ANNUAL LECTURE 2009: DR TONY BATES - FEATURE ARTICLE
In November 2009, Children in Hospital Ireland's annual lecture featured guest speaker Dr Tony Bates, founder of Headstrong, the National Centre for Youth Mental Health. The renowned psychologist told over 100 delegates young people in Ireland have been getting a raw deal when it comes to mental health services and he described access to help as "inaccessible, complicated, not user-friendly and not appropriate". Michael McGlynn, Children in Hospital Ireland Communications Executive, has put together a feature article based on Dr Bates' presentation and it is very worthy reading for parents , youth workers, health professionals and others with an interest in wellbeing of young people. The article follows and pictures of the event are available at http://www.flickr.com/photos/childreninhospitalireland/
YOUNG PEOPLE IN DISTRESS - WHO CARES?
Leading Psychologist Tony Bates, founder of Headstrong, the National Centre for Youth Mental Health, discusses issues relating to youth mental health at the Children in Hospital Ireland seventh annual lecture, Michael McGlynn reports.
Young people are getting a raw deal when it comes to our mental health services and are encountering an inaccessible, complicated, not user-friendly and inappropriate system, the director of the National Centre for Youth Mental Health has stated.
Speaking at the Children in Hospital Ireland annual lecture, the renowned psychologist spoke of the importance of engaging with teenagers and addressing any mental issues from an early age, to prevent a crisis from becoming compounded. Dr Bates spoke to around 120 people at the lecture in the Davenport Hotel in November.
He began his presentation saying some of the most important findings that shaped mental health came from children in hospital, referring to the work of renowned psychologists Anna Freud, Harry Harlow and James Robertson in the 1950s.
NEED FOR EARLY INTERVENTION
A World Health Organisation study conducted in 1996 analysed the most common ages for diseases/illnesses and revealed the highest incidents of mental illness occur between the ages of 20 and 40. It found around 50 – 30 people per 1,000 of the population are affected. However, the illness is often an escalation of mental issues that are factors within people from ten to 20 years, Dr Bates said.
The difficulties are harboured in people and emerge when they move beyond their teenage years, he explained. “There is a small number where there is an emergence of some kind of constitutional difficulty but actually for the majority that is not the case,” he stated. “For the majority, they have a crisis that becomes compounded through time by neglect or the lack of opportunity for support and the person inevitably resolves to finding their own way of holding themselves together.
It is important to deal with issues at an early stage, he explained. “The evidence is very strong that what starts as a crisis begins to grow legs and as it continues to grow, it will begin to accumulate more problems and this will increase the likelihood that they will come to the attention of the police or the mental health services and end up either with a charge or label,” he stated. Experiences are difficult for young people to articulate and they are often frightened of something they do not need to feel frightened of. “Young people are looking for the same things we are looking for; they want to feel some sense of who they are, they want to belong and they want to feel they have a purpose for living.”
Having worked for 30 years in mental health prior to establishing Headstrong, Dr Bates said he has learned that a lot of lives get lost – very tragically – in younger years. It can be too late to resolve people’s mental illnesses when they are 40 or 50 years old, he warned. “The research has shown us that 80 per cent of people who end up in psychiatric hospitals, 80 per cent of them had very serious symptoms of need when they were 18; and 60 per cent had significant symptoms when they were 15.”
A scene from Star Wars was used to highlight how important it is to feel connected and grounded for mental wellbeing. In a key battle, Luke Skywalker is urged by Obi-Wan Kenobi to “use the force”. Dr Bates spoke of the connection between the Jedi Knight and Luke, which comes to the fore as Luke battles to destroy the Battle Star. Young people need such a connection, delegates were told. “It may be with somebody in their family or with somebody else in their lives, and this [connection] is key to finding how I belong in the world and I am part of something bigger than just me, so that I live not only within my own head – a very lonely prism.”
He also spoke of the importance of protecting people. This is evident when young people are suicidal, subsequently visit hospital for three or four weeks to be treated, are discharged feeling better and subsequently take their own lives. People look to themselves and ask did they not ask the right questions and are angry with the suicide person because they believe they were lied to when told everything was alright. The evidence is very strong that they were not lying, Dr Bates said. “They were very truthful and the medical help was perfectly fine but what nobody figured was the network of support that was available in hospital is gone and they go back to their problem and the same kind of isolated existence. The same moods and fears that existed come over them and they say, ‘I’ve had enough of this; I just can’t deal with it anymore.’”
NEED FOR A CARING ADULT
In a pilot study piloted nationally by Headstrong, 1,051 second-level students – 35 per cent of them boys, 65 per cent of them girls – were asked about issues affecting their mental health. The sample was drawn from Dublin, Wexford, Cork, Wicklow and Louth and all school years were represented. It found that the more students had a caring adult in their life, the greater their life satisfaction was, and those who didn’t have the regular caring of an adult, were not as satisfied.
Young people need to learn the skills they need to live. He quoted Ger from Ballymun: “Forget about the fear of being shot or the fear of being killed; what about the fear of something smaller, like having no skills, or not being as tall as any of the lads”.
He said young people are often accused of sitting around and wasting time, but this is an important part of their growing up. “That endless amount of ‘wasted’ time is kind of an art-form that us adults forget and don’t know how to do when we have the time. When you think about it, that conversation is a kind of test all the time: will I say this, won’t I say this; will it be ok for me to say I feel lousy about the way I look? All of that is an education for life and helps people find their sense of identity.”
RESPONDING TO A PERSON IN A SUICIDAL CRISIS
Dr Bates said he is often asked how should you deal with somebody who is suicidal. He’s been involved in numerous initiatives and heard from many people on the issue but said no advice has been as clear as that of the Icarus Project in the United States. It was established by two young people who wanted to afford space for people to express their emotions and share their experiences concerning mental health.
