ERASING THE FUTURE

Arguably the hardest hit generation by the COVID-19 pandemic is Gen Z – those whose adult lives have barely begun. While negotiating school, university, first jobs and relationships, teenagers and young people are understandably fretting about their future – and the rising suicide rate within this cohort reflects their anxiety.

I was on an early morning run before work when I was forced to detour around police tape cordoning off the path. I glimpsed sombre, uniformed figures beside an ambulance, its sirens silent. At home, I was shocked to learn that a teenager I knew had ended his life.

I remember Sam* as a blondhaired kid bent over a book following the words with his finger. Years ago, I volunteered one morning a week to help with reading groups in my daughter’s class and Sam was assigned to me. Now at 16 years of age, his future has been erased. The thought sends a shiver through me.

At the beginning of the pandemic, we were advised that children are invulnerable to the impacts of COVID-19. As a general practitioner working at the coalface, I am seeing the mental health impacts on our teenagers, a spiralling caseload that will have devastating long-term consequences. This cohort is presenting more frequently to general practice with depression and or anxiety. Too many no longer see a future worth living for.

It is the end of a particularly challenging week when I am asked to squeeze in a consultation with 14-year-old Jane* who admitted to pervasive thoughts about suicide. After assessment in a hospital emergency department, she was sent home with a letter recommending follow-up by her general practitioner. Jane had then consulted with one of my colleagues a few weeks earlier. She has a mental health plan in place and her first appointment with a psychiatrist is in one month’s time. The problem is that she needs support right now. A month’s time may be too late.

She slumps in the chair beside my desk, head deep inside her jacket, only her eyes visible above her mask. Mum sits forward in her seat, her eyes pleading, wanting reassurance I can keep her daughter safe. I long to understand what is happening behind Jane’s pale face and the blank stare of eyes trained firmly on her feet.

SCARS ETCHED INTO THIGHS

She has presented to hospital three times in the past month with suicidal ideation and one attempt. There are scars etched into her thighs, her forearms, her history told in ugly cuts and lines, hidden behind long sleeves and shame. I cobble together her story between mumbled, masked words. She was gregarious once, had a group of friends who did things, went out and enjoyed dancing. Intermittent lockdowns and uncertainty have left her anxious and depressed. Her grades have slipped from a solid B to a low C.

She doesn’t see the point in things any more. What is startling is that she is discharged after each presentation to the emergency department. It is difficult to envisage another life-threatening medical scenario where a teenager would be sent home.

Jane’s family are well resourced and supportive. They can access psychological services and fund a private psychiatrist. Despite this, the waits are often several months’ long, a gap with potentially devastating consequences. Even with a mental health treatment plan, the out-ofpocket fees to see a psychologist can be expensive and paying for 10 visits is out of reach for many families. Jane has not slept for five days now. She is pale, a little dehydrated. She has no interest in food and has lost five kilograms. I cross my fingers and ring a psychiatrist for advice. He suggests anti-psychotic medication for sleep and agrees to see her early next week. With her permission, I keep in touch over the weekend with texts to see how she is going, and to reassure myself she is still alive.

Around one third of all deaths in people aged 15-24 are due to suicide. Research indicates there are 100-200 suicide attempts for every single suicide amongst young people. Our teenagers are the future, the next generation preparing to take their place in the world. These statistics are truly horrifying.

Earlier on the same day, I did a mental health plan review for another teen, Tom*. He is 15, and has struggled with anxiety for some years. He has learnt good strategies for managing the panic that often paralyses him, but the current climate of uncertainty has overwhelmed his internal resources.

He enjoys musical theatre and dance, used to attend classes, had a network of friends. His mother works casual shifts in hospitality. His father’s small travel business is obsolete, with mounting expenses and no prospect of income in the foreseeable future. They can no longer afford to send him to dance classes and are struggling to pay bills. The family are supportive, close knit. His older sister recently completed school.

