Pastoral care: from primary right through to third level, it rumbles in the background of every educator’s mind. How can teachers support and help young people who have mental-health difficulties or who might be at risk of suicide or self-harm?
Within the EU, Ireland has the fourth-highest rate of death by suicide among young people. The issue is most acute in secondary schools. Over the summer, a new national suicide prevention strategy, Connecting for Life, promised to help teachers identify risk factors among vulnerable students. As part of a five-year Government strategy, it will also put resources in place to help young people cope with stress and to improve their resilience.
Is it going far enough? Dr Jimmy O’Connor is a teacher and one of two psychotherapists working at St Peter’s College in Dunboyne, Co Meath. He’s going to call for a new approach to mental-health services in schools when he speaks at the Irish Association of Suicidology’s national conference this week. There’s much to be welcomed in the strategy. What’s missing, he says, are counselling services within schools.
“If you look at suicide in Meath, none of the young people who died were known to the school or any professional or adult. How do you identify children at risk? Well, we know that from 9am to 4pm, Monday to Friday, they are in school. It’s obvious that if you want to tackle suicidal ideation and behaviours, you provide mental-health services in a school setting, and integrated within the Child and Adolescent Mental Health Services [CAMHS].”
O’Connor says knowledge-based programmes are not enough. “You need to identify the child at risk and then find the problem. That takes therapy.”
His concerns are echoed by Alan McKelvie, director of Youth Suicide Prevention Ireland, which works with secondary schools to identify risk signs and help put coping strategies in place. "There is a lack of resources, but we welcome some direction from Government. Training for teachers is welcome; they want to know what they should be looking out for and how to deal with self-harm or suicide. There also needs to be counsellors available – ideally but not necessarily resident within the school – where students who are having difficulties can be referred."
Early intervention
Youth mental-health charity Headstrong has long advocated for early intervention in schools, pointing out that the cost of admitting young people to long-stay residential care far exceeds the cost of preventing mental-health issues in the first place. Over the past five years in the UK, counsellors have been employed in every school; here in Ireland, schools are still reeling from cutbacks to guidance counselling, and many are struggling to support students with mental-health difficulties.
But many young people don’t talk about their problems, and this is linked to suicidal behaviour, professionals say. “A lot of discipline issues are not discipline issues at all; they are mental-health issues,” says O’Connor. “Teachers are professionals and are now trained in psychology, and they’re also human beings with families who have their own difficulties, so they can empathise and understand. But they don’t always have the resources to help. Having a psychotherapist in the school is as much a support for them as it is for the students.”
O’Connor emphasises teachers and parents should pay particular attention to self-harming. “It is not attention-seeking or manipulation or a short-term problem; it is a sign of frustration and it needs to be taken seriously.”
St Peter’s in Dunboyne has an infrastructure to support mental health, including two psychotherapists and a peer-support system. O’Connor says it is paying dividends and that investment in mental health benefits the entire school community. Parents, too, learn how to support their children and provide help (although, on a national level, the necessary services are not always easy to access).
Teachers understandably struggle to identify students who may be at risk. Problems can include anxiety, depression, parental separation and family conflict, financial problems at home, abuse, bullying and falling out with friends.
Preventative and proactive
In conversations with mental-health professionals, St Dominic’s, a girls school in Ballyfermot, Dublin, is repeatedly mentioned as an example of best practice: it trains its teachers, provides support to students and is linked with local community organisations.
Since 2010, the school has delivered Storm, an evidence-based suicide prevention training programme developed at the University of Liverpool (Stormskillstraining.com). Sr Liz Smyth is deputy principal and school completion co-ordinator at St Dominic's. "We ran two courses for our staff in 2011 based on an awareness of local needs. There was a local student who had an experience of suicide in her family, and [there were also] ongoing worries around suicide in the community. Young people had come under more pressure since the economic crash and their families were in difficulty. We knew that students sometimes felt down and sad, and we wanted to be preventative and proactive."
The course focuses on suicide prevention, using techniques such as role play and personal evaluation. Teachers learn about the importance of language and avoid damaging and stigmatising phrases such as “you wouldn’t do anything stupid”. They also learn to spot signs of self-harming.
There’s a fear of talking about suicide, but research shows talking about it doesn’t put the idea in people’s heads, says Nolan. “We don’t talk about suicide unless someone brings it to us, but it’s okay to talk about mental health. It’s okay not to be okay, and it’s okay to ask for help. If a student comes to a teacher and says, for instance, they wish they were dead, or they have figured out a plan to take their own life, the teacher and the child need support. And Storm has given us, as teachers, the confidence to not be frightened to talk, and to listen. It’s given us the tools for assessment, for problem-solving, for crisis management, for working with the parents and the Child and Adolescent Mental Health Services to make sure the child gets the help they need.”
