self-harm – Michmutters

Australia’s national peak body for suicide prevention is calling for urgent reforms to care offered at emergency departments for young people in mental distress.

Suicide Prevention Australia consulted dozens of young people with lived experience of self-harm or suicidal ideation and found hospital emergency departments were poorly equipped to deal with young people needing critical mental health support.

The report’s authors recommend all states and territories fund trials for youth-specific “alternatives to ED” to better support young Australians who present to a hospital after self-harming or attempting suicide.

Nieves Murray, the CEO of Suicide Prevention Australia, said young people were being failed by EDs.

“Emergency departments are not the place for people in suicidal distress, particularly not younger people in suicidal distress.

“We need to co-design places for people in suicidal distress with the people who use them … particularly young people.”

A lady speaks into microphones with her hands raised. — Ms Murray warned that youth suicide rates tend to worsen a few years after a traumatic event – like a global pandemic.(Supplied: Facebook)

Ms Murray said evidence showed that poor quality care for a young person’s first suicide attempt tended to lead to worse mental health outcomes, and highlighted the need for specialized “peer support workers”.

“It’s really critical that the first time that somebody tells their story, they’re telling it to someone who can actually assist them, to navigate through that.”

‘Sent home barefoot in a taxi’

Jack Heskett, 25, from Sydney, was 17 when they attempted to take their own life.

Jack said the months and years following were spent in a “revolving door” between home and presenting to emergency departments after multiple suicide attempts.

Jack, who was consulted in Suicide Prevention Australia’s report, believes EDs are a “terrifying” place to be when in acute mental distress, and can make patients like them feel significantly worse – not better.

“It feels overwhelming, it feels terrifying, and very isolating. You’re in a bed with very thin curtain partitions around you. But you can still hear absolutely everything going on around you, and can feel that chaos.

“It only seemed to add to that feeling that I was a burden.”

Jack remembers feeling particularly disappointed after one suicide attempt, when they left the hospital barefoot.

“I’d probably been in the ED for about eight hours… I was told once again, there’s not really anything more they can offer me. And that’s when I had to leave the ED, I didn’t even have any shoes on, and I had to get a taxi home.

“And it was terrifying for me, because I would swing in and out of these acute experiences, and then all of a sudden be at home, left quite isolated.

“Each time I was sent home with no support, it just solidified to me that there was no help.”

Jack said they were “lucky and privileged” to eventually receive extensive care at a private hospital with a specialized team to help with their treatment and mental health diagnoses.

‘Stop talking about 1950s solutions’

Ian Hickie from The University of Sydney’s Brain and Mind Centre, who was not involved in the report, agreed that EDs were at breaking point – and often weren’t appropriate places for young people in distress.

“We saw a movement in the 2000s to wanting to put more mental health in emergency departments as if it would fit easily. It doesn’t.

“It works for some people for some needs, but it hasn’t really worked for young people.

“It’s not that the health professionals don’t care. The system is under pressure. And the physical environment is very challenging.”

Professor Ian Hickie wears a blue suit and red tie and looks into the camera from an office space. — Professor Hickie says EDs often don’t provide quality care for suicidal young people(ABC News: Bryan Milliss)

Professor Hickie said emergency departments played an important role for young people who have physical injuries after self-harming or a suicide attempt, but alternative places for acute care were needed for young people with psychological symptoms.

“It could be another safe location that can be staffed by people who have healthcare experience, or have personal experiences and provide a safe, supportive, warm, human environment.

“It might be close to a hospital, it might be quite separate.”

Professor Hickie said it was “time to stop talking about 1950s solutions and start talking about 2030 solutions” and that preventing youth suicides should be a priority for all governments.

“What we need is it to be at the top of every health minister’s list…young people’s mental health is the future of this country.”

Jack Heskett hoped alternatives to emergency department care were taken seriously by health departments around the country.

“These changes have been required for years. And this report only solidifies that standpoint that something needs to change – otherwise we’re just going to see more young Australians dying.”

Nieves Murray warned that youth suicide rates tend to worsen a few years after a traumatic event – like a global pandemic.

“We know that in two or three years’ time, that’s when we’re going to see the greatest risk for suicide. So if we don’t act now, we’re missing an opportunity to get ready for the distress levels as they increase over the coming few years.

“The time is now. We can’t wait.”

