More and more teenagers are in psychological distress. But instead of filling the traditional role of enemy, parents can be a troubled child's best ally. Kathryn Holmquist reports

One in five teenagers aged 12 to 15 is experiencing psychological distress, which can include behavioural problems, psychological difficulties and early mental illness. Mental health professionals report that such distress is happening at younger ages than ever before, with 10 and 11 year olds experiencing difficulties, particularly around the transition to secondary school.

Parents can feel guilty and confused when faced with a child who has depression, anxiety, learning problems such as attention deficit hyperactivity disorder (ADHD), or who abuses drugs or alcohol.

The universal reaction for parents in this situation is to self-blame, yet they also feel powerless for various reasons. Our culture denigrates the role of parents and celebrates teenage chaos, with the result that we may feel at best irrelevant and at worst intimidated by our own children. What parents need to know is that they have far more influence over their children than they may realise.

When teenagers attending the family and child guidance programme at the Mater Hospital are asked who has been most helpful to them during their crisis, they nearly always say their parents and family. "Parents can do more than they think," says Carol Fitzpatrick, Professor of Child Psychiatry at University College Dublin and the Mater Hospital. It was her 2001 study of over 700 12 to 15 year olds that found that 19 per cent rated themselves in the clinical range on questionnaires concerning their mood.

This put them "at risk" of having a mental health disorder.

Parents of children who are suffering need to be there for their children, they need to be "immensely patient" and should try not to take their children's distress personally, she advises. Teenagers in trouble tend to take it out on their nearest and dearest and the entire family, including siblings, can feel distressed as a result of the teenager's behaviour. Three resources can be useful allies for parents: the GP, the school and other parents.

If a child is having problems at home, it is useful to talk to the school and see if they are also worried. A guidance counsellor can help in these situations.

Most GPs are skilled in identifying psychological problems and in helping families to cope with them. Even if the teenager refuses to see the GP to talk about things, there is nothing to prevent the parents and/or siblings talking with the GP. If the teenager is willing, it can be helpful for the entire family to talk with the GP together. The GP can refer the family on to a Child and Adolescent Mental Health service if required. Unfortunately, health board services are stretched to the limit and have long waiting lists for all but the most acute cases, so the GP's influence is important here in impressing upon the health board the seriousness of the problem. The GP may also be able to refer the family to a private service.

Services are so overstretched, that it is "very, very difficult" to get a hospital bed even for a suicidal adolescent, which throws the care of the child back on the family, says Fitzpatrick. While parents do receive support from outpatient services, the entire family feels intense strain.

Parents need support as much as their teenagers do. According to Fitzpatrick, the key goal should be to preserve the relationship between the parents and the child, between the parents and other siblings, and between the parents themselves, so that when the teenager has come through everything, they have a healthy family to return to. Keep the entire family as healthy as you can and don't just focus on the child who is most obviously troubled.

PARENTS also need to realise that other parents are a great resource, since nearly all parents have problems with their children at some stage. "The vast majority of parents are doing the best they can. Some children have problems that would tax the most saintly parent," says Fitzpatrick.

It's also important for parents to stop blaming themselves, and to look at the social "stressors" that can make a child feel, for example, depressed.

Early episodes of depression may begin with a genetic liability, but also have a lot to do with social stressors. Children may react negatively to their environment, which does not mean that there is anything inherently "wrong" with the child, the parenting or the family. For example, eating disorders, which are on the increase in Ireland, are not a mental illness, but a behavioural adaptation to psychosocial stressors, believes Dr John Griffin, consultant psychiatrist specialising in eating disorders at St Patrick's Hospital in Dublin. We have to look to the whole society, which sexualises girls from the age of seven, for the solution, he believes.

Psychotherapist Donal Casey agrees, seeing adolescence as a confusing time when raging hormones combine with contradictory social messages to throw teenagers off balance. "We infantilise teenagers, delaying their entry to adulthood, yet at the same time the media are telling teenagers that they should act like sexual adults," he says.

Parents have to be the reliable touchstones in teenager's lives. "Parents should trust their own instincts," he advises. "Whatever it is your instincts tell you to do, keep doing it consistently and chances are 99 per cent that everything will come out all right in the end."

AT ODDS WITH THE WORLD: A case study

Michael was always the class clown in primary school, but his behaviour became more challenging around the age of 13 when he reached secondary school. He could not cope with school and school, it seemed, could not cope with him. His mother searched everywhere for help, but was passed from one mental health service to the next, with no one taking responsibility for Michael's treatment. He was placed on one waiting list after another and, somehow, every time his name came up, nobody did anything. At one stage, a social worker visited, spent three hours talking with Michael and his mother, then said that MIchael's problems didn't fall into his area. He would file a report but then went on sick leave and the report was delayed by four months.
Michael's mother, who owned her own home and worked hard to pay for her children's education, often felt blamed because her marriage had ended when Michael's father left, making her a single mother. By the time her son was 16 years old, he was using drugs and alcohol and even had a spell of sleeping rough. She was going out at 2am to find him and bring him home in the small town in which they lived, where there was a growing drugs problem.

By this time, seeking psychiatric help for Michael from the public service was pointless, because at age 16 Michael was too old for the child and adolescent mental health services, which end at the age of 16, and too young for the adult mental health services, which start at age 18. Michael and his mother slipped through the net. Michael's mother paid privately for psychotherapy, which she found more useful for herself than for Michael, who refused to engage with the process. Eventually, Michael ended up in the children's court. It was the local Garda Liaison Officer who had the most positive effect on Michael's life. The Gardai were also supportive of Michael's mother, advising her to stop searching the streets in the middle of the night. They would look after him, they promised her. And they did. It was just a pity that Michael had to end up in trouble with the law and fulfil a community service sentence before anybody took an interest in him. The second turning point came when Michael was given a place on a FÁS course as an apprentice, where he thrived. Now aged 18, his confusion seems to have burnt itself out and he has made a decision to become a responsible adult.

Looking back, Michael's mother believes that Michael may not have benefited from psychological help anyway. He had to get through the difficult adolescent years, then make a decision to change his own behaviour. But she regrets the affect that his behaviour had not just on her, but especially on his brothers and sisters whose lives were "on hold" during those traumatic five years. The wider family needed support as much as Michael did and none of them got it, despite repeated pleas for help.

HELP: Where to go to get it

Your GP should refer you to your local health board's child and adolescent mental health service. However, waiting lists are so long in this overstretched service, that for early and fast help you may need to go privately. But how do you know that a private psychologist is of suitable training and quality?
Members accredited to the Irish Council for Psychotherapy offer help to families for little or no cost, on a sliding scale of fees. They include family therapists and psychotherapists trained in child and adolescent psychotherapy (this latter group are members of the Irish forum for child and adolescent psychoanalytical psychotherapy) They are filling gaps which should be covered by the public service, but which are not. The council has called for the health boards to develop an overall policy for properly organised psychotherapy services for children and adolescents.

Two reports prepared for the Department of Health in 1998 and 2001 have recommended that children and adolescents need support from multi-disciplinary teams of mental health professionals with qualifications and experience in family therapy, as well as child and adolescent psychotherapy.

If you consult the ICP, they will guide you in the right direction and ensure that the psychotherapist or family therapist that you choose is properly trained, experienced and accredited. The ICP publishes a register.

Before choosing a professional to help you and your family, you should first discuss, with him or her, fees and the nature of payment, as well as the duration and frequency of sessions.

ICP, 73 Quinns Road, Shankill, Co Dublin. Tel: (01) 272 2105. E-mail amdps@indigo.ie