A decade ago, students used to see the school guidance counsellor about a huge variety of issues. These days, however, the bulk of the work involves more severe cases including children with high suicidal risk, mental health issues and family violence.
Mental health dominates the counsellors’ workloads. In the last 10 years Christchurch secondary school counsellor Sarah Maindonald has noticed a significant shift in her practice. “A third to half of my workload is now around mental health and well-being.”
“For a lot of kids it’s about not feeling good, feeling stressed, not coping with NCEA. You’ve just got to have one or two other stresses in the mix, like a family separation, problems at home or the loss of a significant person or post-earthquake issues, and it can really increase their risk.”
News stories about the acute crisis of anxiety faced by New Zealand children and young people have become depressingly commonplace.
But they still have the power to shock, such as the fact that New Zealand’s youth suicide rate (teenagers aged between 15 and 19) is the highest among 41 OECD and EU countries.
Between July 2017 and June 2018, eight New Zealand children aged 10-14 and 53 teens aged 15 to 19 killed themselves.
According to the Wellbeing and Mental Distress in Aotearoa NZ’s 2016 Snapshot, a third of 15 to 24-year-olds had suffered medium levels of psychological distress, while the latest New Zealand Health Survey found the numbers of children (2-14 years) diagnosed with anxiety or depression has increased since 2015.
So why is this happening and, as Ponsonby Intermediate guidance co-ordinator Rachel Maitland-Smith puts it: “With our rates of suicide and depression, why aren’t we doing something?”
It can be difficult to pinpoint the exact reason that increasing numbers of children are experiencing mental health issues, says Mental Health Foundation chief executive Shaun Robinson.
It is possible, he concedes, that these days we are better at diagnosing.
“It could be that parents, teachers and whānau have greater awareness of the signs and symptoms to look out for, and that younger kids are better able to express themselves and their emotions.”
But the increase could also be due to social factors, he adds, such as adverse childhood events including family violence, bullying, poverty, sexual abuse and social exclusion.
“IT IS ALSO COMMON FOR YOUNGER CHILDREN TO BE FIGURING OUT WHO THEY ARE AND WHAT’S NORMAL FOR THEM, AND THEY OFTEN FACE PRESSURE TO FIT IN FROM PEER GROUPS AND AT SCHOOL.”
New Zealand children are under more psychological distress than ever, says Maindonald, and that’s symptomatic of the family pressures around them, as well as social issues.
“When families get under stress, these increase things like addictions and mental health issues so it becomes a cyclic storm that you end up being in the middle of.
“You’ve just got to add the family violence rates and child abuse rates and it’s no wonder that children are distressed in our country.”
It’s not just people struggling socially who experience mental health issues. A large number of the students Maindonald sees come from families “that are highly functioning but are really stressed out, so there’s a real mixture”.
Internationally children and adults are suffering higher rates of mental health, particularly in Western countries. “There’s something about the way we are living that possibly promotes disconnection and isolation for people.”
Social media can exacerbate this, she adds.
Maitland-Smith has noticed “a definite rise” in children suffering anxiety and having panic attacks in the last couple of years. She agrees that technology “plays a huge part”.
Of the 80 students she sees in a year, just under one-fifth have serious anxiety.
There are a lot of reasons why anxiety happens, but, these days, “kids are not switching off the same”, says Maitland Smith.
“They’re going home and wanting to know all the time what’s happening online. Parents are anxious too and kids model off what they see in their parents.
“Anxiety comes from when something is happening that is unknown, or we’re not sure about what’s going to be happening, so lots of kids get quite worried when they’re not sure what is coming up, they always need to know what’s happening.”
Most people who experience mental distress will have their first experience before the age of 25. So early intervention is important, says Robinson, as, with the right support, recovery is possible.
“This should include learning skills and tools that will support and sustain them throughout their lives. We should be promoting positive mental health and wellbeing strategies to all New Zealanders from a young age to help prevent mental ill health.”
The Government has promised a review of the mental health system, yet while this takes place, thousands of vulnerable young people are seeking mental health help and can face long wait-times.
According to Ministry of Health data released last month nearly 17,000 under-18s needed mental health help between April 2017 and March 2018.
More than a third of those children and teenagers (5008) waited longer than three weeks to see mental health support services, while 1554 had to wait more than two months.
Despite this, Robinson says it is “heartening” to see that the Government has stated a commitment to increasing mental health support in secondary schools, piloting counsellors in primary school and providing free counselling to under-25s.
More resource and funding has also been put into high-need areas such as Canterbury, he adds, where mental health professionals, counsellors and community workers have begun working in schools to support the wellbeing of children living with the after effects of the earthquakes.
Maindonald is concerned that secondary schools, where the most high-risk students tend to be, are losing out under these programmes.
For example, the initiative to provide 80 mental health workers to help Canterbury schools, Mana Ake (Stronger for Tomorrow) is “great”, but because they are attached to Kāhui Ako, or clusters of education providers, the resource is too thinly spread.
“We are the only secondary school in our cluster of five schools and we are not sure we will see much of that resource”.
Mana Ake practitioners are outside of the schools, meaning students could be less likely to seek them out, she adds.
Robinson would like to see schools actively promoting the Mental Health Foundation’s Five Ways to Wellbeing – Give, Connect, Take Notice, Keep Learning and Be Active – and enabling young people to practice these in their day to day lives. These five actions “have been proven to improve wellbeing in everyday life”.
“If we fail to support people from a young age and get them any help they need and deserve it will certainly have flow on effects throughout their lives and lead to poor mental health and wellbeing.”
