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Keep CALM… and let’s care for our youth

Renee Pilgrim, North Central Regional Health Authority Facilities Manager, Chaguanas Cluster-A&E, Coordinator of the CALM Clinics.

Story and photo by Lara Pickford-Gordon,

Our young people are hurting. They are harming themselves, attempting suicide, experiencing depression and anxiety, bullying; they are displaying trichotillomania (pulling hair out) and Obsessive Compulsive Disorder.

These troubling symptoms were seen during a three-month pilot—Children and Adolescents Living with Mental Health (CALM) clinic hosted by the North Central Regional Health Authority (NCRHA) last September at the St Joseph Enhanced Health Facility.

Prior to the project, research and collaboration with community groups and mental health professions found children and adolescents were being sent to the Accident and Emergency (A&E) departments when a mental health crisis/episode occurs; unless injuries are life-threatening under the triage system they are not attended to immediately, and after treatment referred to the Child Protection Unit or Children’s Authority where they can wait a year to 18 months for assessment.

During this period children/adolescents may attempt suicide, or worsen due to disease progression, engage in self-harm (cutting), destruction of property etc.

The clinic seeks to ensure early intervention and treatment for patients, counselling for parents, education for parents and schools; develop formalised treatment plans with intervention for both parents and child and provide follow-up care and peer group sessions.

Renee Pilgrim, NCRHA Facilities Manager, Chaguanas Cluster-A&E, Coordinator of the CALM Clinics was interviewed at the NCRHA’s administrative office, Chaguanas on March 20 about the project.

She said adolescence (10 to 19 years according to the Pan American Health Organisation) is a period of transition. “They are going through hormonal and physical changes, different things going on in schools etc. and there is no one to speak to about it because there is no adolescent health care.”

“The clinic takes place 9 a.m. to 1 p.m. specifically on Saturdays so it will be user-friendly for clients. Young people do not lose time from the classrooms and parents/guardians do not have to take time off from work,” Pilgrim said. The clinic provides a space where young people feel someone is listening to them. The strategic proximity to the Eric Williams Medical Sciences Complex (EWMSC) allows for any emergency cases to be referred to the A&E department of this facility.

For the first consultation at the clinic the family is seen together, then with the parent’s consent the child is seen by the Adolescent physician and a team of specialists. Discussions are held with the parent/s depending on the findings, Pilgrim said.

Youth acting out

In the pilot, a total of 10 patients were seen. “A lot of self-harm, anxiety and depression” was seen in females. She said when they are counselled separately, the underlying issue is found to be sexual abuse. Pilgrim continued, “With the young men we found that a lot of them were not able to read and write. Literacy problems, which had them frustrated and acting out…They are not doing well. I am not sure how they get from Form One to Five not being able to read and write. These students may be labelled as having behavioural issues and put to sit at the back of the class”.

Issues with males manifest in “acting out”, violent behaviour such as bullying others and “trying sexual advances on young girls in order to get attention”.

She said the public does not understand the extent of the problem. Young people are finding new ways to self-harm. She told of a trend called ‘icing’ in which young girls rub ice on their skin until it numbs. “They literally destroy the tissue so they can feel,” Pilgrim said.

Pilgrim voiced disappointment that even the teachers spending hours a day with a child fail to listen or develop a relationship with them. The underlying reasons for the child’s behaviour are unknown and the child is labelled “bad behaved”, “troublemaker”, sent to the principal’s office or assigned to sit at the back of the class. Pilgrim said, “They get punished before finding out a reason.”

Since the CALM Programme and teen clinic was started last September, suicide cases and cuttings (small cuts made on the body) have hardly been reported at the A&E at EWMSC. Pilgrim said parents are contacting the clinic or visiting to seek advice. Referrals have been made by schools, parents, social workers, other health care professionals and also young adults.

Apart from the pilot, Pilgrim and other professionals took part in a one-hour programme on Power 102 FM from September and ending March 13. Different topics were discussed such as anxiety, bi-polar disorder, autism and self-harm.

Feedback from the public indicates the programmes gave insight to parents. “Because of the taboo associated with mental health, a lot of people are walking around not understanding what is going on with their children but when they get the information they would bring their kids to the clinic,” Pilgrim said.

The NCRHA will soon be opening another clinic at the Arima Health facility. Expansion is necessary to prevent service at the St Joseph clinic being impacted. Pilgrim said clients are booked up to May–June.