, perform and achieve. And the data indicate that many are struggling to cope.Thomas Curran, Assistant Professor, University of BathAndrew P. Hill, Associate professor, York St John UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/768002017-04-28T05:50:06Z2017-04-28T05:50:06ZWhy we shouldn’t ignore what 13 Reasons Why is trying to tell us<figure><img src="https://images.theconversation.com/files/167111/original/file-20170428-15097-dnlkny.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">13 Reasons Why is the story of high-school student Hannah, who took her own life and left 13 tapes explaining why.</span> <span class="attribution"><a class="source" href="http://www.imdb.com/title/tt1837492/mediaviewer/rm3241424384">IMDb/Kicked to the Curb Productions, Anonymous Content, July Moon Productions, Paramount Television</a></span></figcaption></figure><p>The Netflix show 13 Reasons Why has stirred debate recently, with growing numbers of <a href="http://www.abc.net.au/news/2017-04-18/netflix-series-13-reasons-why-prompts-mental-health-concerns/8450176">calls to counselling services</a> from those alarmed the show’s graphic depiction of suicide could be harmful to vulnerable teenagers. </p>
<p>Some have complained about the simplistic, <a href="http://www.mamamia.com.au/13-reasons-why-mental-health/">cause-and-effect</a> portrayal of suicide. Others have chosen to see it as an <a href="http://www.smh.com.au/comment/what-i-learnt-from-watching-13-reasons-why-with-my-teenage-son-20170424-gvr3na.html">educational tool and conversation starter</a>.</p>
<p>Certainly, there are concerns, including the graphic suicide scene in the last episode. But, overall, the story of high school student Hannah who took her own life and left 13 tapes explaining why, raises many realistic and relevant topics for adolescents.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/167128/original/file-20170428-15091-boflyl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/167128/original/file-20170428-15091-boflyl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/167128/original/file-20170428-15091-boflyl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=890&fit=crop&dpr=1 600w, https://images.theconversation.com/files/167128/original/file-20170428-15091-boflyl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=890&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/167128/original/file-20170428-15091-boflyl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=890&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/167128/original/file-20170428-15091-boflyl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1119&fit=crop&dpr=1 754w, https://images.theconversation.com/files/167128/original/file-20170428-15091-boflyl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1119&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/167128/original/file-20170428-15091-boflyl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1119&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Talking about mental health issues is important.</span>
<span class="attribution"><a class="source" href="http://www.imdb.com/title/tt1837492/mediaviewer/rm805384704">IMDb/Kicked to the Curb Productions, Anonymous Content, July Moon Productions, Paramount Television</a></span>
</figcaption>
</figure>
<p>It shows compounding associations between mental health issues and a range of behaviours documented to impact a young person’s mental health. These include social exclusion, rumour and innuendo, <a href="http://ro.ecu.edu.au/ecuworks2012/378/">bullying</a>, <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3314-4">regrettable sexual behaviours</a>, alcohol and other drug use, <a href="https://minerva-access.unimelb.edu.au/handle/11343/58760">drink driving</a> and <a href="http://www.publish.csiro.au/sh/SH14215">sexual assault</a>. </p>
<p>The storyline plays out a tangled web of everyday life: peer relationships, friendships, sexual identity, family dynamics, social media and, importantly, the school environment. </p>
<p>Friends’ reactions to Hannah’s suicide and their response to her depiction of their behaviour also provide the opportunity to discuss how different people relate with and react to each other. </p>
<h2>Issues with the show</h2>
<p>Certainly the media should be careful when portraying suicide. Research shows depicting the means of suicide and/or glorifying the act can in some instances result in suicide spikes. However, <a href="http://econpapers.repec.org/article/eeesocmed/v_3a180_3ay_3a2017_3ai_3ac_3ap_3a152-159.htm">researchers also suggest</a> there are usually complex underlying issues associated with copycat suicides (when one person from a community suicides after someone else has).</p>
<p>The association between media exposure and subsequent suicide is not a simple one, while <a href="https://www.ncbi.nlm.nih.gov/pubmed/15843330">evidence for the impact of fictionalised depictions</a> of suicide isn’t as robust as when it comes to real-life portrayals.</p>
<p>In Australia, the media follow guidelines such as <a href="http://www.mindframe-media.info/home/resource-downloads/?a=10217">those produced by Mindframe</a>. These recognise the importance of raising awareness of suicide and suicidal behaviours, but caution against depicting the method. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/167123/original/file-20170428-15117-9uih5v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/167123/original/file-20170428-15117-9uih5v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/167123/original/file-20170428-15117-9uih5v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/167123/original/file-20170428-15117-9uih5v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/167123/original/file-20170428-15117-9uih5v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/167123/original/file-20170428-15117-9uih5v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/167123/original/file-20170428-15117-9uih5v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/167123/original/file-20170428-15117-9uih5v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The show provides an opportunity to discuss how different people relate with and react to each other.</span>
