201610.03

Mental Health & Suicide: From 3rd Level Education to the Wider Community

Mental Health & Suicide: From 3rd Level Education to the Wider Community

Niall McElwee, Ph.D. & John Madden, B.A.

@ThesisClinic @Drniallmc @JohnMadden1

 

Introduction

depression-84404-1There’s an interesting quote where Life asks Death, “I am so beautiful. Why do you hate me so?” to which Death answers, “Because you are a terrible lie and I am a beautiful truth.” Writing about ‘naturally’ occurring death is difficult enough, but writing about death in the context of suicide is ever the more so because of the ethical dilemma it presents for so many (Chambers & Murphy, 2015). We do not know anyone in our professional or private circles that have been untouched by mental health issues and, more frequently, suicide and so feel compelled to write about this topic. If sharing really is caring, then let’s all share.

‘Mental health’ is conceptualised in the broadest possible sense in our writing, acknowledging that mental health can be either good or poor and that a person’s mental health is not fixed and can change throughout their life. Having stated this, there were 600 deaths of people under the age of 25 recorded in Ireland in 2012 and, of these, 195 of were due to external causes, 101 were accidental and 94 were intentional or unknown – mostly suicide – (The European Child Safety Alliance Report, 2014). Governments fail its people in this area. Reports released by the Health Service Executive in 2015 and 2016 highlight waiting lists for up to one year and beyond for those in need of help, but of course this is not the case if you can afford to pay for private treatment – but that’s uber-modern capitalism and indicative of our two tier health system in Ireland (Royal College of Psychiatrists, 2011).

The reality is that ‘reaction’ to suicide is at its most powerful in the aftermath of ‘high profile’ deaths by suicide but that little actually changes to address suicide once the ‘story’ has dissipated from the pages of newspapers or from the Internet and social media platforms –a point noted by many observers such as the 3ts movement just to use one example.

In our second research blog together we looked at mental health and suicide in the educational arena (see Mowbray, Megivern, Mandiberg, Strauss, Stein & Collins, 2006) and we highlighted some stark and worrying revelations that have emerged from the sector (see the research blogs on www.thedoccheck.com). We want to return to this sectoral discussion again in this research blog.

 The 3rd Level Sector

One in every twenty-two people in Ireland is a higher education student (either full time or part-time) accounting for 4.6% of the population. One in every eight entrants to college is a mature student (over 23 years of age) while 5% of the student body is over 35 (Irish University Association, 2016). Sadly, Irish third level students are reported to be one of the most susceptible to suicide in Europe according to the Union of Students in Ireland (USI) who quoted a survey carried out by the Organisation of Economic Co-operation and Development (OECD) which placed Ireland second in a league table of people under 25 who die by suicide. The model utilised in the sector is much different to that of the “outside world” and it is our experience that attempting to access counselling services in 3rd level is something akin to self-referral or self-selection, whereas the wider community relies on the traditional model of GP referral (Hunt & Eisenberg, 2010). Indeed, we have our own psychotherapist on staff here at the Clinic as we get in so many student queries around mental health.

We have broached the issues around suicide and mental health in Ireland, however, we have merely scratched the surface because we know mental health concerns are so varied that is difficult to pinpoint causes, due to its individualistic nature from person to person. There is no ‘one fits all’ treatment and realistically the only thing that the third level community can do is support, create awareness and attempt to come to know how to combat mental health issues on a local level.

 A Personal Perspective: John

To give a bit of background into why I became interested in the Mental Health arena I need to bring you back about thirteen years just before I returned to Third Level as a mature student. I was experiencing a period of extreme stress and I was a low point in life, truth be known I was depressed but I didn’t know anything about the condition, nor did I realise I was experiencing it. At my wits end and becoming more overwhelmed by a certain darkness, I picked up the courage to act and seek medical advice. I approached a GP in my local area. What’s important to understand is that this was 2003 and the postmodern information age was only an emerging concept. The only readily available information was available in pamphlets from different health providers and departments and the odd article in my mother’s plethora of women’s magazines such as Woman’s Own, Woman’s Way and Take a Break, so essentially mental health was a not a prominent topic by any means. And even when it came to the pamphlets, they’d rarely be read as there was always nearly somebody in the waiting room too ready to chat, but sometimes the literature was read, it’s not as though we had Angry Birds or Candy Crush at the time. So, back to the GP. I waited pensively in the waiting room, considering and almost rehearsing what I was going to say, half-afraid that I wouldn’t be believed or that I would be seen as ‘mad’.

“John?!” that was my cue to enter the doctor’s office. I was welcomed in and the usual arbitrary chat ensued. Following this, I was asked “what can I do for you today,” I paused… this was new ground for me, it wasn’t a conversation I had had before. I had, however, scripted it in my mind, as many of us do but I had never heard it said aloud.

“I can’t remember the last time I slept through the night, I can’t get to sleep and then when I do I have trouble getting out of bed the morning after, I’m beyond exhausted. I’ve lost a shed-load of weight and food makes me sick, I can’t even think straight and all I feel at the moment is anger, and if it’s not anger then I’m just teary, upset and despairing. I don’t know what to do and all I want to do is be somewhere else… I feel like I’m in a dark hole with no means of escape.”

That was the crux of what was said, some of which was said from behind teary eyes and an anxious temperament. Saying it out loud was relieving, certainly cathartic at the time, it gave a sense of ease and it was at that moment I thought “ok, I’ve done myself some good here, next I’ll hear some help, hopefully, life-changing advice from the medical profession sitting across from me”, for those few moment I felt ‘lighter’.