- The Irish Association of Suicidology conference is at the Killashee Hotel in Naas, Co Kildare, on October 8th and 9th. Speakers include President Michael D Higgins; Dr Noel Richardson, director of the centre for men's health at the Institute of Technology Carlow, on self-harm in young adult males; Ian Power, executive director of Spunout.ie, on increasing resilience in young people; and Gerry Raleigh, director of the National Office for Suicide Prevention, on the new national suicide strategy. ias.ie
VICKY'S STORY: 'NOBODY EXPECTED ME TO ATTEMPT SUICIDE'
Vicky Kavanagh, aged 25, a journalist and film-maker speaks out about her experiences of depression and suicide, topics many people are reluctant to go on the record about
“Just before my 16th birthday, my parents separated. Mum took it hard. She stayed in bed and was lethargic and withdrawn. I thought it was normal, but it wasn’t; it was intense and nothing could shift it. She made her first suicide attempt just after my 16th birthday. I didn’t know at the time what depression was, or what it meant, but she made many more attempts, and it became a part of my reality.
“I was a high-achieving student but I lost interest in school. I stayed at home to look after my mum, but I didn’t tell anyone what was going on; I was terrified how people would react. We didn’t know how to get help. The GP prescribed antidepressants and encouraged counselling. I didn’t know how I could cope. So I went out at the weekends and got drunk. Drunk to oblivion. It always made me feel a million times worse.
“I also had anorexia. I was diagnosed at 13. I was drinking only alcohol at the weekends and not eating. One night, blind drunk, I left a birthday party and decided to take off on my own. Half way home, I collapsed in a field in a housing estate. My friends found me and called a doctor. I had a lucky escape.
“I knew things had to change, so I finally started talking. I told my year head in school, who had noticed changes in me but didn’t know what was going on. It was a difficult time in school, but they did as much as they could; they were very supportive regarding me missing school and they helped me get back on track with study. I started telling my friends, too, and this encouraged my mum to open up and talk. She realised it wasn’t weak to go to counselling.
"My mum's depression was eventually identified as bipolar disorder, which is a very different illness that needs different treatment. During this time, I started studying journalism in DCU. When I graduated in 2011 Mum was still ill and still attempting suicide. One summer an interning opportunity with the Washington Ireland programme came up, and I went to work with RTÉ's US correspondent, Richard Downes. It was during this time I got to know Reachout.com, an online youth mental-health service, and got involved.
“As an ambassador I talked about my tough times but in a vague way, worried people wouldn’t be able to understand the complications of my reality. But people’s lives are complicated and messy. I spoke with Mum, and we decided we were comfortable telling our story. ReachOut was involved in an event for Cycle Against Suicide in Cork, so my best friend and I loaded her car with jellies from Aldi and drove down. I gave a speech, sharing my story and how important it is to never give up. It was terrifying; it still kind of is to this day. But people’s encouragement has been unbelievable.
“Nobody expected me to attempt suicide. It was the day after my 23rd birthday. There was still a lot going on at home, work was busy, and I was dealing with panic and anxiety. I went to work with a happy face but I was bottling up my emotions and not dealing with anything.
“One night, I got drunk and sat in my room, overwhelmed. I felt alone and scared, and I wanted to lie down and never wake up. I took an overdose. I don’t know if I really wanted to end my life or just put it all on pause for a while. But I made a potentially irrevocable decision based on a non-permanent feeling. I’m so lucky I didn’t die.
“I would highly recommend cognitive behavioural therapy. It works for a host of mental-health issues, and got me through anorexia and depression. It separates fact from fiction.
And talk. Please talk. There is nothing so broken in this world – including you – that it can't be fixed." In conversation with Peter McGuire
Twitter @VickyWrites
[ Youtube.com/vickykavanaghOpens in new window ]
HELP IS AT HAND: PROGRAMMES AND RESOURCES
- Reachout.com: A mental-health service for 12-25-year-olds. Depression, anxiety, bipolar, crisis pregnancy and workplace bullying are among the most visited areas of the website. "We are talking about increasing mental-health literacy and how to look after wellbeing and [where to] go for support," says Naoise Kavanagh, a member of the team. "People are scared to talk about suicide, but we work with parents and teacher groups about how to have those conversations in the most effective way and how to check in with young people."
- Headstrong: An innovative organisation founded by clinical psychologist Dr Tony Bates, which runs a number of programmes with young people across Ireland designed to make sure every young person has somewhere to turn to and someone to talk to. headstrong.ie
- Pieta House: This service has centres and supports helping more than 18,000 people in suicidal distress or engaging in self-harm. The organisation's Marguerite Kiely says schools are now more open to discussing suicide and mental health. "We meet parents and teachers and provide support and information around good mental health and how to keep parenting if a child is suicidal or having mental-health issues. We get referrals as well from GPs, parents and school counsellors. Teachers can be under pressure and overwhelmed; we tell them to stay calm, let the child speak and keep communication clear." The organisation plans a comprehensive schools programme next year. pieta.ie
- Samaritans: Confidential support for people in distress. No problem too big or small. Call 116123 or email jo@samaritans.org
- Teen Between: Support for teenagers of separated parents. Call 1800303191. teenbetween.ie
- Youth Suicide Prevention Ireland: A Cork-based organisation with a "four-step" programme in secondary schools nationwide that encourages students to look out for one another's mental health. It also runs youth camps and youth support programmes. yspi.eu