<span class="attribution"><a class="source" href="http://www.imdb.com/title/tt1837492/mediaviewer/rm148518656">IMDb/Kicked to the Curb Productions, Anonymous Content, July Moon Productions, Paramount Television</a></span>
</figcaption>
</figure>
<p>Australian fictional television programs and movies that portray suicide and other mental health issues provide information for where to go for help at the end of each program. </p>
<p>Although Netflix provided such information <a href="http://www.13reasonswhy.info/#aus">on its website</a> and a supplementary episode describing the issues raised and options for help, helpline details were not given after each episode.</p>
<h2>Raising awareness is important</h2>
<p>Raising awareness and talking about mental health issues is important and young people are certainly talking about 13 Reasons Why. But talking isn’t everything. Health and education professionals, as well as parents, need the skills to respond appropriately to these conversations. </p>
<p>Given the show’s focus on the school, it is important school staff – especially health service staff and teachers – feel confident discussing mental health problems and influences. This does not mean teachers should become counsellors; rather, teachers need resources and support to enable meaningful discussions about issues with older teenagers as appropriate. </p>
<p>While some may feel confident discussing such issues, studies have found there are a <a href="http://www.tandfonline.com/doi/full/10.1080/14681811.2015.1019665">range of topics</a>, such as a relationships, gender identity, bullying and mental health, that can be challenging and for which many teachers have <a href="http://apo.org.au/files/Resource/sexeducationinaustsecondaryschools2010-1-5-2011.pdf">little or no professional development</a>.</p>
<p>The national secondary curriculum already includes options to discuss literature reflecting many of these issues. The <a href="http://v7-5.australiancurriculum.edu.au/">Australian</a> and Western Australian <a href="http://k10outline.scsa.wa.edu.au/home/p-10-curriculum/curriculum-browser/health-and-physical-education">Health and Physical Education Curriculum</a> provides a specific focus on mental health and relationships issues.</p>
<h2>Seeking help</h2>
<p>School staff also need accessible services to refer students to if necessary. Access to school nurses, psychologists and pastoral care professionals <a href="https://espace.curtin.edu.au/handle/20.500.11937/998">varies considerably</a> across schools. Access to community mental health services also varies. In some areas there may specific services that meet the needs of LGBTI or culturally or linguistically diverse young people. </p>
<p>While accessing help for mental health problems is recognised as a <a href="https://www.mja.com.au/journal/2007/187/7/when-and-how-do-young-people-seek-professional-help-mental-health-problems">protective factor</a>, it is not always easy to do so. Stigmatising attitudes towards mental health problems are improving in Australia, but <a href="https://www.ncbi.nlm.nih.gov/pubmed/22417929">they are still evident</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/167126/original/file-20170428-15097-1v5y6u9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/167126/original/file-20170428-15097-1v5y6u9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/167126/original/file-20170428-15097-1v5y6u9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=346&fit=crop&dpr=1 600w, https://images.theconversation.com/files/167126/original/file-20170428-15097-1v5y6u9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=346&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/167126/original/file-20170428-15097-1v5y6u9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=346&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/167126/original/file-20170428-15097-1v5y6u9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=435&fit=crop&dpr=1 754w, https://images.theconversation.com/files/167126/original/file-20170428-15097-1v5y6u9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=435&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/167126/original/file-20170428-15097-1v5y6u9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=435&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Given the show’s focus on the school setting, it is important school staff feel confident discussing mental health problems and influences.</span>
<span class="attribution"><a class="source" href="http://www.imdb.com/title/tt1837492/mediaviewer/rm2741974528">IMDb/Kicked to the Curb Productions, Anonymous Content, July Moon Productions, Paramount Television</a></span>
</figcaption>
</figure>
<p>We also know young people are less likely to seek help if they feel negatively about it, which may be influenced by previous experiences. In 13 Reasons Why, Hannah sought help from the school counsellor but her efforts were ignored. Mr Porter could have referred her to a more qualified health professional or taken more time to listen. </p>
