Children and young people were taken to hospital after self-harming more than 5600 times in the year to September, escalating an alarming trend that mental health experts say is indicative of growing distress among young New Zealanders.
Mental health practitioners told the Weekend Herald that rates of psychological difficulties among children and teenagers were rising before the emergence of Covid-19 and have got "significantly worse" since the pandemic started. They're braced for another surge after the Omicron outbreak.
Public mental health services that were already stretched before the pandemic are overwhelmed, clinicians and parents say, forcing anguished families into long waits for treatment or to look elsewhere for support. In many situations, they say, their alternatives are minimal.
"It's very isolating, it's very lonely, and it's a real struggle to get support," says an executive at a mental health charity whose own teenage daughter recently went through a psychological crisis that almost killed her.
"We've literally been to hell and back."
Data collected by the Ministry of Health shows the number of self-harm hospitalisations for people aged 10 to 24 rose from 4274 in the year to September 2016 to 5652 in the year to September 2021 – an increase of almost a third.
The figures are published quarterly on a government website, part of a data set intended to help district health boards improve their services, but do not appear to have been widely circulated.
According to the ministry's technical notes on the data, self-harm is "a maladaptive coping mechanism indicating young people in distress and coping with that distress in an unhealthy way. It is often associated with low mood, depression, anxiety, wider family/peer group issues and events, stress, bullying, bereavement, relationship issues, trauma, intense or difficult feelings, or being in a group that self-harms".
The latest figures, released in mid-December, indicate that the number of self-harm hospitalisations for 10 to 24-year-olds nationally rose from 5186 in the year to September 2020 to 5652 in the year ending September 2021, an increase of 9 per cent in a year.
All but three of the 20 DHBs had an increase in numbers last year, with Waitematā, Auckland, Waikato, Counties, Southern and Capital and Coast each recording more than 500 hospitalisations.
Females accounted for 78 per cent of the self-harm hospitalisations.
Dr Hiran Thabrew, a child psychiatrist at Auckland's Starship Children's Hospital, says self-harm has "become a very normal coping strategy" among young people who experience emotional and psychological difficulties. "Much more so than it ever was a few decades ago."
The figures only show how many young people were hospitalised for self-harming, not the total number, Thabrew says. There will be others who weren't hospitalised.
Dr Paul Skirrow, executive adviser to the New Zealand College of Clinical Psychologists, who reviewed the data at the request of the Weekend Herald, says it appears to show a "significant" increase in the number of young people who have reached "crisis point".
The figures are only one indicator of mental wellbeing, Skirrow says, but "they certainly fit with other data both nationally and internationally on the increase in mental distress amongst young people".
In August 2020, the latest edition of the national Youth2000 survey, which tracks the health and wellbeing of secondary school students, warned that the emotional and mental health of young New Zealanders had markedly worsened since the last survey was conducted in 2012.
In the latest survey, conducted before the Covid pandemic, the proportion of students reporting symptoms of depression was 23 per cent, up from 13 per cent seven years earlier. Six per cent of the students surveyed said they had attempted suicide in the past year.
In September 2020, a paper by Koi Tū: The Centre for Informed Futures, a think tank at the University of Auckland, said the rise in distress among young people over the past decade amounted to a "silent pandemic" and had "received insufficient attention for far too long".
The reasons for the increase in mental health problems are complicated and not well understood, experts say.
For some people, an episode of mental illness may be triggered by direct experience of trauma or adverse life events. Social factors such as poverty, racism, and inequality have an impact – as do social media, alcohol and drugs, bullying, academic expectations, parental stress, and existential concerns about climate change.
Some of the increase may be because there's greater awareness among young people of the importance of mental wellbeing.
Those pressures have been compounded by Covid-19, mental health experts say.
Anxiety about illness and death, decreased social contact, unsettling changes to daily life and schooling, family separations, and parents worrying about money and employment can all weigh on young people's minds.
"The pandemic has made the situation significantly worse," Skirrow says. "While we have perhaps avoided the worst [in terms of infections and deaths], the evidence suggests that we haven't escaped its impact on our mental health."
"Young children often take their cue from their caregivers as to how to be in a situation," says Dr Melanie Woodfield , a clinical psychologist and researcher at the University of Auckland. "If there's high expressed emotion in the home, or if parents are really struggling, children are more likely to struggle. And I think many parents are wearing and fatigued at this sustained season of juggling work, childcare, health worries and financial concerns."
In November, a study in the American Medical Association's Pediatrics journal said that one in four young people globally are experiencing "clinically elevated" symptoms of depression and one in five have elevated symptoms of anxiety, rates that were double pre-pandemic estimates. Studies in the UK and other countries have shown a similar pattern.
In December, the US Surgeon General, Vivek Murthy, one of the Biden Administration's top health officials, issued a public advisory saying the decline of children's mental wellbeing in America had become a crisis. Young people were facing unprecedented challenges which were having a "devastating" impact on their mental health, Murthy said.
In New Zealand, experts say they're expecting demand to increase again in the coming months after the Omicron outbreak. And that will put even more pressure on child and adolescent mental health services (CAMHS) that already couldn't cope with the pre-Covid demand.
Anecdotally, parents and clinicians say public mental health services are so swamped that only the most acutely unwell children are likely to be seen quickly. For those who can afford to seek private care, there are also limited options, with private therapists now so busy that their waiting lists are also typically months long.
