Medication Isnt the Answer

 

Sabrina di Lembo was just 19.

A high achiever who was 'sailing through" her law degree at Charles Darwin University, she had a bright future.

“My daughter had everything. She had looks, she had everything,” Sabrina's father told journalists. She also had friends and family who loved her dearly.

Yet on August 17th last year, Sabrina took her own life.

Her parents are angry. 

They believe that the Mental Health system let them down.

Their daughter was suffering from severe anxiety leading up to her exams. “She wasn’t sleeping for two or three nights. I knew this was something we couldn’t deal with alone,” Mrs Di Lembo said.

They took Sabrina to a GP who recommended she see a psychologist.

However, even with ongoing therapy, she didn't seem to be getting better and they sought help from another GP who prescribed her the antidepressant Effexor as well as Valium to help her sleep, but soon after she started to have suicidal thoughts.

Desperate to do something to help their distressed daughter, they sought help from Northern Territory Mental Health Services .

"Ms Di Lembo phoned the Northern Territory Mental Health Line for advice and asked for her daughter to be seen by a psychiatrist, but it wasn't possible.

Sabrina's dose of medication was instead tripled over the phone and the family was told to go back to the GP to get the new script.

When the family took Sabrina back to the GP, they said the local doctor didn't agree, prescribing her with a double, rather than a triple dosage.

Ms Di Lembo said her daughter became "catatonic" on the higher dosage and wasn't able to effectively engage in therapy."

From the ABC Online article by Eleni Roussos

After all the funds injected into youth mental health.

All the awareness campaigns.

The suicide prevention programs.

What are we doing wrong?

There are many issues to consider in this tragic story. 

For a start, our current mental health system is inflexible and under-resourced. It is unable to respond to individual crises or to adequately support ongoing mental health issues in young people. The threshold for support is too high and waiting lists frustratingly long. There aren't enough places to get direct support.

Although the policy of deinstitutionalisation has been in place in Australia since the 70s, there has not been an adequate and appropriate injection of funds into community based mental health services to replace the now defunct large institutions and asylums. With the advent of the NDIS, community mental health is reeling from more changes as well as the removal of government support for mental health programs.

I also think that as a society, we are too dependant on medications and medical models of illness and recovery that negate the importance of social and structural contexts. The more we believe that medications will provide a solution, the more many of us will be tempted to take a pathway that may give us temporary relief, but that can create its own problems.

Primary care providers are under increasing pressure to give answers where there are none - at least in the short term. As parents we can be co-opted into our children's panic, thinking that they must be helped to get better now.

Some meds can help to temporarily support and calm us enough to get some much needed sleep and to undertake the work of psychotherapy. Some more structured modalities like CBT and mindfulness can give us strategies to help get us over a bad patch when we are particularly challenged by life's demands. BUT these things aren't the answer in the long term, at least not on their own.

It can take many weeks for even the most skilled therapist to develop enough of a rapport with their client for a young person to trust them with their vulnerabilities. Most young people are very reluctant to share their scariest thoughts with anyone - that includes their therapist and those closest to them. They may not even want to admit to themselves that they have these feelings. They often will not tell us when they are feeling bad, panicky or suicidal and can take steps to rid themselves of the pain they are going through, but that also take them beyond our help. 

For some young people, appearing weak or needing help can feel shameful. They don't know how people will respond,and in some cases they don't even have the words to describe the often overwhelming feelings that accompany panic and depression.

Suicide is a final and irreversible step that can feel like the only way out, especially without the life experience to understand that panic and fear can be survived and that life can get better.  The terrible but transient feelings that can interfere with study and cripple performance are only a small part of life, but can subsume a young person's ability to see the larger picture. For adolescents whose brain development hasn't finished, these issues are particularly important. 

Sabrina di Lembo took her own life after struggling to deal with the pressures of preparing for her final exams. Exam time can cause anxiety and panic for even the most well-balanced young person. If we don't have the skills and self-soothing to calm down and help ourselves, anxiety can escalate into panic.

Just missing a night's sleep can make us feel terrible, especially when we need to perform the next day. The stress and anxiety can then snowball into an insomnia that destroys our physical and mental well-being and bring us to a place where we can't think straight. We can no longer make good decisions or look after ourselves. We can end up finding ourselves in a black hole into which we fall without any notion of how to save ourselves.

For parents, the best thing to do is to make sure your child is receiving the right sort of help. If they are seeing a therapist, then make sure you support them to continue therapy, preferably weekly or twice a week.

You will not help them by shopping around for the "perfect" therapist or by choosing someone who gives you the answers you want to hear.

You can help them by looking out for signs that things are not right.

SIGNS TO LOOK OUT FOR:

"Predicting suicide is difficult. Changes in behaviour outside the person's normal range of behaviour (and which do not make sense to those close to them) may be a warning sign.

Other warning signs may include:

  • Loss of interest in previously pleasurable activities
  • Giving away prized possessions
  • Problem behaviour and substance misuse
  • Lack of care (apathy) about dress and appearance, or a sudden change in weight
  • Sudden and striking personality changes
  • Withdrawal from friends and social activities
  • Increased ‘accident prone’ incidents and self-harming behaviours.

From Better Health.

If you feel that something isn't right, then you will need to approach your young person and open up the space for them to talk about how they are feeling - without judgement, and without bringing your own fears and emotions into the conversation. The more calm and matter of fact you can be, the better.

There might not be time to allow them to come to you, although in less urgent circumstances this can work better.

Much will depend on your relationship with them. 

 If they feel that they can talk to you without your judgement or anger and most importantly, without your becoming overwhelmed, then they will feel more able to bring these most troubling thoughts to you. Many depressed and suicidal people believe that they are a burden, so will react strongly to your upset. You will obviously have emotions around this (I am not telling you to become a robot!) but you will need to put aside your own needs and fears temporarily in order to reassure and connect with them and how they are feeling. It can be a scary place for both of you, but in order to help them, you will need to be able to sit with these strong feelings - yours and theirs.

If you need support, are worried about a young person, or if you are a young person who is feeling unsafe, please get in touch.

Below are some support services that are free. Many of them are open after hours for phone calls.

For my earlier article on youth suicide, please click here.

 

 

 Sabrina di Lembo was just 19 when she took her own life after battling with anxiety and depression.

Sabrina di Lembo was just 19 when she took her own life after battling with anxiety and depression.