The CALM effect

CALM co-ordinator Renee Pilgrim says there is a need for a safe space for teens who are struggling to cope.
CALM co-ordinator Renee Pilgrim says there is a need for a safe space for teens who are struggling to cope.

After years of talk and attention every time a teen commits suicide, cries for help have finally been answered with the first public clinic for adolescent mental health.

The CALM project (Children and Adolescents Living with Mental health issues), located at the St Joseph Health Centre, was launched on December 16 and is already booked up to the end of January.

The Ministry of Health describes CALM as “a teen-focussed mental health clinic specifically targeting patients 12 to 19 years old, who are at risk, already engaged in, or are exposed to behaviours that makes them vulnerable for undesirable social, behavioural, educational or mental health outcomes.”

Renee Pilgrim, CALM co-ordinator and facility manager in charge of the Chaguanas, Cunupia, Las Lomas and St Helena Health Facilities, told Sunday Newsday numerous people from both islands had already called to get help for children and the clinic would soon have to extend the days and hours of operation, as well as to add more staff. “Once we extend the hours we will fit others in because we don’t want a long waiting period. This is mental health and these are children. We want to be able to deal with them asap.”

The clinic, which catered to walk-ins, referrals from health centres, and appointments, was staffed by North Central Regional Health Authority (NCRHA) workers. However, Pilgrim said the RHA intended to ask staff at the North West RHA to help as it had most of the country’s mental health professionals.

She explained that, when a child went to the clinic, a social worker would meet with the parents and the teen then there would be a separate assessment of the individual. “Depending on what it is we have everything right there so we could just transition them to the various areas. We would also assess the family unit, see if there is a social intervention needed, whatever it is they need, we would be able to deal with it from that perspective.”

“They need confidentiality, a safe space, they need positive reinforcement, their parents need to be part of this, so we are seeing a holistic family unit before going forward to treat the child.”

“The model I am creating, I want it to be rolled out in all the RHAs. It’s not going to be just for North Central. This is for Trinidad and Tobago, not something we are keeping for ourselves. It is something for everybody because the need is there.”

Addressing teen suicide

The idea for the clinic came about seven years ago when Pilgrim became the NCRHA facility manager for the St Joseph area. She said she was being given a tour of the facility when she met a staff member whose daughter had committed suicide and he had never learned why. Soon after, one of her daughters’ friends, a 15-year-old boy, committed suicide and, at the funeral, his parents said they did not know why he did it.

Pilgrim said she did some research and found that there was an area of study called “adolescent mental health” that TT had not considered, nor was there any statistics.

She learned there was public mental health assistance for adults, and that the Eric Williams Medical Sciences Complex (EWMSC) and clinics addressed mental health issues for younger children, but there was no public assistance for children between the ages of 12 and 19.

Therefore, she created a business plan for adolescent mental health and, for five years, she passed it on to her superiors, tweaking it each time, but the project kept being deferred.

Prof Gerard Hutchinson (right), makes a point about teen mental health during the launch of the CALM project at the St Joseph Enhanced Health Facility on December 16. Listening from left are consultant paedatrician Dr Asha Pemberton and Renee Pilgrim, cluster manager, NCRHA.

Then, in June, it was revealed at a Joint Select Committee meeting on Social Services and Public Administration that 400 primary and secondary school students were on suicide watch. One of her superiors remembered her proposal and it was accepted.

She recalled that Gerard Hutchinson, professor of psychiatry at UWI, St Augustine referred her to Dr Asha Pemberton whose speciality was in adolescent health care with a focus on mental health, and the three of them compiled a team and began organising.

The pilot project started in September at the St Joseph Health Centre where, every Saturday for three months from 9 am to 1 pm, 30 teens got support for depression, anxiety, eating disorders, self-harming behaviour, abuse and other issues.

“The feedback was amazing. We had a lot of staff members that would bring in their kids and nephews and nieces. It was almost as though there was a need for it that people were keeping secret because of the stigma of mental health and the taboo associated with it. But now that we gave them this avenue, people were literally jumping at the chance.”

Self-mutilation on the rise

Since children spend most of their time at school, CALM planned school interventions and peer education programmes as a way to promote awareness and fight the stigma of mental health. Pilgrim said she learned there was a high occurrence of self-mutilation at “prestige” schools, especially girl schools as they could not cope with the pressure and unrealistic expectations of their parents.

“I got a call from a school in Central asking for an intervention, and when I spoke to the principal he told me Form One students were cutting themselves, and they were doing it in front of their peers.”

CALM now had four schools lined up for interventions in January.

Also in January, CALM intended to begin its peer education and empowerment programme which would educate and train older teens as peer mentors so they could identify students who are at risk, have the knowledge and tools to help and support other students.

“Young people tend to find it easier to address and trust other young people so that is our next step. In January we will choose two specific schools to run a pilot but then we will do one school once per month until we do the entire catchment of North Central.”

She said teachers and school counsellors would also be trained so they could oversee the process. “The teachers now are understanding that there is a need... The schools are dealing with lot of anxiety, a lot of depression , and a lot of the behavioural problems.”

In addition to the peer programme, Pilgrim said CALM as hoping to organise an annual school drama competition within the north Central area. She said students would have to research a mental health topic, produce a play which a committee would vet, and there would be prizes. The general public would be invited to attend so as to bring awareness to as many people as possible. She said each play must also have a positive message so that people would see what children are really going through and those who suffer in silence would have hope.

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