Children in crisis
Olivia Carville meets Max, pictured with his mum (right), who fears our chronic shortage of public mental health services for kids will mean more young children taking their own lives
Max was 10 when he tried to kill himself and he wants you to know about it. It was the summer of 2014; Max was angry because he’d “lost control” after being kicked out — unfairly — from a game of handball at school. And he was upset because, in the heat of the moment, he’d hit one of his friends and shoved a girl.
Max didn’t need hospital treatment after his suicide attempt, but he told his classmates, his teachers and his parents that he wanted to die.
He was sent to a specialist mental health service by his primary school, but was turned down because his case wasn’t deemed severe enough.
Now a deep-thinking 13-year-old boy, Max has a message for Prime Minister Bill English.
“My mum tried really hard to get me help. She rang many places, places that advertise that they are available 24/7, places that advertise that they are there for you if you need them.
“Nobody was. Nobody believed my mum that I was 10 and had been serious about killing myself,” he wrote in a letter to the Herald.
“I worry that the taxes we are paying aren’t going to the places they should and we will continue to see a rise in child suicide because of this. I hope we can get Bill English to listen to us,” Max wrote, signing off with a smiley face.
Almost 2000 young people like Max were rejected or quickly referred on from specialist mental health services in New Zealand last year. That number, contained in documents released under the Official Information Act (OIA), grows every year.
So does the wait time, with kids in some parts of the country waiting up to six months for an appointment.
The Herald’s Break the Silence youth suicide series this week investigates New Zealand’s thousands of children in crisis; those threatening to become our next suicide statistics; those threatening to cement our position as the worst in the developed world for teen suicide.
The shortage of mental health services for children in New Zealand has been labelled many things during our research over the past few months: A child psychiatrist said it was a “chronic and systemic” crisis, a principal said it was an “absolute nightmare” and a mother who fears her son is either going to kill her or kill himself said it was a “frightening” national embarrassment.
Asked whether New Zealand was doing enough to help children struggling with mental health issues, the Ministry of Health’s deputy director of mental health, Dr Ian Soosay, said: “The obvious answer to that is no. It’s appalling. Our suicide rate is appalling. It’s something we all, as New Zealanders, need to address.”
An extra $224 million was pushed towards mental health in this year’s Budget. Health Minister Dr Jonathan Coleman was not available for an interview this week, but in an email from his press secretary Coleman said he was focused on doing more in this area.
But that isn’t enough for Max’s mum.
“The people who work at the ministry spend so much time having meetings and talking about the situation that they’re not actually listening to the people who have lived through it,” she said. “I spent hours on the phone trying to get my son help; I was screaming down the phone and I got no help. You can give your kids a sticky plaster when they cut their leg and you can tell them everything is okay, but from the age of 10 I couldn’t fix things for Max.
“And you and no one at that ministry have any idea what that feels like for a mother.”
English’s press secretary said he was not available to talk about children in crisis or Max’s letter this week.
The Child and Adolescent Mental Health Service (Camhs) is run by the Ministry of Health and caters only to the most unwell 3 per cent of the population. It provides specialist assessment, treatment and consultation for those with the most extreme mental conditions.
All other cases — those with mild to moderately severe problems — are looked after at family doctors or community centres.
That’s how the system is meant to work, at least.
Child psychiatrist Dr Arran Culver, who works for Camhs in Wellington, fears the entire model is flawed.
The system is based on the presumption that the rest of the services, those beneath Camhs, are running effectively.
“It’s all based on the belief that the whole system of care is working well,” Culver said.
And when it’s not, the whole system breaks.
As increasing numbers of mentally unwell children are referred on to Camhs each year, it becomes harder and harder to access the service.
Last year, 32,064 children and teenagers were referred to Camhs — a demand that has climbed by almost 6000 since 2012, according to data obtained under the OIA.
Increasing demand goes hand-inhand with increasing rejection. Last year, 1824 children and teenagers were turned down from Camhs — these rejection rates have climbed by 720 since 2012.
Schools and parents say suicidal children cannot even make it through the door unless they’ve got a set plan to kill themselves.
Government officials say this perception is “not factually accurate” because Ministry of Health policy says people in crisis need to be seen within 48 hours.
Our investigation found an apparent gap between policy and reality.
Dozens of parents who contacted the Herald said their mentally unstable children were turned down from Camhs because, in the words of one, they “weren’t suicidal enough”. They said they were steered towards community parenting courses or told to use a sticker chart to control their children.
”[My son] was saying that he should be dead and that nobody liked him and they said they couldn’t help him because he wasn’t bad enough,” one mother in Hamilton said.
“The inference was that he actually needed to attempt suicide to get looked at,” a father said.