Tom attended sessions at Headspace (a non-profit organisation for youth mental health) but the counsellor he liked has moved on. Tom is not prepared to tell his story again and refuses to return. His family cannot afford private services and his mental health is deteriorating with no prospect of consistent, ongoing support. He sees the future as bleak and pointless, and he ruminates about not being here any more.

I sit next to him, and we work our way through an app developed by mental health organisation Beyond Blue called Beyond Now. Together we fill in each prompt, find small things that may pause the incessant noise in his head. He lists some of his favourite musicals. His happiest memory is saving up to see Chicago with friends. We agree that when waves of panic threaten to overwhelm him, he will listen to his favourite soundtrack. We arrange to meet up in a week, to consider if medication will help.

SO MANY STRUGGLING

The Headspace National Youth Mental Health Survey of more than 1,000 Australians aged between 12 and 15 indicated that one in two have reported a decline in wellbeing that impacted their ability to carry out their usual daily activities since the pandemic and lockdowns started in 2020. Half of our next generation. Surely that is a national crisis, one that requires urgent, immediate attention.

Lucy* is 16 and new to the surgery. I saw her mother a week earlier. They were forced to leave their home due to domestic violence. Unable to afford accommodation, they are living with an elderly aunt where there is little privacy. Lucy is struggling to find a foothold, misses her friends, is unable to get out of bed some days.

Lucy confesses she has started harming herself, and is finding it hard to stop. It is the only thing that gives her release. The recent move has severed her from a vital resource – friendship with peers, being part of a tribe. This is compounded by a history of domestic violence, further exacerbated by financial stress and the threat of homelessness.

We decide to focus on her insomnia, an important risk factor for poor mental health. I prescribe short-term medication to break the cycle of sleeplessness, discuss sleep hygiene. She agrees to make an appointment in a week, and is happy for me to send her a daily text to touch base.

The Federal Government has invested $5.7 billion in mental health support in 2020–21, and a National Youth Policy Framework is currently under development. In the words of Federal Health Minister Greg Hunt, the pandemic “has had an unprecedented impact on the lives of young people across Australia.”

Jane is now seeing a psychiatrist, who manages her drug therapy, and a psychologist, who provides counselling. She also checks in with me every other week. She still has more bad days than good, but she is taking medication, her suicidal thoughts are less pervasive, and she finds the strategies suggested by her psychologist helpful.

She is fortunate to have access to a number of supports to help her navigate her way out of the dark space she finds herself in.

Tom’s parents agree to let him use the garage to choreograph dances to his favourite songs. We continue to set short-term goals, celebrating every small achievement. His father has found some casual shifts stacking shelves at a supermarket.

Lucy is keeping in touch with her old friends via social media and has a boyfriend now. She has chosen to drop out of school for the time being and is considering distance education next year. I am worried that her opportunities are slipping away and feel helpless to make a difference.

One local school principal keeps a list of students whom she knows are vulnerable and when they don’t turn up, contacts them, encouraging them to attend school. Imagine an initiative where more of us regularly touched base with our teenagers, sent a text just to check in and let them know we are available if needed. Every kind word and genuine effort to reach out is a positive step towards filling the gaps in mental health care for this vulnerable group.

The long-term impact of the pandemic on mental health continues to shadow our current cohort of teenagers. This crisis is too urgent to wait for much-needed changes in our mental healthcare system. If this generation of youngsters are to emerge as resilient adults, we need to find creative ways to check in with them, to listen with acceptance and an open mind, ask them to imagine possibilities for a post-pandemic future, then work with them to make it happen.

On my morning run a couple of weeks later, I pause at the spot where Sam died. It is marked with a small shrine, bunches of flowers in cellophane laid by those who love and remember him. I do not know his story and wonder what intervention might have touched him, nurtured him through his despair, given him hope. His death has a ripple effect on every one of us. We cannot afford to lose our next generation, for to lose them is to erase the future.

“JANE’S MUM SITS FORWARD, HER EYES PLEADING FOR REASSURANCE I CAN KEEP HER DAUGHTER SAFE.”

DR JO SKINNER