Dr Sue Bagshaw discusses why #students don’t seek professional medical help
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CONTENT WARNING: #SUICIDE
Every year about 580 people are lost to #suicide in New Zealand, many of them #students. A Stuff examination of 270 coroners’ reports of student suicides from 2007 to 2019 found that one in three had no known #mentalhealth concerns. How can vulnerable #students be helped in time when there are no red flags? Sam Sherwood and Mariné Lourens investigate.
When 19-year-old Mason Pendrous’ body was found in his bed at his student accommodation on September 23 last year, up to four weeks after he died, it prompted renewed questions about the extent to which tertiary institutions can and should be held responsible for students’ wellbeing.
The cause of Pendrous’ death could not be determined and no evidence of self-harm or drug use was found. But that didn’t change the fact that his body lay in his university hall for weeks before someone checked on him.
Somehow this first-year student living away from home had fallen through the cracks – a worrying thought given mounting concerns that #students are under more pressure than ever. Are we missing the mark in providing adequate and timeous support to #students?
A Stuff investigation analyzed 270 coroners’ reports from 2007 to July 2019 for #students aged 17 and over who died by #suicide. One in three of those cases involved no prior #mentalhealth concerns, with only 48 per cent of the affected #students ever seeing a doctor or #mentalhealthprofessional to discuss their wellbeing.
The average age of the #students was 22, and 61 per cent of them were #men.
Recent figures released by Chief Coroner Deborah Marshall show 53 #students died by #suicide in the year to June 2020, with 678 student suicides since July 2007.
The reasons for the distress that the #students experienced were widely varied and, in most cases, a reason for their tragic decision could not be established with certainty. However, among the contributing factors mentioned regularly in the coroners’ reports were struggles with studies, #financial problems, foreign students feeling isolated, relationship breakups, diagnosed #mentalillness and feelings of #loneliness.
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space. #http://bit.ly/JamesMentalHealthArticle
Losing a battle with bipolar
For 30-year-old Masters student Matthew Skellern, his battle with a diagnosed #mentalillness was a factor in his death.
“The note he left basically said that bipolar disorder was a lot harder to deal with than he had figured. And he just became tired, really,” says Matthew’s father, Graham Skellern.
Matthew was a qualified town planner and doing his Masters thesis on surfbreak protection through Auckland University. At the time of his death, he was back home living with his parents in Tauranga after suffering a relationship breakup.
He was diagnosed with bipolar disorder when he was 26 and admitted to the Tauranga Hospital #mentalhealth unit.
The diagnosis propelled Matthew and his #parents into unknown territory. “I think it was in a way a relief to finally know what was going on, but we knew nothing about bipolar disorder. And there was no support structure around him or around us. He was diagnosed and then told to go home, that sort of thing,” says Graham.
Matthew was prescribed medication to stabilize his mood and dutifully took his meds for about three years. But he did not like the way the medication made him feel and eventually sought to come off it.
“The medication made him a bit zombie-like,” says Graham. “Some days he would wake up and just not want to get out of bed, not do anything. He also put on weight, which he didn’t like.” A harrowing account of what it’s like losing your child to #suicide.
Graham says Matthew wanted to keep his diagnosis private and did not want even his closest friends to know. As a family they protected Matt’s privacy. “Even at his funeral, I would say most of the people just did not know. He fought it on his own. They just thought, oh Matt’s exuberant, a little bit out there, a little bit different, and they just took him as being normal – until that sad day when they had to come to his funeral.”
About nine months after going off his meds, Matthew took his own life.
Counselling was seemingly also ineffective for Matthew. “He told me they kept asking him the same questions, and he knew all the answers. Basically, he knew what they wanted to hear,” says Graham.
Looking back, Graham is annoyed that as parents they were not included in Matthew’s counselling sessions. They would have been able to create a more transparent situation by calling Matthew out when he was not answering questions truthfully.
“The last time I took Matt to one of his sessions, he told me they asked him if he had any suicidal thoughts. And I asked him, ‘well, have you?’ And he said no. And I believed him.”
Graham said as a family they were not quite equipped to handle Matthew’s bipolar diagnosis. The family tried to find a balance between providing support for Matthew, but also giving him space and not worsening the situation by constantly hassling him, says Graham.
“We did everything we could do, but it still wasn’t enough. And he also said that in the note – that we did everything we could have done, but he just decided he was not going to have a happy life here and enough is enough.”
When Matthew decided to stop taking medication, Graham bought a month’s prescription from the pharmacy and kept it on hand just in case. His plan was to give it to Matt if he realized things were getting really bad.
“I ended up putting his medication in his coffin with him.”
More than simply #mentalillness
Carla na Nagara, director of the #SuicidePrevention Office, said #suicide has traditionally been framed in New Zealand as a #mentalillness problem that services will resolve.
“And services absolutely have a role to play in treating and supporting people with #mentalillness. But the answer to our #suicide problem lies in improving wellbeing across the whole of life.”
