By: Sadhbh Byrne
“The number one health issue for [Irish] young people is their mental health”
(Dooley & Fitzgerald, 2012, p. vii).
Approximately 20% of young people globally, and in Ireland, experience mental health difficulties in any given year. Of all mental illnesses that affect young people, depression is among the most concerning, due to its prevalence in youth and its link with suicide.
In Ireland in 2015, 21% of deaths of people aged 15 to 44 years were attributed to suicide and intentional self-harm.
Suicide is the third leading cause of mortality in young people worldwide, and Ireland has the fourth highest rate of youth suicide in Europe.
Worryingly, however, research over the past twenty years has consistently shown that young people are unlikely to seek help for mental health difficulties, or to engage with professional mental health services. Furthermore, it has been demonstrated that adolescents who experience depression or suicidal ideation are particularly unlikely to reach out for support. Therefore, it appears that the young people perhaps in most imminent need of help are those least likely to seek assistance.
Why is this so?
Access to mental health services in the Irish public healthcare system is typically initiated through a visit to a general practitioner (GP). However, the My World Survey (the largest study of youth mental health in Ireland to date, conducted by UCD and Jigsaw) found that less than one fifth of adolescents with mental health difficulties access a GP service. Given that young people name concerns about confidentiality as a prominent barrier to service use, the fact that caregivers of Irish adolescents under 16 years must be informed of any mental health treatment from a GP is problematic. The cost of a GP visit may also place a further burden on adolescents. Some young people can access support from a school counsellor, but specialised psychological counsellors are not present in many secondary schools. Although the Irish public healthcare system is supported by some organisations that offer free services for young people (e.g., Jigsaw), these are typically situated in urban centres, limiting access for young people living in rural areas.
However, it has been found that if adolescents do seek help, they first turn to family and friends. Furthermore, it has been suggested that members of a young person’s social network may also be able to reach out and provide help before it is sought by the young person themselves. Psychological or mental health first aid is the help given to someone developing a mental health problem or in a mental health crisis. The first aid is given until appropriate professional treatment is received or until the crisis resolves. This concept essentially formalises the informal support provided by members of an individual’s social network. Owens et al. (2011, p. 1-2) go so far as to state
“Relatives, friends, and colleagues may be the only people to know that a person is distressed, and the burden of care lies entirely with them, until such time as the person decides, or is persuaded, to consult a doctor”.
Parents appear to be important providers of this ‘informal’ support for young people in distress. Parents possess inherent motivation to provide help to their child if they are suffering from mental health difficulties, and young people place importance on their parents’ opinions when making important decisions. However, while there has been some research conducted on the role that parents play in facilitating young children’s mental health service use, there is currently very little information available on the support that parents may offer to their adolescent children. The limited research available suggests that parents understanding of mental health services may be somewhat poor. For example, although 65% of parents in one Australian study recommended getting ‘professional help’, only 3% encouraged seeking the help of a psychologist or psychiatrist. Other studies have found that the majority of parents of children with mental health problems do not identify that their child has a problem. Parents in a UK study reported worries about not being ‘good enough’ parents if they ‘resorted’ to seeking help for their child. These research findings are troubling given that, for young children at least, mental health service use is not predicted by the severity of the child’s problems, but is instead mediated by parental perception of need for services.
Peers as providers of support
Given the pervasive nature of youth depression, many young people will have contact with a peer with depression during their adolescence, with over half of adolescents in one recent study reporting that they had contact with an individual experiencing a mental health problem in the past three months. As adolescents spend increasingly more time with peers than with family as they grow older, peers may also be in a unique position to observe changes in an adolescent’s behaviour before these changes may be noticeable to adults. Again, however, there is a scarcity of research on the role that peers may play as providers of mental health support in adolescence.
In a previous study that I conducted, published in 2015, I presented participants (aged 15 to 19 years) with descriptions of two young people, Tony and Emily, who were experiencing life difficulties. The behaviours and symptoms described for both Tony and Emily met Diagnostic and Statistical Manual of Mental Disorders (developed by the American Psychiatric Association) criteria for depression, and in Emily’s story, the character made reference to suicidal ideation.
The majority of participants in this study did not identify depression in either character’s description, and only 9% identified Emily as suicidal. The participants did, however, show concern for both characters;
99% of female participants and 89% of male participants answered “Yes” when asked “Do you think Tony needs the help of another person?” In response to Emily’s scenario, 90.6% of female participants and 83.5% of male participants answered “Yes” to the same question.
When asked to explain why they would help the characters, participants mentioned reasons such as: “Because if he needs help then his friends should be the people to get him the help that he can’t.” (Female, age 17). The types of help mentioned included comforting and reassuring their peer: “I would reassure her that whatever is going on will be alright in the end.” (Female participant, age 16). However, some participants felt ill-equipped to provide this type of support to a friend: “I’d honestly have no idea how to help Tony.” (Male, age 17).
My PhD research
In sum, it is clear that parents and peers play an important role in supporting young people with depression. However, knowledge of the support that parents and peers actually provide is comparatively scant. In my PhD research, which is ongoing, I am further exploring this. I am particularly interested in investigating the association between certain factors, such as knowledge of mental illness, and different types of support offered.
I hope that my research will help to understand the support that young people may receive – especially those young people who do not engage with mental health services. Furthermore, I hope that this new understanding will in turn inform policy and practice that will improve outcomes for young people in distress.
Note: If you are a parent/guardian of a young person aged 12 to 18 years, living in the Republic of Ireland, you can contribute to this study by completing a questionnaire at: bit.ly/TCDcaregiverstudy
Mental Health Ireland has a list of those who support those with mental health issues. See the list here if you are affected by any of the issues discussed in this piece.