With limited specialist support available, a growing burden is falling on schools, GPs, hospital emergency departments, police, families, and other institutions that are not proficient at helping people in a psychological crisis, the experts say.
The Ministry of Health did not comment specifically on the rise in self-harm hospitalisations.
A spokesperson for the ministry said: "Undoubtedly, the Covid-19 pandemic has affected the mental health of many children, young people and their whānau. That's why we have been relentless in our efforts to continue to improve access to support, increase the choice of support services available and ensure every New Zealander has somewhere to reach out to if they need help."
The spokesperson said the Government's $455 million initiative to provide more access to talk therapies for mild and moderate mental health conditions has "significantly enhanced our ability to respond to the pressures the pandemic has placed on the mental health and addiction sector and the health system more widely".
The Government is also expanding school-based support services, the spokesperson added.
'HELL AND BACK': A MOTHER'S DESPERATE STRUGGLE TO SAVE HER TEENAGE DAUGHTER
It was in a managed isolation facility in Manukau, in March last year, when Heather realised that her teenage daughter's mental health was deteriorating badly.
Heather, 40, is an executive at a mental health charity in Auckland. Her only child, Lucy, 17, had just returned from a trip to Australia to stay with her father. Heather had not travelled to Australia but joined Lucy at the Sebel Hotel for two weeks to supervise her in quarantine. (The Weekend Herald agreed to change their names to protect Lucy's privacy and avoid causing her more distress.)
Lucy was once a confident, happy child, but had been struggling for several years. A traumatic event at the age of 12 had left her with anxiety so severe that she stopped going to school. And, Heather soon noticed, it had escalated while she was away in Australia.
"It was very, very evident that there was something wrong," Heather says.
In quarantine, Lucy ate only once a day, exercised obsessively, and seemed to constantly be searching online for advice on how to lose weight. It struck Heather as extreme. Worried that Lucy was developing an eating disorder, she took Lucy to their GP when they were out of quarantine.
The doctor was attentive and thorough, Heather says, but Lucy's mental state rapidly worsened. And because she wasn't eating, so did her physical health. One day in June, the doctor became so concerned about Lucy's low heart rate and blood pressure that she sent her to hospital.
It was the start, Heather says, of nightmarish few months in which Lucy grew increasingly distressed, harmed herself on several occasions, and was hospitalised three times.
Heather, having worked in the mental health field, knew the system and had contacts she could call upon, but she still felt hopeless as Lucy deteriorated. ""It's very isolating, it's very lonely, and it's a real struggle to get support," she says.
She grew desperate as she fought to get help from specialist public mental health services that she says seemed to be overwhelmed by young people in crisis. There were hours-long waits in emergency departments. Calls to crisis helplines in which she was told to ring the police instead. Repeated arguments with medical staff who, Heather says, wanted to discharge Lucy before she was ready.
"I cannot do this," Heather recalls pleading with a doctor on one occasion. "I need help! She needs help! I'm not leaving."
It got worse before it got better.
In November, Lucy nearly died after self-harming. She was taken to hospital after the incident and her heart stopped while she was in the waiting room. She was resuscitated.
After that, Heather says, Lucy's mental health provider allocated a bigger team to support Lucy, which she says has helped stabilise her. Lucy now has access to respite care that gives her somewhere to go when she needs space. She spent Christmas Day in a respite facility so she didn't have to be around food.
But Lucy still faces a long wait before a space opens in the psychological treatment that Heather says is crucial to her recovery.
For Heather, the past several months had an enormous impact on her career, her relationships, and her own mental health. "We're just exhausted," she says.
Lucy now wants to go back to Australia. Heather says she's "absolutely terrified" about letting her go but thinks her chances of getting treatment are better across the Tasman than in Auckland. "I just feel completely let down over here," Heather says.
Heather says she's not alone. "I know of many other families with children with eating disorders who've had to stop working because they need 24-hour care and there's no other option."
HELP US INVESTIGATE
The Weekend Herald will continue reporting on the nation's mental health and the way that services help people who experience difficulties. But we need your help.
We want to hear from as many people as possible who have experienced mental health problems or those who care for them. Do you, or does someone you know, live with mental illness? Are you the parent of a child who is struggling emotionally and psychologically? Did you or your loved one get timely and adequate care?
We also need to speak to people who work in the system. Do you work for, or have you recently worked for, a DHB, charity or public body in a role that gave you an insight into the pressures on frontline providers? Do you work in a government position with access to documents and data that could help us better understand the challenges the system is facing?
The more people we can speak to, the more thorough and accurate our reporting will be. We will not publish your name or identify you as a source unless you want us to. Please share your experience by contacting the Investigations Editor, Alex Spence, at email@example.com
WHERE TO GET HELP:
• Lifeline: 0800 543 354 (available 24/7)
• Suicide Crisis Helpline: 0508 828 865 (0508 TAUTOKO) (available 24/7)
• Youthline: 0800 376 633 or text 234 (available 24/7)
• Kidsline: 0800 543 754 (available 24/7)
• Whatsup: 0800 942 8787 (12pm to 11pm)
• Depression helpline: 0800 111 757 or text 4202 (available 24/7)
• Anxiety helpline: 0800 269 4389 (0800 ANXIETY) (available 24/7)
• Rainbow Youth: (09) 376 4155
If it is an emergency and you feel like you or someone else is at risk, call 111.