She says while risk factors could be identified from #suicide cases, families should never feel they ought to have seen something. “I can completely understand that from where they sat there was nothing to see […] because it’s not that simple, #suicide is really complex.”
Youth health advocate Dr Sue Bagshaw believes there are several reasons why students do not seek medical professionals’ help. “Partly they’re not aware, partly it’s too expensive, partly too long a waiting list, partly the whole squeeze on our services,” she says.
New Zealand Union of Students’ Associations (NZUSA) president Isabella Lenihan-Ikin believes #isolation, finance, a fear of failure and of being overwhelmed are among the biggest concerns for #students.
“People come to tertiary institutions to study, but it is not possible for them to just be #students. They also have to get a job and work long hours to support themselves because it is so expensive to be a student today. That means we are not spending time on campus with other #students, and we are not spending time in the places we live, because we are either working or studying.”
Many #students admit they are studying for a qualification they are not truly interested in, in a bid to get a well-paid job.
“They are told they have to do all these different things and produce this incredible CV, because that is the only way they’ll be able to get a good job at the end of it to pay off their tens of thousands of dollars of student debt.”
She says being overwhelmed by a large academic workload, coupled with long working hours, a fear of failure and increased pressure due to high expectations from #parents and wh?nau all add to their #stress.
In a post-#Covid-19 world, #students feel more pressured than ever before, Lenihan-Ikin says. “The causes of student poverty and hardship – the combination of limited weekly government support, employment and housing insecurity, and systemic power imbalances between #students and their tertiary providers – have only been exacerbated by the [#Covid-19] #pandemic.”
Lenihan-Ikin says the Government needs to invest in long-term welfare infrastructure for #students, so they do not need to borrow money to live.
Leaving behind unanswered questions
Experts agree #suicide can happen against a background of no apparent emotional distress or wellbeing issues. Such was the case for Victoria University student Christopher Rosenberg.
On February 9, 2012, the 21-year-old spent the day with two of his best friends at Lake Wainamu in the Waitakere Ranges, catching up on their summer activities and drinking wine. Rosenberg and his friends were staying at his family’s Auckland home for the weekend while they attended two 21st birthday parties.
The following evening Rosenberg’s sister dropped the three young men at one of the parties, where they stood by the pool talking to people they knew from Wellington.
At some stage in the evening, Rosenberg’s friend, Josh Pyne, was confronted by some of his flatmates saying they had heard Rosenberg was saying he would not be living with them the next year.
“It was news to all of us. So I went to find [Christopher] and he said he was just playing and it’s all good, we’re still living together. Everything was fine, and he still seemed happy and excited to be there,” Pyne says.
Pyne never saw Rosenberg leave the party that night, but says it was not unusual for him to slip out and leave without saying goodbye
Pyne woke up the following morning at the house the party was hosted at and tried calling Rosenberg but his phone was dead. They started contacting friends to see who he had stayed with.
By mid-afternoon they started to get really concerned. Pyne called his missing friend’s father, Garry Rosenberg, and a search was started.
Rosenberg’s body was found on February 17 by a member of the public piloting a boat outside Bayswater Marina, who contacted police. A coroner would later confirm he had committed #suicide.
Garry Rosenberg says his son was a high achiever who performed well both academically and in his sporting endeavours. He was due to head back to Wellington the following week to begin his fifth and final year of a conjoint arts and law degree.
“From our side looking in, everything looked great,” said Garry. “Certain suicides people are found or notes are left which give a bit of an indication as to what might’ve been going on, or there was a history of #mentalillness, but in our case there was nothing.”
Pyne has often pondered why his best mate took his life. He said Christopher was a “smart guy”, but never considered himself that way and put a lot of pressure on himself.
“It’s university, it’s a high-pressure time and it’s not uncommon for things to become too much for the majority of people… we would sit down and have a chat, and he would be honest about being stressed out and all that kind of stuff. But we’d get up the next day and laugh, go down and have a beer, kick the ball around and all was good. There was just no sign that there was anything deeper going on than the workload just being a bit much.”
Eight years on from his son’s death, Garry says the family have stopped asking themselves why Christopher chose to take his life.
“At some point you’ve got to park it, it’ll just eat you alive. You can’t keep thinking about why because you’re never going to get the answer.”
He says it’s “concerning” that one in three student suicides involve no #mentalhealth history.
“Clearly there’s a gap in our understanding of why people take their lives, clearly there’s a gap because nobody’s got the answer, nobody understands why.”
Demand for #mentalhealthservices increase
Earlier this year the Government announced a $25 million #mentalhealth package for tertiary #students to give them the support they need to manage #Covid-19 related #stress.
The announcement was largely welcomed, especially since many tertiary institutions had reported an increase in #students using #mentalhealth services over the past few years. Depending on the university and urgency, wait times range from same-day to four weeks.
Auckland University of Technology (AUT) has increased its #mentalhealth staff from seven to 12 since 2017. Last year the university provided nearly 4000 appointments, spokeswoman Alison Sykora said.
