youth health - national youth council of ireland · web viewone such partnership is with the...

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Rapid Mental Health Needs Consultation: National Youth Health Programme

INTRODUCTION

The National Youth Health Programme (NYHP) is a partnership between the National Youth Council of Ireland, the HSE and the Department of Children and Youth Affairs. The NYHP’s work has, and continues to be informed by key strategic and policy developments within the Health Sector. The HSE Health Promotion Strategic Framework (HSE, 2011) promotes a ‘settings based approach’ for health promotion in Ireland. The youth setting is identified in the Strategic Framework as a key setting for health promotion. The NYHP works to develop and build the capacity and sustainability of youth health promotion across the youth sector in line with evidence based and evidence informed practice. The NYHP endorses a settings based approach, focusing on the broader determinants of health rather than simply addressing individual and behavioural risk factors. The approach is underpinned by values such as empowerment, public participation, equity and partnership. One such partnership is with the National Office for Suicide Prevention who has recently launched Connecting for Life, Ireland’s National Strategy for Reducing Suicide (2015-2020).

Mental health has been identified by young people and those working with young people as the number one area of importance in the National Youth Strategy. The topic of mental health arises regularly in the interactions between the NYHP and the youth sector and while we have anecdotal information it is important for the programme to explore this topic in more depth through this consultation. The results from this consultation will inform the work of the NYHP going forward to best meet the needs of those working with young people in the youth sector, and to support the implementation of Connecting for Life, and the National Youth Strategy.

. METHODOLOGY

An online questionnaire (Appendix A) was distributed to NYCI’s database and via social media. 284 respondents completed the online questionnaire. These respondents represented a range of youth organisations and those working with young people (Figure 1). Alongside the online survey, interviews (Table 1) took place with 20 staff members who were employed in the youth sector. These included youth workers, youth service managers, and educators within youth settings who were all asked a standard set of questions (Appendix B) which explored the area of mental health in their setting. The data was analysed to indicate the following results.

RESULTS:

Issues affecting young people’s mental health

When asked what the main issues affecting young people were a range of issues were highlighted (Figure 1). The predominant issues identified were;

o Anxiety, 97% (n=274), o Stress, 96 % (n=282) o Body image, 90% (n=264)

Mental Health Needs Consultation, National Youth Health Programme September 2015

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Other areas identified included; relationships, family, education, anger, depression, sexuality, money, alcohol use, employment, drug use, self-harm, suicidal thoughts, eating disorders, bullying and peer pressure.

This supported the opinions of participants in the interviews who frequently commented on the prevalence of young people presenting with anxiety in their services.

Interviewees felt young people are under more stress from a range of sources, which primarily can arise from family dysfunction, lack of stability, and a lack of being able to understand and to control their emotions leading to unhealthy ways of coping.

Young people from the interviewee’s perspectives are under more pressure from their peers and from society and a lot of this is seen through social media.

There was a sense that young people need instant gratification and when they don’t get it they don’t know how to cope.

Homelessness was an issue for interviewees working in the Dublin/Wicklow region and the issue of family breakdown was an issue throughout the country that plays a large part in young people’s ability to cope as they don’t at times have a supportive adult in their lives.

While homelessness was an issue for Dublin/Wicklow rural isolation was a difficulty experienced by young people outside of Dublin. This rural isolation impacted on young people’s ability to access services when and where they needed them.

Interviewees felt young people in care were a particularly vulnerable group especially when they transitioned out of the care system as there were very little supports put in place for this group. They experience rejection and this has a negative impact on their mental health.

HOW YOUNG PEOPLE DEAL WITH ISSUES

Substance Misuse

When asked how young people cope it was generally observed that young people engage in unhealthy coping mechanisms. There was a strong belief that young people use substances as a way of escaping, primarily using weed, alcohol and “benzo’s” which are all easily accessible to young people. This was supported in the online questionnaire where:

77% (n=212) reported alcohol use as being an issue that affects the young people they work with.

70% (n=199) reported drug use as being an issue that affects the young people they work with.

Interviewees were of the opinion that young people do not make the connection between mental health and drug use and see it as helping when in fact it is having a detrimental effect on their mental health. It was also felt that the potency of weed in particular is something they are becoming concerned about with some interviewees feeling there is a link between drug induced psychosis, schizophrenia, mental health and the young person’s drug use, which for some can be daily. Interviewees believed the use of weed especially has been normalised and is seen as an everyday activity. They also felt a lot of young people are self-medicating with “benzo’s” and that some are selling them on when they have been prescribed them.


