Working with young people with mental health issues 2018-12-08 Working with young people with mental health issues Ingrid Sievert Uddén, manager of youth health department Stockholm City Mission

20. Flicka, 25 år, söker för: vill förstå sig själv, perioder The waiting list 1. Flicka, 17 år, söker för: självmordstankar, ensam, svårt skaffa vänner, alkohol i familjen, dålig kontakt med pappa 2. Pojke, 18 år, söker för: utmattad, traumatisk uppväxt, psykiskt/fysiskt våld 3. Flicka, 20 år, söker för: pressad, hög ambitionsnivå, tidigare anorexi, tuff barndom, tar hand om sjuk pappa 4. Flicka, 21 år, söker för: deprimerad, dricker i perioder, vän dog i överdos 5. Flicka, 20 år, söker för: deppig, isolerar sig, fobier, mamma sjuk, konflikt med pappans nya kvinna 6. Pojke, 20 år, söker för: dåligt självförtroende, obekväm i sociala relationer, prestationsångest, otrogen flickvän, klandrar sig själv 7. Pojke, 17 år, söker för: tankar kring svåra händelser, bipolär, pappa självmordsbenägen, mamma utmattad för sjuk mormor 8. Flicka, 24 år, söker för: pendlar mellan självförakt och självsäkerhet, självmordstankar, depressivitet, ångest 9. Pojke, 22 år, söker för: bearbeta tuff uppväxt, mår dåligt, gråter, pappa och bror narkoman, mamma alkoholist, barnhem sen 6 års ålder 10. Flicka, 22 år, söker för: rädd att börja med droger igen, personlighetsproblem 11. Pojke, 17 år, söker för: oro, ångest, svårt att koncentrera sig och prestera, stressad 12. Flicka, 19 år, söker för: ångest, självskada, stressrelaterat, våldtäkt, sexuella övergrepp, inte pratat om dem tidigare 13. Pojke, 20 år, söker för: ångest, självskadebeteende, mamma dog i cancer, flickväns känslor går ut över honom 14. Flicka, 23 år, söker för: tvångstankar, skilda föräldrar, slut med tjej, grubblar, ältar 15. Flicka, 18 år, söker för: djupa tankar och osäkerhet, påverkar relationer, tillbakadragen, försvinner in i egen värld 16. Pojke, 17 år, söker för: trycker ner känslor, svårt att ta kontakt, var utstött i klassen 17. Flicka, 19 år, söker för: tvångstankar, överdrivna skuldkänslor, ångest för tidigare händelser 18. Pojke, 21 år, söker för: mår dåligt, svåra diagnoser, blyg, problem med surfande 19. Flicka, 17 år, söker för: ingen motivation, känner inte så mycket, autism 20. Flicka, 25 år, söker för: vill förstå sig själv, perioder This is a fake waiting list, our phone lines are open only 30 min twice weekily and our waiting list is always full, we even have to close the airtime?

Self reported anxiety from 37% 2011 to 43% 2016 Mental health amongst 16-25 year olds in Sweden Self reported anxiety from 37% 2011 to 43% 2016 Prescription of antidepressants from 148/1000 prescriptions of SSRI (serotonin inhibitor) in 2006 to 197/1000 in 2016 Suicide still at high level: slight decrease however still high (20-29 year olds – 11,7/100000 inhabitants) In the past ten years mental illness has increased with 100% in age group 10 – 17 and by 70% agegroup 18-24 Mainly depression and anxiety disorder The big gap between high unhealthy numbers and the lack of support, care and treatment Sweden stands out internationally , OECD 2016 points out lack of access to health in schools and long wait to se psychologist. No other country in Europe has the same situation for under 25s. Oecd = Organisation for Economic Co-operation and Development

Multifactor, no one knows why, but some ideas: Reasons? Multifactor, no one knows why, but some ideas: Life conditions for youngsters have changed Awareness of social status The number of young adults that perceive demands of perfectionism from the surroundings has increased with over 30% since 1989 Awareness of mental health issues Humbeled by the question Individualistic, choices give freedom and resoponsibility, it up to you! Young people aware, to be popular, study done youngsters far from the norm tend to have more mental health problems, but those close to the norm also report mental illness

Treatment available in Sweden and challenges The National Board of Health and Welfare national guidelines – focus on prescription drugs and CBT Primary Health care provides counselling (with Psychologist or Social worker) but the concept is very specific (10 sessions, Cognitive Psychotherapy) and the waiting time is very long (several months). Private psychodynamic and other forms of psychotherapy available if you can pay for it, for those that can not it is limited Initiatives on the way – more money, a national coordinator, a guarantee for patients seeking care, a commission for equal health care. – Stockholm City Mission amongst others critical. We consider them to lack different options for patients to choose from. Focus on KBT (cognitive behavioral therapy) and percription drugs. Primary

Ungdomsmottagningen /”Youth guidance centre” What the Stockholm City Mission does Therapy Centre Clinic for young Men Ungdomsmottagningen /”Youth guidance centre” Lobbying Psycodynamic a psychotherapy clinic for all sexes with individual and group therapy; 5000 consultations 2017, 189 patients, 5 psychotherapists and 30 volunteers a clinic for young men with only male therapists, individual and group therapy; 3000 consultations 2017, 91 patients, 4 psychotherapists and 5 volunteers Midwives and counsellors meet young people between 13 and 25 in low threshold; 3600 consultation in 2017, 500 reached through external work. 2 midwives, 2 social workers/counsellors

Who do we meet? Psychotherapy: Post adolescents and young adults 16-25. Average 21 when starting treatment Mainly by self-referral, but also peer-to-peer communication, through our website and recommendation by parents or other SSM We meet all kinds, representative of the average person (ethnicity, socioeconomic background, parents divorced etc) Many have had previous contacts for mental health, 56 - 66% had some kind of therapy before We assess the severity of symptoms with every user before and after treatment with a self questionnaire. The profile of symptoms are very stable over the years. Mainly mild to severe depression.

Difficulties in relationship Inflicting harm on oneself Phobias Main reasons for seeking our help Anxiety, depression Difficulties in relationship Inflicting harm on oneself Phobias Compulsive behaviour Eating disorders Other mental health disorders

Results Self administered questionnaire reveals high success rates however not statistically sure What do patients say; That I was able to continue as long as I needed despite lack of money gave me a feeling of security I had suicidal thoughts, I got the chance to work on my fears of being abandoned I don’t know where I would have been had I not been part of the group therapy, maybe I had still been in the destructive relationship

Vår vision Ett mänskligare samhälle för alla! Contact details Ingrid.sievertudden@stadsmissionen.se www.stadsmissionen.se www.facebook.com/stadsmissionen www.instagram.com/stockholmsstadsmission Vår vision Ett mänskligare samhälle för alla! www.twitter.com/STHstadsmission