“When it comes down to an 11-yearold talking about suicide and running into walls and threatening to kill himself, then enough is enough,” said a mother in Auckland. “You go to these services that are supposed to help you and think, ‘hang on a minute, you’re not even listening to me’.”
It’s not just parents. According to one principal, primary schools across New Zealand are at crisis point and “screaming out for help”.
Some particularly desperate principals are considering taking radical action to force the Government’s hand into providing urgent support because, they say, the alternative is child suicide.
Pat Newman, head of the Te Tai Tokerau Principals Association — a collective voice for 150 schools in the north — is contemplating advising all schools in the association to expel all students with severe behavioural issues so the Government can deny the problem no longer.
He said two primary school students, aged 9 and 10, in Whangarei had attempted suicide on school grounds recently and he couldn’t get either into Camhs. “That’s why we are screaming and yelling,” Newman said.
“I’ve been in the education sector for 40 years and it used to only be adults committing suicide, but then it came down to teenagers and now we’ve got primary school kids.
“[I’m] fighting to get help for these children, but it is impossible to get any mental health support. This school is not alone with regards to this need. And it’s not an education problem, it’s a health problem.”
There are no guidance counsellors based in primary schools in New Zealand, but the Ministry of Social Development funds social workers in schools and the Ministry of Education funds 800 national Resource Teachers: Learning and Behaviour, RTLBs, to work with children with behavioural and learning needs in classrooms.
While RTLBs deal with difficult children who may refuse to sit at their desk or throw tantrums or break school property, Newman said they were not trained “to deal with children who pick up a pair of scissors and try to stab themselves, other kids or teachers”.
Teachers played a “vital role” in helping students through emotional distress, said Katrina Casey of the Ministry of Education, but “they are educators, not mental health experts”.
Canterbury Primary Principals executive member Denise Torrey, who is also principal of Somerfield Te Kura Wairepo, said primary schools in the lower South Island were also “totally and absolutely underresourced in mental health for children”. She has eight students cur- rently waiting for mental health services and has been told they won’t be seen for 26 weeks — half a year.
“It’s a nightmare. We need some help. Our kids need help,” she said.
“I’m battling for these kids. I’m constantly trying to get them in somewhere and I’m really worried about my colleagues, they’re exhausted and fighting every day to help their students access services that don’t exist.
“We are at saturation frustration point.”
The cries for help have reached those in power and are being discussed behind closed doors at the top levels of government.
“The issue around school principals being concerned about the rates of mental health problems within their schools needs to be addressed and it’s one of the things we are discussing at the moment,” said Soosay.
“I wish we could instantly solve this, but the problem is that it’s not going to be instantly solved.”
Just as the solution to childhood obesity isn’t sending bariatric surgeons into primary schools, the
way to solve the mental health crisis is not asking psychiatrists and psychologists to man school gates.
It’s a societal problem — it doesn’t just rest with the Ministry of Health — and it needs to be solved through wider change. And that, Soosay said, could take decades.
Some cannot wait that long. Sarah, a mother in Mangere, is afraid her 14-year-old son won’t even make it to his 18th birthday.
At the age of 4 Jamie was chasing her around the house with a cricket bat and outlining elaborate plans to kill himself.
“I was in shock the first time he said it. I told him he didn’t even know what that meant, but he fully knew what it meant, he said ‘I’m going to die’,” Sarah said.
She read everything to try to help her son, but nothing worked and no one would help. Aged 8, he threatened to stab his primary school principal.
Jamie was referred to Camhs, but, like Max, wasn’t deemed severe enough to enter the system. Sarah was advised to use a sticker chart to try to control his behaviour.
He started damaging property, hurting other children, making up stories about being related to Miley Cyrus and even falsely accused two teachers and a social worker of assaulting him at school.
When Jamie was 12, Camhs told Sarah her son would likely be diagnosed with a personality disorder as an adult, but that there was nothing more they could do for him “at this stage”.
“What did they expect me to do? My kid was 12 and he’s going to be waiting for years to be diagnosed as an adult. I told them he’s having increased suicidal thoughts. I told them I didn’t see us getting through his teenage years. I said ‘Please, tell me how to help him!”’
Again, she was told to use a sticker chart to monitor his behaviour.
Sarah ended up on antidepressants, her marriage broke down and Jamie was kicked out of high school.
She now has locks on every cupboard in the house so he can’t access the knives. She’s installed locks on her and her 9-year-old daughter’s bedroom doors so they can hide during his tantrums. And these are no normal teenage tantrums, Jamie has cracked walls, ripped out plants, broken concrete fences, tried to set the barbecue on fire and strangled his sister.
“He’s 14 now and he’s bigger than me. When he was little I could put him in a bear hug and hold him and try to calm him down. Now there’s no way I can do that,” she said.