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Self-Harming/Suicide

Self-harming is becoming a more prevalent issue with some interviewees feeling that young people do it because it creates a physical pain that they can see as opposed to mental health which is silent. Many of the services have experiences of young people self-harming and attempting and completing suicide;

69% (n=189) reported self-harm as being an issue for the young people they work with. 67% reported suicidal thoughts as being an issue for the young people they work with.

Several interviewees felt that some self-harming is occurring within peer groups and that they are trying to “out misery” one another. Many interviewees have had experiences of young people attempting and completing suicide and where there has been a suicide it has had a devastating impact on the service. Concern was expressed that there is a morbid fascination about death among some young people.

Risky Sexual Behaviour

Several interviewees reported that young people are also engaging in risky behaviours especially around sexual health where they are engaging in unsafe sexual relationships. Interviewees were of the opinion that girls do this to gain affection and that they are under pressure from the boys. Interviewees have seen young girls leaving services as a result of pregnancy. They believe there is no incentive for girls to attend as they can now only receive one payment for attendance on a course. When they received two payments it helped encourage them to attend. Without dual payments young girls are dropping out and interviewees expressed concerns for the mental health of these young girls when they are not connected into services. They also felt that education is a way of breaking the cycle of poverty that many of the young people are in.

Positive Ways of Coping

When staff see young people dealing with issues in a positive way they tend to speak to each other or someone they trust. In general the interviewees felt young people trust the staff within the youth services as they have spent time with them and have built up trust. The main barrier though is to get the young people to open up and talk about their issue and this can take time as the young people may have built up negative perceptions about adults through their experiences in the formal education system.

Male vs Female Differences

Interviewees felt that young males have more barriers up when it comes to discussing their mental health and help seeking. They believed this has a lot to do with gender as it’s not seen as masculine to be perceived as weak and while girls are encouraged to show emotion boys are socially conditioned to keep their feelings to themselves. Several interviewees also highlighted the fact that many of the young men come from one parent families where they may not have a positive male role model. Sometimes they can get this positive male role model through the service they attend.


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HOW THE ISSUES ARE PRESENTING IN SERVICES

Panic/Anxiety Attacks

Several interviewees recounted instances of young people having panic attacks in the service and workers having to support them to manage this. They felt that the young people are anxious about their home lives, relationships, peer pressure, money, the future and for some drugs debt. When they have a panic attack the worker deals with it as best they can but they acknowledge they do not have a skill set around this and what skills they do have they have developed over time. Many young people are medicated to help them deal with their anxieties and the staff generally know if they are on medication because they disclose this when they join.

Anger

There was a dominant theme within the interviews of young people becoming angrier and “acting out”. It was felt that their emotions and difficulties are expressed through anger especially among young men. Interviewees expressed opinions that young men do not know how to deal with emotion and do not know how to look after their mental health. This therefore seems to impact on their ability to seek help. Several interviewees commented how they had felt unsafe in work and referenced a variety of situations where young people had scared them. They believed in some instances this anger is connected to drug use and that young people are coming in under the influence of substances with weed being seen more commonly. This is more seen in Youth Services, CTC’s and Youth Reaches as opposed to uniformed organisations.

Self-Harm/Suicide

In some instances staff are bandaging student’s self-harm injuries when they present to them injured and refer them onto appropriate supports if there are any available. They can see physical injuries on people who self-harm and scars once they have healed. Sometimes other young people may share with a trusted worker that a young person is self-harming. Many of the services have experiences of young people completing suicide. Interviewees shared instances of young people disclosing suicidal thoughts to staff. In these cases if they are trained they use the skills they learned on ASIST, keeping the young person safe and refer onto services if appropriate and in some situations they have accompanied the young people to A&E, which many described as being a terrible solution for the young people.

Low Mood

Interviewees felt that that some young people are becoming withdrawn and disengaging from services. They believed that some young people display low self-esteem, low self-confidence, can find it hard to make eye contact and generally have a lot on their mind therefore it is hard for them to concentrate and participate. It is hard for the staff to stay connected in with every young person due to their work commitments. Interviewees within Youthreach’s and Community Training Centres felt that there is a strong results orientated focus to their work and that this limits a space for the personal development of the young person to be supported which would have a positive impact on their mental health.


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Effect on Education

Interviewees were of the strong belief that mental health issues are having a negative effect on the ability of the young people to learn and to get the most out of their experience. Interviewees believed if the young person is dealing with issues then it effects their concentration in class and limits their ability to achieve academically. This in turn puts more pressure and anxieties on the young person. Interviewees firmly believed if young people’s mental health was supported better it would have positive outcomes on their academic achievement.

