Woman's Hour - Parenting: Teenage mental health

Episode Date: June 19, 2019

Over the next couple of weeks we’ll be focusing on teenage mental, talking to health professionals, teachers, parents and teenagers. Today the Prime Minister is at a school in London to launch a new initiative, that all teachers will be trained to spot early signs of mental health issues in pupils. Last year referrals to child and adolescent mental health services were at their highest level ever. We’ve become much better at acknowledging mental health issues, but if you need help, is it available? We speak to a consultant in emergency medicine with responsibility for mental health issues and to a GP.

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BBC Sounds. Music, radio, podcasts. This is Jane Garvey and this is the Woman's Hour podcast. Today, mental health. There's no doubt that we're all able, we're almost encouraged to discuss mental health like never before. But if you need help or if a child, particularly a teenager, needs help, is it actually available these days? Can you get the right help?

How long do you have to wait? Over the next couple of weeks on Woman's Hour, we're going to be looking very closely at the issue of teenage mental health. And what you'll hear on the programme is the people who are going through it, whether as carers, as patients or as medical professionals, telling us how it really is. We've kept them anonymous so they can be free to be absolutely honest about their experiences.

And we start that series of conversations on the podcast today. You might well have heard already that the Prime Minister is at a school in London today. She's launching a new initiative. This is about teachers being trained to spot early signs of mental health issues in pupils. Well, this head we've spoken to, and you'll hear more from him later in the next couple of weeks, this head says, frankly, schools have already got too much to do.

The expectations society has of schools is getting greater, and the pressure on schools to achieve outcomes in terms of both academic performance, financial performance, the well-being of people has changed and increased and we're in the public eye for everything and anything. I think rarely a day goes by without a story on the news where a politician or someone from industry will say, and of course what we need is schools to do. And that's lovely and we'll try and do whatever we can, but we can't do everything. Well, that headteacher was speaking frankly to us and we've kept every contributor anonymous so they can really speak freely. You might well know that last year, referrals to child and adolescent mental health services across the country were at their highest level ever.

There's no doubt we're all becoming so much better at talking about mental health issues, but if you need help, is it available? This week and next, you'll hear from health professionals, from teachers, from parents and from young people themselves. Today, the voices of a consultant in emergency medicine with responsibility for mental health issues, and first, the real-life experiences of a GP. People come for a very large variety of reasons which now have all been subsumed under an umbrella sort of idea of mental health.

And we more and more are pathologising sort of feelings that people have, and we're very disconcerted by any form of distress, so that when particularly young people become distressed, they come, I think, often quite quickly to the doctor or a family member will come to the doctor, and it's difficult to know whether they want to be labelled and they want to be sort of diagnosed as having a psychiatric problem or a mental health problem or whether they want not to be. I mean, that's part of a supposed skill of a GP,

is being able to pick out which of those things is wanted but also you are you do have to sort of balance the fact that you don't want to medicalize every everybody who comes through the door and also even even sort of looking for diagnosis is only the first step in actually helping people to feel better so your role as a GP is in some cases kind of a gatekeeper to other services you You're kind of signposting people on, you could go here, you could try this, this is what I can offer you. So if a young person comes to you and you think actually yes they do require more attention and it's not for the primary care team to give it to them, what do you have in your arsenal? In a sense real real crisis is almost easier because there is some services there available for that you may be able to get the acute psychiatric team and get an early appointment for someone to be seen

by a secondary care specialist the sort of middle range are really difficult actually because there isn't so child and adolescent mental health which is called CAMH in most parts of the country has been systematically really totally under-resourced and under-loved. And really tragically, actually, at the exact same time as they increase awareness, they've continued to run down those services. And now we find the waiting lists for that are absolutely extraordinary. Like what? I don't know what it is in our region at the moment.

The last place I was, we would be waiting usually three to four months. Months? Yeah. And during that three to four months, that child or adolescent has no support other than GP usually, family and school, but there isn't anything else. So how does that feel then if you've got a young person who, I don't know, has an eating disorder or is self-harming and would really benefit from those services. How do you feel when you think, I'm about to tell them there is somewhere to go,

they're going to have to wait for it? I mean, it's incredibly difficult. I think anyone can see that that's difficult. Eating disorders are a very specific example. They have, again, they're very, very specialist services and they're immense waiting lists which are quite firmly gate-kept so that you have to hit a certain BMI to be included in various places. It's incredibly frustrating when

it's early days in an illness and you can see where it's going to go but you haven't got any way of intervening early and actually if you can get in early you can make a much more significant difference whereas waiting for it to become entrenched is really really frustrating actually furthermore families and children themselves become incredibly upset and frustrated you're the only point of contact people will come back to you week after week more and more upset more and more frustrated you're offering them 10 minutes at a time to deal with that if they're very lucky you can give them a double that would be 20 minutes you know they want something doing you you you've achieved this diagnosis which can sometimes be elusive but now you can't sort of give them the help they need to get going and that that's incredibly frustrating and in the sort of gp community is it something that you talk about

