Thursday, February 28, 2013

Tony Ryall, NZ Minister of Health and the $10 Million Suicide Solution

Tony Ryall, New Zealand's Minister of Health



New Zealand's Minister for Health, Tony Ryall, is handing over $10NZ million to school based health services.

At first glance this would appear to be a very generous offering. However, there seems to be some sort of madness, ignorance, call it what you will, going on here.


The $10NZ million injection is part of the Prime Minister’s Youth Mental Health Project and Ryall claims, "...over 8,000 more secondary school students will be able to see a registered nurse or access other health services at school if they need it."

While some of what nurses in schools deal with is physical health, by far the greatest component is mental health – screening, assessing and referring.

This national government led initiative already funds $5.6NZ million per to school nursing services in 135 decile one and two secondary schools, alternative education facilities and teen parent units. It is billed as an initiative that contributes to suicide prevention.

Now, let's just take a look at the suicide problem here in New Zealand, I'm merely trying to understand the logic of messrs Key and Ryall here.

Last year there was a 42% increase in kids aged 15-19 killing themselves in NZ.

The school based health services initiative has been in place since 2008, each year it has been granted an extension.

Mental health screening, it appears, is failing miserably at preventing suicide in this vulnerable age group – and the stats would suggest is making things worse - yet the government is throwing buckets of cash in to it.

Part of the school based health services is features a "Wellness" check for 12-13 years olds, new secondary school starters. "That’s a physical check-up but there’s also an assessment of each young person’s mental well-being. This covers areas such as home-life, eating, activities, drugs, sexuality, suicide and depression," Ryall said in a press release.

I took a look at the assessment, which, it appears is called the “HEADSS” Assessment, A Pyschosocial Interview For Adolescents. Adapted from Contemporary Pediatrics.

The assessment is available at the foot of this post if you want to see how children are being diagnosed with brain abnormalities they haven't got.

I'd like you all, as adults, to cast your minds back to your school years and ask yourselves if you would have passed or failed this test.

Incidently, HEADSS is an acronym for Home environment, Education and employment, Eating, peer-related Activities, Drugs, Sexuality, Suicide/depression.

The basic screening interview is designed to be reasonably rapid [1] and sees many questions. Keeping in line with the suicide theme I'm focusing on the questionairre [screening] for suicide and depression. You can see for yourself the other questions in the other catagories by downloading the HEADSS assessment guide.

SUICIDE/DEPRESSION


Do you feel sad or down more than usual? Do you find yourself crying more than usual?

Are you "bored" all the time?

Are you having trouble getting to sleep?

Have you thought a lot about hurting yourself or someone else?

Does it seem that you've lost interest in things that you used to really enjoy?

Do you find yourself spending less and less time with friends?

Would you rather just be by yourself most of the time?

Have you ever tried to kill yourself?

Have you ever had to hurt yourself (by cutting yourself, for example) to calm down or feel better?


Remember, these types of psychological questions have been asked in NZ since 2008.

Let's take a look at the suicide rate of 15-19 year olds during the last three years.








Would it suggest to you that the current method of mental health screening in kids is saving lives?


In 2009 the Nursing Services in New Zealand Secondary Schools report was sent to the Minister of Health. [2] The report found that Nurses in lower decile schools** (deciles 1−3) tend to undertake more health and HEADSS assessments; are slightly more likely to provide personal health services; are more likely to administer medications.

**A school’s decile rating indicates the extent to which it draws its students from low socio-economic communities. Decile 1 schools are the 10% of schools with the highest proportion of students from low socio-economic communities, whereas decile 10 schools are the 10% of schools with the lowest proportion of these students.

So, let's get this straight. The poorer the student, the better chance he/she has of [a] undergoing a HEADSS assessment and [b] the more likely they are to receive medications from nursing staff.

Step forward Linwood College, or rather The Lane Project [3] a pilot programme for the HEADSS assessment- they found that: "Whereas HEADSS is not a research tool it is a good screening tool. The results of this exercise showed that it may help to discover mental health issues in students at an earlier stage than otherwise would have happened."

Hmmm, so in other words HEADDS is basically a DeLorean.

I've used the term 'DeLorean' before regarding pre-school mental health screening. Patrick McGorry, a psychiatrist from Australia, planned to pre-screen kids for mental illnesses too, it was thought that McGorry and his team could detect psychosis in kids. Public pressure and scrutiny into McGorry's methods saw McGorry do a complete U-Turn in 2012. [4]

McGorry had called for pre-psychosis to be listed as a mental illness, in other words children could be diagnosed with a mental disorder before they actually got it... hence the term DeLorean [time travelling car in Back to the Future]

During his research into 'pre-psychosis' McGorry received $222.4AUS million Commonwealth funding injection for Early Psychosis Prevention and Intervention Centres across Australia.

I've wrote about McGorry on a number of occasions, good to see that he has, finally, come to his senses regarding his DeLorean.

In America a very similar programme, TeenScreen planned to catch mental illnesses and prevent suicide. After 9 years and much criticism the program was terminated in 2012.

So, here we are today. New Zealand, the country that boasts the highest rate of youth suicide in the OECD. The country that has, for the past 5 years been screening it's youth for possible mental disorders. The country that saw a 42% increase in suicides in 2012 for the age group of 15 to 19 year olds, those same kids they would have screened during the past 6 years.

New Zealand's stubbornness could just be raising the suicide figures for next year. It's plainly obvious they are climbing but the Ministry of Health’s latest published suicide figures are for 2010 so they are able to ignore the trend reported by the Chief Coroner who recently published his 2012 figures which the Ministry ignore as not being ‘official.’

Looks to me like the recent $10NZ million gift from Tony Ryall to school based health services is just injecting cash into a system that will trap kids into a process that has been described by Marcia Angell , a medical ethics lecturer at Harvard Medical School "...is just a way to put more people on prescription drugs."  Drugs clinically proven to induce akathesia, violence, withdrawal problems, self-harming and suicide in youth.

I'll leave you with the final offering. It's a paragraph from a NZ Adolescent Health Assessment bulletin that discusses HEADSS. [5]

1. Who to assess
All young people (from ages 10-24) should be assessed. Adolescence is a time of rapid growth and development which occurs within the domains of physical, cognitive, emotional and social development.

Way to go Mr Ryall.


Bob Fiddaman



[1] Getting into adolescent heads: An essential update - 2004 John M. Goldenring, MD, MPH, JD, David S Rosen Contemporary Pediatrics
[2] Nursing Services in New Zealand Secondary Schools - 978-0-478-31909-5 (Print), 978-0-478-31910-1 (Online)
[3] Report on the HEADSS Assessment on YR 9 and YR10 students at Linwood College [Link]
[4] About-turn on treatment of the young - Sydney Morning Herald February 20, 2012
[5] NZ ADOLESCENT HEALTH ASSESSMENT [Link]






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