It might be a self-harm act, suicidal ideation, a panic attack or a verbal plea for help but there’s usually a “defining moment” at which a parent of an adolescent with mental health problems realises they need to seek outside help.
Until an adolescent shows the true extent of their distress in such an incident, parents may have put their behaviour down to normal teenage angst.
In new UCD research, mothers and fathers speak about how an event stopped them in their tracks and forced them to acknowledge, as one put it, “sweet Jesus we need to do something about this”. Another parent recalled: “He got a big carving knife from the kitchen and held it up and was like ‘I just can’t take it any more’.”
We know adolescence is a period of great change, to the body, to the mind and a time to establish independence. It can be hard for parents then to distinguish between typical adolescent behaviour and red flags for a mental health difficulty, as a study led by Dr Daráine Murphy highlights. Her exploration of parents’ perspectives on seeking help for adolescents’ mental health problems also shows how isolated and lost they can feel in trying to navigate mental health services in search of treatment for their teenager.
The main reason they did the study was that it is an under-researched area, says Murphy, who worked on it as part of the YouLead programme with Prof Eilis Hennessy and Dr Caroline Heary, for her PhD thesis. “We need to understand better in Ireland how we support parents seeking help for adolescents’ mental health problems.”
An estimated one in seven youngsters aged 10 to 19 experiences a mental disorder, according to the World Health Organisation. Among adults with a mental disorder, the onset for nearly half of them was before the age of 18, according to a 2021 meta-analysis of 192 studies worldwide, which underlines the importance of prevention measures and early intervention. Yet this requires not only parents to recognise the warning signs and to know how to seek help on their adolescent’s behalf – but also for services to be available and accessible.
A consistent theme among the parents surveyed in the UCD research was that looking for help is like “navigating a labyrinth”. There can be confusion about who treats what in the three-tiered public mental health services, incorporating primary care, the specialised Child and Adolescent Mental Health Services (Camhs) and intensive, in-patient care. “Seeking help is not a straightforward process; parents have to overcome a number of ‘culs-de-sac’ in order to access appropriate care for their child,” says Murphy.
“There is no central resource for parents of adolescents experiencing mental health difficulties, so parents are just Googling for information and they are looking up anything they can find. Sometimes the information that they are finding is not always relevant to their situation and that increases their anxieties and worries.”
If we helped the child, the adult won’t suffer so much. I really believe that
“The taboo is gone but I still don’t think the information is there,” said one parent. Another explained: “It’s hard because when you’re searching, not really 100 per cent sure what you’re looking for and […] some of it is kind of scary, to be honest.”
For others, stigma around mental health issues still lingers. Some parents reported that they would not talk to those close to them about their adolescent’s problems for fear that other people would judge their parenting and would see them as responsible for their child’s distress. Others were afraid it was their child who would be judged.
GPs play a pivotal role in directing adolescents to appropriate services and a referral from them is the gateway into Camhs. However, some parents in the study believed that while their GPs were well-informed on public services, they were not always so familiar with other options.
A minority of parents thought schools should have a role in helping to manage a child’s wellbeing and be able to guide parents towards appropriate sources of treatment. “Even as a parent Monday to Friday, you don’t see your child as much as that teacher does,” said one. While another suggested it would be better if the school “could at least have had some information to say ‘look these are the services, it does take five months, would you like to put down the children’s name, is there someone I could ring for you?’.”
“Although schools could not direct parents to services,” says Murphy, “they were a huge source of support for some and went above and beyond to do what they could to help the family within the school system.”
The research shows that charity services are an important avenue for parents and many spoke highly of them. These organisations were often able to offer appointments to parents at short notice, when their child was at the height of distress. However, parents also expressed disappointment that these are typically short stints of therapy, after which the adolescent and their parents can feel they have been cut adrift again.
