It's not in the Genes:It's not in the Genes:Suicidality in Children, and its Suicidality in Children, and its

PreventionPrevention

Graham Martin OAMGraham Martin OAM

MD, MBBS, FRANZCP, DPMMD, MBBS, FRANZCP, DPM

Professor Emeritus Child Psychiatry, UQProfessor Emeritus Child Psychiatry, UQ

PrefacePrefaceI would like to sincerely thank:I would like to sincerely thank:

Michelle and her team for bringing together such a Michelle and her team for bringing together such a great bunch of stimulating international/national great bunch of stimulating international/national speakers.speakers.

Sue Bailey for for reminding us that we can, and Sue Bailey for for reminding us that we can, and should, be clear and strong with politicians if we should, be clear and strong with politicians if we want to achieve outcomes. And also for her want to achieve outcomes. And also for her advocacy of mental health programs in schools.advocacy of mental health programs in schools.

Michael Halliday and Richard Rose and others for Michael Halliday and Richard Rose and others for describing so exquisitely the traumatised kids who describing so exquisitely the traumatised kids who often end up as suicides.often end up as suicides.

Naomi Wray and Brett McDermott for their Naomi Wray and Brett McDermott for their exposition of genetics to date – so I don’t have to.exposition of genetics to date – so I don’t have to.

I am reminded…I am reminded…

Data is not necessarily informationData is not necessarily information Information is not necessarily knowledgeInformation is not necessarily knowledge Knowledge is not necessarily wisdomKnowledge is not necessarily wisdom And none of the above is actionAnd none of the above is action

Or…Or… When all is said and done, there is a lot When all is said and done, there is a lot

more said than done. (Aesop 620-564 BC)more said than done. (Aesop 620-564 BC)

Serenity PrayerSerenity Prayer

God grant meGod grant me

the serenity to accept the things I the serenity to accept the things I cannot change;cannot change;

the courage to change the things I can;the courage to change the things I can;

and the wisdom to know the difference.and the wisdom to know the difference.

Reinhold NiebuhrReinhold Niebuhr

Child SuicideChild Suicide

Queensland Child Death Case Review Committee Queensland Child Death Case Review Committee (CDCRC) (statutory part of the Commission for (CDCRC) (statutory part of the Commission for Children and Young People and Child Guardian).Children and Young People and Child Guardian).

Monthly review of deaths within Dept. Child Safety Monthly review of deaths within Dept. Child Safety and connected systems.and connected systems.

Between 3 and 12 cases per month, of which 1-2 a Between 3 and 12 cases per month, of which 1-2 a month were suicides.month were suicides.

Commissioner had power to demand change in Commissioner had power to demand change in systems practice.systems practice.

Trends and Issues Trends and Issues Paper No 19Paper No 19 (CCYPCG, Qld, January 2014)(CCYPCG, Qld, January 2014)

A total 169 suicide deaths of children and A total 169 suicide deaths of children and young people were registered in Queensland young people were registered in Queensland between 1 July 2004 and 30 June 2013 (9 yrs).between 1 July 2004 and 30 June 2013 (9 yrs).

Of these 124 (73.4%) were aged 15–17 years Of these 124 (73.4%) were aged 15–17 years (average 13.8 suicides per year).(average 13.8 suicides per year).

44 suicides (26.0%) were of children aged 10–44 suicides (26.0%) were of children aged 10–14 years (average 4.9 suicides per year).14 years (average 4.9 suicides per year).

One was a child aged 9 years (2011).One was a child aged 9 years (2011).

Source: Queensland Child Death Register (2004–13)

Trends and Issues Trends and Issues Paper No 19Paper No 19 (CCYPCG, Qld, January 2014)(CCYPCG, Qld, January 2014)

In 2012-13, for young people aged 15–17 In 2012-13, for young people aged 15–17 years, with 10 deaths, suicide was the years, with 10 deaths, suicide was the second-leading external cause of death second-leading external cause of death (5.5 per 100,000).(5.5 per 100,000).

Suicide was the Suicide was the leadingleading external cause of external cause of death for children aged 10–14 years (12 death for children aged 10–14 years (12 deaths, 4.1 per 100,000 children), and the deaths, 4.1 per 100,000 children), and the rate was the highest since 2004.rate was the highest since 2004.