“I’ve spent nights worrying that he is going to stab me in my sleep. I’ve spent days worrying if today is the day he follows through on his plans to kill himself. I can’t get any help for him.
“I will be amazed if we make it to 18 without a criminal record or suicide.”
An official document sent to Health Minister Jonathan Coleman from his ministry officials in March this year states that Camhs is “experiencing significant demand pressure”.
“Many district health boards are reporting that their Camhs is under considerable demand pressure. The scope for further improvement in the Camhs sector is limited and the gains are now flat-lining,” the document said.
To translate, that means they’re struggling to help any more children within the current resource pool.
Almost 1500 people aged 19 and under had to wait more than eight weeks for a non-urgent mental health appointment last year. This increased by 174 from the previous year. Among those aged 11 and under, 753 had to wait more than eight weeks for an appointment. This increased from 706 in 2015.
Those who work in the sector predict the wait times will continue to worsen.
“It’s awful knowing people are having to wait for these services, because often while somebody is waiting their problems are getting worse and we deal with the parents’ distress when we do get to see them,” said Culver, who also represents the Royal Australian and New Zealand College of Psychiatrists.
“Everybody is working very hard and we are trying not to burn people out, but there is a lot of burn-out in the sector.”
New Zealand now faces a “chronic and systemic lack of services for children”, Culver says, and there is no quick fix.
First, Camhs is significantly underfunded, he says. It gets about 13 per cent of the total district health board specialist mental health funding, but is expected to meet the needs of all those aged 19 and under — about a quarter of the population.
“If we were getting a fair slice, we should be getting 25 per cent of the overall funding because we are seeing 25 per cent of the population,” Culver said.
Second, there is increasing demand and a growing number of children “presenting with more complex issues at younger ages”.
Third, Culver pointed to the limited services in schools — particularly primary schools.
And finally the “patchy” and under-resourced family doctors and community services that are expected to handle mild to moderate cases, but have no confidence to do so.
“If I was going to be blunt, I’d say we don’t value children. We don’t prioritise children for their mental health needs and this is largely a hidden problem because people don’t want to talk about it.”
Kawharu Kingi was a kid who couldn’t get help. Now 26, he started having problems aged 7. He was called naughty because no one knew what was wrong with him.
A private psychologist diagnosed Kingi with ADHD, ADD and Asperger’s, but he was never referred into the strained public mental health system because he was never deemed bad enough. Not when he was expelled from primary school for stealing the deputy principal’s laptop. Not when he was expelled from high school for hacking the computer system to pull exam results.
His parents couldn’t afford to continue to pay the private psychologist fees, so Kingi was left to his own devices.
Aged 14, he started self-harming. Aged 15, he attempted suicide. Aged 16, he fled New Zealand and moved to Britain on his own.
“I feel like the system [ in New Zealand] never really helped me,” he said. “I couldn’t connect with anybody because nobody took me seriously.”
If Max, Jamie and Kawharu can’t access Camhs, who can?
The Parents of Children with Additional Needs Collective carried out a survey of 100 parents who have struggled with these services and found at least half felt their child was at risk of suicide. They shared strikingly similar tales of woe:
“I was dismissed and told to do a parenting course.”
“They gave me a brochure and said go to a parenting class.” “Denied us help.” Many of those parents have quit work to stay home and care for their kids because they say the schools and the system just doesn’t know how to.
Tracey Rountree is one of those parents. Her son was 6 when he first said he wanted to die.
“I was beside myself. I didn’t know what to do. I had a 6-year-old boy saying he wanted to die and we couldn’t get access to these services.”
Aged 8, he was stood down from primary school for throwing things at other children.
He was referred to Camhs three times; once by a paediatrician and twice by a Ministry of Education psychologist.
“I was tearing my hair out to get him into Camhs and when he was [finally] seen I was just told to go to a parenting course.”
When Max’s mother exhausted all other options to get her son into the public system, she too turned to a private child psychologist, even though she couldn’t afford it. (Appointments can cost about $400.)
After speaking with Max for an hour on his first visit, the private psychologist said he didn’t want to charge, telling his mother: “There should be something in place for these children.”
He suggested she exaggerate the truth to get Max into Camhs. “You need to tell them that he’s cutting himself, that’s the way to get him in.”
Last June, Max was rejected from Camhs again and sent back to his GP for help.
In his letter to the Herald, Max said he had been referred to specialist mental health services seven times and they “continue to reject me”.
“I worry that other kids are going through what I went through and still go through. I worry that their parents are as upset as my parents are at the lack of help. I agreed to speak to you and put my story out there to try and help these other kids,” he wrote.
The Herald was provided Max’s last rejection letter from Camhs. It simply said: “Max does not require secondary mental health services. We will now close Max’s file.”
● Some names have been changed to protect the identity of the children in this story.