“A lot of parents turn to private services and are paying extortionate amounts of money – money they often do not have but they are so desperate to get their child better,” says Murphy. There is still no statutory regulation of counsellors, psychologists and psychotherapists but that is something the health and social care regulator, Coru, is working on.
One of the conclusions from her research is the importance of more education for parents, particularly fathers, about adolescent mental health. “Fathers were found to have more negative attitudes towards seeking help compared to mothers.”
Murphy also observes how parents are on their own here navigating the services with their child “and there is no one they can turn to”. Whereas in Australia, there is a system of family peer support workers. “Somebody who has been through it with their own child then acts as a liaison with the parent going through the services. They are an advocate for the parent in services and someone the parent can trust and rely on.”
Mother-of-three Carolann Copland has extensive experience of trying to steer two daughters, 10 years apart, through mental health services. She reports little improvement in support during that decade for her youngest child, now aged 19, when compared to when her now 29-year-old daughter was going through adolescence. “There isn’t a system and you are trying to get through what you think is a system,” she tells The Irish Times. “Unfortunately, mental health services in Ireland are so outdated and fragmented, there is very little to navigate through.”
With mental health problems prevalent in the family, Copland says they have to be as open as possible, to try to remove the stigma. There is little understanding, she suggests of the broad area of anxiety, depression and emotional behaviour disorder, although it has been a bit better with the younger girl. “I tell my children if you had diabetes, asthma, epilepsy, instead of panic attacks, people would take you more seriously. We have to make people aware that mental health illness is exactly the same illness as others.”
She believes the need for affordable and accessible counselling is “really, really huge” and “is so much the way forward for so many children with mental health problems. Somewhere safe that they can discuss their problems.” Children can’t sit down with a parent, friend, uncle or aunt who isn’t qualified to discuss how they are doing and how they can get better, she says. “They can only do that with a qualified counsellor or therapist. Without access to that they can’t get better, be better and make a better life. That impacts on their family, their friends and their education.”
I have seen parents fall apart themselves and then they can’t help their child at all
Her experience with a public clinic for the older daughter and Camhs for the younger was that “you go every six months to have a five-minute chat with somebody who would discuss medication” because they don’t have the time and the resources to explore other options. “It’s not the psychiatrists’ fault, it’s not the psychologists’ fault, there is not enough time there to get a proper diagnosis for that child.”
Both of her daughters should have been able to sit the Leaving Certificate, she says, and neither of them were. “I just wonder if they had had the right access at the time. It needs to happen from an early age.” The younger daughter has received in-patient psychiatric care twice and her sister five times as an adult. (Ironically, their private insurance covers hospitalisation, but not outpatient counselling.)
“If we helped the child, the adult won’t suffer so much. I really believe that,” says Copland who found that when her daughters turned 18, the crossover from childhood to adult services “is just a minefield and most of them are lost in the crater”. At that point of transfer, she got almost identically worded letters, 10 years apart, saying that her adult child was not eligible for mental health treatment within the adult system.
“Despite it being evident from their treatment record that they had always suffered from mental health problems, there was nothing for them,” she says. The inference was that the service’s capacity was limited and there were others more in need.
Although both daughters are on medication, which she believes is the right thing for them, counselling has a crucial role in maintaining wellbeing. The older one is lucky enough to live in the southeast Dublin catchment area of Cluain Mhuire Community Health Services, which cover her counselling and medication for free. But the younger daughter still lives at home in Knocklyon and can’t access those services. However, she has just started to attend the local, low-cost Village Counselling Service run by volunteer counsellors, after being on its waiting list for six months.
Copland, a former primary schoolteacher and now a writer, avails of counselling too. While other family members have been living with clinical depression, she had to cope with “situational depression” after suffering spinal injuries in an accident seven years ago. She says she knows it might sound bad that the whole family needs counselling “but I don’t know what we would do without it”. Yet if private services are the only accessible option, costs rapidly mount up for a family.
