'Nobody's going to help me': Family looks for help after boy threatens suicide
Family says they are staying up at night, watching, worrying that 11-year-old will hurt himself
It's been two months since their 11-year-old boy said he wanted to kill himself, and they say they still haven't received all the support they need to help him.
Jane and John say Evan told two of his friends at school that he wanted to die on a Friday in October. The friends told their parents, their parents told the school, and the school called Jane and John. (These are not their real names — which aren't being used to protect the boy's identity.)
"A kid sits there and says that. I broke down. I didn't know what to say, I didn't know what to do," Jane said.
"What am I supposed to do? How am I supposed to fix that comment? I don't even know what to do."
Since Evan made the comment, Jane says she and her husband have been taking turns staying up at night to make sure nothing happens.
"The last thing we wanted to do was go into his room and find him dead," said John.
From a clinic, to the ER, to home
When they were told Evan was talking about suicide, the couple pulled him out of school that day and took him to a mental health walk-in clinic. They don't have a family doctor. At the clinic they say they were told no one there could evaluate him, and they should go instead to the Queen Elizabeth Hospital.
They went straight there.
At the hospital, they met with a doctor who they say asked Evan two questions: Had he hurt himself? He said no. Did he want to hurt himself? He said yes.
Jane said the doctor told her Evan couldn't be further assessed because there wasn't a child psychiatrist available. Instead, he was released with a referral back to community mental health.
The family went home. Jane and John were terrified. That's when they started their nightly vigils.
"As far as I'm concerned, in my opinion if someone says something like that, they should be admitted to the hospital," John said. "At least an evaluation. Keep them in overnight, even if it's a stranger sitting there talking to them. Maybe that would help. Maybe that would save one life."
'We get to walk around on eggshells'
Jane and John say they waited three weeks before getting an appointment to a mental health clinic. Evan now meets with a therapist every week, but Jane said he's still expressing suicidal thoughts and he hasn't been evaluated by a psychiatrist.
"We get to walk around on eggshells," Jane said. "I'm scared not knowing what to do for him."
John is glad Evan has been able to see someone, but he feels it isn't enough.
They want to know if he has a disorder, if he needs medication, and what the risk is that he will hurt himself — but they say they haven't been able to get answers.
"Nobody has ever called us and said, 'You know, the threat level is whatever it is,'" he said.
Acting out
Jane and John speak proudly about Evan's achievements, saying he helps out at his school. A medal is proudly displayed in the living room, and they speak of the other trophies he's earned.
But in the past two months, it's clear he's been struggling. Evan's had trouble managing his emotions, leading to outbursts in class and a school suspension. He's repeated the statement that he wants to die.
Jane said the school has been helpful and the guidance counsellor has been working with him on ways to cope with his emotions.
"Some days are good. Sometimes he's really happy-go-lucky kind of kid, and other days he's just moody," she said.
When they try to talk to him about what's been going on, Jane says, it goes nowhere.
"You try to talk to him, he shuts down. He doesn't want to talk. He'll talk a little bit. Give you a little bit and he shuts right down," Jane said. "And then says, 'I don't want to talk about it.' And then he'll leave the room."
A family history of suicide and trauma
Evan calls Jane his mum, but she's actually his aunt. She says his mother — her sister — died by suicide when Evan was six months old, and he had a traumatic start to life.
He came under their care when he was 3½ years old.
"The first three-and-a-half years of his life were the most horrendous years … I could tell you I wouldn't have survived it, but he was strong and he did and we've got him," she said.
He had received some help to deal with that trauma, Jane said, and had been doing a lot better — until recently.
In the seven-and-a-half years since he's been with them, Jane and John say they've had to teach Evan to trust them by being open and honest about everything.
"As parents you try to do what you can for your child."
John said they tell him, "'We're going to get you some help,' because that's what I believe to be true. And then at the end of the day when everything is said and done, you come back home and sit down at the kitchen table and he looks at you like, 'I told you. Nobody's going to help me.'"
Risk and needs for support are assessed: Health PEI
Health PEI would not address this family's situation directly for privacy reasons. However, the agency did lay out the protocols for situations like this.
It said that depending on the presenting symptoms, in conjunction with information gathered from the family, the emergency department physician may:
- Refer the family to community mental health for follow-up assessment and services.
- Request the mental health crisis response nurse meet with the child and family to assist in determining next steps.
- If the child is under the age of 12, a consult with pediatrics may be requested before psychiatry is engaged.
- A psychiatric consult may be requested.
The agency said referrals to community mental health are screened within two days, and that in urgent situations the family should get an appointment within one week.
Sean Morrison, the program manager for children's mental health and addictions, added that patients are assessed at mental health clinics by clinicians — usually people with a master's degree in social work.
"Every time somebody walks through our doors, we're always assessing them, and we're trying to determine what symptoms are being presented and what risk levels we have to be concerned about," he said.
If they determine more support is needed, they can refer them to the hospital to meet with a physician, who can assess whether the child should be referred to a psychiatrist.
He said in the case of children, the child's family will be involved in that process.
When a patient presents with suicidal thoughts, he said, the clinician will work to figure out how serious those thoughts and feelings are.
"In most cases, the majority of people who have those [suicidal] thoughts and feelings, we actually work with them and process it a little bit out, we have conversations with them around what are the support systems that they do have in life, their real intent, what are they actually struggling with," he said.
"When we peel back the layers, often we start finding out that it might be a thought that has occurred to them … but it doesn't mean that they took it to the next phase of actually starting to plan that out."
Shortage of child psychiatrists
There is currently a shortage of psychiatrists in P.E.I. — including child psychiatrists. The province has two positions for child psychiatrists, but only one is filled. It is actively recruiting for the second position.
Health PEI said that in the last fiscal year there were 1,274 children under 17 referred to community mental health services. Of those, 1,102 children were directly referred for clinical therapy services and 172 were directly referred to psychiatry.
"One of the misconceptions is that everybody needs a psychiatrist in order to obtain services. People can have anxiety and depression … and really never see a psychiatrist in their life, obtain services in community or with a physician and actually function fairly well with some skills training," said Morrison.
When asked if the child psychiatry shortage affects the ability for children to be referred, Morrison said, "It doesn't affect the ability to refer to a psychiatrist. We are taking steps to triage, at times, who is sitting in front of the psychiatry."
Morrison clarified that to "triage" means, "Really trying to determine the acuity of the situation that's in front of us — What are we seeing? What are we dealing with ... Do we actually have the community supports and the community services that we offer in place to support them?"
This story is part of an ongoing series CBC P.E.I. is doing on mental health services in the province. You can share your experiences with us here.
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