<p>Young people may also be <a href="https://www.mja.com.au/journal/2007/187/7/when-and-how-do-young-people-seek-professional-help-mental-health-problems">hesitant to seek help</a> if they feel they should resolve the issue themselves. And those with suicidal thoughts are <a href="https://www.mja.com.au/journal/2007/187/7/when-and-how-do-young-people-seek-professional-help-mental-health-problems">less likely to seek help</a>, so there is concern they may feel that programs such as 13 Reasons Why validate their thoughts.</p>
<p>It is important to <a href="https://www.ncbi.nlm.nih.gov/pubmed/11059991">enhance health literacy</a> so young people are better able to <a href="https://www.ncbi.nlm.nih.gov/pubmed/16403031">recognise signs of problems</a> and feel confident seeking help. It is also important friends, family and other significant people look out for warning signs and encourage young people who are feeling distressed to seek help. </p>
<p>Such signs <a href="https://www.headspace.org.au">may include</a> withdrawal from activities people usually enjoy, changes in sleep or appetite, being unusually moody, angry, stressed or anxious, participation in risky behaviours they would usually avoid, and expressing negative thoughts. </p>
<p>If, as in Hannah’s case with the counsellor, the help isn’t great, then seek another source. Acting on issues early and preventing problems from developing should be a focus. Similar to 13 Reasons Why, too often interventions are implemented only after a crisis. Prevention programs that consider the complexity of mental health and include strategies that focus on the broader environment and ethos are important. </p>
<h2>Should you watch it?</h2>
<p>Netflix suggests viewing 13 Reasons Why for young people <a href="https://www.netflix.com/au/title/80117470">aged 15 years and over</a> (MA15+) and the <a href="http://www.classificationoffice.govt.nz/find-ratings/new-zealands-classification-labels.html">New Zealand Classification Office</a> recently rated the program as RP18. Concerned parents can help by watching the program with their teenager and discussing salient issues.</p>
<hr>
<p><em>If you are feeling distressed or are concerned about a friend, family member or work colleague, call Lifeline 13 11 14 <a href="https://www.lifeline.org.au/">www.lifeline.org.au</a>, Suicide Call Back Service 1300 659 467 <a href="https://www.suicidecallbackservice.org.au/">www.suicidecallbackservice.org.au</a> or Kids Helpline 1800 55 1800, <a href="https://kidshelpline.com.au/">www.kidshelp.com.au</a></em></p><img src="https://counter.theconversation.com/content/76800/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sharyn Burns does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>While there are some some safety concerns about watching the show, 13 Reasons Why raises many issues relevant to adolescents – and we should learn from them.Sharyn Burns, Associate Professor, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/375102015-02-19T04:15:49Z2015-02-19T04:15:49ZDetained children risk life-long physical and mental harm<figure><img src="https://images.theconversation.com/files/72454/original/image-20150219-20793-wjftns.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Deprivation and trauma and early childhood can affect the developing brain.</span> <span class="attribution"><a class="source" href="https://www.humanrights.gov.au/sites/default/files/CI-PIC-129.jpg">Australian Human Rights Commission</a></span></figcaption></figure><p>Many refugees and asylum seekers, including children, have experienced conflict, family separation and significant human rights violations, including <a href="http://www.ncbi.nlm.nih.gov/pubmed/12383986">torture, physical and sexual violence</a> in their countries of origin and transit. </p>
<p>These experiences <a href="http://www.ncbi.nlm.nih.gov/pubmed/15823380">increase the risk</a> of mental health conditions such as depression and anxiety, which is <a href="http://www.ncbi.nlm.nih.gov/pubmed/19336779">exacerbated</a> by the uncertainty and harsh conditions of detention. Stressors <a href="http://www.ncbi.nlm.nih.gov/pubmed/16311898">accumulate</a> to cause mental distress; the more stress we add, the more we compound the problem.</p>
<p>Immigration detention can have life-long impacts on children’s mental and physical health. The Australian Human Rights Commission report, <a href="https://www.humanrights.gov.au/our-work/asylum-seekers-and-refugees/publications/forgotten-children-national-inquiry-children">The Forgotten Children: National Inquiry into Children in Immigration Detention</a>, released last week, found one-third of children in immigration detention centres have a mental health disorder that requires psychiatric support. </p>
<p>If these children are supported and protected from further stress, they are more likely to improve their mental well-being and achieve their potential.</p>
<h2>Chronic stress</h2>
<p>When the brain is chronically exposed to stress, it produces hormones that make it more reactive: the “fight response”. People are more likely to be nervous, to respond without thinking and to be frightened a lot of the time. In this fight mode, it’s difficult to concentrate, plan for the future and sleep.</p>