Trends and Issues Trends and Issues Paper No 19Paper No 19 (CCYPCG, Qld, January 2014)(CCYPCG, Qld, January 2014)

Trends and Issues Trends and Issues Paper No 19Paper No 19 (CCYPCG, Qld, January 2014)(CCYPCG, Qld, January 2014)

Of the 22 2012-13 suicides (just one year):Of the 22 2012-13 suicides (just one year):15 (68%) were male and 7 female15 (68%) were male and 7 femaleOnly 6 (27%) were from an indigenous Only 6 (27%) were from an indigenous background (17.1 per 100,000), but this rate background (17.1 per 100,000), but this rate was 5.5 times higher than the non-was 5.5 times higher than the non-Indigenous (3.1 per 100,000).Indigenous (3.1 per 100,000).Only 1 was from a remote background, Only 1 was from a remote background, with 7 from regional Queensland, and the with 7 from regional Queensland, and the rest (14) from metropolitan backgrounds.rest (14) from metropolitan backgrounds.

Trends and Issues Trends and Issues Paper No 19Paper No 19 (CCYPCG, Qld, January 2014)(CCYPCG, Qld, January 2014)

11 were from a low to very low 11 were from a low to very low socioeconomic background, with 5 from socioeconomic background, with 5 from moderate, and 6 from high or very highmoderate, and 6 from high or very high

11 (50%) were known to the child 11 (50%) were known to the child protection systemprotection system

There were 18 hangings, 1 gunshot, 1 There were 18 hangings, 1 gunshot, 1 jumping from height, 1 in front of a train, jumping from height, 1 in front of a train, and 1 poisoningand 1 poisoning

11 being known to Child Protection (7.1 per 11 being known to Child Protection (7.1 per 100,000) was 3.9 times more than expected. 100,000) was 3.9 times more than expected.

The Commissioner suggested this was The Commissioner suggested this was because these children often “live in because these children often “live in circumstances characterised by substance circumstances characterised by substance misuse, mental health problems, lack of misuse, mental health problems, lack of attachment to significant others, behavioural attachment to significant others, behavioural and disciplinary issues or a history of abuse and disciplinary issues or a history of abuse or violence”. or violence”.

Trends and Issues Trends and Issues Paper No 19Paper No 19 (CCYPCG, Qld, January 2014)(CCYPCG, Qld, January 2014)

Well-researched Risk FactorsWell-researched Risk Factors Male genderMale gender Low socio-economic statusLow socio-economic status Parental mental disorder Parental mental disorder Experience of lossExperience of loss Parental separation/divorceParental separation/divorce Suicides in the family or local community or Parental deathSuicides in the family or local community or Parental death Family history of suicidal behaviourFamily history of suicidal behaviour Restricted educational achievementRestricted educational achievement Adverse childhood experiences like neglectAdverse childhood experiences like neglect Physical, sexual and/or emotional abusePhysical, sexual and/or emotional abuse Being bulliedBeing bullied Mental disorder (depression, anxiety, ADHD,Mental disorder (depression, anxiety, ADHD, Asperger’s)Asperger’s) ImpulsivityImpulsivity Interpersonal difficultiesInterpersonal difficulties Substance misuseSubstance misuse History of self-harm History of self-harm

NHMRC literature review on Risk Factors for youth NHMRC literature review on Risk Factors for youth suicide (Commonwealth, 1999),suicide (Commonwealth, 1999),

Conceptual Model, Annette Beautrais (page 123) Conceptual Model, Annette Beautrais (page 123)

The National Scene (ABS, 2014)The National Scene (ABS, 2014)Table 5.1 Suicide, Number and age-specific rates of death by

age group and sex, 2008-2012 (5 years)

Males Females Persons Males Females Persons

Cause of Death and ICD-10 codeSelf-harm

No. No. No. 

Rate 

 Rate

 

 Rate

 

5-14 29 28 57 0.4 0.4 0.4

15-24 1119 410 1529 14.2 5.5 10.0

Both ages

1148 438 1586 16.8 5.1 11.0

The National Scene (ABS, 2014)The National Scene (ABS, 2014)http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/3303.0Appendixhttp://www.abs.gov.au/ausstats/abs@.nsf/Lookup/3303.0Appendix

1201112011

Table 5.2 Suicide, Number of deaths by age group and state or territory of usual residence, 2008-2012 (5 years)

NSW Vic QLD SA WA Tas NT ACT

Age group

no. no. no. no. no. no. no. no.