Urgent appointments were available on the day, while the wait time for non-urgent appointments varied “depending on the point in the semester”, she said.
At Massey University, which has about 30,000 #students, councillors provided more than 8000 sessions last year. The target was to see clients within two weeks and, while wait times fluctuated from one to three weeks, emergency counselling usually took place within 24 hours, a spokeswoman said.
The University of Waikato recruited two dedicated #mentalhealth #nurses after noticing a steady increase in demand, particularly over the past three years. Same-day appointments were normally available, Mike Calvert, director of student services, said.
Unitec in Auckland had seven student counselling and #mentalhealth service staff. Wait times for counselling ranged from one to two weeks. High-risk cases were dealt with immediately, either on-site or through the DHB crisis team or emergency services.
After a review of its #mentalhealthservices in 2016-17, the University of Otago has not had a counselling wait list since January 2017. However, there were wait times of up to four weeks in 2019/20 to see a clinical psychologist, said #mentalhealth and wellbeing clinical director Richard Mooney.
Last year the university’s #mentalhealthsupport team provided more than 9000 appointments to more than 2000 #students.
A University of Canterbury spokesperson said despite the lockdown and level 3 and 2 restrictions, its counsellors had provided 3.5 per cent more appointments by the end of the first semester this year than in 2019, and 84 per cent more appointments than in 2015. The university did not provide the numbers.
University of Canterbury vice-chancellor Professor Cheryl de la Rey earlier told Stuff that following Pendrous’ death, the way in which the university saw the undergraduate year had been “reconceptualized” with a focus on the first year, recognizing that the transition from high school to university came with a “whole lot of challenges”.
The relationship between staff, residential assistants (RAs) and first year #students had “changed completely”, with more than double the number of RAs.
The university has also introduced a system where, with first-year #students’ permission, the university can message either the student or their contact person if they are not engaging with their studies.
Pendrous’ stepfather, Anthony Holland, recently spoke with de la Rey and says he believes the university has done “everything that they promised and more”.
“We believe the University of Canterbury have filled all the holes in the system and I’m comfortable that no-one will be alone for four weeks again.”
A way forward
Interviewed in September, Education Minister Chris Hipkins said the Government was aware of the #financial pressures #students faced. “We’ve been looking at what extra #financial support we can put in place, things like the increases in hardship funding, so those who are in #financial distress can actually get a bit of extra support where they need it.”
Hipkins said more money had been made available to support #students who faced increased pressure from the #Covid-19 fallout.
Lenihan-Ikin says more funding is always welcome, but more needs to be done to address the root causes of poor #mentalhealth and unhealthy #stress levels among #students.
“We need #mentalhealthservices on campuses that are actually tailored for #students.”
Despite tertiary institutions increasing their #mentalhealthservices to keep up with demand, there are still campuses where #students have to wait up to six weeks to get an appointment, says Lenihan-Ikin. “I don’t think you can ever say that is an adequate service.”
The solution is more complex than simply increasing the number of #healthcareprofessionals available, she says.
Lecturers coordinating to spread the workload and testing over the academic year would go a long way in addressing students feeling overwhelmed or overly anxious during exam times. Educating academics about the genuine #mentalhealthissues for #students would break down the #stigma.
“We need to change the way we respond to #students who may have issues with poor #mentalhealth. This goes beyond tertiary institutions. Generally we need to create a society where people feel that their poor #mentalhealth is being legitimized and that there is help available.”
Bagshaw says the Government needs to take responsibility for people’s health, education and social welfare. “When this is pushed aside in favour of making more money, you don’t get a healthy, contented society – you get suicides and you get #mentalillness.”
David Cairns, #SuicidePrevention Coordinator at Pegasus Health, says responsibility also falls to parents, friends, tertiary institutions, and #students having “self-awareness and knowing when and where to seek help”.
According to Cairns, the Japanese #suicideprevention plan dictates that help-seeking can be taught and learned, and they teach it in #schools. “It would be nice if everyone at a university [in New Zealand] had to pass a course on health that included relationships, wellness, alcohol and #stress,” he says.
Bagshaw says young people transitioning from high school to tertiary institutions need more support.
“When you are 18 years old, you get transferred to the adult system, but you don’t yet have an adult brain. Some people might, but some people who are still developing definitely won’t,” she says.
“We need an education system that helps to nurture brain development, not just become qualification factories.”
Hipkins agreed education providers have to take responsibility for the overall wellbeing of their learners and ensure they have support. He called Pendrous’ death an “absolute tragedy” that revealed “glaring gaps” in university pastoral care that needed to be closed urgently.
“We introduced the code of pastoral care for tertiary #students because we actually wanted to send a message to tertiary education providers. We’ve got a duty of care to students who are studying in our institutions that goes well beyond their academic progress, and we all need to acknowledge and recognize that.”
Na Nagara says while #suicide rates will likely not drop fast because of the changes required, she is optimistic – “because the alternative is simply not acceptable”.
“If we as a society can buy into understanding what the problem is and how it needs to be addressed… we will get there.”