Insomnia, self-harming, anxiety – these are not ‘normal teenage problems’

James Kirwan was in his Junior Certificate year when he began to withdraw from friends, staying in his bedroom and often unable to face school.

“I knew I didn’t feel right – kind of divorced from proper feeling,” James recalls. “I was spending time by myself, not eating, crying.”

As third year went on, he found it increasingly difficult to socialise; his friends began to drop off as he withdrew from them. There was a snowball effect, leaving him both lonely and angry. But it wasn’t something he felt he could talk about with peers at school. Instead, he was inclined to inflict his anger on his family.

“The classes are so big; there’s a group mentality,” he says. “It’s very scary to feel yourself on the outside of it.”

James also suffered terrible bouts of insomnia “that really crippled me through my Junior Cert exams”. During the mocks, he kept falling asleep at the desk.

“I can laugh at it now, but at the time it was horrible,” says James (17), from Donabate, Co Dublin. He is about to start his final year at school in a far happier frame of mind.

Yet two years ago he was self-harming. At one stage during transition year, he had to be put on suicide watch, which he found very frightening. His desperation, James feels, was due to the combination of his inner confusion and spending so much time by himself crying and not sleeping.

“I knew maybe I would get better, but maybe I wouldn’t. But I didn’t think that I could survive the stress of waiting until I got better.”

Initially, James was told by health professionals that he was having “normal teenage problems” that he would get through. But he knew from talking to others who were having “normal teenage problems”, that what he was suffering was something else.

A turning point came when, attending a convention in Croke Park, he spotted an information stand run by ReachOut, the online mental health service for 12-25 year olds. He was just beginning to understand that his problems were linked to depression, and after logging on to the ReachOut website he first began to learn about the condition.

“The main problem I had was that I kept getting told what I did or didn’t have by the doctors, which I suppose was fair enough,” James says. “But after reading on ReachOut about depression and anxiety, I really felt that resonated with me and I believed that’s what I had.”

When James attended a new GP, she immediately recognised there was something wrong and referred him to the Child and Adolescent Mental Health Services (CAMHS) in Swords. He started seeing a psychiatrist and moved later to a psychologist. “This was pretty much – in combination with a couple of other things in my life – what helped me through,” he says.

At that stage, James had become so anxious that meeting school friends or going on school tours provoked physical symptoms of vomiting, excess sweating and diarrhoea. To cope with such situations, he learned “to push through it, and that makes it easier to do it the next time”.

James also realised that he was naturally introverted. And while he had been putting pressure on himself to be in groups of peers, he was much more comfortable hanging out with just one or two at a time.

Getting to know yourself better, he believes, helps in overcoming depression and anxiety. Mindful now of maintaining good mental health, he says “standard” advice, such as keeping physically fit and finding a medium in which to express yourself does work. For him it is self-defence classes – the one thing that got him out of the house even during the worst times – and playing the guitar that help balance his life. He also volunteers for ReachOut.

Operating in Ireland since 2009, ReachOut was developed in Australia in 1998 as a response to the escalating level of suicide among young people there at the time. Involvement of young people in designing and driving the service was championed by Jono Nicholas, who is now chief executive of ReachOut Australia.

He will be in Dublin next week to speak at ReachOut’s Technology for Wellbeing conference on September 14th, where he will be stressing that digital solutions need to be an integral part of how future mental health services are delivered.

When young people are going through tough times, the internet is now the first port of call for the majority of them. Over its first five years operating in Ireland, ReachOut found that 62 per cent would visit a website for support first, compared to 38 per cent who would go to a health professional, 28 per cent to a parent or guardian and 14 per cent who favoured calling a helpline.

The ReachOut service is "information, support and advice online", says communications manager Naoise Kavanagh. Taking a broad view of mental health, it deals with anything from loss and grief to relationships and conflict with friends.

It aims not only to explain what is going on for people but also to provide means of self help. Being a youth organisation it wants to provide tools that can enhance the resilience of young people so that they can problem-solve themselves, she says. When other help is needed, there is signposting to services and advice on how to access them.

There is also a commenting facility on the website, which had to be temporarily closed recently because they just couldn’t deal with the volume of contacts, although they do hope to resume the service shortly.

“It has to be safety first – and we weren’t able to keep on top of it for a while,” she explains, as they undertake to get back within 24 hours. They were getting 200 comments a month and it can sometimes take three or four hours to craft a response to just one.

There have been occasions when, out of concern for a person’s safety, incoming comments about suicide ideation – none of which would be published online – have been passed on to the Garda, with details of the IP address from where they have been made.

“I think it happened 13 times last year,” she says.

The “exponential growth” of commenting has proven to be a good litmus test of what young people are struggling with. Loneliness is a huge issue, as is students not fitting in at college and feeling everybody but them is having a great time.

“It was a really unfiltered, uncensored, unprompted organic way that people were getting in touch with us. The anonymity gave them great freedom and for some of them it was a bit of a catharsis – laying it all out.”

She acknowledges that a common complaint is that young people are spending too much time online and that this has a negative impact on their mental health. However, she believes that here there is real potential for a positive effect.

“This is what they’re more comfortable using in ways of communicating feelings of distress,” she points out.

The ReachOut team is gearing up againfor the start of the new academic year.

In the last two years they have also run a separate site for parents, who often feel very isolated when a son or daughter is having mental health problems. They don’t want to discuss it with other parents because they don’t want to be divulging very personal information about their child.

While there are lots of positive uses of technology, not knowing when to switch off is definitely not good, says Kavanagh. “But it is not just young people who are grappling with that, older people are exactly the same. Technology is everybody’s shiny new toy and it has opened up dark recesses as well.”

However, at the conference the emphasis will be on some of the good that comes out of the fact that most of us now carry little computers around in our pockets.

Carmel Sayers from Co Kerry had just finished her Leaving Certificate in 2010 when a friend texted her to say she had been suffering from anorexia and depression for the past year and didn't know who she could talk to about it.

It came as a total surprise to Carmel who had always regarded her friend as a happy girl, doing the usual teenage things and hanging out with the group.

“I didn’t know what to say to her, so I decided to look online to see how I could come to terms with all of these things. I found the ‘help a friend’ section on ReachOut and that helped me to understand what I could do and what was going on with her.”

It was a time when “the notion of mental health wasn’t even in the consciousness of Ireland in general”, she remarks, with very little in the media compared to now. She was very frustrated by the “small town” attitude towards her friend’s problems.

"It was only from that horrible situation that I have come to understand about mental health," says Sayers, who, while studying communications at Dublin City University, became a youth ambassador for ReachOut.

Her friend has only come “fully around” in the last couple of years and been able to go to college.

Meanwhile, James is going into sixth year. He wouldn’t say he is completely over his depression but says he “can manage it”, having been discharged from the CAMHS service last October

“Before I would be having problems daily, now I would be surprised if I was having them monthly.”

He is not too daunted by the upcoming Leaving Certificate – “I just want to get through it” – because he is impatient to move onto the next stage of his life, planning to study either psychology or journalism at college.

James’s advice to any teenager experiencing feelings similar to his is not to bottle them up but to tell people and try to get help. And if the professional advice offered at first doesn’t seem to do any good, as in his case, keep looking until you find the right support for you.