like what do we do about this how can this be better managed how can we help to advocate for better services what's the sort of chat amongst gps these will be the consultations that often do cause distress to the doctor as well because the frustration of not being able to help someone and then not being able to help them again and then again it is really demoralizing and i think it's one of the things that we do tend to talk about a lot informally amongst ourselves is you know what can i do with this specific person is there anything you can think of that we can offer him or her in the interim and and is there any way to manage the risk because actually for a lot of um adolescents

you you know you can sort of split hairs over diagnosis all you like, but there are a significant, small but significant number of children and young people who will actually seriously harm themselves. And whether they did it with a full depression diagnosis or not, or they were fully suicidal or not, they've done something terrible that's irrecoverable for everybody concerned. And you always have that in your mind, I think, in the sense that you're holding the risk on your own and that the poor family and the child are holding the risk at home.

And there's no other sort of safety net. And the outcome could be as bad, whether it's an actual mental health crisis or whether it's someone with normal distress trying to express that. Exactly. Yeah, exactly. So I think that what makes them a particularly difficult group, in a sense, and a group that should be distinguished from adult mental health, is that you have this impulsivity that is slightly less dominant in inverted commas, normal adults.

So adults with severe psychiatric illness, often impulsivity will be a feature, but otherwise it is less so. Whereas in children or in young people, you can have impulsivity anyway as a feature but otherwise it it is less so whereas in children or young people you can have impulsivity anyway as part of a growing brain and and that can mean that a child who really perhaps isn't severely depressed and is actually functioning and would not score on any of our systems and perhaps if you sat down and did a proper diagnostic consultation over an hour they wouldn't perhaps come up as markedly distressed or even or even at

significant risk of suicide but who will then have one impulsive evening or one you know accidental moment where even whether it was on purpose intentional whatever their hope of outcome some you know catastrophe can occur is there anything that gives you cause for hope that the government might be talking about or that moves in primary care towards better understanding or funding of mental health or do you feel quite despondent I find young people themselves quite a large source of hope because they are so articulate and they are so keen to help each other actually and I usually I actually find the patients themselves more

inspiring and and promising than than anything else and also the fact that families do care so much and they are you know although it can create difficult scenarios that you know it's amazing to see how much people knock themselves out for each other it really is in terms of systems I don't want to speak for everyone else but I do feel that there's a sort of disingenuousness going on whereby there's a lot of sort of lip service paid to mental health and a lot of we've done a mental health initiative and we've raised awareness. And I don't really care to see any more posters or adverts.

I'd like to see some proper funding put back into CAMH, some recognition that family therapy is an important part of it, that the allied disciplines are crucial recognition that family therapy is important part of it that the allied disciplines are crucial that occupational therapy is important that practice nursing which has been decimated is essential there's hardly any community psychiatric nursing anymore that was incredibly valuable but they've taken out the whole there's some recognition that specialist services need money but they're the they're the last point of the pyramid and they're absolutely funneled down so we have waiting this and there's some awareness that gps can deal with lots of things but very little kind of

funding or training available and actually it's not so much training you need the actual stuff and it it sounds like a boring much raised political point but you can't look after people if you don't have people there to do the looking after. You know you can raise as much awareness as you like but if there's one doctor in a room with nowhere to refer to it doesn't really help me or anyone else to be aware. I'm an emergency medicine consultant in an emergency department and I'm mental health lead for that department. In my own department we know there's a 25% increase in attendances for under-16s with mental health problems, so that's a big hike and we think that's been going on for a long time.

That's against a background of adults going up by about 12-14% each year. That's significant. Yeah, yeah. For a long time rural colleges psychiatrists and other people have been saying if you come in crisis as an adult you should get a response within an hour so that's if you're 18 that's what'll happen if you're 16 you wait a day is that just purely funding yes yes it is there's been a bit of an uplift of funding in beds a couple of years ago and the government's talked about more funding.

It's going to take a long time for it to get through, and I doubt it'll even touch the surface, really. There's a survey on the Royal College of Emergency Medicine website about CAMH services for patients coming to the ED, and there's some very interesting comments, one of which described, I'll read it to you, it's so appalling that it has reduced our staff to tears under the resignation of a senior ED nurse emergency department is not the place

for an acutely disturbed or distressed children or young person to be there's no appropriate room to accommodate them they wait hours for assessment have you had any staff who just can't hack it and think actually perhaps understandably for their own mental health I can't do this yes there are people in our teams that have moved on moved on to things that are perhaps a bit more sustainable longer term you see a bit of compassion fatigue there's a few people that come regularly in child and license there's more in adult care where we see them twice a week sometimes. Yeah, it's hard to start again afresh and keep being sympathetic

and keep being kind, potentially. 53% of people rated the services for young people in their department as poor. 12% said it was awful. Over that, they meant they had safety concerns and so it goes on so what does a typical day look like in terms of your role is there a typical isn't no there's no typical day so i if i'm doing a clinical shift i will just go and see whatever patient is there a tricky bit i find with seeing particularly a teenager is it takes longer to get them engaged to try and work out

