Gino Kenny on Jigsaw: Youth Anxiety, Triggers and Treatment Choice

My first question is in relation to Jigsaw Services. When people are seeking intervention, what are they presenting with in relation to that kind of cohort of people? What's the kind of, I know it's that kind of one fit, it's kind of fits all, but what are people presenting themselves? Yeah, and I suppose I can give you the sense of our kind of top presenting issues at the moment are tend to be, have tended to be fairly typical over the last number of years, but their anxiety is the first, first and foremost, I think, followed by low mood and sleep disturbance. So they tend to be the big ticket items. And then I suppose what you need to get to is what's underneath that. So what's led to maybe that presentation of anxiety. And that's where we really open up that lived experience of the young person. So what we would do in Jigsaw is we'd invite a young person in and often a parent, you know, for part of that if they're, if they're under 18, or even if they're over 18, and they want to have a supportive adult there. But we find out really what's been going on for them, we try and help them make sense about, you know, why they're feeling the way they're feeling at this time. And every young person will have a different story about why that is, there can be some common threads. And in that, you know, we know that we've gone through a very particular point in our history, and that's that's bound to have an impact. But there's no two narratives that are the same. So while we can classify them and say, you know, anxiety is a big issue, and the research is telling us, you know, that, you know, young people are feeling highly anxious, they're the rates of kind of or the levels of depression, or the higher rate, you know, we know that there is a lot more prevalence of suicide and self harm and things like that. But it's really trying to what we're trying to do is get under the surface of what's happening for that young person. Is there any particular triggers? That's a kind of a general nerd in situations like this particular triggers. I mean, it really depends on the individual young person. And I suppose I'm mindful of the purpose of this subcommittee. And I think triggers, you know, can often happen at points of transition as well, you know, so if we consider the tasks and journey of a young person through that, say, even 12 to 25 year period, we think about those points of time that require something new or different of the young person. So the first time I have to sit state exam, the first time I face a relationship breakup, the first time I get excluded by a group of friends, the first time that, you know, I have to start a third level education, or I don't get to go to third level education. And that's before we start to consider maybe young people who have those extra layers of challenge, you know, who are growing up in, you know, marginalized communities who are growing up in poverty, in stable, unstable housing situations with specific health concerns or other levels of diversity that exclude them or other. So there is any number of triggers. And I suppose what we're always trying to do is rather than us come from a very expert level and say, well, we know what triggers young people's distress, we want to hear from young people about what's happening for them. And that's both in the session room and what we how we approach our therapeutic work, but very much in how we approach our kind of our youth participation strategy. So how we engage our youth advocates, because it's not going to be 12 to 25, but we have young people who have voice and want to tell us and want to share their experience. So we draw quite a lot from that as well to help us understand what is happening now. And in terms of say, intervention via say, drugs, would that be kind of common in terms of relation to say, prescribed kind of medication in relation to treating some of the conditions that you see, in terms of using kind of particular medication to manage, I suppose just to place where jigsaw sit on the landscape is we're a non medical service. And while we have complete a pre association for our colleagues who work in that medical model, it's not the model that we've been set up under, it's not how we conceptualise mental health, and as such, or how we view it. So there is, you know, clinically, you know, I feel there is a place for for, I think we need to be open to any intervention that might work for a young person. But I think what we need to steer away from is an assumption that one size fits all. So where some young people will and do tell us that they've benefited from, you know, from carefully prescribed medication, there's other young people who feel that's not for them. And I think choice is the word that comes to my mind about how do we work collaboratively with young people, or we bring our expertise. And that's, I think everyone around the table, you know, psychiatry, social work, psychology, all of the allied health professionals, but that young people are equal partners at that table, and are able to say, I hear you, but this is the way I want to go with it. And that's, correct me, correct me if I'm wrong, but jigsaw don't have the remit medications, they don't. Yeah, okay. Just in relation to Dr. Duffy. This is a kind of a broad kind of question. Does he see kind of there is a crisis in society, particularly around young people's mental health, particularly all the pressures that young people have to endure, particularly around social media, kind of I think it's very, you know, it's difficult being young, you know, we're all young, and we all have difficulties, you know, and some kind of, some periods of our life are kind of, when you get the intervention, it's, it's, you know, it, it makes it's revolutionary in some ways. But being young these days, there's so many kind of pressures on young people. You know, it is different than it was, say, 20 years ago. But it is sort of kind of a crisis out there of, you know, people how young people are kind of, I suppose, treated in society, I think there certainly is. And I think that when we want to speak to the staff in the services, what they talk about is the amount, the levels of anxiety, young people experience. And then when, as Connor was saying, when you begin to peel that back, and you ask them, what's behind that? A lot of it is around that sense of social comparison. Yeah. Who am I? How do I fit in? And if we think about, you know, Sarah's mentioned earlier