The Ministry of Education recommends a range of ways that teachers and parents can access mental health support for students. These include families seeking support directly from the local District Health Board (DHB) via their GP, to additional support from Child Development Services and Child and Adolescent Mental Health services.
Teachers, too, play a vital role in promoting wellbeing but they are educators not mental health experts.
Trained school counsellors are the frontline for helping students and evidence-based research has shown school counselling reduces psychological distress.
In 2013 an Education Review Office (ERO) survey found that school guidance counsellors were the first person students wanted to talk to about mental health, family violence, drug and alcohol issues and sexuality.
Yet, around the country, counsellors are “incredibly over-worked” and desperately under-resourced, says Maindonald.
This is both in terms of caseloads and the severity of the mental health issues presenting.
If the current average ratios of counsellors to students remain at 1:1000, then students will continue to struggle to access adequate support, she says.
A return to the pre-Tomorrow’s Schools ratio of one counsellor for every 400 students ratio “would at least give all young people an opportunity to connect and talk”.
With greater staffing, counsellors could also return to doing crucial preventative programmes including group work.
But the situation doesn’t look likely to change any time soon.
Delegates voted to reject the pay offer at the Post Primary Teachers’ Association (PPTA) annual conference in Wellington last week. The PPTA had hoped the Government’s offer would include a new working party to look at the staffing levels of counsellors.
However, some counsellors say they are skeptical about the idea of another working party.
The last working party, set up in 2014 following an ERO review of guidance and counselling, repeatedly recommended upping staff levels but its calls went unheeded by the previous government.
Maindonald, who was part of the earlier working party, says the suggestion of yet another one has left her “fairly cynical”.
“Addressing staffing ratios was the number one recommendation from the ERO review. Yet Cabinet in the previous government would not entertain it, despite both ERO and the working party raising it repeatedly.”
Counsellors had been “optimistic” things would change under the new Government, she says. “Let’s hope this is more than a placatory offer”.
In the current climate, counsellors are often forced to prioritise mental health crises (those with high suicidal risk and mental health issues).
Prior to the Canterbury earthquakes, Maindonald would make three or four specialist referrals a year to mental health services under the District Health Board, now it’s every week – and not just in Canterbury.
“THERE HAS BEEN A HUGE INCREASE, AND THAT IS ACROSS THE COUNTRY. IN CANTERBURY THIS IS EXACERBATED BY THE STRUGGLES PEOPLE ARE FACING POST EARTHQUAKES.”
Rachel Maitland-Smith advocates an “across-the-board” counselling programme in all schools – including primary and intermediates. “It’s quite ad hoc at the moment, I’d like to see that change.”
The ECE curriculum, Te Whāriki, and the New Zealand Curriculum/Te Marautanga o Aotearoa have a strong focus on wellbeing and mental health.
Many schools and ECEs use the evidence-based programmes and tools from the Positive Behaviour for Learning (PB4L) suite of initiatives.
Schools and ECEs have access to social workers and youth workers (funded by Oranga Tamariki) and in-school public health nurses (funded by the Ministry of Health).
Ministry of Education deputy secretary of sector enablement and support Katrina Casey says the MoE works closely with other agencies, including Oranga Tamariki, Child Development Services, Child and Adolescent Mental Health services, Paediatric and Outpatients (District Health Boards), “to ensure that students and their families get the right support”.
But there needs to be “a fundamental shift” in the way that young people are supported, says Maindonald. “We are still pretty much in that view of pathologising psychological stress as a mental illness.”
Students with clinical depression and anxiety will always need appropriate support.
However many in the mental health professions have identified that a lot of children they are seeing are suffering from huge social distress and lack the skills to cope.
“Their parents are under stress and some of the basics that need to be present in family life are missing.
In response Maindonald advocates a “strength-based and relational” approach.
That way, counsellors and schools can work with children in that early intervention stage.
“If we can get in early when they are first starting to suffer from some signs of psychological distress and they’re feeling isolated and disconnected, so that it doesn’t just increase and increase and they end up with full-blown depression.”
When families and whānau are supported there is likely to be a more positive outcome. Counsellors can refer students to the mental health service, for instance, but it is up to their families to take them to appointments.
“Parents feel shame, they feel pathologised when they are going into a mental health system, there’s still that kind of stigma. We’ve got to find a way that is a bit more strength-based to help families who are struggling.”
It’s not simple, she adds.
“But I do think we would have the answers if we were thinking a bit more outside the square and we were well-resourced.”
Mental Health Awareness Week (MHAW), runs from 8–14 October 2018. This year’s theme is Let nature in, strengthen your wellbeing – Mā te taiao kia whakapakari tōu oranga
Where to get help:
If you are worried about your or someone else’s mental health, the best place to get help is your GP or local mental health provider. However, if you or someone else is in danger or endangering others, call police immediately on 111.
Need to talk? Free call or text 1737 any time for support from a trained counsellor.
Or if you need to talk to someone else:
Asian Helpline – 0800 862 342
Lifeline – 0800 543 354
Suicide Crisis Helpline – 0508 828 865 (0508 TAUTOKO)
Youthline – 0800 376 633 or free text 234
Kidsline – 0800 54 37 54 (for under 18s)
What’s Up – 0800 942 8787 (for 5–18-year-olds 1pm–10pm weekdays and 3pm–10pm weekends)
Depression Helpline – 0800 111 757 or free text 4202
Samaritans – 0800 726 666
OUTLine NZ – 0800 688 5463
Healthline – 0800 611 116