A GROWING number of children aged between 10 and 14 are presenting to Hunter emergency departments with suicidal thoughts, intentional poisoning and self harm injuries.
A retrospective study published in the Medical Journal of Australia (MJA) found that between 2010 and 2014, the number of mental health-related presentations to NSW emergency departments (EDs) was highest for 15-to-19-year-olds.
But the presentation rates had grown most rapidly in the 10-to-14 age group.
The same upward trend is reflected in the growing number of young patients presenting with suicidal ideation and self harm injuries to Hunter EDs, Dr Balkrishna Nagarsekar, the clinical director of the region’s Child and Adolescent Mental Health Services (CAHMS), said.
“The journal article confirms what we have seen in practice,” he said.
“We have patients who are 11 or 12 presenting with these problems. It is less common in children younger than 10.”
Dr Nagarsekar said complex trauma, depression and anxiety, eating and behavioural disorders, as well as substance use and developmental disabilities, were driving the rising numbers, but social media and the use of electronic devices was also playing a major role.
“We have certainly seen a significant impact of social media and electronic devices on young people’s mental health and functioning,” he said. “For example, they might exclude peer relationships, or even isolate themselves from family, because they are spending a lot of time gaming.
“They might be exposed to bullying on social media, which can certainly impact on their mental health.
“Besides that, this particular age group – from 10 to 15 – is the age where they spend a significant amount of time transitioning from primary school to high school, which can be difficult. It can lead to changes in peer relationships, there might be particular school-related issues – like bullying or learning problems – that might make it hard for them to adjust.”
Hunter New England Health was unable to provide the number of adolescents that presented with suicidal thoughts, self harm, or intentional poisoning to the region’s emergency departments from 2010 to 2014.
But data for the number of 10-to-14-year-old children admitted to hospital with these mental health concerns had risen from 60 in 2009/10, to 78 in 2016/17.
“Presenting to the emergency department can be a safety net,” Dr Nagarsekar said. “It is not a bad thing they are coming to emergency, it is a good thing they are seeking support and help when it is needed.
“Ultimately the goal is to keep young people and families safe.”
Often, children had witnessed or experienced trauma which had caused disruption in their important relationships.
“We see a lot of complex trauma in our service.
“Sometimes these experiences are severe enough for families to break down, which has resulted in kids being in out-of-home care, in foster placement or with non-profit agencies who are looking after them in the community.
“But things like social media can also play a role.”
Dr Nagarsekar said some patients used self harm as a way of expressing distress.
“They may not always want to attempt suicide, but they do it to manage their emotional distress,” he said.
“Often young people will say they feel calmer afterwards. It is a distraction from the emotional pain they may be experiencing at the time.
“But I think if we support them, and help the families and schools support them in managing their emotional distress in a different way, they may not need to use self harming as a way of expressing that distress.”
Dr Nagarsekar said early intervention, as well as mental health promotion and literacy, was key in efforts to reverse the current trend.
He said Hunter New England Health had begun training medical officers in EDs to do assessments on children and adolescents presenting with mental health problems.
There was a psychiatrist on call for help and advice too.
“We are trying to build really strong partnerships with all the different stakeholders, such as schools, and build capacity in the young person to manage their distress,” he said. “We have certainly invested a lot of effort and time in building a system of support and safety within the community.
“We talk to young people about mental health and well being, and about sleep hygiene,” he said.
“We talk about retiring our devices at a particular time, going to bed at a particular time, waking up at a particular time, and the importance of sleep hygiene to maintain good mental health.
“It is a whole of community approach, where schools, primary health care, early intervention and mental health promotion services within public mental health collaborate to address some of the issues relating to social media particularly.”
The study published in the MJA found the combined number of presentations for suicidal ideation, self-harm, or intentional poisoning increased across all ages groups bar the 0–9 year bracket.
But the greatest increase was for the 10–19-year-old age group, at 27 per cent per year.
The study says that suicide was the most common cause of death in those aged 5-to-17 in Australia in 2016, and it cites a survey that found 11 per cent of Australians aged 12-to-17 had self harmed at some point in their lives.
A third of all mental health presentations were associated with another ED presentation during the previous month – suggesting deficiencies in current models of care, access to general practice follow-up, and community mental health resource provision, the article said.
LifeSpan Newcastle coordinator Tegan Cotterill said The Black Dog Institute had developed guidelines for emergency departments to better care for patients who were suicidal. They were working with the EDs at the John Hunter and the Calvary Mater.
“In schools, we have a program called Youth Aware of Mental Health, which was delivered in Newcastle last year. That was the first time it had been delivered in Australia,” she said.
“The trial is being offered to Year 9 students for now. Even though it does help in reducing suicidal behaviour in young people, the program is more about mental health literacy to help young people have a better understanding of how they can look after their own mental health, and what they can do to support their peers who may not be travelling so well.”
Ms Cotterill said people in the community could learn how to begin conversations with someone they were concerned about via training programs such as ASIST, and QPR – or Question, Persuade, Refer.
For help and support, call Lifeline: 13 11 14.