Young people in crisis will prop each other up rather than seek mental health treatment in hospital, a leading suicide prevention expert has revealed.
Emergency departments can be "toxic" environments, notoriously devoid of compassion, for people at risk of suicide or experiencing acute mental illness, explains Orygen Associate Professor Jo Robinson.
That's a "frightening" situation given what she describes as a sharp increase in the number of young people, particularly females, presenting with suicide attempts, suicide ideation and self-harm in recent years.
"Emergency departments are designed for people with a broken leg or having a heart attack; they are not designed for young people having a mental health episode ... and they can be turned away," she says.
"It puts them off going.
"They stitch each other up rather than go to hospital - it doesn't bear thinking about."
Associate Professor Robinson, who heads the suicide prevention research unit at Orygen (regarded as a world leader in youth suicide research), describes a "very real" crisis in youth mental health.
The award-winning researcher, who will address this year's Albury-Wodonga Winter Solstice, says demand for services has "gone off the scale" as a result of the pandemic.
And yet, she argues, there is not enough capacity in an already fractured system to deliver a model of care that is "truly fit for purpose".
Study after study, data piling upon more data, coupled with a staggering weight of anecdotal evidence, shows young people (under the age of 25) have been "disproportionately" affected by COVID-19.
A 2022 Child and Adolescent Psychiatry and Mental Health report concludes that while "mandatory lockdowns and quarantine periods, school closures and social restrictions have been effective in mitigating the spread of the virus ... these measures have probably increased psychiatric symptoms among children and young people".
Evidence suggests suicide rates increased during the second wave of the pandemic; meanwhile young people languish on lengthy waiting lists to get help.
"They are too sick for (services like) headspace but not sick enough for tertiary mental health centres," Associate Professor Robinson explains.
"We call them the 'missing middle' and this is the group we really worry about.
"There are too many cracks that need to be knitted together."
This leading light in youth suicide prevention has developed an innovative way to tackle one of the gaping holes in an unwieldy discussion space.
Associate Professor Robinson recently won the eMental Health International Collaborative Leadership Excellence award for creating the #chatsafe guidelines - an initiative to support young people to communicate safely online about suicide.
Launched as a booklet in 2018, #chatsafe has evolved into an online platform with social media campaigns and is now available in 12 countries.
There are too many cracks that need to be knitted together.- Associate Professor Jo Robinson
The idea of talking about suicide in a social media setting typically elicits concern about the potential for cyber-bullying and the harm of distressing or inappropriate content, according to Associate Professor Robinson.
"Traditionally there is a lot of anxiety in the suicide prevention sector about the ways we communicate publicly," she says.
"But at Orygen, young people were telling us it was a really important avenue to have those conversations."
The team partnered with young people and worked collaboratively to develop a safe online space where they could help themselves and each other, according to Associate Professor Robinson.
"We have empowered and equipped young people to have those conversations safely and respectfully," she says.
"If we can harness the good aspects of platforms like Facebook and Instagram we have the power to reach a whole lot of young people very quickly to minimise the risk of suicide."
On June 21, the Albury-Wodonga Winter Solstice will mark 10 years spent shining a light in the darkness of mental ill-health and suicide on the border and beyond.
A decade of dedication by the founders of Survivors of Suicide & Friends has brought this community together to break the silence and stigma, cocooned in the warmth of uplifting presentations from incredible speakers and entertainers.
This year's guests include Australian author and ABC journalist Indira Naidoo and Orygen Associate Professor Jo Robinson with a third international speaker to be announced later this month.
This year's event coincides with the premiere screening of Albury film-maker Helen Newman's documentary, Solstice, on June 5.
Four years in the making, Solstice is described as a "brave, grassroots film".
Her parents, Annette and Stuart Baker, were met with shame and stigma over her death.
They refused to be silent.
The film shares their journey and expands out to Australia and across the globe, documenting the stories of those on the frontline, working for better mental health care even as they continue to traverse their own grief.
Solstice aims to help "unite, challenge and change how we respond to our collective mental health crisis now and into the future".
Associate Professor Robinson says the future lies with a "seamless avenue of care".
A model that encompasses compassionate, evidence-based care - no matter where you present - and traverses the gamut of need, particularly in crisis support and on a scale that addresses the complexity of cases.
That's easier said than done, she concedes.
"It's hard and it's costly," Associate Professor Robinson admits.
"Governments want shiny 'announceables' that win votes.
"There is a lot of rhetoric about mental health being a priority but politicians are not doing what they need to achieve that.
"We need genuine commitment to re-designing services, increasing access to care and addressing other factors ... like climate change and the cost of living ... that impact on mental health."
The associate professor applauds the powerful work of individuals like Annette and Stuart Baker in "galvanising the community" to advocate for change.
But she says the responsibility should not rest entirely with "grieving communities".
"Parents and carers are already such an important piece of the puzzle," she says.
"Too often they are left behind, holding the responsibility for navigating a fractured system.
"They are the invisible workforce we need to support."
That support is coming, slowly but surely, out of the shadows.
From schools to social media and even Victoria's recent royal commission, Associate Professor Robinson is heartened by the growing chorus of voices that will not be silenced by shame or stigma.
"As a community, we are now having honest conversations about suicide and suicide prevention, she says.
"We are threading stories of lived experience with research, policy reform and great innovation.
"We have our work cut out for us but the young people I work with inspire me and give me hope."
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