5-14 12 14 14 2 7 3 4 1

Compare:Queensland 2008-2012 9–14 years (25 deaths)

The National Scene (ABS, 2014)The National Scene (ABS, 2014)

We have some problems…We have some problems… Child suicide (ages 9-14) may well be increasingChild suicide (ages 9-14) may well be increasing Differences between state and territory and ABS Differences between state and territory and ABS

reporting may obscure the size of the problemreporting may obscure the size of the problem The ABS works on ICD 11, which demands ‘proof’ that The ABS works on ICD 11, which demands ‘proof’ that

it was a suicide. State and National figures differ by a it was a suicide. State and National figures differ by a lot!lot!

The National Coronial Information System (NCIS) has The National Coronial Information System (NCIS) has been problematic, and depends on a coroner having been problematic, and depends on a coroner having substantive informationsubstantive information

Some coroners may still be loath to finally judge a child Some coroners may still be loath to finally judge a child death ‘suicide’death ‘suicide’

But if the problem is hidden, we cannot prevent it…But if the problem is hidden, we cannot prevent it…

Finding real figuresFinding real figures Great report by WA Ombudsman (Ombudsman-Great report by WA Ombudsman (Ombudsman-

WA-Suicide-by-Young-People-Investigation-WA-Suicide-by-Young-People-Investigation-Report-2014.pdf). Parrots ABS figuresReport-2014.pdf). Parrots ABS figures

National Mental Health Commission, 2012: A National Mental Health Commission, 2012: A Contributing Life, the 2012 Contributing Life, the 2012 http://www.mentalhealthcommission.gov.au/http://www.mentalhealthcommission.gov.au/media/39273/NMHC_ReportCard_Lo-res.pdf media/39273/NMHC_ReportCard_Lo-res.pdf Inspirational. No figuresInspirational. No figures

National Committee for Standardised Reporting National Committee for Standardised Reporting on Suicide (NCSRS) is working on this problemon Suicide (NCSRS) is working on this problem

Kid’s Helpline InformationKid’s Helpline Information(http://www.kidshelp.com.au/upload/22913.pdf) (2012) (http://www.kidshelp.com.au/upload/22913.pdf) (2012)

17% (one-in-six) of all suicide-related calls came from young people 17% (one-in-six) of all suicide-related calls came from young people aged between 10 to 14 years. aged between 10 to 14 years.

Kid’s Helpline InformationKid’s Helpline Information(http://www.kidshelp.com.au/upload/22913.pdf) (2012) (http://www.kidshelp.com.au/upload/22913.pdf) (2012)

Martin, G., Swannell, S., Hazell, P., Harrison, J., & Martin, G., Swannell, S., Hazell, P., Harrison, J., & Taylor, A., 2010. Self-Injury In Australia: a Taylor, A., 2010. Self-Injury In Australia: a

community survey. community survey. Medical Journal of AustraliaMedical Journal of Australia, , 193: 9, 506-510. 193: 9, 506-510.

In our national study of self-injury of 12,006 In our national study of self-injury of 12,006 Australians (ANESSI), 32 of 396 children aged 10 – Australians (ANESSI), 32 of 396 children aged 10 – 12 (8.08%) claimed to have ‘ever self-injured’ 12 (8.08%) claimed to have ‘ever self-injured’ (according to our specific definition). Only 12 (3%) (according to our specific definition). Only 12 (3%) claimed self-injury in the month prior to survey, but claimed self-injury in the month prior to survey, but 29 (7.2%) claimed self-injury in the 12 months 29 (7.2%) claimed self-injury in the 12 months prior to survey. Within this, 21.2% (12) had prior to survey. Within this, 21.2% (12) had deliberately cut themselves, 17.7% (10) had deliberately cut themselves, 17.7% (10) had scratched, 17.7% (10) had bitten themselves, 21.2% scratched, 17.7% (10) had bitten themselves, 21.2% (12) had hit a part of the body on a hard surface, (12) had hit a part of the body on a hard surface, 13.4% (8) had punched or hit themselves. 13.4% (8) had punched or hit themselves.