what's happened to them and often I get the feeling I don't necessarily get to the bottom of what's happened but I get an idea and then I have to work out whether that patient potentially could go home the national guideline is that everybody stays in to have an assessment by a CAMH team the next day but that's quite a big thing for a teenager to stay in a pediatric ward overnight the average age of a pediatric mission is probably two or three so little people who are snotty and coughing and short of breath and then you have a some teenagers well not many but one or two at any one time that's hard and then there's the ones that are really distressed and you think

okay you're going to come in you're going to wait to see can h and then if you need to have a be admitted to a adolescent mental health bed they could be five days in an acute hospital the most distressing thing for me is watching people get worse in that time in hospital so they're completely they're distressed anyway because they've done a significant self-harm or they're significantly suicidal, enough that people want them to be admitted. We tend to keep the 16 year olds in our emergency observation areas, so there's people with head injuries and alcohol and older mental health patients with sort of established patterns of self-harm. You don't really want them to have to be exposed to that. So they get a single room, which is good. It's quiet. It's calm. It's safe.

But it's like being in a prison. Our room has one window that looks out on a brick wall. And there's that. So nothing's happened yet. So no news on the bed, no news on the assessment. And then coming to keep going back and say, this is what we've done, we've phoned, you've got nothing to offer. It's really frustrating. You're trying to manage parents' expectations. The child usually just becomes quite, not a child, a young person, quite quiet, quite withdrawn potentially, and that's not good. I have an amazing manager who,

whenever there's a young person waiting for a bed, he just gets on the phone and he will phone everybody until he can agitate to get to bed. And he does a good job, actually. He's worked his way around the system. And he feels that's one thing he can do. But I watch the frustration with him and how many phone calls that takes. The emergency department is the default for when everything goes wrong. So I've looked after a child in a foster care or in an institution. When that breaks down, they end up with us.

And then we end up with a young person who has been violent because their life's not going well for them in a paediatric A&E. And then we have security around trying to keep this person safe because they might be acting out or trying to help self-harm or sometimes being quite aggressive. I mean, that's rare, but that's really distressing and that's when my nurses really struggle. We then come in and we'll offer some sedation,

which doesn't seem like a great option either. Sometimes it gives someone some time out, but it does feel a bit like, well, we're just kind of medicating you to make you easier to manage, not necessarily to help you. That's hard. Sometimes our only treatment has been, can someone go and buy this child a burger king that will help sometimes thinking outside the box and i worry about the effect it has on staff working in a service that's not sustainable so if i was a mental health clinician only seeing people with self-harm

i'd want there to be quite a few supports and opportunities for training and perhaps doing other things that's not always self-harm but yeah actually they seem to be just right rotas you'll you'll see that many people and you'll you'll work that many weekends and i worry that that's not sustainable for people i wonder as a clinician what your sense of some of the factors behind maybe teenage suicide rates going up or more self-harming or more presenting at A&E and I wonder what they tell you about why they're unhappy they often feel isolated in their social groups so they may have a few friends some will say they have been bullied online there's a bit

more sort of gender dysphoria i'm very biased because i don't see the people who have gender identity problems that don't have mental health problems but i see some that do and that often seems to be a long-term thing academic pressures i think in some environments everything is measured isn't it you have an attainment goal and I think people are always comparing themselves to other people people's self-esteem quite often is quite low because they are being measured at school and they're also effectively measured on social media by how they how they feel that they are viewed by others sometimes there are kind are groups of young people who manage their mental health problems together,

and that has good points and bad points. So there's a community of people who've been in hospital together, and when one of them tries to take their own life, everybody else seems high risk. Sort of contagious. Yeah, sort of, but I guess they're distressed because someone they've effectively lived with in a mental health hospital has tried to take their own life or has completed suicide.

And then we've actually not had many, but when we have had a suicide, we've actually put alerts on people that know that person so that we are aware when they come in that they may be at higher risk. What does it feel like when somebody who has been under your care or you're aware of on your radar as an A&E department does end up taking their own life as a young person it's horrific there's one or two of them I've known really well actually and then they've they've you've watched them sometimes you've watched them for several months and they've continuing self-harm behavior and assessment and people trying to manage them in the community and then the same behavior then ends up in a completed suicide and you know about their pets you know about their family yes it's it's tough. Very very powerful testimony from a consultant in emergency medicine who has responsibility

for mental health issues and before that the GP and the line I took away from what she had to say you can raise awareness as much as you like she she said. But there is a but, of course, and the but being you can't always get the help you need when you go out there and are brave enough to ask for it. Catherine Carr was the reporter there. And there'll be more voices on Women's Hour over the next couple of weeks. I'm Sarah Treleaven, and for over a year, I've been working on one of the most complex stories I've ever covered. There was somebody out there who was faking pregnancies.

I started, like, warning everybody. Every doula that I know. It was fake. No pregnancy. And the deeper I dig, the more questions I unearth. How long has she been doing this? What does she have to gain from this? From CBC and the BBC World Service,

The Con, Caitlin's Baby. It's a long story. Settle in. Available now.