We have been having a lot of discussion about our children in crisis. Here are two fictitious cases to highlight the complex problems these children face and their complex behavioural and mental health.
Case one is Anna, a 15-year-old girl. Her guidance counsellor discovered that she was cutting herself and that she recently took an overdose of an over-the-counter painkiller. Anna has also been getting into fights at school and her mother reported that her behaviour has got out of control at home. Anna ran away from home and went to the house of her 20-year-old boyfriend. Anna's mother wanted her daughter to be put away, as she could not deal with her.
Her mother had her when she was 15 years old. Anna grew up with her grandmother up to age five. Her grandmother was very abusive physically and emotionally. When Anna started to display problems in basic school, her grandmother sent her to live with an aunt. At age 11, the boyfriend of Anna's aunt started to abuse her sexually. He did this for three years. Anna reported the matter to a family friend who confronted the aunt. The aunt responded by saying Anna was a liar and that Anna was a wicked girl who wanted to break up her relationship. One day, both the aunt and boyfriend beat Anna.
Anna ran away
Anna ran away to her mother. Her mother was angry with her and also accused her of being a liar. Anna was living with her mother and stepfather and at age 14, Anna's stepfather forced her into sexual activity with him. Anna's mother found out. That was the end of the relationship between her mother and stepfather. Anna's mother became resentful towards her and became verbally abusive. She cursed her and accused her of being a whore. Anna was an unhappy child. She had a history of prolonged abuse. She felt unloved, unwanted and rejected. She started to display self-harming behaviour by cutting herself. She ran away from home because she felt unloved and was constantly being abused.
Jack is 16 years old. He attends high school. He has been getting into frequent fights at school and recently stole a mobile phone from another student. He has been caught on the school compound smoking marijuana and recently it was reported that he was selling marijuana. He is frequently absent from classes. He is very rude to his teachers and his grades have been falling.
Jack lives with his mother and stepfather, who is an alcoholic. He shares room with five siblings and his stepfather physically abuses his mother and abuses Jack and his siblings. Jack's father was shot in front of him when he was eight years of age. Jack does not receive money from his parents and every weekend he sells downtown in order to earn his lunch money. The school has done everything for him, but his behaviour has not improved. Jack is a very angry young man who has never recovered from his father's death. He feels unloved and no one seems to understand him.
What needs to be done for these children
1. We must recognise that these children have complex problems and require long-term counselling and intervention.
2. These children should be referred to competent counsellors. Unfortunately, many of the persons who work with them are not adequately trained to work with these complex issues.
3. Locking these students away in children's homes and special facilities will not necessarily solve their problems. These facilities should be the last resort when all other interventions have failed and it is deemed that this is the best option for these children.
4. These children have suffered repeated abuse. Their lives have been violated and, in many instances, the adults in their lives betrayed them or failed to protect them. It is very difficult for them to trust. Taking them away from their home environments can only heighten this sense of betrayal and further destroy their sense of trust.
5. Any counselling or intervention programme should involve working with their family and parents. Taking them away from their home environment may not necessarily facilitate working with the family.
6. Jamaica needs to first develop several first-level interventions for children and adolescents in crisis and ensure that these work well before we start to invest in the second-level interventions such as special facilities that are very costly to operate and have not been shown to be effective for the majority of children with complex behavioural and mental-health problems.
7. The Ministry of Education needs to expand the Programme for Alternative Student Support so that when these students are identified, they can receive early counselling and intervention. This is an excellent first-level intervention that has been shown to be effective when properly operated.
8. The Ministry of Health needs to expand the counselling and interventions services through the network of child guidance clinics. These clinics are not available everywhere, and the waiting period to get into these clinics is far too long in many instances.
9. The health ministry must also move quickly towards establishing a specialised facility to treat children and adolescents with complex behavioural and mental-health problems such as repeated suicidal behaviours, self-harming behaviours and eating disorders.
10. Dealing with the problems of children and adolescents involves collaboration between several ministries, and a comprehensive policy must be developed to address the needs of children and adolescents with complex behavioural and mental health problems. Maybe the Ministry of Youth should undertake this responsibility to coordinate the development of such a policy so we do not have a fragmented approach to the problem of dealing with children in crisis. We need to develop a more comprehensive and proactive approach to the problem.
Dr Wendel Abel is a consultant psychiatrist and head, Section of Psychiatry, Dept of Community Health and Psychiatry, University of the West Indies, 977-1108; email: firstname.lastname@example.org.