Siobhan Davidson was 21 when the mental health system first let her down. Her story is uniquely hers, but it also echoes those of many young Australians struggling with mental health issues.
“I was living in poverty with no financial family support – it was incredibly stressful and self-esteem destroying. I was so busy trying to study and earn enough money to scrape by that I had nothing else in my life.
“Then my depression reached a point where I would have more than one panic attack in a day, I couldn’t sleep for more than an hour or two at a time, and only at the point of absolute exhaustion, and I started seriously planning to take my own life.”
She was already taking antidepressants but knew she needed extra help, so she saw her GP, who referred her to a psychologist. Except at the time, the only psychologists able to see her for a subsidised fee were located at least an hour away from her home in the Hunter region, about 150km north of Sydney.
“This is where the system let me down,” Siobhan said. “Even though my GP gave me six free sessions with the psychologist for being a youth, no psychologist within an hour of where I lived would see me under that scheme. I was considered too old to be a priority, and would have to pay full price. I did so twice. I would spend my fuel money, aimed at getting me to uni and back, to work and back. As a result, I was sleeping in my car at the places I had to be the next day, because I didn’t have the money to drive home and back again.
“And the help I received was having someone ask me what was wrong, and nod silently while I discussed with them that I wanted to die because I was trapped in a cycle of poverty that I saw no way out of, that I couldn’t sleep or function any more because I was so stressed at trying to solve my daily financial struggles, all while giving them my last few dollars for that head nod.”
I couldn’t sleep or function any more because I was so stressed at trying to solve my daily financial struggles.
In the end, Siobhan said it made no sense to continue the psychology sessions given the financial burden was so much greater than the help.
A generation of young Australians facing an uncertain future due to climate change, the pandemic and job insecurity is driving mental illness, according to the peak body representing general practitioners, who said young people are also finding accessing mental health support a financial and administrative burden.
The president of the Royal Australasian College of General Practitioners, Dr Karen Price, said young people like Siobhan were struggling, and their doctors shared in their despair as they struggled to refer them to appropriate help. Hundreds of young Guardian Australia readers who responded to a callout asking for experiences navigating Australia’s mental health system reported similar issues. About one in five people aged 15-19 meet the criteria for serious mental illness, according to the 2014 Mission Australia’s Youth Survey, and more than 75% of mental health problems occur before the age of 25.
Price said she regularly saw teenagers and people in their early 20s who said their poor mental health was being exacerbated by worries about being unable to find employment after study, fears about the impact of climate change and powerlessness to stop it, and stress and anxiety due to the global pandemic which has seen drastic changes to their education and future.
“I mean anyone at these ages, historically, stands there looking forward with anxiety but also with hope as they try to find their place in the world,” Price said. “But these days young people look forward and they just see a whole lot of uncertainty. They see challenges with the climate. They see, now, a pandemic. And then they also hear about the fact that jobs are being lost and industries are crashing and so forth. So they are the sort of the sort of dire predictions coming their way at the beginning of their lives.
“I think that’s really hard.”
For families of teenagers with mental health issues, the concerns stretch beyond the illness itself to frustration with getting timely help while being turned away from emergency services. Guardian readers who responded to the reader callout in relation to seeking help for their children wrote of desperation and fear of losing their children to suicide while trying to navigate a confusing system.
One mother who wanted to remain anonymous said when her 12-year-old son was suicidal and highly distressed, he was sent home from emergency as “not bad enough to hospitalise”. As he was walking out of emergency the son sent a text to friend saying he would kill himself. Only when the mother could show the hospital the text was he admitted. Two years and many dead ends later, the mother feels he is still not getting the help he needs in a system “lacking clarity and consistency”.
Another mother who wished to remain anonymous has a teenage daughter with a history of self-harm, depression, anxiety and who has received “very little education over the past four years as a result of her mental health”.
“In addition to my daughter’s mental health, my own life has been on hold, stuck in a ‘carer’ role (rather than ‘career’ role), for many years, with an indefinite period ahead of me. It is two lives being wasted.”
