Teen Counselling Service has an average waiting time of 103 days for assessment A new report on teenage counselling underlines why adolescent psychiatry needs urgent funding. Kitty Hollandreports.
The speciality of adolescent psychiatry needs to be urgently developed here, a senior child and adolescent psychiatrist has said.
Dr Martin O'Sullivan, who works in both the Mater Hospital and St Vincent's Hospital, Fairview, was speaking as the only dedicated teenage counselling service reported its phone lines had been "inundated" after it published its annual report last week.
The Teen Counselling Service, which is offered by the Dublin Archdiocese social care section, Crosscare, provides counselling to people aged 12-18, and to their families where appropriate, in five centres in Dublin.
For the first time since it was established in 1973, it published its annual statistics at a public event.
"We put our head above the parapet," says Mary Forrest, director of counselling. "The next day we had hundreds and hundreds of calls from people all over the country asking how they could get into the service. We had to tell them we only serve our catchment areas and had to advise them to go to the local HSE or GP."
The service already has a growing waiting list with average waiting time for an initial assessment now running at 103 days.
O'Sullivan is not surprised at the flood of calls to Teen Counselling, given the paucity of dedicated services for teenagers, particularly in the 16-18 age group.
"It's a real problem," he says. "It's a problem culturally for those people who are not quite children and not quite adults."
It is well known that child mental health services are there for the 0-16 year-olds and adult services for the 18 years-plus. But added to this is that fact that both services are under-resourced, says O'Sullivan, and so tend to focus on either young children or older adults.
"Child services are not adequately resourced to look after that chunk of their client base [12-16 year-olds], and that chunk needs a lot of work, and is presenting with a potentially heavy burden on the service."
Those running child services will tend to see "that chunk" as involving crisis-management, firefighting and dealing with suicidal tendencies, he says.
"My personal take on it is that we should be developing a specialty in adolescent psychiatry. While there are some in day hospitals, it is very difficult in specific areas where adult services are also refusing to see adolescents between 16 and 18 years of age."
Some may find their way to an assessment via A&E, particularly if the young person has harmed themselves, he says, but these are not set up either to be outpatient psychiatric services.
"In some cases if a family has resources they may access treatment privately. But it is a mess. And it needs resolution."
Though the headlines that spring from the Teen Counselling report is the fact that half of the 248 clients last year were abusing alcohol and almost 10 per cent of them planned to commit suicide or 14 per cent were thinking about it, perhaps the most encouraging message is how important their parents actually are to them. Teenagers are actually not an out-of-control, mysterious, law unto themselves and they put a lot of stock in their parents.
The majority of the clients (60 per cent) were referred by family members, usually their mothers.
"The key relationship for teenagers is with their parents and we are probably the only service that involves the parents," says Forrest.
"Two counsellors see both the teenager and their parent or parents together in the first session, and then the counsellors will separately see the young person and the parent."
This means the services can work with each "party", with a view to improving communication and understanding and unravelling issues.
As Forrest describes some of the work the counsellors do and issues that come up repeatedly, it sounds almost like marriage guidance counselling. "Well, it is relationship counselling," she says.
There is sometimes resistance from parents to receive counselling themselves but most, she says, "buy into it".
The behavioural issues at home or school that may have prompted the teenager's referral - such as moodiness, being withdrawn or conversely being aggressive or surly - may actually be about an issue they are having difficulty processing.
This could be caused by bullying, a bereavement, parental separation or moving away from friends.
"For the teenager, often they just need a space to process that undigested lump in their chest - whether it's been caused by anger, grief, frustration. They may not have the words to articulate the feelings for themselves."
Some, particularly teenage boys, feel they cannot express vulnerabilities or fears.
One young man who attended the service in west Tallaght and who was "in considerable trouble with the gardaí", says "I can talk about things here I wouldn't dream of saying anywhere else."
Most importantly, Forrest says, they want to be heard and to "know they are connected" to their parents. She describes as "hugely important" that parents take time to talk to and with their teenagers, and not at them.
While teenagers may say they don't want to hear from their parents, that they want to get out of the house and be with their friends, they actually need to know there are boundaries - albeit negotiated ones - and that their parents love and value them sufficiently.
"A lot of what's happening is a natural part of preparing the young person, who is not quite an adult yet, to leave the nest; it's about equipping them to take risks, but not overreacting when things go wrong; not grounding them because their friend got drunk; and resourcing them for all that," says Forrest.
She says that while the "emotional journey" of being a teenager is the same as ever, the world has changed, in many ways for the better.
There is no longer a shame about having your parents split up. While mobile phones have made it easier for young people to be independent, their parents have the reassurance of being able to keep track of them.
"Although . . . too many parents abuse that, phone their teenager 10 times when they're out at night and so drive them crazy," she smiles.
However, there are now fears about random violence and more alcohol abuse.
"We try to help the parent hold that anxiety in control and rather than overprotect, talk to their teenager about what they would do in certain situations, how would they react if they saw five lads looking threatening or what they'd do if they missed their last bus home.
"It's about being a adult to them and preparing them for adulthood."
She says there is "clearly a huge need" for far more dedicated adolescent counselling services throughout the State.
O'Sullivan agrees, saying adolescent services need expansion, adding that their being so under-resourced means those in the field don't have time to be innovative.
"I worked in Southwark in London and I had about half the caseload I have now. And I worked very hard in London."
Adding a word of caution however, he adds: "It would probably be a mistake to assume that creating hundreds more mental health teams will solve everything. The pace of societal change is such that services can't always keep up.
"It's an issue of looking at our community too."