Family Matters 2011Family Matters 2011Issue No. 89 (AIFS)Issue No. 89 (AIFS)

Calls for PreventionCalls for Prevention Tony Jorm recently called for a national MH Tony Jorm recently called for a national MH

prevention strategy (ANZJP, 2014. 48(9), 795-801.prevention strategy (ANZJP, 2014. 48(9), 795-801. He made some excellent suggestions for strategies He made some excellent suggestions for strategies

focused on families, schools and workplaces. focused on families, schools and workplaces. Embarrassingly, he ignored the fact that we have Embarrassingly, he ignored the fact that we have

had a national mental health strategy with a policy had a national mental health strategy with a policy and plan since 1992, and every state & territory and plan since 1992, and every state & territory has emulated this.has emulated this.

Painfully, he also ignored all the work done under Painfully, he also ignored all the work done under the nationally funded ‘Auseinet’ begun in 1996, the nationally funded ‘Auseinet’ begun in 1996, but sadly defunded in 2009, midway through a but sadly defunded in 2009, midway through a national workforce training program.national workforce training program.

A Model of PreventionA Model of PreventionNIH - Patricia Mrazek & Robert Haggerty, 1994NIH - Patricia Mrazek & Robert Haggerty, 1994

Australian National Australian National Mental Mental Health StrategyHealth Strategy

Endorsed in April 1992, affirmed in 1998 and 2003 with Endorsed in April 1992, affirmed in 1998 and 2003 with mental health plans, revised in 2008, and with a 4th national mental health plans, revised in 2008, and with a 4th national mental health plan released in November 2009) the strategy mental health plan released in November 2009) the strategy aims to:aims to:Promote the mental health of the Australian communityPromote the mental health of the Australian communityWhere possible, prevent the development of mental Where possible, prevent the development of mental disorderdisorderReduce the impact of mental disorders on individuals, Reduce the impact of mental disorders on individuals, families and the community, andfamilies and the community, andAssure the rights of people with mental illness.Assure the rights of people with mental illness. http://www.health.gov.au/internet/main/publishing.nsf/Content/mental-strat (accessed July 7th 2014) (accessed July 7th 2014)

Australian National Australian National Mental Mental Health StrategyHealth Strategy

The latest plan is comprehensive, providing 5 action The latest plan is comprehensive, providing 5 action areas:areas:Social inclusion and recovery; Prevention and early Social inclusion and recovery; Prevention and early intervention; Service access, coordination and continuity of intervention; Service access, coordination and continuity of care; Quality improvement and innovation, and… care; Quality improvement and innovation, and… AccountabilityAccountability - measuring and reporting progress. - measuring and reporting progress.Each of these has a clear set of outcomes, with action Each of these has a clear set of outcomes, with action statements. statements. This can be downloaded as a pdf fromThis can be downloaded as a pdf from: : http://www.health.gov.au/internet/main/publishing.nsf/Content/9A5A0E8BDFC55D3BCA257BF0001C1B1C/$File/plan09v2.pdf (accessed July 7th 2014) (accessed July 7th 2014)

Australian National Australian National Mental Mental Health Strategy – the problemHealth Strategy – the problem

In the actions to support this, there are terms In the actions to support this, there are terms like ‘Develop’, ‘like ‘Develop’, ‘Implement’, ‘Expand’, Implement’, ‘Expand’, ‘Coordinate’ and ‘Work with’, and a focus on ‘Coordinate’ and ‘Work with’, and a focus on increased education and working together increased education and working together across jurisdictions.across jurisdictions.

Even in the detailed examination of these later, Even in the detailed examination of these later, there is little guidance as to there is little guidance as to howhow to to ‘Develop’, ‘Develop’, ‘‘Implement’, ‘Expand’, ‘Coordinate’ and ‘Work Implement’, ‘Expand’, ‘Coordinate’ and ‘Work with’. with’. There are no guides to what works bestThere are no guides to what works best, , no examples of what is most cost-effectiveno examples of what is most cost-effective. .

Mates in ConstructionMates in Construction For individuals 15–64 years, the greatest risk of For individuals 15–64 years, the greatest risk of

suicide was in Queensland agricultural, transport suicide was in Queensland agricultural, transport and construction industries - and construction industries - allall suicides by suicides by construction workers were male.construction workers were male.