The group offers the best definition concerning suicide, Dr Bates believes. “There is no accepted theory about why one person who is suicidal ends up doing it and another doesn’t,” the Project states. “There is no perfect answer to what you should do when someone is suicidal, and no reliable way to prevent someone from killing themselves if they really want to. Suicide is, and always will be, a mystery. There are, however, a lot of things that people have learned; things that come from a real sense of caring and love for people who have died or might die, and truths people have realised when they were on the brink and made their way back.”
Feeling suicidal is not giving up on life, but is about being desperate for things to be different, the group states. People are holding out for a better person they know they can be and a better life they know they deserve, but they feel totally blocked. It says people who are suicidal are often really isolated, and need someone to talk to them confidentially on a deep level. This person should not judge or reject them.
People also need to hear things that might seem obvious to them; you are a good person, your friendship has helped me and you have loved life and can love it again, being a few examples. The Project also believes suicidal people are often under the sway of a critical voice or belief that lies about who and what they are. It might be the voice of a parent, an abuser, someone who betrayed them, or a twisted version of themselves that depression and madness have put in their brain. There are ways to get past these feelings and to change life, it tells people.
The Headstrong founder also pointed to Icarus when speaking of signs of depression. It conducted a study that asked people their personal warning signs of depression. Such people may misjudge people’s intentions and assume everyone is thinking of them and noticing how awful they are. They might also find it harder to see anything good anywhere, dislike how they look, and find it unreasonably hard to get out of bed or out of the house. Anything that involves multiple tasks can seem incredibly complicated, appointments with people can be cancelled, concentration can be a struggle, and they might want to go to bed early in the afternoon.
If dealing with someone in distress, Dr Bates said the most important response is to validate their experience. “If you could only say one thing to a young person, I would suggest it’s to say whatever you’re feeling, I’m sure there’s a good reason for feeling it and there’s a good reason for going what you’re going through.”
HEALTHCARE
“When it comes to mental health services and young people, they are all too often inaccessible, complicated, not user-friendly, [and] inappropriate” Dr Bates said.
The Inspector of Mental Health Services reported in 2008 247 children were admitted to adult psychiatric units. This is not appropriate and needs to be addressed, the psychologist said. When help is sought, the signs are often misread and people look for an “exact” problem.
Hospital is thought of as the best solution but it can be a distressing experience, he warned. He quoted Ashley, a 22 year old, who spent time in hospital. Ashley said it can be “excruciatingly miserable”, “boring”, “incredibly claustrophobic and horribly depressing”. “It can feel like you’re being held hostage by a bunch of patronizing doctors who have no idea what you’re talking about; it can feel like hell or it can feel like the most necessary calm in the eye of a storm.”
There are a particular set of principles concerning mental healthcare in hospital and these are based on the findings of a study the UK Department of Health published in 1991. It called for separate child and adult wards to provide privacy, flexibility of regime and independence. Space for socialising, hobbies, homework or to be alone was another requirement, and friends and family need to be accommodated and young people need the freedom to wear their own clothes. Access to kitchens, telephones and space for personal belongings should also be provided, young people need to be involved in their treatment and have the opportunity to make decisions which affect their life-style and development, and there’s a need for male and female nurses. “Hospital needs to be part of a comprehensive plan that includes aftercare and what’s going to happen,” delegates were told.
He pointed to Australia, where there has been a fall in suicide because more young people are seeking and getting help, not that fewer young people need help. A Vision for Change, the Government’s ten-year policy on mental health reform that was published in 2006 and edited by Dr Bates, called for the mental health system to deliver a range of activities to promote positive mental health in the community. “It should intervene early when problems develop; and it should enhance the inclusion and optimal functioning of people who have severe mental health problems,” it states. “Service providers should work in partnership with service users and their families, and facilitate recovery and reintegration through the provision of accessible, comprehensive and community-based mental health services.”
Quoting the Children’s Rights Alliance, he said three years after the publication of A Vision for Change, mental health services for children remain widely unavailable, fragmented, and severely under-resourced. Adolescents aged 16 to 17 do not have the same access to child and adolescent mental health services as younger children, since most child and mental health service teams do not accept new referrals of adolescents over the age of 15 years. From January to December 2008, 263 children were admitted to adult psychiatric centres and a 2007 study found 83 per cent of children in detention had at least one form of mental illness, with one fifth experiencing suicidal thoughts. The vast majority of these children with mental health problems did not receive any mental health intervention, it stated. “While Government expenditure on mental health services rose from 1997 to 2008, the College of Psychiatry in Ireland has reported that child and adolescent services account for only 10 – 15 per cent of spending on mental health services, while serving 22.68 per cent of the population,” the alliance stated.
The news is not all bad though. Dr Bates said young mental health has become a priority issue in the mental health sector, with several dedicated professional interest groups. He said transitional arrangements have been put in place for extending child and adolescent mental health services to all children under 18, and ‘Working Things Out’, an emotional literacy programme for the junior cycle, is being rolled out by the Department of Education. The psychologist pointed to the emergence of dedicated young mental health websites, such as letsomeoneknow.ie and reachout.com, and to the establishment of Headstrong.
Headstrong is working with communities in Ireland and aims to bring community resources together around young people and what they want. Young people are actively involved in the running of the non-profit NGO that is supported by health, business and public affairs expertise. It aims to offer a means to engage with young people in accessible settings where they feel respected and safe and to provide them with the highest quality, evidence based care.
Children in Hospital Irelandcelebrates its 40thanniversary in 2010and is a national voluntary organisation - one of Ireland’s leading children’s charities – and promotes the welfare of all children in hospital regardless of illness or condition.CHI has worked since 1970 to promote the emotional and developmental needs of sick children by providing play in hospital.
