When Alex Panton passed away from suicide at the age of 16, his mother, Jane Panton, set out to change the culture surrounding mental health in Cayman. She soon realised that a staggering number of students suffered from similar symptoms of anxiety and depression. A 2018 study by the National Drug Council found that one-third of Caymanian students in Grades 9-12 had reported considering suicide, with 13% attempting to take their own life; of this number, only 5% claimed to have sought medical help.
The National Drug Council (NDC) concluded that one in every ten children and adolescents on-Island are affected by mental health issues. These are daunting numbers, but Cayman has various avenues to get the teens of Cayman fighting fit. In recent years, medical experts, educational professionals, community organisations and stigma-fighting parents have been making strides to help change the way the community deals with mental health.
The field of mental health and the understanding of mental health conditions has come a long way since 1952, when the first Diagnostic and Statistical Manual of Mental Disorders (DSM) was published by the American Psychiatric Association. Medical professionals, such as Dr. Laurence from KidsAbility, stress that finding the root of behavioural problems in children and adolescents is tremendously important for creating their treatment path. We shouldn’t just label a child as a ‘bad kid’, she says, but realise that there are usually many factors that cause individuals to express symptoms of mental health problems.
Clinical Psychologist Dr. Chelsea Walton expands on this by adding that there might well be something going on in the child’s home environment, such as problems with the interactions between the child and their caregiver. Speaking to a mental health professional can help to identify the patterns and things contributing to the child’s difficult behaviour.
The most common conditions that Dr. Laurence sees in adolescents are self-harming, eating disorders, anxiety and depression, all of which are maladaptive coping mechanisms stemming from an inability to appropriately deal with stressors. As a specific example, eating disorders often start from an underlying need to feel in control of something.
Dr. Laurence explains how parenting and familial structure can play into this; there is a push and pull between the teen’s need to develop their identity and the parent’s innate impulse to hold on. Most of the time parents have the right intentions, however, in their attempt to do what is best for their child they can often over-parent, do too much for the child and not let them learn through trial and error, ultimately hampering their child’s own sense of self-efficacy. When a child feels they have lost control and cannot cope this can lead to a host of difficulties.
Dr. Laurence uses the imagery of a tightrope walker to explain this parenting scenario: children must learn to walk the tightrope of life alone, with parents acting as the net below them. If they fall, pick them up and put them back on course, but don’t hold their hand through all of it. If you hold their hand the child will be safe, but they will not develop the vitally important self-belief that they can cope on their own. Left to walk on their own, children will stumble — they always do — but eventually they will become self-reliant and be able to navigate the world with confidence and resilience. They will make their own decisions and their own mistakes, and they will learn that they can pick themselves up, dust themselves off and keep going. This new found self-governance will often bring them a sense of control that could have otherwise manifested into unhealthy behaviours. That autonomy and development of identity is something to strive for even in the early assessment of children. Mr. Myles, Dean of Students at Hope Academy and former social worker, believes that screening for mental health issues should accompany primary school physicals. His opinion stems from a frustration at the lack of access to affordable mental health services (behavioural therapy sessions often begin at CI$150-$200 per hour) – especially at public schools.
Dr. Laurence agrees with the importance of early detection. It is easier, she says, to address the root of the issue when children are young, rather than fight years of symptom manifestations later on. Mental Health America also stresses this stance, making the policy statement that they support universal screening for potential mental health problems under the same timeline as long-mandated physical screenings, such as vision and hearing. Identifying and treating symptoms at an early age could off-set thousands of school children’s trajectories, leading to meaningful and productive lives. If you are interested in obtaining a confidential screening for your child, you can find a list of local professionals at the end of this article.
Of course there are many other issues that are causing teens to have anxiety and depression, including the economic instability of many families in Cayman; single-parent homes where a healthy role model is absent; relationship instability and the breakdown of the family unit due to divorce or fighting; and mental health issues due to a parent abusing drugs or alcohol. Many family units also have challenges stemming from intercultural and intergenerational traditions, such as giving female children too much responsibility at a young age to cook, clean and help raise siblings. Other parents simply do not know how to parent properly as they were never parented properly themselves. Dr. Walton believes that most parents are doing the best they can with the skills that they already have, however, she could not stress enough the importance of parents dedicating time to just being with their children, without questioning or commanding. If parents would just pay positive attention to their children, and an active interest in their children’s hobbies/lives, then children would feel safe expressing themselves and confiding in their parents. She closes by adding that there are numerous books and resources online where parents can learn the skills needed to help them communicate their love and appreciation to their child.
Parents cannot, however, always be there to stop the outside factors, such as online bullying and toxic social media use, from hurting their children. Kary Claybourn, a local mum of three, believes that social media can be dangerous, especially because kids as young as 10 years old often now have Snapchat, Facebook and Instagram accounts. Claybourn expands upon this by saying “the social aspects of being a teen can be more challenging that the academic side”. Obvious examples include cyberbullying, which can be a very real threat. For example, a teen could post an ugly picture of an animal and say that it looks like a particular child in the class. This will get lots of laughs from other students but be devastatingly painful to the child being targeted. Or the attack can be more insidious; a real example is one teen purposefully leaving someone out of a social media chat, or an upcoming event, but making sure that the excluded child hears about it. The message that the excluded child gets is that they are not good enough and they are not liked by their peers; a devastating thing for a child to contemplate.
Dr. Laurence explains that it is very important to help children understand how social media portrays an unrealistic reality, and that there are both predators and bullies online. Through her lecture series, and counselling, she teaches children how to decipher unhealthy online content, develop self-reliance, and learn both resilience and coping mechanisms. She adds that increasing a child’s self-esteem and self-efficacy creates a protective resiliency layer; we can’t stop them from coming into contact with negativity, but we can increase their resilience to not be beaten down by it.
