Last month the national depression initiative launched its youth campaign, Youthbeyondblue with the startling news that around 160,000 young people aged 16-24 years live with depression, making it the most common of all mental health problems in young people. But the real tragedy is the news that there can be a delay of anywhere between 5 to 15 years before the illness is diagnosed.

The need for properly trained, empathic adults in pastoral care roles was clearly illustrated a few years ago, while kicking a football in a park with my son, when I came upon an oak tree with six or seven bunches of flowers at the bottom of it. Stuck to the tree with some tape was an achingly sad note from the younger brother of a girl, who a few nights earlier had ended her life at the tree, which had become a shrine to her memory. A few days later, I was coincidentally contacted to offer help to grieving family and friends. In talking about this girl, it was clear that there had been no one in her educational institution that she felt she could reach out to.

As another school term draws to an end, memories of the park, its sad tree and the agonising questioning of a grieving sibling come to mind especially, because Youthbeyondblue tell us that 1 in 4 young people are battling mental illness across Australia, and I wonder how many are thinking about how they might end their lives. So perhaps it is timely to reflect on some of the challenges faced by parents, schools and welfare teachers in the early detection and referral of young people with mental health problems. The reality for all schools, private, state or catholic – in 2009 is that in any one school, at least 20% of the young people will develop depression before reaching the age of 18. The problem, highlighted in the National Child and Adolescent Mental Health Survey commissioned by the federal government several years ago, found that only half the young people with the most severe problems, actually received treatment. Given that early intervention and prompt treatment is associated with a better outcome, this is a distressing state of affairs.

The reasons for this failure to identify young people at risk are many, but at least one resides within the young people themselves. One of the worst things about being a teenager is being different and this propels many of these young people to mask their symptoms, suffer in quiet desperation and put on a good front to fool others, while experiencing unbearable levels of loneliness, anxiety and depression but unable to share what’s happening with anyone. As time progresses, often these problems increasingly impact upon their ability to get through their day to day routine, erodes the foundation of their relationships with family, friends and undermines their ability to concentrate on sporting, artistic or academic pursuits.

One of the greatest challenges for schools and parents in 2009 is the early identification of these students at risk, along with prompt referral. These days, the Federal Government has made this a little less difficult. Thanks to a Medicare system, those interested in the welfare of young people can now refer students to a local GP who can arrange referral to a properly qualified psychologist for up to 12 sessions or refer them to one of 30 one stop shops around the country which are part of headspace – Australia’s national youth mental health foundation. The headspace mission is to deliver improvements in the mental health, social wellbeing and economic participation of young Australians aged 12-25. To this end, headspace aims to be the focal point for youth mental health issues across the country. This includes providing funding to improve services for young people who may be experiencing mental health and/or drug and alcohol issues and the latest information about these important health issues for young people.

Most schools now have first class student welfare teams, displaying levels of skills and confidence unheard of 20 years ago. But if this system is to work, parents must also play a part, working with schools to monitor the mental health of the young people and alerting them to signs of trouble. But how many Mums and Dads know when to worry, how many know the difference between normal adolescent behaviour and signs of serious distress that warrant an intervention? The trick for Mums and Dads is to look for a change in their son or daughter’s normal behaviour. In some cases, teenagers with depression may look sad or tearful more frequently than they had previously. In others, they may be constantly irritable, tired, listless, or uninterested in activities that used to give them pleasure. A case in point is Sarah (not her real name), who presented with a 6 week history of feeling miserable most of the day, most of the time.

Her Mum told me that in the past month or so, her generally happy disposition had been replaced by irritability, temper tantrums, arguments and unexplained tears. Interestingly she had stopped riding her horse, withdrawn from her netball team, and was no longer sitting with her friends at school, instead preferring to be on her own during recess and lunch. When interviewed, Sarah described a real change in her sleep patterns, including difficulty falling asleep, restlessness, early awakening, excessive sleeping, taking more naps, wanting to go to bed after school, and going to sleep earlier at night. Her parents had also noticed changes in her eating behaviour, with Sarah eating much more than usual with some weight gain, which made her feel even worse.  Sarah also said that she felt she did not have enough energy to get through the day, and complained of headaches and stomach aches.

But one of the most striking signs that all was not well were her repetitive comments to her parents such as “I’m no good,” “I can’t do it,” accompanied by a refusal to even try activities or to do anything around the house. These profound feelings of worthlessness or low self-esteem are commonly observed in young women with depressive illness. Thankfully, Sarah reported no self-harm behaviours or preoccupation with death, which can all too often accompany depressed moods. Some young people can make comments about not caring whether they live or die, may give away prized possessions, or talk about how life would be different if they were no longer alive. While others will use alcohol or drugs as a way to reduce suffering which can actually worsen their depressive symptoms. Sarah responded well to a combination of talking therapy and medication and is now beginning to re-engage in life. But it was a combination of concerned parents and an alert welfare team at school that picked up on the symptoms of her illness and got her the help she needed.

Parents who suspect their sons and daughters may be depressed and suicidal can now visit their family GP and ask for a referral to a psychologist on Medicare and maybe we can hope for a reduction in the number of shrines at the foot of the trees in the park in the years to come.

Dr Michael Carr-Gregg is an adolescent psychologist working in private practice in Kew, Melbourne and is the author of the Surviving Adolescence (Penguin 2006)

General editor of article: Dr Ramesh Manocha.