Suicide rates for construction workers, at 40.3 per Suicide rates for construction workers, at 40.3 per 100,000, were significantly above the overall 100,000, were significantly above the overall national rate for males (16.8 per 100,000). In national rate for males (16.8 per 100,000). In particular, the rate for 15–24 year olds (58.6 per particular, the rate for 15–24 year olds (58.6 per 100,000 people) represented a three-fold increased 100,000 people) represented a three-fold increased risk of suicide compared with male Australians of risk of suicide compared with male Australians of that age group generally, and in Queensland. that age group generally, and in Queensland. (AISRAP report, 2006)(AISRAP report, 2006)

Mates in ConstructionMates in Construction MIC began in 2008 as a multimodal prevention MIC began in 2008 as a multimodal prevention

and early intervention program, consistent and early intervention program, consistent with the Australian National Suicide Prevention with the Australian National Suicide Prevention Strategy (Living Is For Everyone ‘LIFE’, Strategy (Living Is For Everyone ‘LIFE’, Department of Health and Ageing, 2012), and Department of Health and Ageing, 2012), and reflecting Mrazek and Haggerty’s (1994) reflecting Mrazek and Haggerty’s (1994) spectrum of prevention and intervention – spectrum of prevention and intervention – particularly the areas of Universal, Selective particularly the areas of Universal, Selective and Indicated prevention.and Indicated prevention.

It is a program that works!It is a program that works! MIC has won 5 consecutive national SPA MIC has won 5 consecutive national SPA

awards, and 2 industry safety awardsawards, and 2 industry safety awards

Mates in ConstructionMates in ConstructionMIC is an industry-based, but workplace-focused, MIC is an industry-based, but workplace-focused, program with components delivered at program with components delivered at construction sites or company offices, except for construction sites or company offices, except for Suicide First Aid training, which is delivered in a Suicide First Aid training, which is delivered in a training facility. It is tiered:training facility. It is tiered:General Awareness TrainingGeneral Awareness TrainingConnector TrainingConnector TrainingSuicide First Aid – ASIST WorkersSuicide First Aid – ASIST WorkersField OfficersField OfficersCase ManagementCase ManagementMIC Suicide Prevention HotlineMIC Suicide Prevention Hotline

MIC Help-seekingMIC Help-seeking We noted (Gullestrup et al., 2011) that a total We noted (Gullestrup et al., 2011) that a total

674 workers accessed case management from 674 workers accessed case management from MATES in Construction between April 2008 MATES in Construction between April 2008 and November 2010 (7% of MIC participants). and November 2010 (7% of MIC participants). Of these, 44% were self-referred (n = 287), Of these, 44% were self-referred (n = 287), with referrals also made by unions (n = 94), with referrals also made by unions (n = 94), Connectors (n = 74), employers (n = 67), other Connectors (n = 74), employers (n = 67), other service providers (n = 57), family (n = 23), service providers (n = 57), family (n = 23), training organisations (n = 15) or due to a training organisations (n = 15) or due to a critical incident response (n = 7). critical incident response (n = 7).

MIC Presenting issues MIC Presenting issues

A current 2013 update suggests 38,115 workers A current 2013 update suggests 38,115 workers have completed GAT, 2866 have completed have completed GAT, 2866 have completed Connector training, and 392 have completed Connector training, and 392 have completed ASIST training.ASIST training.

As of August 2013, Mates in Construction was As of August 2013, Mates in Construction was active on 582 different sites with 59 sites being active on 582 different sites with 59 sites being classed as ‘MIC accredited’.classed as ‘MIC accredited’.

Since 2008, the number of Case Management Since 2008, the number of Case Management clients has grown from an average 4 per month to clients has grown from an average 4 per month to an average of nearly 40 per month, with over 160 an average of nearly 40 per month, with over 160 case management hours per month total. case management hours per month total.

Mates in Construction (Qld)Mates in Construction (Qld)

MIC (Qld)MIC (Qld)Accumulated TrainingAccumulated Training

Pattern of Usage of After-hours Pattern of Usage of After-hours Emergency line Emergency line

MIC Outcomes (Qld Males)MIC Outcomes (Qld Males)

MIC Outcomes (Qld)MIC Outcomes (Qld)(Males - preliminary)(Males - preliminary)

We estimate that, against a background of We estimate that, against a background of currently rising general male rates for currently rising general male rates for suicide nationally and in Queensland, the suicide nationally and in Queensland, the lowered rate for male construction lowered rate for male construction workers we workers we may have may have ‘prevented’ the ‘prevented’ the equivalent of 19 male suicides for 2008-12 equivalent of 19 male suicides for 2008-12 compared with 2003-7.compared with 2003-7.