Worry for staff

Staff spoke quite openly about worrying about the young people they work with and some had a very real fear that they might die by suicide. They felt that the boundaries can sometimes be blurred between youth worker/educator and mental health professional. While they feel it is not their role to provide mental health support, because of the lack of accessible services they are the ones who are on the frontline providing the support to the young person. This in turn has a detrimental effect on staff with more self-care required.

WHAT SUPPORTS THE SECTOR NEEDS:

Training:

“We need more training to deal with these issues. We also need more tools to help kids deal with these issues” Survey Respondent

80% (n=213) of respondents highlighted a lack of training as being a challenge they encountered when working with young people concerning their mental health.

96% (n=270) felt training and education was needed for young people. 96% (n=264) felt education and training for staff was needed to support the needs of the

young people they work with.

This was supported in the interviews where staff believed that more training was needed to:

Support young people to understand more about mental health, their emotions and feelings and how to positively cope.

Support their own confidence dealing with the topic of mental health considering 66% (n=161) of respondents highlighted a lack of confidence in discussing mental health.

Develop a deeper understanding of different mental health issues and how these can present in the service with particular reference to self-harm and suicide. This was important as young people are presenting with a range of diagnosis and staff are unsure of the nature of the diagnosis and a deeper understanding would help them support the young person more effectively.

Understand how the young person can be supported safely while waiting for a service. Develop a deeper understanding about substance misuse and its impact on mental health. Develop self-care plans and practices for staff within the services who are working with

young people with mental health difficulties.


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Develop mental health policies and procedures for the service. To know what do when there has been a suicide. Interviewees felt they needed to have clear

guidelines on what to do should a suicide occur and that there needed to be support services in place to support them and the young people they are working with when a suicide occurs.

Staff also felt that there was some good training available and in particular Mind Out and ASIST were discussed but they felt it was hard to release people for trainings when resources were being reduced as a result of the economic crash. ASIST was referenced strongly throughout the interviews as a really practical training that has supported people in their work as it has given them very clear steps to follow. Interviewees felt they themselves found it easy to discuss mental health with young people but this was supported over time by training and the experience of working with young people.

Toolkits and resources:

73% (n=190) felt a lack of toolkits and resources was a challenge for them in their work. Few interviewees could name mental health resources or toolkits and many expressed a

desire that more were needed. It was highlighted that these toolkits and resources should be practical for youth workers to use and if they were accompanied by training they would be stronger.

Toolkits and resources could be used to support organisations to develop policies, procedures and guidelines in the area of mental health as 55% (n=141) of respondents reported the lack of policies, procedures and guidelines as being a challenge they had encountered when working with young people concerning their mental health.

60% (n=110) of respondents reported that their organisations did not have any mental health policies/strategies/procedures/guidelines.

Information

All youth work is mental health related” Survey Respondent

75% (n=264) felt that they needed information alongside the same themes highlighted in the training needs.

This was supported in the interviews where staff felt that they needed more information about mental health conditions and that they also needed more information about what services were out there and what the services do. They needed to understand what the referral pathways were for young person and what was their role in this area and how could they support the young person safely. They also needed to be able to give information out to young people about where they can seek help.

Several services highlighted the importance of bringing in guest speakers in the area of mental health and how this has supported them in their work. The importance of mental health weeks raising the issue of mental health also acted as a good conduit for mental health information.

Services


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A dominant theme within the interviews was the need for more accessible, age appropriate services for young people. Interviewees felt there needed to be more joined up thinking and working between the services for the better outcomes of young people. They believed it was hard to get young people to engage with services and when they do they have to wait in some instances months for a service and that is if they are deemed suitable for the service. Interviewees felt this was not good enough especially when a young person was in a crisis.

Interviewees raised a concern about the levels of young people who have been prescribed medication by G.P.s. While they acknowledge that some young people may need medication they felt there was a gap in alternative options being offered to young people. There was a strong belief that some young people are selling on their medication to other young people.

To fill the gap several services have started to employ their own counselling services and there were varied time allocations for this between services. There were also varied qualifications between these people, and while they all seem to receive external supervision there did not appear to be any clinical governance systems in place.

In the absence of services the youth worker is really left in a holding position. When this holding position was explored it really seemed to be that the service provided the young people with stability, food, and routine and that was the best they could do. When queried about how they are able to do it, the general consensus was that you just get on with it and do the best you can do.

