R AGING AGAINST T HE MACHINE :

T E E NS IN CR ISIS

(EXPLICIT LANGUAGE WARNING)

Dr Shannon Morton

Child & Adolescent Psychiatrist

Clinical Director of The Kooky Clinic

www.kookyclinic.com.au

THE PROBLEM WITH

YOUNG FOLK TODAY…

According to ABS: Suicide is the leading cause

of death in youth aged 15 to 24 years, followed

by car accidents

THE PROBLEM WITH

YOUNG FOLK TODAY…

❖ Second Australian Child and Adolescent Survey of Mental Health and Well-being 2015:

• >6300 families surveyed with youth aged 4 to 17

• 1 in 7 youth experienced mental disorder in previous 12

months (560,000 young Australians)

• 1 in 10 teens, and 1 in 4 girls aged 16 to 17, had self-

harmed in their life-time

• 1 in 13 teens aged 12 to 17 had contemplated suicide, 1

in 20 had made plans, 1 in 40 had attempted suicide

THE PROBLEM WITH

YOUNG FOLK TODAY…

• Depression rates doubled when young people

self-reported, compared with parent report, 1

in 5 girls aged 16 to 17 met criteria for Major

Depressive Disorder

• More youth seeking help, with 2/3 of those

with mental disorders accessing health

services, compared to 1/3 in first survey

(1998)

THE PROBLEM WITH

YOUNG FOLK TODAY…

❖ Technology/cyber-bullying

❖ “Future shock”

❖ Family breakdown

❖Youth unemployment, $

❖Educational pressures

❖ “Tiger” & “helicopter” parents

❖ Busy, disengaged parents

❖Gender, sexual, identity role

confusion, body image issues

❖ Social contagion effect

❖ Loss and trauma

❖Dismal state of the world

THE PROBLEM WITH

YOUNG FOLK TODAY…

The Old Template for teen angst…

THE PROBLEM WITH

YOUNG FOLK TODAY…What Old Goths Get Up to Now…

The New Template..

TEENS RAGING

“I think a big one is to stop treating depression as a type of

math formula and thinking that there is only one solution and

problem to each patient. Eg: he/she felt sad so they cut

themselves and if we take away the knives and force them to

watch happy happyvile of the happy people in the little town

of happiness, then the patient will be cured.” – Mr Hamish

aged 16.

HAVE WE TRAINED OUR

YOUTH TO BE THIS WAY?

❖Prior to Headspace, to access validation and

containment of distress by free public health services,

troubled young people needed to demonstrate imminent

high risk of harm to self or others, or psychosis…

❖Is it a surprise we currently have a cultural epidemic

of teens who self harm or hear “voices”?

❖ where validation and containment requires imminent risk or psychosis

leading to an epidemic of teens who self harm or hear voices

THE PROBLEM WITH “THE

SYSTEM” TODAY…

RISK ASSESSMENT

TASR-AM

❖ Family History Suicide

❖ Psychiatric Illness

❖ Substance Abuse

❖ Poor Social Supports

❖ Problematic Home-life

❖ Depressive Symptoms

❖ Psychotic Symptoms

❖ Lack of Pleasure

❖ Anger/Impulsivity

❖ Suicidal Ideation

❖ Suicidal Plan

❖ Access To Lethal

Means

❖ Past Suicide Attempts

❖ Current Problems

Seem Unsolvable

❖ Command

Hallucinations

❖ Recent (last 24hr)

Substance Use

WARNING BELLS

❖ Losing sleep over a student

❖ Worrying about a student after hours

❖ Wondering whether a student might be “better off dead”, or “better off

not in school”

❖ Hoping you will be sacked by the student or parents

❖ Listen to your gut instincts! Our therapeutic alarm systems can be triggered

by non-verbal communication by the patient which doesn’t easily fit in risk

assessment proformas

BELLS & WHISTLES,

RALLY THE TROOPS

❖ If nothing reassuring, or nothing changed since previous suicide

attempt, consider sending to ED, calling QAS or their parents

❖ Safety planning, including removing access to lethal means, social

supports, emergency contacts, and contingency plans

❖ Shared care – GP, NGOs, CYMHS, Psychologists or other

professionals, second opinions

PARENT SUPPORT

http://www.selfinjury.bctr.cornell.edu/perch/resour

ces/parenting-2.pdf

KEEPING KIDS SAFE

Durkheim’s 4 types of suicide (1897):