The economic saving in terms of YLL, The economic saving in terms of YLL, may may be be in excess of $35m.in excess of $35m.

The ParadigmThe Paradigm Program based on evident and demonstrated need, and Program based on evident and demonstrated need, and

making sense to everyonemaking sense to everyone Industry specific and acceptable at all levelsIndustry specific and acceptable at all levels Driven from withinDriven from within To an extent self-supportingTo an extent self-supporting Tiered program begins with education about help-seekingTiered program begins with education about help-seeking Clear understanding that trajectories can be avertedClear understanding that trajectories can be averted Early intervention by the industry for the industryEarly intervention by the industry for the industry Specially trained people to manage specific issueSpecially trained people to manage specific issue Highly trained people to support the processHighly trained people to support the process Responsive 24 hour hotline built inResponsive 24 hour hotline built in Evaluation of process, outputs, Evaluation of process, outputs, but most of all OUTCOMESbut most of all OUTCOMES

San Sisto Ladies CollegeSan Sisto Ladies College Request from school about self-injury and fear of Request from school about self-injury and fear of

suicidality with contagion in year 8 (13 year olds)suicidality with contagion in year 8 (13 year olds) Presentations to staff and discussions with senior Presentations to staff and discussions with senior

staff exposed worries about range of mental health staff exposed worries about range of mental health problems and possible actions.problems and possible actions.

We proposed ‘Aussie Optimism’ over 20 weeks (2 We proposed ‘Aussie Optimism’ over 20 weeks (2 terms) with pre/post testing and feedback.terms) with pre/post testing and feedback.

Each year for 5 years we identified young people at Each year for 5 years we identified young people at Time 1 with problems – derived from SDQ scores Time 1 with problems – derived from SDQ scores and profiles, CESD scale scores, and the LOT-Rand profiles, CESD scale scores, and the LOT-R

San Sisto Ladies CollegeSan Sisto Ladies College We never had names – simply the school We never had names – simply the school

numbers. Our question was: “Are you aware of numbers. Our question was: “Are you aware of this child’s problems?” (A: about 50%)this child’s problems?” (A: about 50%)

Shared information led to preliminary tailored Shared information led to preliminary tailored strategies – often just wait and watch, but strategies – often just wait and watch, but sometimes urgent referral out.sometimes urgent referral out.

At the end of 20 weeks we compared pre/post At the end of 20 weeks we compared pre/post and revisited our discussions.and revisited our discussions.

Overall change for the sample was positive, in Overall change for the sample was positive, in some cases quite remarkable.some cases quite remarkable.

Those with ongoing problems investigated.Those with ongoing problems investigated.

San Sisto Ladies CollegeSan Sisto Ladies College A recurrent theme was: “How do we manage A recurrent theme was: “How do we manage

the friends?”the friends?” We suggested a system ‘Listening Post’ staffed We suggested a system ‘Listening Post’ staffed

by teachers who did not have special training.by teachers who did not have special training. Over the last 3-4 years this has morphed into a Over the last 3-4 years this has morphed into a

‘Wellness’ approach, with all staff trained to be ‘Wellness’ approach, with all staff trained to be aware, coordinated by 5 counselling staff.aware, coordinated by 5 counselling staff.

Last year the school completed a centre called Last year the school completed a centre called “The WELL”“The WELL”

To date this year there have been 768 ‘visits’ by To date this year there have been 768 ‘visits’ by students, parents and othersstudents, parents and others

San Sisto Ladies CollegeSan Sisto Ladies College Of the ‘visits’ to ‘The WELL’ in terms 1 & 2 this Of the ‘visits’ to ‘The WELL’ in terms 1 & 2 this

year, there have been 405 visits by students, year, there have been 405 visits by students, with an average 1.22 visits per student.with an average 1.22 visits per student.

Of note, there are a broad range of reasons Of note, there are a broad range of reasons including academic problems, relationships, including academic problems, relationships, career advice, family problems and anxieties.career advice, family problems and anxieties.

When we first began, this school had about 20-When we first began, this school had about 20-25 self-injurers each year surrounded by at risk 25 self-injurers each year surrounded by at risk friendship groups, and frazzled teachers.friendship groups, and frazzled teachers.

