Warning: This article is about suicide and may be distressing for some readers.
If we want to stop so many of our young people killing themselves each year we need to urgently strengthen our community mental health services, says a leading New Zealand child psychiatrist.
"The whole idea is so bloody simple and it would cost so little, but no one is listening to me," said University of Auckland Emeritus Professor John Werry, a Companion of the New Zealand Order of Merit who has written nearly 200 publications and books in child and adolescent psychiatry.
He recently wrote a paper outlining how demand on specialist mental health services - which only cater to the top 3-5 per cent of the most severe cases - is growing because we do not have the resources to handle the mild to moderate level cases that fall beneath them.
For the past five weeks, the New Zealand Herald has run a special series on youth suicide called Break the Silence. For the final week of the series, we are focusing on potential solutions to reduce our unacceptably high suicide rates.
The Child and Adolescent Mental Health Service (Camhs) is run by the Ministry of Health and provides specialist assessment, treatment and consultation for those with the most extreme mental health conditions.
All other cases are supposed to be looked after at family doctors or community centres.
But these conditions are complicated and cannot be treated in a 15-minute GP consultation, Werry said.
Fellow child psychiatrist Dr Arran Culver who works for Camhs, fears the entire model is flawed.
The system, he said, is based on the presumption that the rest of the services, those beneath Camhs, can handle all other cases that fall outside its boundaries.
"It's all based on the belief that the whole system of care is working well," Culver said. "When it doesn't, the whole system breaks."
Last year, almost 2000 young people were rejected from Camhs and that number is continuing to grow, according to documents released to the Herald under the Official Information Act.
"There is widespread concern about the mental health of young people," Werry, who worked as a psychiatrist for 57 years, wrote in his recent paper, which has been submitted to the New Zealand Medical Journal.
At any one time, at least 15 per cent of young people have a significant mental health issue, yet only the top 5 per cent of the most severe cases receive any help from government services, he said.
"Despite recent recognition of the gap and some recent initiatives, this situation is likely to continue," Werry's paper concluded.
As growing numbers of people are referred to specialist services like Camhs, rejections start to mount up as increasing numbers are not deemed bad enough to access the system.
"These rejections create disappointment by referrers impairing the image of Camhs and underlining the need for a primary level service," Werry said.
One of those young people rejected from Camhs was 13-year-old Max, who attempted to take his life at 10.
In a letter to the Herald, Max wrote: "My mum tried really hard to get me help. She rang many places, places that advertise that they are there for you if you need them. Nobody was. I worry that the taxes we are paying aren't going to the places they should and we will continue to see a rise in child suicide because of this."
Health Minister Jonathan Coleman said in an exclusive interview with the Herald published this week that he was "very aware" that the mild to moderate level of care was an area of increasing demand.
"It's also an area where people are really concerned publicly about an ability to access services so yes, that's on my radar," Coleman said.
The way to solve the problem, says Werry, is to create an official list of community mental health services and non-government organisations who are willing and able to help those with moderate-level needs.
This list should be passed to doctors so they can refer patients who fall beneath the most severe 5 per cent of cases on to appropriate services; rather than just sending everyone to Camhs.
"I've tried to get several people in key positions to do something and so far nothing has come of it. Somebody just needs to pick up the ball and call a meeting to try and get something going," Werry said.
"I'm 86 and I'll probably be dead before I see any bloody movement. It pisses me off."
WHERE TO GET HELP:
If you are worried about your or someone else's mental health, the best place to get help is your GP or local mental health provider. However, if you or someone else is in danger or endangering others, call 111.
If you need to talk to someone, the following free helplines operate 24/7:
DEPRESSION HELPLINE: 0800 111 757
LIFELINE: 0800 543 354
NEED TO TALK? Call or text 1737
SAMARITANS: 0800 726 666
YOUTHLINE: 0800 376 633 or text 234
There are lots of places to get support. For others, click here.