<p>Children exposed to these <a href="http://www.ncbi.nlm.nih.gov/pubmed/12584488">cumulative stressors</a> for long periods of time become less able to learn, more difficult to settle and console, and are unable to enjoy the fun and games of childhood.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/72460/original/image-20150219-24298-nq3mgi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/72460/original/image-20150219-24298-nq3mgi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/72460/original/image-20150219-24298-nq3mgi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/72460/original/image-20150219-24298-nq3mgi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/72460/original/image-20150219-24298-nq3mgi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=533&fit=crop&dpr=1 754w, https://images.theconversation.com/files/72460/original/image-20150219-24298-nq3mgi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=533&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/72460/original/image-20150219-24298-nq3mgi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=533&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">National inquiry staff visited immigration detention facilities to speak to children and asked them to draw something about their life. These are their drawings.</span>
<span class="attribution"><a class="source" href="https://www.humanrights.gov.au/sites/default/files/CI-PIC-10.jpg">Australian Human Rights Commission</a></span>
</figcaption>
</figure>
<p>Chronic stress response in childhood, especially early childhood, also sets up biologic reactions that <a href="http://www.ncbi.nlm.nih.gov/pubmed/15640511">predispose children to chronic diseases</a> such as high blood pressure, obesity and heart disease.</p>
<p>The mechanisms by which stressors in early childhood <a href="http://www.ncbi.nlm.nih.gov/pubmed/10681890">contribute</a> to <a href="http://www.ncbi.nlm.nih.gov/pubmed/21944375">poor adult health</a> aren’t fully understood, but are likely to be linked to the chronic production of stress hormones, stress-related activation of genes, patterns of brain connections and learnt behaviours to cope with high levels of stress.</p>
<h2>Impacts on the developing brain</h2>
<p>Children respond differently at different ages, and also differ in temperament and genetics. A combination of these factors determines how a child will respond to environmental exposures and whether certain genes will be turned on in response to stress. </p>
<p>There is good evidence that critical windows of opportunity for development can be lost if the child experiences deprivation or trauma during early childhood.</p>
<p>If a child’s impaired vision is not corrected within the first few years of life, that child may lose sight in the affected eye as the brain suppresses the distorted image. Similarly, if a child is hearing-impaired and not encouraged to communicate verbally or provided with hearing aids, it may be impossible to develop spoken language even with hearing aids provided later in life.</p>
<p>This occurs in <a href="http://www.ncbi.nlm.nih.gov/pubmed/20796183">more subtle ways</a> with all aspects of a young child’s development. Missing sensitive periods for laying down brain architecture can have lasting impacts that cannot be reversed.</p>
<p>The typical impact of chronic early stress and deprivation in young children include:</p>
<ul>
<li>language delays</li>
<li>emotional regulation difficulties leading to excessive tantrums</li>
<li>regressive behaviour disorders such as bed-wetting</li>
<li>self-stimulation such as headbanging</li>
<li>sad and anxious behaviours such as fear of separation from loved ones</li>
<li>crying a lot </li>
<li>nail-biting </li>
<li>difficulty eating or sleeping.</li>
</ul>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/72461/original/image-20150219-24286-8bga4v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/72461/original/image-20150219-24286-8bga4v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=547&fit=crop&dpr=1 600w, https://images.theconversation.com/files/72461/original/image-20150219-24286-8bga4v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=547&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/72461/original/image-20150219-24286-8bga4v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=547&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/72461/original/image-20150219-24286-8bga4v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=687&fit=crop&dpr=1 754w, https://images.theconversation.com/files/72461/original/image-20150219-24286-8bga4v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=687&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/72461/original/image-20150219-24286-8bga4v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=687&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Children who spend time in immigration detention centres are often plagued by nightmares, anxiety and depression.</span>
<span class="attribution"><a class="source" href="https://www.humanrights.gov.au/sites/default/files/CI-PIC-7.jpg">Australian Human Rights Commission</a></span>
</figcaption>
</figure>
<p>Adolescence is another highly sensitive period. Unaccompanied children, who are mostly in their teenage years, are particularly <a href="http://www.un.org/documents/ga/docs/52/plenary/a52-273.htm">vulnerable</a> as they do not have a parent, guardian or relative to care for them and buffer the harshness of their environment. </p>
<p>Many detained adolescents experienced the death of family members, persecution, conflict, forced military recruitment and physical and/or sexual violence. These experiences occur during the critical adolescent developmental period, placing them at risk of long-term mental health problems such as post-traumatic stress disorder (PTSD), anxiety, learning difficulties and depression.</p>
<p>On the other hand, <a href="http://www.ncbi.nlm.nih.gov/pubmed/19861471">children can be very resilient</a> and some can fully recover from extreme circumstances. </p>
<h2>Buffering the harshness</h2>
