MindMatters Panel: Module 4.3 When should I be concerned?

Julia Zemiro:
Hello, I'm Julia. Welcome to the Mind Matters panel. For a drama student, my teenage years were remarkably free of drama, but it's not the same for everyone. Here, to help us figure out when you should be concerned about a young person are: Young and Well Cooperative Research Centre Managing Director, Dr. Michael Carr-Gregg; Brain and Mind Research Institute Executive Director and Professor of Psychiatry, Professor Ian Hickie; National Centre of Excellence in Youth Mental Health Senior Research Fellow, Dr. Alexandra Parker, Alex for short; School Psychologist, Sarah Inness; and Teacher Martin De Clercq. But first, let's take a look at the Eagleton Way.

Eagleton High clip:

PHILLIP
When you’re in a school, you’re on the front line of mental health. Always alert – radar scanning for even the sign of a problem. 

Take young Jackson for example. Talented kid, but this year his ‘artwork’ has got a bit out of hand. In fact his whole behaviour. Why? Well one thing I have noticed, he used to buy his lunch from the canteen but lately he’s been bringing a packed lunch. Is this some sort of clue?

Hello Jackson. I see you’re bringing your lunch to school these days. 

JACKSON
Yeah, my mum’s not giving me canteen money anymore.

PHILLIP
Ah, family struggling a bit financially are they?

JACKSON
No, no, no, no. It’s just that she’s on this weird diet thing. It’s all about like beetroot, and cutting things a certain way...

PHILLIP
Dad’s not at all happy about it hey? 

JACKSON
Well, he says he loves it. But then I’ve noticed his car’s got this weird KFC smell now, so…

PHILLIP
Sounds like a bit of tension there. Familial, financial... dietary.

What’s that you’re reading there mate?

JACKSON
Twilight.

PHILLIP
Twilight. I think we’ve got enough there. 

Julia Zemiro:
Hmm, yes, very interesting. Ian wears blue, Michael doesn't. Interesting, interesting. There, yes, I'm doing my little Eagleton note taking. Phil talks about scanning for potential issues. What do you actually look for? 

Dr. Alexandra Parker:
I think that when you do have that relationship with students that you can have a look for those obvious changes, so changes in classroom behaviour, changes in their social behaviour, changes in their academic performance as well, but bearing in mind that obviously, all young people have different ways of normal functioning. Some are quieter than others, some are more extroverted. It's just the way that things are. So to keep that in mind but also to be looking for things when times do change and that could be a sign that something's happening.

Julia Zemiro:
Did Phil do anything right, Martin?

Martin De Clercq:
I mean, he got it right in terms of that he was looking. And he can get it right by getting it wrong. It's better to act and make a mistake, it won't be the end of the world, than not to act at all.

Dr. Alexandra Parker:
It may be doing something a bit different about picking the right moment as well, I mean –whether or not in that video whether it's the right time to do it, out in the middle of lunchtime, lots of other kids around, thinking about when's the right time to start that conversation as well and maybe for it to be more of a conversation than an interrogation, too.

Julia Zemiro:
That was a bit of an interrogation, wasn't it? So what is normal, Michael? What does the term even mean, does it exist?

Dr. Michael Carr-Gregg:
Well, I think that there are things that we expect young people to do as they make the journey from childhood to adulthood. One is to basically... There's a neurological veil that's lifted where they see their parents for the first time through adult eyes and their response is generally "Oh, my god. Look what I've got for parents. People sent from Planet Boring to make my life hell." That's fairly normal. We expect them to explore their sexual identity. We expect them to rebel a little bit against authority. We expect them to probably have a little bit of difficulty with the transition from primary to secondary school, but hopefully will then settle in. So I think the really important things to look for are kids who struggle with those key developmental tasks. Keep an eye on them. Monitor them. And really, I like the model of teachers being the eyes and ears of the school and then the higher life forms basically be the person that they go to if they're concerned and then Sarah would do her investigation.

Julia Zemiro:
Sarah, what kind of investigation would that be then? 

Sarah Inness:
Oh, probes, no. Well, no, often it's just gathering information. My work is a lot of looking and listening, but there's also gathering information from teachers who work with them and parents who live with them and getting a sense of well, is this what they've always been like? Is this a personality trait? Is this now more severe than it has been before? Has this been going for an extended amount of time? Is it causing distress for the student? Is it causing distress for family members and friends? Those behaviours that are starting to emerge, and that's why I think we start to want to intervene more.

Martin De Clercq:
It doesn't take long to send an email out to teachers to just say, "I had some concern about this student, can I just have a brief sort of report back on their welfare or their concentration or pinpoint some stuff." Takes two seconds to send out and then you can start to get... Build a better picture.

