The Severe and Complex Youth Mental Health Cohort

A New Year has begun.
So what lies ahead for people affected by severe and complex youth mental health issues?
Of course we can’t know. We can hope.

BUT IS HOPE ENOUGH AFTER ALL THAT PEOPLE HAVE HAD TO ENDURE?

The people who genuinely understand what “severe and complex” is in adolescence remain a minority.
Those who know exactly are those who live it every day.

Beyond them, who else recognises that severe and complex youth mental health issues” defines a unique group of young people? That this is a group whose mental health issues are far from treatable depressive or anxiety disorders.

Young people with severe and complex mental health issues experience symptoms, behaviours and triggers that are unpredictable, tortuous, idiosyncratic and often extreme and life-threatening.
They are burdened by the challenges of balancing between child- and adulthood – all while they confront the implications of multiple conditions that interact with each other to produce effects that sometimes don’t relate to any one of their individual diagnoses.
They can be young people whose traumatic histories have left them socially isolated, traumatised, misunderstood and even ignored for significant portions of their lives.
This cohort of patients – as well as those who care for them – MUST HAVE proper recognition.
If this does not happen on a wide scale in 2019, then the devastation of the Barrett Closure will be part of an ongoing tragedy.

Yes, a new centre is being built which is an incredible relief.
And yes, there has been a real commitment to a collaborative design process that includes people with lived experience as well as healthcare professionals and experts in the architecture and construction of mental healthcare buildings. It’s hoped that this will mean the beginning of this kind of process for other healthcare service development.

But as we start the New Year with the deaths of Talieha Nebauer, Will Fowell and Caitlin Wilkinson Whiticker still under examination by the Queensland Coroner, we need to ask:

Will this be another year that ends with uncertainty?

Will there be the vital outcomes for the families who repeatedly warned that the closure of the Barrett Centre would put the most vulnerable young people at even higher risk?
Will there be public recognition of the false administrative deadline, political cost-cutting motivation and lack of appropriate replacement services that meant transitions from the closing centre could never encompass the fundamental principles of stability and continuity of care for young people whose illness bears the risk of fatal consequences?
Will there be the long overdue acknowledgment of the few professionals whose understanding and expertise allowed them to continue their dedication to the welfare of traumatised young people with skilled measures that prevented even greater permanent damage?

Will there be a move towards wide-reaching processes to educate healthcare professionals about this cohort and the fact that their needs differ from the majority of people requiring clinical support for mental health issues?

Without the clear and tangible acceptance (with whatever documentation/ endorsement is required*) across the healthcare sector – and beyond – that young people with severe and complex mental health issues require truly SPECIALISED support from skilled practitioners who have the KNOWLEDGE of and COMMITMENT to individualised care, the young people in this cohort will continue to be referred to treatment options that have little chance of achieving progress. …
They will find themselves repeatedly confronted by the futile expectation that treatment that has been effective for those whose illness is less complex and less severe might eventually achieve a modicum of progress.
They will stand in Emergency Departments and be told that their compulsion to harm themselves is ‘just attention-seeking’ behaviour.
They will be informed by more than one practitioner that they are too complex for his/her level of experience. And then be left with nowhere left to turn.
And they will retreat to somewhere where they feel they cannot fail again. But where they will become even more lost.

But this lack of progress is not THEIR failure …

These young people and their families and friends deserve better.
They always have.
They have always deserved the best. But have too often received the worst.

They are still often judged and dismissed.
Even though they compromise and keep trying to give clarity to what their lives are like and what they need.

They slip through the cracks of both healthcare and education.
Even though they are desperate for effective treatment and an opportunity to have lives that are even a shadow of the opportunities they see other young people immersed in.

The lives of young people with severe and complex mental health issue are hard enough.
It takes effort to face a world that terrifies.
It takes strength to sit in corridors waiting to give voice to your greatest fears and darkest moments.

No one WANTS to expose thoughts and feelings that are deep inside and quashed because an illness has created them but yet for which the sufferer feels personally responsible. Or like a Freak. Or Weird. Or Evil.
No one WANTS to stay in a psychiatric facility unless they know that it’s the only thing that can save them.
And no person wants to do those things again and again and again because their medication isn’t effective or because their complexity is beyond their current clinician’s experience.

But this is the life that those affected by severe and complex mental youth health issues have been living.
Because of illness.
Not karma. Not punishment. Not of their own doing in any way.

It is a health issue. That becomes an emotional issue. A social issue. It affects development and learning and relationships and futures.

It changes lives.

It takes lives.

AND ALL THESE YOUNG PEOPLE AND THEIR FAMILIES HAVE EVER NEEDED IS TO BE TRULY SEEN AND HEARD.
SO THE WORLD NEEDS TO LISTEN.
CLINICIANS NEED TO KNOW.
AND THEN APPLY THAT KNOWLEDGE.
The status quo is not good enough.
Not knowing is not good enough.

We know 3 young people died after the closure of the Barrett Centre.
We know other young people died before them and after them because their severity and complexity was not adequately recognised and supported.

So 2019 must be the year that Queensland,  Australia – and beyond –
SEES these young people and those that care for them.

RECOGNISES them.
LEARNS ABOUT THEM, FOR THEM AND WITH THEM.
AND DOES WHAT IS NEEDED TO GENUINELY HELP THEM.

.

If this year passes without those things happening,
we all should
know better.

.
Because we will have learnt absolutely nothing.

.

.


*  This need for clarification extends from those with lived experience to experts in the area of youth mental with extensive clinical and research backgrounds and a genuine understanding of the severe and complex cohort.
Orygen, the National Centre of Excellence in Youth Mental Health, is the world’s leading research and knowledge translation organisation focusing on mental ill-health in young people.  Professor Patrick McGorry is Orygen’s Executive Director. Their official response to the draft version of the National Mental Health Plan highlights a serious lack of clarification as regards severe and complex mental health issues i.e.

“… greater clarity (and consensus between the governments) needs to be articulated in the Fifth Plan to describe what is meant by ‘complex and severe’… “

and under “Specific feedback on the priority areas“, it’s stressed that there is:

“Over simplification of the experiences and stages of mental ill-health in the division of ‘complex and severe’ and the rest of the population. 

Unfortunately when the final version of the Plan was released, no changes had been made in that area. (Click image, right, to view draft and final text comparison.)

It’s also worth noting that in this 74 page document, the word “youth” appears only in reference to the Youth Suicide Prevention Plan for Tasmania (within a list of State and Territory Plans and Commitments). The word adolescent” appears a total of 4 times (two of those in one bibliography listing) and the phrases “young people” and “young adult/s” do not appear at all.

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