on, there's normal tasks in adolescence. The reason we have adolescence is that transition from being a child to an adult. So people can learn more about the world, they get a sense of their identity. There's a real sense for young people now of wanting to know immediately what their identity is, because other groups on Instagram or whatever other social media are gathered by identity. So rather than actually let it flow, let it work itself out, there's a real sense of everything needs to be immediate. So that is producing a lot of anxiety around it. Yeah. There's a lot of anxiety around that broader sense of identity, you know, in terms of people would think about sexual identity, but now in a much broader sense. So there's, there's, and there's constant feedback in that sense of Connor mentioned earlier on, and that's it, that experience of being excluded. And the other part of it, when, when we talk to the, to the staff, what they say is that parents who are young parents themselves are finding it difficult in terms of how do they parent and how can they parent a child now that is experiencing and used to using technology in a way that they're not used to using at all and have no understanding of that. So it's about trying to, how do you take some of the heat out of that? How do you say this is normal to go through lots of different feelings, you know, have lots of different friendships have, you know, not know what you want to do in your life, all of those things. And how can we normalize that? And I think that there is still enormous pressure in terms of our education system, our expectations around, you know, being in school full time for people who can't be all sorts of different things with us. And would you recommend any kind of, I suppose, solutions to not kind of young people being, I know it's difficult, but not being caught up in all this kind of, I suppose, anxiety bubble, you know, and it's very difficult. It's very, very difficult. But if there's any kind of, you know, in your professional opinions or anything that, you know, young people should kind of steer it away from. And I know it's difficult. It is difficult. I think it's, I suppose, it's about trying to think about what sort of a society do we want. And, you know, are we thinking about the individual and sports is their thing brilliantly, if writing is their thing, or drama is their thing, or walking up a hill, or what is their thing, or what is their thing for now? How are we thinking about the broad education of young people? And what messages are we giving? And what do we, what do we prize? Are we, you know, you know, I talked to friends from abroad, and they're always quite surprised in terms of the hoo-ha in Ireland around the Leaving Cert. You know, back in my day, all of the points were published in the papers, and that sort of sense of, we do this in a very, you know, we almost take national pride in it, but that really does exclude people, it puts enormous amount of pressure. It's trying to think about what are the broad messages we want to give, and how do we help, I suppose, families and communities understand that looking after people's mental health is a normal everyday thing, and not something that can be just done in jigsaw, or just done in cams, or just done somewhere else. So how do we manage some of those messages as a society is part of the bigger conversation. Yeah, okay, okay. If I could maybe just add to that as well, I mean, I suppose we're kind of focusing a little bit here on triggers and things to avoid, but equally there's a whole, you know, body of evidence there to support things that actually young people can do to stay well and to protect their mental health. And one of those things that is key and that's really universal is around connectedness and belonging. And whether that's online, whether that's in a physical environment, whether that's in a campus or whether that's in a school or in a workplace, that is something that can be developed and can be really protective for young people. So I think we also need to focus very much on not only things that we want young people to avoid that may be harmful to their mental health, but also things that we can promote that may protect them and keep them well. Okay. Sarah, would you like to comment? Yeah, I have a couple of thoughts there. And I think what Declan was saying around the connectedness and belonging, and pre-pandemic USI did some research on student mental health. And one of the key things we found was loneliness was a major, major issue. And despite, you know, at the time this was when everybody was still on campus and all of that, there was still a very high level of loneliness. And I think some of it comes from, we've moved a long way in terms of stigma reduction in this country, like the conversation about mental health is national now. Yeah. And we do trot out the phrase, you know, it's okay to be not okay. And it's okay to ask for help. And what we're kind of finding, particularly with the student population is that's accepted, but not like on a general level, not for me as the individual. You know, it's, it's, it's a, there's a self stigma still going around. And I think when we look at that sort of sense of anxiety as well, there's, there's a lot of sort of perfectionism, you know, the need to, to, you know, to get the first, not just pass the exam, you know, to, to get the best work experience, that kind of thing. And I think when you, when all of those kind of things interplay, you get somebody who's got a lot of thoughts going around in their head, but not really reaching out to anybody about it. But if you spoke to them, they'd be like, oh yeah, no, people should definitely talk about their mental health. Did you say loneliness? Yeah. Okay. Okay. And that was one of the main. Mm hmm. Very high levels among the student population pre COVID. Okay. Okay. And was there a reason for that? We didn't tap into that within the survey. Um, but you know, I think particularly when you're looking at that sense of perfectionism, it's a sense of not wanting to admit to their peers that they're struggling so much. Right. Which was an interesting finding because on the flip side, there were a lot of people who wanted more information to build their confidence in how to support a friend. So it's kind of, it goes one direction, but not the other direction there. Everybody's prepared to help their friends, but nobody wants their friends to know that they're suffering themselves. Okay. Thanks very much. Thank you. Thank you.