Moving “violent young offenders” out of Western Australia’s only youth detention center to a separate unit at an adult prison has “worked”, the WA government says.

The comments follow widespread criticism of conditions for children being held in detention, in both the existing Banksia Hill Detention Center and an ad hoc facility set up in a section of Casuarina — one of the state’s maximum security male prisons.

Last month the Department of Justice moved 17 children, including one aged 14, to the unit at Casuarina, dubbed “Unit 18.”

Their hands and ankles were reportedly shackled during the move.

Toilets have been ripped out of walls in a damaged prison cell — The young offenders were moved to Casuarina Prison after they damaged cells at Banksia Hill Detention Centre.(Supplied: Department of Justice)

The department said the move was prompted by widescale damage to cells at Banksia Hill, and detainees had to be relocated so the cells could be repaired.

Reports of self-ham emerge following transfer

There have been subsequent reports of four of those children being taken to hospital after attempted self-harm.

The West Australian has reported four children harmed themselves with shards of broken glass, something the ABC has been unable to immediately verify.

The Department of Justice declined to provide figures on the number of children at Unit 18 that had self-harmed or attempted suicide since they were moved there on June 20.

The department said there were now 16 children inside Unit 18.

Corrective Services Minister Bill Johnston said he would not comment on individual cases, but added the “good news” was that Banksia Hill was now running well.

“While we still have this difficult to manage cohort at Unit 18, for the overall majority of young offenders who are at Banksia Hill, they’re now in a much better environment,” he said.

“It was not functioning to have these young offenders causing violence at Banksia Hill, and so that the other kids who were not being violent, were not acting out, were not getting the services they need because the facility was constantly going into lockdown.”

Improvements in behavior following move

He said there had not been any significant disturbance at Banksia Hill since moving those children on July 20.

And the Minister said some of the young offenders at Unit 18 were starting to improve their behaviour.

“Now, it’s not sustained and I’m not going to comment on individual cases but as we are confident those young offenders can reintegrate into Banksia Hill, we’ll continue to bring them back,” he said.

But he granted the Intensive Supervision Unit (ISU) at Banksia Hill was not “fit for purpose”.

The head of the Perth Children’s Court described Banskia Hill as a “dehumanizing” environment. (Supplied)

“We know we need to improve the ISU so it has a more therapeutic environment,” he said.

“At the moment we have violent and disturbed offenders in ISU, that’s completely unacceptable.”

He said a new unit would be constructed at Banksia Hill to provide a more therapeutic environment.

According to figures provided to WA Parliament during budget estimates, the average hours children at Banksia Hill spent outside their cells each day was 9.37 in 2020-2021, falling to 7.6 hours in 2021-2022.

The exercise yard at Banksia Hill has been likened to a cage.(Supplied)

Self-harm on the rise at Banksia

There has been a dramatic rise in suicide attempts and self-harm incidents in the past three years.

There were two recorded suicide attempts, one of which was serious, and 105 minor self-harm incidents at Banksia Hill in 2020.

That compares with 31 suicide attempts – six of them serious – and 314 minor self-harm incidents in 2021.

In 2022, there had already been 20 suicide attempts and 285 self-harm incidents by June 20.

The longest-serving president of the Children’s Court of WA, retired Judge Denis Reynolds, has told the ABC the transfer of children to a unit at Casuarina represented a “broken” system.

He said the court had lost confidence in the state’s justice system.

Judge says likely figures tip of the iceberg

The former judge said the 20 suicide attempts so far this year likely only represented the type of the iceberg.

“We need to also look at those children who have also gone back into the community,” he told ABC Perth.

“Many of them turned 18 and subsequently committed suicide in the community, or perhaps in an adult prison facility.

He believes in excess of 100 young lives of former Banksia Hill detainees had been lost to suicide in the community in the past two decades.

The WA government has committed $7.5 million to building a crisis care unit at Banksia Hill and an additional $2.6 million will be spent on fencing and “hardening works” for Jasper Unit at Banksia.

Another $3.5 million will be spent on preventing children from being able to climb onto the roofs at the facility, and another $2.5 million on upgrading the CCTV system.

The department told Parliament it had recently developed a new operating philosophy for Banksia Hill that would have a greater emphasis on rehabilitation and therapeutic models.

Recidivism rates for young offenders have been on a downward trend since 2017-18, falling from 58.7 per cent of offenders to 49.2 per cent in 2021-2022.

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