<p>Young children are completely dependent on others for their <a href="http://www.who.int/social_determinants/resources/ecd_kn_evidence_report_2007.pdf">basic care</a>, which should include play, recreation, stimulation, affection, as well as food and shelter. If a parent or carer is unable to meet the child’s needs, this presents a stress for that child. </p>
<p>In the detention environment – especially with current policies of offshore processing, indefinite detention and non-settlement of boat arrivals – parents are extremely fearful about their future and realistically have little hope for a positive outcome. They’re unable to create a positive, safe, encouraging, caring and child-focused space.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/72462/original/image-20150219-24243-1bacr5f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/72462/original/image-20150219-24243-1bacr5f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=849&fit=crop&dpr=1 600w, https://images.theconversation.com/files/72462/original/image-20150219-24243-1bacr5f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=849&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/72462/original/image-20150219-24243-1bacr5f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=849&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/72462/original/image-20150219-24243-1bacr5f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1066&fit=crop&dpr=1 754w, https://images.theconversation.com/files/72462/original/image-20150219-24243-1bacr5f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1066&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/72462/original/image-20150219-24243-1bacr5f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1066&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Chronic stress in childhood predisposes children to chronic diseases such as high blood pressure, obesity and heart disease.</span>
<span class="attribution"><a class="source" href="https://www.humanrights.gov.au/sites/default/files/CI-PIC-6.jpg">Australian Human Rights Commission</a></span>
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<p>However skilled they are as parents, they’re unable to shield their children from the physical and emotional environment. </p>
<p>They’re also aware that, in seeking asylum to protect their children, they have unintentionally brought their children into a potentially damaging situation. This further undermines their confidence as parents, adding to their despair.</p>
<p>Families may be separated across the detention system, with one parent in one detention centre while another is sent elsewhere. This can be terrifying for children who have lost loved ones and are highly sensitised to separation. </p>
<p>On a practical level, parents are frequently <a href="http://www.ncbi.nlm.nih.gov/pubmed/15707201">unable to provide basic care</a> for their children, or do “ordinary things” such as cooking for them, eating a meal as a family, reading to them or playing with them. In a restricted and monotonous environment, family life erodes and dependency is fostered. </p>
<h2>Treating refugee children</h2>
<p>Children who spend time in immigration detention centres <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=18558318">are often</a> plagued by nightmares, anxiety, depression, poor concentration and may suffer from PTSD for many years after the experience. This manifests in the way they cope with school, their social life, relationships, trust and their capacity for enjoyment.</p>
<p>My colleague and I spent a week <a href="http://www.theguardian.com/commentisfree/2014/may/12/sadness-and-fear-what-the-drawings-by-children-in-detention-showed-us">providing medical care to children</a> on Christmas Island. Speaking to these children, we noted many of the above symptoms. Most cried as they told us their stories and described their loss of hope. Those unable to speak drew harrowing images of life in detention.</p>
<p>Unfortunately there are no magic cures for such symptoms, though skilled mental health services can help. </p>
<h2>Building trust</h2>
<p>The provision of high-quality and accessible services can help children realise the world <em>can</em> be a safe and trustworthy place. This includes health-care, support in learning English, safe and pleasant housing and education delivered by teachers who understand what the child has experienced and the <a href="http://www.ncbi.nlm.nih.gov/pubmed/24976219">extent of their educational disadvantage</a> in prior interrupted schooling. </p>
<p>Supportive and welcoming communities reassure children that they will not be harmed and they need not fear that being “naughty” will send them back to detention. This settles the child’s stress response and gradually enables them to reclaim their childhood.</p>
<p>Children have <a href="http://www.unhcr.org/protect/PROTECTION/3b66c2aa10.pdf">rights</a> to health, education, play and participation in decisions affecting their lives, as well as rights to protection from physical and mental violence, injury, abuse, neglect and maltreatment. Keeping children seeking asylum in detention contravenes these rights.</p><img src="https://counter.theconversation.com/content/37510/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karen Zwi is Chair of the Royal Australasian College of Physician's Asylum Seeker and Refugee Health Working Party, which made a submission to the AHRC for the Forgotten Children report.</span></em></p>Many asylum seekers, including children, have experienced conflict, family separation and significant human rights violations. So how does immigration detention affect their mental health?Karen Zwi, Paediatrician and Associate Professor, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.