The Alex Panton Foundation (APF) is also actively working in this area. They have started a free social-emotional wellbeing programme in schools for children. They have partnered with Partnership for Children (PfC) which is a UK based non-profit organisation that creates school programmes for children to help them develop skills to communicate effectively, cope with anxieties and difficulties, and foster their mental health. The programme covers important topics such as feelings, communication, friendship, conflict, change and loss and moving forward/coping skills. Dr. Erica Lam, Clinical Consultant and Board member of the APF, said, “It is easier to build healthy and resilient children for our future, than to repair broken adults”. For more information on this programme and to get it in your child’s school, please email: firstname.lastname@example.org.
Dr. Walton encourages parents to increase the amount of socialisation that a child gets outside of social media by involving them in extra-curricular activities and encouraging their interest in the offline world. Involvement in sports or the arts can also help them to gain a sense of mastery over a skill and boost their self-esteem. It’s also an opportunity to build peer relationships amongst those with similar interests. Claybourn adds that it is vital to create and maintain an open relationship with your children, as well as with other parents, in order to foster change and bring awareness to teen mental health.
The conversation can’t end there, as anxiety and depression can often be evidence of something beyond online use. In the National Drug Council‘s survey of 2018, they found that 60% of students had witnessed violence and aggression. 38% of this violence took place at home; a rate they found correlated directly to rates of bullying and weapon carrying in Cayman’s schools. The impact of that in the community was reported to be huge: 54% of young people in Cayman claimed they had experienced bullying.
To help break this cycle, Dr. Erica Lam and Dr. Catherine Day founded Aspire Therapeutic Services in George Town, Grand Cayman. Their clinic specialises in the assessment of, and intervention for, people who have suffered some form of trauma. This includes people who have a disability (whether intellectual or genetic) or neurodiversity. They strongly believe that neurological differences should be recognised and respected as with any other human variation. These differences can include those labeled with Attention Deficit Hyperactivity Disorder, Dyslexia, Dyspraxia, Dyscalculia, Autistic Spectrum, Tourette Syndrome, and others. They assess the child, work out what the intervention must be, and their approach always involves navigating any concerns and challenges in the child-parent relationship. They don’t just put a band-aid over the problem.
Michael Myles from Hope Academy was a social worker for many years and saw the importance of this first hand. All three experts agree that this is a key factor in adolescent mental health and that without looking into the root cause of the problem, you cannot stop the rotating cycle of mental health problems which pass from one generation to the next.
Abuse and neglect can also manifest into addictions and lead to criminalised behaviour, creating a near-impossible cycle to break. In order to foster a ‘working together’ approach to child safeguarding in general, the Royal Cayman Islands Police Service’s Family Support Unit (FSU) and the Department of Children and Family Services opened the Multi-Agency Safeguarding Hub (MASH). Established in March 2017, the group aims to understand the extent to which childhood suffering and adult criminality go hand-in-hand in Cayman.
Inspector Kevin Ashworth, the FSU Manager, explains that when individuals have or are experiencing abuse, they often experiment with or resort to drugs in order to suppress the subsequent feelings of anxiety and depression, which often leads to arrests. Reporting any abuse (emotional, sexual, physical, neglect, etc.) to the Department of Children and Family Services (DCFS) is essential to help break free from this criminalised cycle of behaviour. In fact, it is mandated by law that any abuse suspected or witnessed by youth serving organisations must be reported. If you have a lead or a referral to make, please contact MASH directly at MASH@gov.ky or (345) 949 0290. In all emergency situations please call 911 for assistance.
The Taya Lounge in George Town is also attempting to curb the mental health effects of trauma. Working to eliminate the stigma around teen mental health and create a safe space for Caymanian adolescents, the Taya’s Lounge hosts individuals for the night (approx. 20 per night) that do not feel safe in their own home, and runs a two-year programme for 60 children to foster healthy relationships and build life skills. The majority of those individuals are victims of bullying or domestic violence, or have lost a loved one. Located in Crown Square just off Easter Avenue, a young person can either just drop in (they open at 3pm each afternoon) or call Natalie Baldwin, Director of Taya Lounge, on (345) 914 2721.
Natalie, who also works for the Cayman Crisis Centre, says that they strive to give responsibility and respect to all those they encounter through a stigma-free zone in both organisations. Luckily, she isn’t the only one working towards this goal. Other organisations such as The Alex Panton Foundation and the Loud Silent Voices group (Tel: (345) 922 3847), to name a few, share this approach.
Dr. Marc Lockhart, a Board Certified Consultant Psychiatrist, Medical Director of Behavioral Health Associates Cayman (BHAC) and Chairman of the Cayman Islands Mental Health Commission, is working to promote those same values in the public sphere. His most recent incentive for this comes from a 2018 report noting that the number of adolescent mental health cases has increased by 30%. “We’re seeing it across all age groups”, he said, “but the demographic most affected is youth and adolescents. The number of completed suicides is up; we are seeing large numbers of [intentional] overdose cases. Numbers of self-harm cases are increasing”.
These statistics have only added fuel to his case that a dedicated mental health facility is needed on-Island: with only eight beds, the mental health unit at the Cayman Islands Hospital is running at capacity and is not designed to treat children. The government has approved plans to build a dedicated 54-bed mental health facility in East End, but due to the cost of construction, the project has yet to get off the ground. The Mental Health Commission has recently reported that the bidding process for the new facility has re-commenced and that the process is again moving forward. As Dr. Lockhart said in June 2019, “Everyone is still on board; the money is still there in the budget, not just for the project, but the operations as well”.
Dr. Alexandra Bodden is a licenced psychologist in both Cayman and Maryland, USA.
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