Tackling mental health head on

The Jigsaw project aims to bring mental health services to where the children and teenagers are, rather than wait for the most vulnerable to access help themselves, writes MARESE MCDONAGH

Between 2005 and 2007, a number of teenage students died by suicide in one small area of Co Meath.

For the health authorities, one of the most worrying aspects of the wave of tragic deaths was that not one of the teenagers, some as young as 13, had previously come to their attention. None was linked into the mental health services in the county and, according to Headstrong (the National Centre for Youth Mental Health), none had been identified by their schools as being particularly at risk.

Headstrong investigated and found that every town and community in the county had a small group of young people “ living on the edge”. They also found that there was a “a hidden population” of young people who rarely come to the attention of service providers but yet were probably among those most need of help.

Jigsaw project

As a result, the Jigsaw project was launched in Co Meath in 2009 in four post- primary schools and one youth centre . The focus of the initiative was on bringing mental health services to where the children and teenagers were , rather than wait, probably in vain, for the most vulnerable to access help themselves.

A key to the project was that psychologists from the HSE and National Educational Psychological Service (NEPS) would be available to work with teachers, students and the wider community.

Teacher Jimmy O’Connell has a bird’s eye view of how badly many children need the interventions which have been introduced through the Jigsaw initiative.

The interventions are designed to help the entire student population negotiate burdens such as exam stress and bullying but crucially they also identify and help those students who are teetering on the edge.

A qualified psychotherapist, as well as a teacher, O’Connell is one of two counsellors at St Peter’s post-primary school in Dunboyne who is always available to the 1,000-strong student population. The issues they raise with him range from anxiety about exams to depression, family problems, relationship difficulties and suicide ideation.

He says most of the referrals are self-referrals, but other students and teachers also regularly alert him to those in trouble.

Some of the cases he encounters are horrifying. Referring to one boy who had talked to a friend about how he would take his own life, the teacher remarks: “It is more usual than you might think.”

Utter relief

That case was brought to his attention when the friend told her mother who in turn informed the school authorities what the student was contemplating. “When I asked him was it true what I had heard, the first thing I noticed was the relief on his face,” says O’Connell, adding that students who are in despair often can’t find the words to tell their parents or simply don’t want to worry them.

Of the 70 or so students he deals with in a year, about six are self-harming, usually by cutting themselves in places where the wounds won’t be seen. If he encounters such a case , he calls in the parents, and the child will be referred to a psychologist.

While the HSE has said that young people who urgently need to access mental health services won’t experience delays, there were more than 2,000 around the State waiting for appointments with the Child and Adolescent Mental Health Services last September, and delays are a recurring nightmare for parents.

“Jigsaw is a good model because children have access to a caring adult from the start of the process to the end,” says O’Connell.

Peer mentoring

Martin Reilly, principal, of St Oliver’s in Oldcastle which, like St Peter’s, is a co-educational VEC post-primary school, says that “peer mentoring”, an initiative introduced by HSE psychologist Dr Alan Dibble as part of Jigsaw, has been “one of the best things that came into the school”.

Peer mentors were introduced three years ago and their role is to watch out for other students in their year who are having a bad time, perhaps not mixing well, or being picked on. If they spot a problem, they are encouraged to inform the teacher who is tutor of the relevant class.

There are 12 peer mentors in first, second and third year. This year 43 first years applied for the 12 places in their year.

“If peer mentors became aware that a student was a victim of cyber bullying, they would not be shy about passing it on,” explains Reilly who says the arrangement works because students know everything that is going on with their peers whether it is bullying, a relationship breakdown or anxiety.

He says cyber bullying is not a major issue “but we would be very very aware of it”. Talking to the students about it is crucial, he believes.

“The more it gets talked about, the more that helps students who might be targeted. By talking about it you can ease the burden for those who are suffering.”

Reilly tells parents that their child should never be in a room on their own with a laptop.

“Students who are 12 or 13 or even 15 or 16 cannot deal with systematic cyber bullying. They can feel very alone,” he says. “The old saying sticks and stones may break my bones but words will never hurt me – that’s not true anymore.”

He says that a parent who is close by when a child gets an abusive text or email may become aware by the reaction that something is wrong.

There are over 500 students in St Oliver’s and, according to Reilly, every teacher is expected to take responsibility for the wellbeing of students.

Through Jigsaw, adolescent health teams have been put in place in each school and the HSE and NEPS psychologists are involved alongside teachers, parents, students and other stakeholders.

Initially reluctant to participate in the Jigsaw project because cutbacks had already caused staffing problems, Reilly says he has no regrets now about the manpower he had to assign to get the system in place.

“There is a great atmosphere in the school – a caring, nurturing atmosphere.” He believes that because of Jigsaw there is an awareness among staff and students about the need to be on the alert for those who might need help.

Bullying surprise

Eamon Gaffney, principal at St Peter’s, has long been aware of the importance of mental health issues among students. When the school opened in 1994 he deliberately recruited teachers with counselling expertise. But when students’ views were canvassed at the beginning of the Jigsaw project, some of the findings surprised him.

“The extent to which bullying was highlighted was a big surprise. We would have thought we were the bee’s knees when it came to working on bullying but we found that while many kids cope very well with the odd bit of slagging, there were some who were finding it very difficult, probably because they were the butt of everything.”

Reluctant to talk about the school’s past experiences with suicide “because it is still so raw for parents”, he says that the mental health problems which students are presenting with are wide ranging.

Sexuality, eating disorders, relationship problems and anxiety are among the issues raised.

“Usually a child will present with more than one problem,” says Gaffney. “If a child has an eating disorder, you might also find that there are problems at home.”

The longtime principal learned that stress was a recurring problem for students.

“A lot of the stress was self-induced and not coming from parents,” he explains. “Students were worried not just about exams but where they were going in life.”

He also learned that some Leaving Cert students felt trapped in a cycle of binge drinking . Because so many celebrate their 18th birthday in sixth year – and parties to celebrate this milestone are common – some students felt under pressure to drink almost every weekend.

Predictably the economic downturn has put pressure on students who see their parents struggling.

“Parents are splitting up but not moving out of the house because with big mortgages they cannot afford to,” says Jimmy O’Connell. “You have parents in the same house, but in different bedrooms who are still fighting and the kids have to listen to that. I call it divorce Irish style. It is a huge stress for kids.”