Professor Ian Hickie:
There is a key developmental thing to get straight. To get more emotional is normal for a young adolescent. That's a brain developmental thing to react more and see it through more personal eyes. Get moody, get whatever. If it persists, you know, it goes on and it's associated with impairment. Like it's affecting their school performance, or affecting their social relationships, then you want all those eyes and ears to react. 

Dr. Michael Carr-Gregg:
I'd like to highlight the importance of relationships. At no other time in your life is the desire to be with your age mates so strong. So, if you get a kid who was and always seems to have been quite social and suddenly they withdraw from their friends, I think that's actually a very, very significant sign that you have to take notice of. And in conjunction with maybe a dramatic change in their behaviour, they're no longer enjoying the things that they used to enjoy. These are the things that have ratcheted up the risks for me.

Julia Zemiro:
So, if you do have a concern, Sarah, if it's starting to ramp up and if you're a teacher, what would be the next step? 

Sarah Inness:
Well, I would hope that it would be drawing in the support they've got inside the school and parents' support and possibly even knowing there's supports around them outside the school, what GPs are youth friendly. What psychologists are in the area or community services are in the area that might be able to be a good starting point for supporting the students who are – 

Dr. Michael Carr-Gregg:
headspace.

Sarah Inness:
headspace.

Dr. Michael Carr-Gregg:
Don’t forget our friends at headspace.

Dr. Alexandra Parker:
That's right and online version too. So, e-headspace, as well. So, if there isn't a centre nearby, yeah, there's an option for online counselling too.

Julia Zemiro:
Now, even if you're doing your best to pay attention, will you always know what's going on inside the head of a young person? 

Professor Ian Hickie:
Absolutely not. You have to be really careful about making up explanations. One of the problems when kids go under the radar here, is everyone goes, "Oh, I know what's going on." You know, his grandma died, or this year's stressful, whatever else. We got to be just a bit careful. When problems really do persist, and some of the things Michael was talking about, people withdraw and they've changed, one way of normalising that is to make up the explanation. We all think we know. But, no one's actually kind of looked at an issue as to why that is the case. So, you know the levels are getting to a reasonable level of assessment and understanding is a critical issue with the person themselves and with those people who are in that wider context. And then being well aware there is a bigger health system out there these days that can actually help with that. That's not the role of the school or the teacher individually to do all that. But, you know, just assuming you do know what's going on in people's head often.

Julia Zemiro:
Do you ever? 

Professor Ian Hickie:
Anyone's head, not only the heads of teenagers. You know, just be careful, because we all think we know a lot. Often we haven't got it straight.

Julia Zemiro:
Can you miss signs of mental health difficulties in a student that's flying under the radar?

Dr. Michael Carr-Gregg:
I absolutely admit that I have, I think I've been doing this for about 30 years now, and any psychologist says they haven't is a liar.

Julia Zemiro:
And did it surprise you that you hadn't seen it or with hindsight, did you see why you missed it? 

Dr. Michael Carr-Gregg:
Yes, in hindsight, you're a genius. But, you know, looking down the retrospecto-scope, I think you get more experienced in time and sometimes the kids know you. Yes, Ian? They'll tell you stories...

Professor Ian Hickie:
Well, the disclosure I mean, you know, people... The more and more intimate something is, you're not telling every... Not everyone is telling everyone everything the first time. So, lots of kids go under the radar, we don't see the problem. We see the kids that wanna burn the school down. We see the kids who are destroying stuff or being arrested on the weekend. You know? The obvious behavioural stuff demands attention. A lot of the other stuff on the inside, emerging sexuality, emerging other difficulties, social anxiety, it's not causing trouble, it's not seen. But a lot of that's associated with very desperate thoughts, you know, particularly thoughts of self-harm, really serious identity issues. They take a while to disclose. And they'll be disclosed in relationships in which people trust. And they feel the other person understands, you know, there's some empathy in those. That doesn't happen immediately. It doesn't happen immediately with professionals, and really importantly, somebody else you do trust, a teacher, a peer, somebody else who feels... Gets to understand what's going on in your head, you're much more likely to tell than somebody you've been sent to see to tell everything to.
Dr. Michael Carr-Gregg:
Best friend's mum, a very important person.

Dr. Alexandra Parker:
Yeah, and then if a young person has disclosed some thoughts about self-harming or that they have been self-harming or that they've had some suicidal thoughts. Again, to not to think you have to jump in and problem solve at that point. But to just to listen, to hear what they're saying and then but to know how to then tap into the next step of resources that you need to get them the support that they have. To not be reactive in the way that you respond, to think about your own emotions at that time, but then to just gently encourage them and know how to help them get that next step of help that they need.

