Fearless Conversations: SA’s teens are struggling – and more crisis beds aren’t the only answer

A rising tide of anxiety and depression among SA schoolkids isn’t just the “Covid cloud” – experts say mental health resourcing needs a complete overhaul.

Rising rates of anxiety, depression and other psychological distress among young people must be considered away from the “Covid cloud”, South Australian high school children say.

Lead Mental Health Commissioner in South Australia, John Mannion, says it is a clear message year 11 students have recently given him and his colleagues.

“(They’ve) identified there were high levels of anxiety … (acknowledged) the negative impact of social disconnectivity (during Covid),” he said.

“But they also said, ‘these were issues before Covid and we don’t want them to be clouded by (the pandemic) … (it) has just magnified the issues we were previously facing’.

“Our kids are very clear on the complexity (of mental health and wellbeing), the risks, what the triggers are … the thing they face is how best to actually reach out (and not) feel they are being belittled, that or no one actually understands what is happening to them,” he said.

“Friendships are really important, for a child the first responder is a best friend, it is not a teacher or parent … we need to look at how we empower people to have the skills to have those first conversations.”

David Kelly, also a Mental Health Commissioner, said schools played a pivotal role in protecting young people “against challenges and distress” but needed to be part of a “whole-of-community” approach.

“We have to have a bunch of strategies in place … one single initiative will not deal with the mental health and wellbeing needs of our children and young people,” he said.

“Schools must be supported with resources so staff know how to respond to mental health challenges (to ensure) schools are made safe places.”

Mental health and wellbeing is a focus at Christian Brothers College, where cross-year level activities are held as part of pastoral care lessons. Participants in the school’s Big Brother Program include Mubeen Afzali (Year 2) and College Captain Marcos Arbon (Year 12). Picture: Alex Ly

Sonder youth services executive manager Steven Wright, who has worked in the mental health sector for more than two decades, agreed.

“We need to have multi-layered approaches within the community … we have a generation that (through social media) is no more connected but more lonely than ever … (it’s about creating) opportunities to connect as individuals, as communities,” he said.

At all-boys’ school CBC in the city, encouraging students from across year levels to “check in on each other and have the courage to start a conversation when they need support” is a growing focus.

“We know that young men, in particular, struggle to reach out for help or support when they need it, quite often due to the stigma that surrounds male stereotypes,” CBC director of students Anthony Farina said.

“Our Big Brother Program, initiated by our college prefect team … was designed to improve engagement between our year 12 students and the younger members.

“This provides our senior boys with an opportunity for mentorship and positive role modelling and strengthens our sense of community … it also emphasises the importance of having a strong support network … when things get tough.”

MORE BEDS NOT THE ONLY ANSWER

There needs to be a radical shift in how mental health resources are prioritised and funded beyond hospital beds if real change is going to happen, experts say.

They say just 1 per cent of the mental health budget nationally is channelled into prevention activities.

Lead Mental Health Commissioner in South Australia, John Mannion, said hospital bed numbers told only part of the story.

“We measure mental health by beds but we shouldn’t … our emergency departments, by default, have become the position we go to in crisis time,” he said in a roundtable discussion – part of the Flinders University Fearless Conversation series – in Adelaide during the week.

“We need to drill down … have we invested in early intervention – have we pipelines for children, pipelines for older people?”

His colleague David Kelly, a state Mental Health Commissioners, said more investment in early intervention was needed.

“We can’t do the important work building mental health in the community if we are constantly channelling all our resources, let’s be honest, primarily into hospitals,” he said

“How can we intervene early to reduce the severity and duration of psychological distress and ill health if we aren’t resourcing it appropriately?”

Khaidyn, 14, Charlee, 14, and Liam, 15, taking part in Operation Flinders, which for years has transformed the lives of troubled young people. Picture: Simon Cross

Mr Kelly said policy needed focus beyond “personal wellbeing strategies”.

“We are affected by the context in which we grow up … our access to services like good education, good employment, good local parks, good neighbourhoods,” he said.

“We need to be smart – we need to have multiple strategies.”

Sonder youth services executive manager Steven Wright agreed.

“(As an example) teaching mindfulness or meditation (in school) is not necessarily going to have a large impact on the violence that is happening within (the young person’s) home, or the fact that mum or dad don’t have a job and can’t put food on the table … these are societal problems,” he said.

Mr Wright is an advocate for programs which offer people exposure to those with lived experience. “We need to be exploring other models,” he said.

“To (be able to) share experience is so powerful … at times, it can have equally equivalent outcomes to clinical intervention, (to) talk therapy, or cognitive behaviour therapy.”

The Operation Flinders Foundation, which aims to “transform the lives of young people through quality remote outback adventure programs” is a case in point, with many of its volunteer mentors those who themselves did the program as troubled youth.

Social worker Jessica Morgan, who is a program manager at national youth mental health foundation Headspace, said providing people with hope, as well as support, was critical.

“It comes down to how do we recognise some of the difficulties that young people, (their) parents and families are experiencing and balance that with hopeful messages … (to) change that trajectory,” she said.

Fearless Conversations panellists David Kelly, Jess Morgan, Mark Soderstrom (presenter), John Mannion, Sarah Cohen-Woods, and Steve Wright. Picture: Matt Loxton

OVER-MEDICATED AND UNDERSTAFFED

Too many people are being prescribed antidepressants, South Australian Mental Health Commissioner David Kelly says.

“We are now the third-highest users of antidepressants in the developed world … our use of antidepressants and antipsychotic drugs has increased fourfold since the 1990s,” he said.

“The reality is, most people can’t get into a psychologist when they go to their GP, so they are put on medication.

“The data is pretty clear, there are too many people in this country who are given medication because, quite frankly, they can’t access mental health specialists.”

Mr Kelly said he and his fellow commissioners were exploring a “social prescribing” concept in which doctors and primary health care providers referred patients to “community connection opportunities” which might be as simple as a group that cooks and shares meals together.

“We need to be able to link those really important engagement and participation activities … back to where most people, young or old, start their mental health journey and that is with the GPs,” he said.

“The major way we pathologise is putting people on medication (when) it is not always necessary … maybe they don’t need antidepressants, maybe what they need is something that keeps them engaged or interested.”

For the sixth consecutive year, doctors have listed psychological issues as among the top three reasons for patient presentations nationally.

“GPs are under enormous pressure, we are helping patients who have delayed or avoided screenings and consults during the pandemic and assisting those with mental health concerns,”

said the SA deputy chair of the Royal Australian College of General Practitioners, Dr Sian Goodson.

“A 2021 study found 38 per cent of GP consultations in a typical week include a mental health component so that gives you an idea of the scale of this vital task.”

“Better funding for mental health services to improve access to psychology and availability of psychiatrists would be enormously beneficial to assist GPs in managing the large burden of mental health we are currently facing.”