When police knocked on her door three years ago, Katie – not her real name – thought her grandson had killed himself. “They wouldn’t let me in his room, in case...” she trails off.
Her grandson had had a complicated life, even before he was abandoned at a train station in his pram when he was six months old. He has lived with Katie ever since.
The police turned up this time because her grandson had confided in a friend that he no longer wanted to live. He was 11.
The boy was taken to hospital but was soon discharged without an adequate mental health treatment plan, Katie recalls. “I was worried. I stayed with him 24 hours a day, seven days a week, until he was in a better state of mind. His mental health had overflowed into school, the anger and the aggression … We had a battle with suspension, declining grades. He felt worthless.”
Katie details the years trying to get help for her grandson, navigating barriers and setbacks. They were turned away from treatment programs – her grandson was too young or his case too complex. When they found help, psychologists would leave or funding for the program would dry up and they’d be put back on lengthy waiting lists.
“He got disheartened,” Katie says. “He said, ‘I don’t know why you’re bothering, no one can help.’ ”
While the pandemic has seen demand for child and youth mental health services surge amid a shortage of psychologists, the challenges Katie and her grandson confronted long pre-date Covid-19.
Half of all adult mental health challenges in Australia emerge before the age of 14, and more than half of children experiencing issues do not get help.
The mental healthcare landscape for young children is a fragmented assortment of programs, service offerings and siloed professionals in private practice. The National Mental Health Commission concedes this in its Children’s Mental Health and Wellbeing Strategy, reporting that, for children under 12, there’s “no real ‘system’ of affordable, integrated care, delivered on the basis of need”.
The strategy highlights that young children with complex mental health needs are more likely to be turned away from support because providers may not have the skills or resources to treat them. And services such as headspace, a national youth mental health foundation funded by the Australian government, do not cater for under 12s.
Young children are often referred to private psychiatrists or psychologists, which are financially out of reach for many families, even with a subsidised mental health treatment plan available from their GP. They are also frequently locked out by long waiting lists.
Those who have experienced abuse and neglect are among the most vulnerable and are more likely to be turned away because of their complex needs. Children who’ve experienced out-of-home care are five times more likely to experience mental illness, or be at risk of suicide. Yet, according to the commission, they may be “unable to access health and wellbeing support until their mental health has declined severely”.
The Australian Childhood Foundation is one organisation providing specialist trauma support to children in care. They also have outreach services and support for carers, and sometimes work in partnership with other organisations. But they can’t get to everyone who needs help.
Meanwhile, children in informal relative or kinship care, such as Katie’s grandson, aren’t eligible for the state-funded psychological support offered to some children who have been formally placed in care by child protection services.
Zooming out, the Australian Child Maltreatment Study released findings last month that show about two-thirds of Australians have experienced maltreatment as children, including abuse, neglect and exposure to domestic violence. The study lays out the increased risk of mental disorders in children who’ve experienced maltreatment, and argues for significant investment in prevention and early intervention mechanisms. The Blue Knot Foundation has previously estimated the annual budgetary cost of unresolved childhood trauma could be as high as $24 billion.
With natural disasters becoming more frequent and ferocious, mental health experts say the trauma they leave behind in children is a growing concern. Regional and remote areas are often hardest hit – and these are the places where services are most lacking.
One mother of three tells The Saturday Paper she went on an exhaustive search for help after bushfires destroyed her family’s home on the New South Wales South Coast in 2019. Her then seven-year-old son, who has ADHD, was left traumatised and suffering from constant anxiety.
“It’s hard to find someone who understands children who’ve gone through fires,” she says. “There was a lot of trial and error, and trialling ones that were really far away.”
She eventually found Royal Far West through her son’s school. The charity moves into communities virtually and in person after disasters, offering children mental health services, speech pathology and occupational therapy they wouldn’t have access to otherwise.
“We’ve had [children] with suicidal thoughts and even some suicide attempts – and this is in primary schoolchildren,” says Royal Far West chief executive Jacqueline Emery, who goes on to describe children with high levels of anxiety and sleep disturbances and flood victims who now fear the rain.
“We’ve seen kids that have really what we refer to as big behaviours, explosive behaviours. They might really struggle managing and controlling their emotions because they haven’t processed what they’ve been through.”
Demand for the service is unrelenting. Because children who need mental health support are frequently unable to access services in their areas in the first place, the charity is seeing an increase in case complexity, with children displaying more challenging behaviours at younger ages.
“You’re up to twice as likely to start school with a developmental challenge if you live in a regional or remote area of this country, so you’re already at a disadvantage … Children who have underlying developmental challenges, particularly undiagnosed conditions or disorders, are at much greater risk of [poor] mental health and PTSD as a result of the trauma [from a natural disaster],” Emery says.
“They’ve already got a lot going on and then this major catastrophic community trauma event is another layer of trauma for these children, and they just don’t have the tools or the resources to be able to cope.
“Without appropriate support, long-term adverse impacts for children following a natural disaster include lower educational attainment, mental ill health, PTSD, chronic disease, substance abuse and contact with the justice system.”
The National Children’s Commissioner, Anne Hollonds, is frustrated by the failings of the system, recalling how she has been told more than once that “there are no votes in children”.
It goes to the heart of Hollonds’ longstanding call for the creation of a national children’s minister and taskforce. “There is no accountability for children,” she says. “That’s your answer as to why this hasn’t been fixed before.”
Federal Health Minister Mark Butler admits there are significant challenges in this space, emphasising, like everyone interviewed for this article, that early intervention and prevention are critical.
Butler says the government is making headway addressing key measures of the Children’s Mental Health and Wellbeing Strategy, including establishing integrated child and family hubs, with 17 Head to Health Kids Hubs being created to provide multidisciplinary support, assessment and treatment for children up to the age of 12, and their families. He tells The Saturday Paper the hubs will fill a gap in children’s healthcare and build a “foundation for reform”.
Additional and appropriate pathways must be created, Hollonds says. She makes the case for “pulling in mental health and other services” to schools, virtually or in person, “so families aren’t left to navigate these poorly designed and fragmented systems themselves”.
This includes having social workers or psychologists embedded in every school, like they are in some wealthy schools, to enhance access for children and alleviate pressure on teachers who are at the front line when children aren’t getting help.
Katie’s grandson only found help after he gained a place at a specialised school with support programs. The Saturday Paper is aware of other families with similar experiences.
Hollonds says more child psychologists are desperately needed, along with more family therapists, who can see issues within the context of an entire family. She emphasises the need for the professionals to work in services that all children have access to, not just those with wealthy parents.
“There’s a real equity issue to address here,” Hollonds says. “Why is it that those who have no choice but to use the public education and health systems miss out? These really serious equity issues are core issues for our kids.”
This article was first published in the print edition of The Saturday Paper on May 6, 2023 as "Childhood traumas".
For almost a decade, The Saturday Paper has published Australia’s leading writers and thinkers. We have pursued stories that are ignored elsewhere, covering them with sensitivity and depth. We have done this on refugee policy, on government integrity, on robo-debt, on aged care, on climate change, on the pandemic.
All our journalism is fiercely independent. It relies on the support of readers. By subscribing to The Saturday Paper, you are ensuring that we can continue to produce essential, issue-defining coverage, to dig out stories that take time, to doggedly hold to account politicians and the political class.
There are very few titles that have the freedom and the space to produce journalism like this. In a country with a concentration of media ownership unlike anything else in the world, it is vitally important. Your subscription helps make it possible.
Select your digital subscription