Julia Zemiro:
Did anyone notice Chris in the video, in the Eagleton video up the back? Still suffering the break-up of the girlfriend. Obviously in that case, Phil hasn't seen him, but that must happen?

Sarah Inness:
Well, it's really easy to focus on the externalising bad behaviours, isn't it?

Julia Zemiro:
The loud ones.

Sarah Inness:
At schools, the loud ones, the ones who make the most problems, while the quieter sufferers who put their masks on to come to school every day tend to get overlooked. So, yes, I think Phil has missed something by focusing on one particular issue in the school. And I think we do that at schools if we're not careful. We can miss it if we're not connected to our students.

Professor Ian Hickie:
But this is the complexity, isn't it? I mean, these things are not simple. So sometimes we have a very simple community narrative. Life events happen, people get distressed, that’s the explanation. The more connected you are, the less chance you'll have those disasters and those things. The disclosure point that Alex was making, people do write it down. Now they write it down on social media. Now it's shared. Everyone, older non-digital natives, go "Ahh! Bad!" Actually, good.

Julia Zemiro:
I would never in a million years write anything! 

Professor Ian Hickie:
One of the advantages of the new media, which everyone’s sort of in a panic about, is the sharing of things. "Oh my God, if she writes about suicide, they'll all do it." But actually, it's the capacity to actually connect and respond, to actually make it a thing, take it outside and have the capacity that somebody else will be able to help somebody who themselves is not able to get that help.

Dr. Michael Carr-Gregg:
We've got to stop demonising social media. The Young and Well CRC has done lots of research, which shows, in fact, that it can build resilience. Being on Facebook is a good thing, not a bad thing.

Julia Zemiro:
Really? Truly? 

Dr. Michael Carr-Gregg:
Yes. I'll send you the research.

Julia Zemiro:
Oh, I'd love to see it.

Dr. Alexandra Parker:
And a lot of young people, they're wanting to know. They're wanting to know, "How do I help a friend?" And so they're seeking that advice. And so we need to be in that position where we help them to know what to say, and also how to encourage that formal help-seeking when it's needed as well.

Professor Ian Hickie:
But this goes back to before. Julia's point's very important. People wrote that down forever. Virginia Woolf wrote down she was gonna kill herself forever. No one responded in the same sort of way. Actually, what's happening with the social media, taking it outside so you can actually start to deal with it, is the opportunity this presents. The more connected you are, afraid to say, Facebook 's really good for you. The more connected you are, the more that somebody will see, "She's behaving differently," whatever. And if they see those other things, they're likely to say look, there are strategies. There are things to be done. There are options to actually help. Just saying to someone in trouble, "You should do different. You should get help," doesn't help. Other people need to provide that help at key times. And that's the opportunity social media adds to social connection. And the real issue in schools is, as you said, it's terrible. Always great, what you do in the schools. If there are three kids in the school that no teacher identifies, that says heaps. But that's a real responsibility for the social environment. It's not just putting the, "It's the end of the year, your kid's done very well, whoever they are. I don't know who they are, but they've done very well." That's a school that's doing something really socially responsible, that's smart. Well, we also know young people are far less stigmatising than older people. So the whole stigma idea we have, which everyone's totally pre-occupied with, arises with age. So this stuff gets shared amongst younger people with no other assumptions about the person's a bad person or no longer worth being a friend. We've got issues about mental health, got issues about guilt, is it our fault? What do we do? I got all the responsibility, too.

Julia Zemiro:
Yeah.

Professor Ian Hickie:
But, the opportunity of the young people, I mean Martin's making a key point is it's actually very helpful to encourage young people to do what they’re already doing. To share the information, to disclose, to pass it on to others. What they often don't have is the answer. You don't want to be stuck in the cul-de-sac of 15-year-olds taking care of 15-year-olds. Because they don't have the experience. So the facilitating issue, I think the bullying examples, we’ve seen this in suicide prevention. Much of the smarter responses are coming from 15-year-olds organising themselves on social media to actually help the person than what is coming from the outside world, which is having a panic attack over are we doing the right thing or not in these areas. So, there's a whole issue here; we’ve got to make use of what we’ve already got. An awareness, a non-stigmatising attitude and then back it up with the school environments and the professional situations that then can take over responsibility and for those in serious trouble, get them on a path to recovery.

Julia Zemiro:
So, let's wrap up with a take-away message, Dr. Alex Parker, what is the most important thing you want to tell school staff? 

Dr. Alexandra Parker:
I think for this is to not be afraid to ask questions, to not be afraid to give the time to listen, and then to actually know who to go to in the next phase if you need to. Take on as much information as you can from peers, from parents, from other staff and then formulating what is the best approach to help that young person.

Julia Zemiro:
I think she's correct.