Shocks to the system mean bundles of nerves
Since the Canterbury quakes, mentalhealth services have struggled to cope.
Three-year-old Luke had a plan. With a small spade in hand, he would dig a hole in the preschool sandpit big enough, he told his mother, Kathryn, to bury the earthquake. A sweet strategy doomed to failure. As the aftershocks rolled through quake-hit Canterbury and as other children exhibited signs of stress, Luke showed increasing symptoms of anxiety: nightmares, persistent bedwetting, fear of loud noises, clinginess when starting school.
“He held himself together at school, but at home his behaviour was horrendous,” recalls Kathryn. “He was very anxious. He just didn’t seem happy and he didn’t seem to be doing a lot of learning.”
On a family trip to the Air Force Museum of New Zealand at Wigram, the unexpected audio of World War II bombers triggered an extreme reaction.
“He screamed and screamed. He was yelling at everybody to get out of the building – he was just beside himself.”
When Luke started at Mairehau Primary School five years ago, he was one of a cohort of Canterbury children whose limited experience of the world was dominated by the earthquakes and their aftermath. Now, new research by Kathleen Liberty at the University of Canterbury School of Health Sciences is showing that as many as one in five Christchurch primary school children born between 2007 and 2010 have symptoms of post-traumatic stress disorder.
Alongside a catalogue of stomach aches, headaches and eating problems, three-quarters of children had trouble sleeping, just under half were experiencing nightmares and more than 40% were displaying “high behaviour problems” and hyperarousal symptoms – biological reactions triggered by the autonomic nervous system that regulates stress reactions and the amygdala, part of the brain’s limbic system responsible for emotion regulation. While girls tended to be clingy, boys were restless and irritable, often cut off from support strategies because of the assumption they were “just being naughty”.
“When children’s ability to learn coping skills has been affected, school is just more and more stress,” says Liberty. “We saw a huge number of children getting worse over time, not calming down.”
In an office still bearing the scars of Canterbury’s earthquakes, Mairehau Primary School principal John Bangma describes new entrants who are anxious, hypervigilant, oversensitive, distractable. Many began their school year without the
usual basic understanding of letters, colours and numbers. “We have always had children who were quirky, who did not fit into the mould, but we were having lots of children like that.”
Mairehau Primary is one of 13 Canterbury schools adopting a range of strategies recommended by Liberty aimed at calming down the classroom environment. Low-hanging decorations have gone; windows have been de-cluttered of artworks; the school routine has been changed so children hit the playground before eating morning tea or lunch; and parents are encouraged to give their children healthy snacks and lunches, adequate water and omega-3 supplements.
The results so far are good: children appear calmer, less wired for sudden flight, more ready to learn – the proportion of those reaching National Standards jumped from 68% to 82% over two years. Luke is more confident, says his mother, and better able to cope with the school day.
But across the region, the demand for mental-health services remains high. Demand for child and youth services has doubled since 2010; mental-health assessments undertaken at Christchurch Hospital’s Emergency Department have jumped 150%; the number of adults seeking community support has grown by a third. Doctors, community workers and Canterbury District Health Board professionals report adult inpatient beds full to overflowing, support networks buckling under their own stress, overburdened community health organisations and a system stretched by damaged building stock and new building projects.
“For us, it was three years and thousands of aftershocks,” says Canterbury DHB clinical director of child, adolescent and family health Harith Swadi. “We had no idea when it was going to end. We are talking about chronic toxic stress.”
Such stress can trigger depression, anxiety, alcohol problems – he says quake-hit Cantabrians saved the alcohol industry – and trip the genetic switch for conditions such as schizophrenia. “Your whole system becomes more vulnerable to infections – mental illness, heart disease, increased cancers.”
In her central city office, Sue Ricketts, general manager of Christchurch’s Mental Health Advocacy and Peer Support, describes a growing sea of unmet need as people too unwell for a 10-minute GP consultation yet not ill enough for specialist mental-health services find themselves with nowhere to go.
Funding has not keep pace. Because of a short-term drop in population and the red-zoning of some low-income areas, Canterbury’s share of the main national health pie fell. This despite a resurgence of the population, escalating costs of new building projects and repair and a predictable increase in mental illness. As the Prime Minister’s chief science adviser, Sir Peter Gluckman, said in 2011, psychosocial recovery will be a long-term process. Although most people will recover in time, he wrote, 5% or more “will have ongoing significant psychological morbidity requiring professional help”.
The DHB stepped up, co-funding counselling sessions through GP services, leading the Government-sponsored All right? well-being campaign and instigating a school-based mental-health team.
The previous Government chipped in with an extra $20 million for mentalhealth services, but further requests for more financial help were turned down and the deficit continued to climb, from $18 million in 2014/15 to nearly $58.5 million this year.
Such chronic toxic stress can trigger depression, anxiety, alcohol problems – he says quake-hit Cantabrians saved the alcohol industry.