More children aged 10 to 14 are presenting to Hunter hospitals with serious mental health concerns

Help: There are more young people presenting with mental health issues.A GROWINGnumber of children aged between 10 and14 are presenting to Hunter emergency departments with suicidal thoughts, intentional poisoningand self harm injuries.

A retrospective studypublished in the Medical Journal of (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 are11 or 12 presenting with these problems. It is less common in children younger than 10.”

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Dr Nagarsekar said complex trauma, depression andanxiety, eating and behavioural disorders, as well as substance use and developmental disabilities, were driving the rising numbers, but social media andthe use of electronic devices wasalso playing a major role.

“We have certainly seen asignificant 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 isolatethemselves from family, because they are spending a lot of timegaming.

“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. Itcan 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.”

What next: The study highlighted the need to improve targeted mental health care delivery in emergency departments.

Hunter New England Health was unable to provide the number of adolescents that presentedwith suicidal thoughts, self harm, or intentional poisoningto the region’s emergency departments from 2010 to 2014.

But data for the number of 10-to-14-year-old childrenadmitted 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,” DrNagarsekar 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.”

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Often, childrenhad witnessed or experiencedtraumawhich hadcaused 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, infoster placement or with non-profit agencies who are looking after them in the community.

“But things like social media can also play a role.”

DrNagarsekar said somepatients used self harm as a way of expressing distress.

“They may not always want toattempt suicide, but they do it to manage their emotional distress,” he said.

“Often young people will say they feel calmer afterwards. It isa 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.”

DrNagarsekar said early intervention, as well asmental health promotion and literacy, was key inefforts 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 awhole of community approach, where schools, primary health care, early intervention and mental health promotion serviceswithin public mental healthcollaborate to address some of the issues relating to social mediaparticularly.”

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 barthe0–9 year bracket.

But the greatest increase was for the 10–19-year-old age group, at27 per centper year.

The study says thatsuicide was the most common cause of death in those aged 5-to-17in in 2016, and it cites a survey that found 11 per cent of ns aged 12-to-17 had self harmed at some point in their lives.

Athird of all mental health presentationswere 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 coordinatorTegan Cotterill said The Black Dog Institute had developed guidelines for emergency departments to better carefor patientswho were suicidal. Theywere working with the EDs atthe John Hunter and the Calvary Mater.

“In schools, we have a program called Youth Aware of Mental Health, whichwas delivered in Newcastle last year. That was the first time it had been delivered in ,” she said.

“The trial is being offered to Year 9 students for now. Even though it does help in reducing suicidalbehaviour inyoung people, the programis 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 wereconcerned about via training programs such asASIST, and QPR –or Question, Persuade, Refer.

To find out more, visit Lifeline, The Black Dog Institute or Everymind websites.

For help and support, call Lifeline: 13 11 14.

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