Her advice to any parent caring for a troubled adolescent is to look after yourself. “I have seen parents fall apart themselves and then they can’t help their child at all.”
Also, “don’t give up”. It’s hard to be constantly ringing, constantly e-mailing, constantly writing letters, but you have to do it, she says, to advocate for your child.
Advice for parents worried about a teenagers’ mental health
Trust your parental instincts if you are worried about the mental health of your teenager, says Dr Blánaid Gavin, associate professor in child and adolescent psychiatry at UCD School of Medicine.
“It is really common for parents to second-guess themselves and to lose trust in their own ability to make judgments when mental health concerns arise in teenagers,” she observes. If you’re not sure the behaviours you’re worried about are within the expected range for teenagers, or whether they might be indicators of additional challenges, talk to a healthcare professional, such as a GP.
Behaviour patterns or recurring emotions that seem to be causing notable distress, or are impairing functioning or wellbeing, are signs that there could be a significant underlying problem.
“It is not uncommon for someone’s behaviour and emotional wellbeing to become a little ‘out of whack’ for a week or two,” she points out. “However, if there is an ongoing, enduring, persistent element to the difficulty, this heightens the probability that there may be some underlying issue at play.
“Whether a mental health support focus rather than a treatment focus is required,” she says, stressing the difference, “will relate to the severity of the symptoms and associated impairment evident.” Navigating the mental health system is one of its biggest challenges, acknowledges Gavin. However, this is not a problem confined to Ireland, as international research shows.
“In general, mental health literacy is much lower than physical health literacy,” she explains. “If somebody has a particular physical symptom, generally speaking they know broadly what to do and, more particularly, where to go to start the process of getting help.” The same cannot be said in regard to mental health.
Your GP is generally well placed to provide that very important initial advice as to the likely best direction to go and to know the services available in a given locality. However, there is no uniform availability of mental health services nationwide, she says, “and, as such, there is a ‘postcode lottery’ in play”.
Most of the systemic issues, she believes, relate to chronic underfunding and understaffing, which has been further depleted by the impact of Covid. At the same time there has been increased demand on mental health services post-pandemic.
“In addition, the existing services have not been developed within a framework which is efficient or effective. Essentially, there are multiple different silos and there is inadequate resourcing of primary level interventions, such as within the educational system. The necessary therapeutic support and expertise is not available at a community level to facilitate secondary or tertiary level specialist services to work at their most effective or efficient.”
Finally, Gavin reiterates the importance of parents’ confidence in themselves. If your concerns about a teenager persist, despite professional reassurance, you are “very much entitled to revisit them”. The various national support and advocacy groups can be extremely helpful at signposting to relevant service providers.
“While it is not to everybody’s taste or preference,” she adds, “many teenagers find online mental health support and resources more accessible and stigma-free and, as such, they can provide a great first-line support mechanism.”
At a primary care level, Jigsaw, the national centre for youth mental health, offers both online and face-to-face support for problems such as low mood, sleep issues and anxiety. Now operating 14 centres around the country, referrals to its community-based services have increased 33 per cent since January 2020, and waiting times vary from service to service.
However, a spokesman adds that “our online services are open during certain times during the day, and average waiting times are no longer than a few minutes for a one-on-one session for a clinician”. While it doesn’t offer one-to-one support to parents of adolescents, there are webinars for parents on its website, dealing with topics such as mental health awareness and self-care.
If you are worried about the mental health of a young person in your life, advice from Jigsaw includes:
- Let them know that you’re available to talk and there to support them. Talking through issues may help young people gain a sense of perspective on anything that may be impacting on their mental health. It may also help them identify and name the issue, even if it can’t be fixed in the moment.
- Most importantly, don’t diminish, wave away, or ignore their concerns.
- If possible, avoid trying to solve their problem for them, instead help them to come to any conclusions themselves by breaking down the issue.
- Remind them of times they have previously faced and solved issues to encourage them.