‘The level of self-harm and suicide among young people is a very serious issue’

A school-based pilot programme which has been shown to counteract the incidence of depression and self-harm among teenagers in Cork and Kerry should be rolled out across every second-level school in the country, according to one of the country’s foremost experts on the issue.

We are not sufficiently prioritising mental-health services for young people, according to Prof Ella Arensman, who has just published a guide to mental health, depression, self-harm and suicide in Ireland, An Understanding of Suicide and Self-Harm, in conjunction with health insurer Laya (layahealthcare.ie/thrive).

"The level of self-harm and suicide among young people is a very serious issue," warns Prof Arensman, who is research professor with the School of Public Health, University College Cork, chief scientist with the National Suicide Research Foundation (NSRF), and an expert adviser to the World Health Organisation.

She believes a school-based intervention, which has proved successful both on an international basis and in two counties in Ireland, should be introduced to help counteract these problems as a matter of urgency.

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The programme should be implemented across Ireland's second-level education sector so as to reach teenagers at a crucial time in their personal development, according to Prof Arensman, who pointed to a 22 per cent increase in self-harm in children and teenagers aged 10-14 years between 2007 and 2016. Other statistics show the suicide rate among young people aged 15-19 in Ireland is the seventh highest of 33 European countries, while in Ireland, the highest rates of self-harm are consistently recorded in young people, according to the NSRF National Self-Harm Registry Ireland 2017 Annual Report.

Ireland lacks "an effective mental-health programme at both primary and second-level education," says Professor Arensman, who has been involved in research and prevention of suicide, self-harm and related mental-health and social issues for more than 30 years – in Ireland, she played a key role in developing the first and second Reach Out: Irish National Strategy on Suicide Prevention 2005-2014, and Connecting for Life 2015-2020.

Deep concern

The failure to sufficiently prioritise the problem was a cause for deep concern she says.

Although at primary-school level, more work needs to be done in terms of effective mental-health interventions, she says international research has highlighted the efficacy of a second-level-school-based intervention, Youth Aware of Mental Health (YAM), which had been associated with a “significantly lower” number of subsequent suicide attempts and suicidal thoughts.

YAM, which is targeted at 14-17 year-olds, was originally piloted in a number of second-level schools across Cork and Kerry in 2009 and 2010, as well as across 10 European countries including France, Germany, Hungary, Italy and Spain as part of a larger, international mental-health research initiative.

A universal mental-health awareness programme, which in pilot form, was delivered in classrooms over a four-week period, YAM included role-play sessions, interactive lectures and workshops.

“The findings in Ireland were consistent with findings in other countries – it reduced depressive symptoms and suicide attempts and improved help-seeking behaviour,” Professor Arensman says.

“In the schools where YAM was implemented, there were better outcomes – YAM stood out in having the most obvious significant outcomes.”

An important aspect of YAM was its emphasis on role play, which, Professor Arensman explains, helps young people learn how to communicate their difficulties – and also how to encourage a friend or peer to seek help.

“YAM is suitable for wider implementation and I would like to see YAM implemented across the entire second-level system because of its proven effectiveness,” she says, adding she believes the programme needs to be “urgently” implemented across all Irish second-level schools, ideally in the original nine-week format, which takes place in the classroom under the guidance of an independent facilitator.

This could be organised by the HSE National Office for Suicide Prevention along with partners such as the Department of Education, she says, adding that the programme addresses different themes in each session – coping with stress or difficult life events, improving resilience, reducing stigma related to mental health, depression and self-harm and improving help-seeking behaviour.

‘Provide information’

“It would also provide information to young people as to how and where they can find help in their local area in terms of available services,” she says, adding that although there is a lack of services, Childline and Jigsaw could be of help.

Originally developed by researchers in Columbia University in the USA in conjunction with experts in Sweden, YAM was one of a number of interventions run across 10 European countries, including Ireland, in 2009 and 2010, under the Saving and Empowering Young Lives in Europe programme, with the aim of improving the mental-health literacy and coping skills of young people, raising awareness of risk and protective factors associated with suicide, and enhancing young people's knowledge about mental-health issues such as depression and anxiety.

A recent study by the National Suicide Research Foundation, which found that peak rates of self-harm during the study period were among 15-19-year-old females and 20-24-year-old males, indicates, says Professor Arensman, that the age of onset of self-harm was decreasing and that mental-health promotion and targeted interventions in key transition stages for young people are warranted.

Other interventions like cognitive behavioural therapy (CBT) and dialectical behavioural therapy (DBT) have also proved to be effective, she says, adding, however, that there should be improved access to such therapies.

“We should have increased capacity across all counties in Ireland to make it easier for GPs to refer a patient to CBT or for DBT. There has been a very positive roll-out of national training of DBT but the challenge is to provide ongoing sustainability in terms of availability of these services – without the current lengthy waiting lists for medical card patients.”

– Childline: 1800 66 66 66; Samaritans 116 123 or text 087 260 9090; Aware: 1800 804848