Karen Price said the “piecemeal approach” to care was frustrating for families, as was finding psychiatric care quickly.
“I do a lot of adolescent mental health, and I often send them to a psychologist for extra support because, for many of these young people, it’s about giving them islands of resilience [with] adults who can be their life raft in a sea of uncertainty,” she said.
“Their GP can also support them, or sometimes I might refer them to [youth mental health service] Headspace who can also support them with specific skills. Others might need to go into specialised units, for example those with eating disorders, and I have certainly had a few of those over this pandemic, and though there are different theories about eating disorders one is that it is a symptom of anxiety and needing control, but they can be very difficult.”
Price said one of the most difficult parts of her job was referring young people to psychiatrists with near-future availability. The best and most affordable psychiatrists were often so busy they closed their books to new patients, she said, while even with Medicare-subsidies, other psychiatrists had a gap to the patient of hundreds of dollars.
“We might have to work a bit harder if we need to find a bulk-billing psychologist, but psychiatrists, they’re really, really, really hard because they’re virtually all private,” she said.
Those first few months out of hospital can be overwhelming and lonely.
“These patients are often also complex. They might live in a higher economic area, but because of their mental illness they have fallen down the economic scale. I could see people who had been to the best private schools but for whatever reason have fallen into psychosis. These people can’t work, and for many of them they slide down the socioeconomic scale and so then they become public patients, and they don’t have often a very stable relationship with one psychiatrist.
“They may go into and out of our public hospitals with different staff seeing them all the time, and it’s very piecemeal. I’ve got patients who’ve had psychiatric admissions where they refuse to go back because they don’t feel that that helped them at all.”
Reform aimed at severe cases
While there are reforms occurring to make access to mental health support easier for young people, these initiatives are aimed at the more severe cases. In March, the New South Wales government allocated $3.8m in funding toward a trial to give children and young people access to community-based, non-clinical support following an attempted suicide.
The Youth Suicide Crisis and Aftercare service pilot sites, which are funded by the federal government, will begin operating in April at Blacktown in western Sydney and Coffs Harbour on the mid-north coast to ensure those living outside cities are catered to.
The service will be designed by young people with lived experience of suicide alongside families and carers, youth mental health and suicide prevention experts. It will involve follow-up of patients, continuity of care by the same health staff, and will be designed by young people with experience of mental illness.
Jack Heskett, a 23-year-old living in Kogarah, South Sydney, has previously attempted suicide and is a member of the NSW Health reference group that shaped the scope of the trial.
“Those first few months out of hospital can be overwhelming and lonely,” Heskett said. “This type of care could make a real difference to young people feeling disconnected or a burden on others after they leave hospital.”
But a report from Victoria’s mental health royal commission, tabled to the state parliament in March, made recommendations targeting youth ranging from those accessing help for the first time through to acute cases.
By the end of 2022, the Victorian government will establish a dedicated service stream for young people. Youth mental health centres throughout the state will provide both short-term and ongoing treatment, care and support to young people, including those who require ongoing intensive treatment, care and support.
These youth “area mental health and wellbeing services” will be available for young people aged 12 until a person’s 26th birthday, with age boundaries and transitions to be applied flexibly by services in partnership with young people and their families, carers and supporters.
But psychiatrist Prof Patrick McGorry, who is executive director of Orygen youth mental health in Victoria, said a national approach was desperately needed, especially following a Headspace survey conducted in 2020 that found 75% of young people reported their mental health had deteriorated in the context of the pandemic.
He said some of the publicly funded Headspace youth mental health centres had waiting lists 3.5 months long, even after a $1.1bn federal government funding boost in 2020.
“There’s been a surge in need and we can’t meet it,” McGorry said. “The sort of things we are hearing from young people are concern about the greater instability and uncertainty about the future, especially around employment and disruption to education. A lot more eating disorders are presenting, as well as obsessive compulsive disorder.
“We modelled the pandemic would lead to a 30% increase in people with mental health problems. Young people will be driving a significant part of that increase.”