“Youth Workers are often the first port of call when a young person is in crises, especially because of the relationship they have with the worker. Youth Workers should not have to wing it when they find themselves in this situation. Mental wellbeing with young people can be complex, but clear training as to how to respond, whether the issue is mild, moderate or very serious. Clear protocol across all agencies is absolutely necessary. A little bit like Child Protection (everybody is clear now what to do) to do nothing is not an option’’. Survey Respondent

Appendix A:


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National Youth Health Programme Mental Health Needs Consultation

Service: Interviewer: Interviewee:

1. Is your project/service/organisation a member of NYCI.

2. What kind of service/project do you work/volunteer for?

3. How many young people does your service/project work with?

4. From your experience of working with young people, what are the main five issues that affect young people’s mental health?

i. ii.

iii. iv. v.

Other:

5. From your experience of working with young people, what are the five most common ways young people deal with mental health issues?

6. How are these issues presenting in your project/service?

7. What supports are required by your project/service to meet the needs of these young people?

8. When working with young people about mental health 9. How easy or difficult do you find it to discuss mental health


Appendix B

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issues, does interaction take place on a one-to-one or a group basis? (you may tick more than one)

with young people?

10. Please describe why it is easy/difficult for your service/project to discuss mental health with young people

11. Please highlight any challenges encountered by you / your service/project in addressing the topic of mental health:

12. Do you use any resource materials (training resources, manuals, Journals, HSE reports, websites, etc) when you are dealing with issues around mental health with young people?

13. Does your service/project have any of the following policies/strategies/procedures/guidelines:

Health promotion Mental health Critical incidence Substance misuse Anti – Bullying Sexual Health Physical Health Spiritual Health Other ________

14. Please identify any good practice guidelines / policy which has been developed by your service/project to support your work in this area.


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Needs Assessment Organisations

1) Arklow Springboard *

2) Arklow Youthreach *

3) Hospital Youthreach *

4) Irish Girl Guides*

5) Kerry Diocesan Youth Service, Youth Reach Tralee *

6) Rush Youthreach *

7) Sligo CTC *

8) Youthreach Transition Centre *

9) Swan Youth Service*

10) Stoneybatter Community Training Centre *

11) North Connaught Youth and Community Service*

12) Foróige's Big Brother Big Sister Programme *

13) Tipperary Regional Youth Service*

14) St Vincent’s Trust *

15) Irish Red Cross *

16) Milltown Malbay Youth Reach *

17) The Vault- Arklow

18) Ferns Diocesan Youth Service

19) St Michaels Youth Project Inchicore

20) Roscrea Youth Reach *

* Health Quality Mark Organisation


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Youth Service Youth Reach Community Based Training

Centre

Uniformed Organisation

Faith Based Organisation

Specialist Organisation

Youth Club Other

107

25

11

39

12

52

20

72

What type of project/service/organisation do you work/volunteer for?

Anxiety

Stress

Body Image

Relationships

Family

Educati

onal Anger

Depres

sion

Sexuali

ty

Money

Alcohol U

se

Employm

ent

Drug Use

Self-H

arm

Suicid

al Th

oughts

Eating D

isorders

274 272264 260 257 254 253

235223 220

212199 192 189 185

167

7 715 17 17 14 12

37 40 37 33 3443

6073 78

From your experience of working with young people, do the fol-lowing issues affect the young people you work with?

Yes No

I do not know

Figure 3

Figure 1

Figure 2

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66

31170

How do you engage with young people who present with mental health difficulties?

One - to - one One - to - one

Group work Group work Both Both

Figure 4

66

31170

How do you engage with young people who present with mental health difficulties?

One - to - one One - to - one

Group work Group work

Both Both

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Lack o

f Trai

ning

Lack o

f Toolki

ts and Reso

urces

Lack o

f Funding

Lack o

f Inform

ation

Lack o

f Confiden

ce

Lack o

f Polici

es/Pro

cedures

/Guidelin

es

Difficu

lty Communica

ting with

Young P

eople

213190

173 169 161141

83

41 46 43

7589

77

155

14 2550

15 1540

21

Which of the following challenges have you encountered when work-ing with young people concerning their mental health.Yes

No

Unsure

Health Pro-motion

Mental Health Critical In-cidence

Substance Misuse

Anti-Bullying Sexual Health Physical Health Spiritual Health

188

159

199213

254

147159

9885

110

68 62

23

119106

160

Does your organisation have any of the following policies/strategies/procedures/guidelines? Yes

No

Figure 5

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youth health - national youth council of ireland · web viewone such partnership is with the...

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