“Tell me, John, do you drink?” this seemed like valid question…

“Well, no more than anybody else my age I guess, maybe the odd heavy weekend”.

“Ah ok, and during the week?”

“Rarely to never, I suppose”.

“Well maybe that’s what you should do, head down town and get yourself a pint or two the odd night”

I had something of a stoic reaction to this, what I had just heard was the professional advice from a Doctor. A pint was my prescription. I left, more disillusioned than I was upon entering, well almost. I reflected on this ambivalent experience and thought “that was of no benefit” but I then remembered that ever so short air of calm that graced my body when I opened up about it, so maybe it wasn’t all bad; Ok I didn’t get treatment but it did provide a eureka moment for me. I did not use the ‘prescription’ that was given. I did, however, speak about what I was going through to a select few and from there, the little pin-hole of light that was on the horizon within the darkest of tunnels grew brighter and more brilliant over time until eventually my bleak view of the future was placed tidily behind me.

 Where to from Here?

It is important to remember that this was at the beginning of the 21st Century, just three years in and a mere thirteen years ago. However, practices have changed since. If anything, it highlights how backward the country was such a short time ago when it came to topics around mental health provision, awareness, and care in Ireland. There is no reason to believe that the third level community might be any different to wider society and vice versa as the former is a microcosm of the latter. People stay in third level for only a short time and must emerge at some time. Some Colleges are better resourced than others in terms of mental health expression.

Over the last decade laws and policies have changed but in such a brief window of time we can pose the question, “have our own attitudes changed accordingly?” many will say yes, but personally until we stop hearing phrases such as “sure, what would he be depressed about?” and “what worries would a young one like her have?” We will say steadfastly that attitudes are not changing fast enough.

Having stated the above, it is clear that mental health is a significant topic of discussion now. We have our own mental health bloggers here at the Clinic, a psychotherapist, and two graduate social care practioners on staff. A number of high profile personalities have talked about depression, most notably and recently, Bruce Springsteen from the music world and Jason McAteer from the sporting world. This will help place mental health on the discussion agenda, on talk shows and will fill countless hours and columns of media time. But, will it change the HSE’s funding and overall strategic plans? Will it result in additional services in our urban and rural communities? Will more posts be created in the third level sector? Those are searching questions and we await the answers.

Concluding Commentary

Ireland compares favourably with other EU countries in certain policy areas and is, for example, one of only four countries to have either a national programme of multi-disciplinary child death reviews or regional programmes across the whole country in situ. Despite this, at 5.12 male deaths per 100,000 of children aged 0-19, Ireland had the second highest rate of suicide across Europe (The European Child Safety Alliance Report, 2014).

One thing we, as a nation are seeing is the rise of what we would coin as ancillary gatekeepers in communities across Ireland, and this is borne out of necessity, it is abundantly clear that we still have people falling through the cracks every single day because we still have people who suicide every single day These ancillary gatekeepers may not have ever envisaged themselves being strong figure heads in their local communities but they are the ones that are taking on the training and awareness programmes.

We both have training in mental health and suicide and find this very useful. We would urge readers to do the same as there are now many courses available in urban and rural centres and in the third level colleges themselves. Sometimes, it is enough for people to know that one has an interest in this area for them to ‘open up’ as John alludes to earlier in this blog. Sharing is caring. Showing that one cares enough to participate in a mental health or suicide awareness course might just make a difference one day. Be that difference.


Useful References

Chambers, D. & Murphy, F. (2011). Learning to Reach Out: Young People, Mental Health Literacy and the Internet. Dublin: Inspire Ireland Foundation.

Chambers, D. & Murphy, F. (2015). Technology, Mental Health and Suicide Prevention in Ireland: A Good Practice Guide. Dublin: ReachOut Ireland.

Department of Health (2015). Connecting For Life: Ireland’s National Strategy to Reduce Suicide 2015 – 2020. Dublin: Department of Health.

Dooley, B. & Fitzgerald, A. (2012). My World Survey – National Study of Youth Mental Health. Dublin: Headstrong (The National Centre for Youth Mental Health) & University College Dublin School of Psychology.

European Child Safety Alliance Report, (2014). ECSAR.

Horgan, A. & Sweeney, J. (2010). Young students’ use of the Internet for mental health information and support. Journal of Psychiatric and Mental Health Nursing, 17, 117-123.

Houghton, F., Keane, N., Murphy, N., Houghton, S. & Dunne, C. (2010). Tertiary level students and the Mental Health Index (MHI-5) in Ireland. Irish Journal of Applied Social Studies, 10(1), 40-48.

Hunt, J. & Eisenberg, D. (2010). Mental health problems and help-seeking behaviour among college students. Journal of Adolescent Health, 46, 3 – 10. .

Montagni, I., Parizot, I., Horgan, A., Gonzalez-Caballero, J., Almenara-Barrios, J., Lagares,- Franco, C., Peralta-Sáez, J., Chauvin, P. & Amaddeo, F. (2014). Spanish students’ use of the internet for mental health information and support. Health Informatics Journal, 1 – 22.

Mowbray, C.T., Megivern, D., Mandiberg, J.M., Strauss, S., Stein, C.H. & Collins, K. (2006). Campus mental health services: recommendations for change. American Journal of Orthopsychiatry, 76(2), 226 – 237.

Royal College of Psychiatrists (2011). Mental Health of Students in Higher Education. London: Royal College of Psychiatrists.

WHO-5 (1998) WHO-5 Wellbeing Index: retrieved from https://www.psykiatri-regionh.dk/ who-5/Pages/default.aspx on the 14th of January, 2015.