In the last 2 terms, self-harm has been discussed In the last 2 terms, self-harm has been discussed in 10 visits , and suicidal thoughts in 2.in 10 visits , and suicidal thoughts in 2.

ProblemProblem Q: How do we stop an extremely troubled 9 Q: How do we stop an extremely troubled 9

year old boy from writing a suicide note, year old boy from writing a suicide note, and using his father’s belt to hang himself and using his father’s belt to hang himself in the father’s wardrobe?in the father’s wardrobe?

A: We A: We adopt the systems we haveadopt the systems we have, reach , reach out and help them out and help them adapt current resourcesadapt current resources, , and and improve their ability to support and improve their ability to support and interveneintervene

(?based on the kind of models I have presented)(?based on the kind of models I have presented)

A Proposal (1)A Proposal (1) Schools have within them the knowledge, expertise Schools have within them the knowledge, expertise

and will to change – with some help from and will to change – with some help from CAMHS/CYMHS/Child Psychiatry – if we reach out…CAMHS/CYMHS/Child Psychiatry – if we reach out…

They They mustmust get the idea of Mental Health as ‘health’ get the idea of Mental Health as ‘health’ As others have noted this week, schools are As others have noted this week, schools are

interested in academic results; that is their jobinterested in academic results; that is their job They need to fully understand the implications of They need to fully understand the implications of

Trajectories – “if you don’t begin to change this Trajectories – “if you don’t begin to change this child’s mental health problems and family difficulties child’s mental health problems and family difficulties this year, it may all go from bad to worse…”this year, it may all go from bad to worse…”

A Proposal (2)A Proposal (2) Many schools get that mental health improves Many schools get that mental health improves

academic results, but they have pressures that academic results, but they have pressures that block adoption of programsblock adoption of programs

Many have adopted ‘social and emotional Many have adopted ‘social and emotional learning’ programslearning’ programs

In Australia, we have brilliant home grown In Australia, we have brilliant home grown programs like Mind Matters and KidsMatter, programs like Mind Matters and KidsMatter, and RAP, and ACE, but they have been and RAP, and ACE, but they have been voluntary, and schools can cherry pick which voluntary, and schools can cherry pick which bits they take on. They do not want to have to bits they take on. They do not want to have to do more with less…do more with less…

A Proposal (3)A Proposal (3) There is a new national system in schools There is a new national system in schools

which is time-consuming, divisive, which is time-consuming, divisive, makes makes schools competitiveschools competitive, and gives some parents , and gives some parents the power to cherry pick schools. NAPLANthe power to cherry pick schools. NAPLAN

I propose we as Child Psychiatrists negotiate I propose we as Child Psychiatrists negotiate strongly to add a mental health measurement – strongly to add a mental health measurement – an SDQ, or CESD for instance. an SDQ, or CESD for instance.

We feed back to schools a league table of We feed back to schools a league table of mental healthmental health..

This may drive schools to compete This may drive schools to compete on the issue on the issue of mental health, of mental health, and actively seek programsand actively seek programs

A Proposal (4)A Proposal (4) We could call the We could call the program ‘WELLPLAN’program ‘WELLPLAN’ One advantage would be a national database One advantage would be a national database

which tracked children’s mental health over which tracked children’s mental health over time, and assisted schools and Child Psychiatry time, and assisted schools and Child Psychiatry to target services and individual care.to target services and individual care.

We could ask Prof. Michael Sawyer to oversee We could ask Prof. Michael Sawyer to oversee the program in conjunction with the ‘Young and the program in conjunction with the ‘Young and Well’ CRC. We need measured outcomes!!!Well’ CRC. We need measured outcomes!!!

A further advantage is that it would show up A further advantage is that it would show up disadvantage in rural and remote or deprived disadvantage in rural and remote or deprived regions, and guide extra funding to those schools.regions, and guide extra funding to those schools.

PublicationsPublications

Child and Adolescent Suicide and its Child and Adolescent Suicide and its Prevention ReferencesPrevention References

See the printed sheets at the back of the See the printed sheets at the back of the auditorium.auditorium.

For published and downloadable booklets For published and downloadable booklets and other resources, see and other resources, see http://www.familyconcernpublishing.comhttp://www.familyconcernpublishing.com.au/products-page/.au/products-page/