The study, “Adolescents with suicidal ideation: Health care use and functioning”, was recently published in Academic Paediatrics and carried out by researchers at Seattle Children’s Research Institute at the University of Washington, and the Group Health Research Institute in the US. According to the study, only 13 per cent of teenagers with suicidal thoughts accessed mental health services while just 16 per cent received services in the second year of the study, despite being eligible for and having access to mental healthcare without a referral.
When all types of mental health services were combined, including antidepressants and care received through outside sources, still only 26 per cent of teenagers with suicide ideation in the study received services in the second year. Speaking to IMN, Dr Harry Barry, Louth-based GP, said the US spends very little on mental healthcare and that while “Ireland is making more of an effort, we still have a long way to go”. “In Ireland at the moment, theoretically everyone under 18 is regarded as a child,” he said. However, only children under 16 have clear access to mental healthcare services, leaving a gap in services for those aged 16 to 18, he added. Recent research conducted at UCD by Professor of Psychiatry Professor Kevin Malone showed that suicides in children and teenagers in Ireland has doubled since 1993.
Prof Malone, who co-founded the charity Turn the Tide of Suicide (3TS), compared data from between 1993-1998 and 2003-2008. It revealed there has been a 40 per cent increase in the rate of suicide among boys aged 15 to 17. In girls under 18, the rate has doubled. Professor Mary Cannon, consultant psychiatrist at Beaumont Hospital, Dublin, told IMN that the gap in services for teenagers comes when they need access at the most difficult time. However, she said that “often, even when they have an appointment, they just don’t come in for it” and added there needs to be research in order to understand why this is so. In the US study, the researchers examined the use of healthcare services among 198 teens aged between 13 and 18. Some 99 teens were studied who endorsed suicidal thoughts, as well as 99 control teens, who were matched on age and gender.
Administrative data spanning two years were collected from medical records, in addition to interviews conducted with teens and their parents. It found that utilisation of mental health services was low among both the control group and those with suicidal thoughts. While 86 per cent of the youth with suicidal ideation had seen a healthcare provider, only 13 per cent had a mental health specialty visit and just seven per cent received antidepressants. Only 10 per cent of those without suicidal ideation had received any mental health services in the first year. However, respondents with suicidal ideation had significantly more severe depression, a greater prevalence of lifetime diagnosis of depression or anxiety, and higher scores of paediatric chronic disease. When all mental health service questions were combined, 26 per cent of the teens with suicide ideation received services in the first year, and 16 per cent received services the following year.
These findings confirmed previous studies examining self-reported mental health services among adolescents, the authors wrote. The lead author behind the US study, Dr Carolyn A McCarty, said: “We know that asking teens about suicidal ideation does not worsen their problems. It’s absolutely crucial for a teen who is having thoughts of selfharm or significant depression to be able to tell a helpful, trustworthy adult.” Prof Cannon said that the old idea of “screening increasing risk is not true”. She told IMN that suicide screening is helpful as studies show that rates in suicide ideation are decreasing in correlation with it. “Maybe it is just asking the questions that helps, maybe it enourages teenagers to think more about things, maybe they read online about their problems, maybe just acknowledging that there is a problem helps so they can talk to their parents about it,” she said. The US study concluded that the findings “underscore the need for clinicians to be aware of the potential for suicide in adolescence”.
It recommended that, “primary care physicians and healthcare providers should be specifically assessing suicidal ideation in the context of depression screening for teenagers.” However, neither Dr Barry nor Prof Cannon agreed that accessing services in primary care would be helpful. “It is quite common for young teens to have suicidal thoughts. But teens in general are reluctant to go to primary care at all. A lot of the time they may have mental health difficulties, but may never come near anyone [for help],” Dr Barry said. Prof Cannon agreed that seeing a GP is not the ideal pathway for teenagers to receive mental healthcare. “There needs to be screening in schools as it has a low stigma,” she said, adding that teachers and counsellors in schools may also need to be more vigilant. Furthermore, Prof Cannon said that teenagers are more comfortable with internet-based services, which may be down to the fact that this method does not take place face-to-face with a healthcare professional.
Dr Barry emphasised that teenagers do not want to go to see their GP or see a psychiatrist if they experience thoughts of suicide. However, he pointed to Headstrong, “which brings community services and supports together around young people in order to better meet their mental health needs”. Dr Barry told IMN that as Headstrong specifically addresses young people and is geared towards them, they are more
likely to open up to the organisation than to their local GP.