❖ Egoistic – prolonged sense of not belonging, or having no purpose

❖ Altruistic – e.g. suicide bombers, hunger strikes

❖ Anomic – moral confusion and lack of direction, economic upheaval,

excessive options with lack of guidance, values, or identity

❖ Fatalistic – excessive regulation and limitations on freedom to pursue

pleasure (e.g. prison)

Ikigai = A Reason For Being

KEEPING KIDS SAFE

It’s all in the therapeutic

relationship!!

❖ Regular reviews

❖ Setting the frame

(confidentiality)

❖ “Safe” non-judgmental space

❖ Maintaining hope

❖ Time, caring, & validation

❖ Judicious use of self disclosure

❖ Reframing – “the phoenix”

❖ Mobilising supports (family,

friends, services) – repair

connections

❖ Logotherapy - Ikigai

❖ Transitional objects

CREATING SPACE FOR

DARKNESS

❖ Positive psychology approaches can make sad people feel worse

❖ Teens have good reasons to be miserable, and need space to safely

manifest it

❖ Art, music, and written pieces from teens should be gloriously dark,

angry, and disturbing

❖ Does “RU OK? Day” need more poetry slams, “screamo” music

concerts, and macabre art shows incorporating smashed items, rather than

cupcakes and false cheer?

NESS’ STORY

A tale of two desperados, and a ridiculous

idea to save a young life by trusting she

could help herself to heal, through helping

others to heal…

THE HEALING CIRCLE

THE HEALING CIRCLE

❖ Open, bulk-billed group for under 25s, consists of a 60 to 90 minute session with

Psychiatrist once a fortnight plus a “lived experience” peer-moderated online facebook

forum. Began August 2015.

❖ N = 17 referred in total

❖ Dx: ASD 3, Gender DD 2, Eating Disorder 3, all have struggled with depression,

anxiety, and self harm for years.

❖ 15/17 have had ED presentations for self harm (often multiple), 10/17 have had

psychiatric hospital admissions, 6/17 have had medical admission for severe DSH, and/or

multiple or prolonged psychiatric admissions, 3/17 have had a near-lethal suicide attempts

THE HEALING CIRCLE

❖ Based on DBT, ACT, group therapy principles

❖ Emotional regulation/distress tolerance skills practiced: painting,

clay, “pom-pom love bombs”, charity work, colouring-in swear words,

animal therapy, mindfulness, meaning-making

❖ Peer relationship support and identification crucial.. Seeking out

personal messaging support, raising alarms for each other, enforcing

group safety rules

“Mum put my colouring in

on the fridge!”

CHANGING THE CULTURE

OF HARMING TO HEALING

❖ First few months – Boundary-testing:

Initial escalation in crisis presentations resulting in 2 hospital admissions and

removal of 3 members, 2 on 2 occasions. 3 members have removed themselves and

returned a number of times.

❖ The First Year:

Prolonged “storming period”, conflict between members, accusations of

favouritism (sibling rivalry), some defections and sub-grouping

Increasing participation in the remaining members

Norming, repairing, sharing triumphs, bonding

CHANGING THE CULTURE

OF HARMING TO HEALING

❖ Last 6 months:

• Greater engagement in “learning and earning”, and individual

treatment

• 8 of 8 currently in the Circle have maintained abstinence from self

harm for at least the last 6 months, many for years. Older members

are tattooing over healed scars, and now the Circle is addressing

underlying body image and trauma issues, together as a group

• Increasing group cohesion, activity, and autonomy, without the

therapist driving it

• Shift of identity from mental health patients, to co-healers, lived

experience advocates, and survivors

HEALING CIRCLE