How Are Our Young People Doing?

What is Mental Health? Why is it Important?

Mental health is an essential part of our overall health and wellbeing. Our mental and physical health are strongly connected and affect each other directly and indirectly. One cannot be understood without the other.

When we think about an individual with good mental health, we envision someone who has a strong sense of self-worth and is comfortable in their own skin. They have the ability to form healthy relationships, communicate in an appropriate manner, manage emotions and cope with life stressors.

Mental health can be defined as the way one thinks and feels about themselves and their life, and it can massively affect one's ability to cope in times of adversity. In every stage of life, our mental health is extremely important: from childhood, through adolescence and as an adult. Positive mental health at a young age is key to a happy and healthy adulthood.

Mental Health in Children and Adolescents

In recent years, there has been an increased acknowledgement of the importance of mental health, especially in relation to children and young people. It has been proven that many mental health challenges faced by adults have roots in early years, and that failing to address these concerns at a young age can lead to consequences that can last a lifetime. As Dr. Erica Lam (Consultant Clinical Psychologist and Board member of the Alex Panton Foundation) explains, It is easier to build healthy and resilient children than to repair broken adults.

When a child experiences positive mental health, they develop self-worth, confidence and emotional balance. On the other hand, mental health struggles in childhood can lead to lifelong low self-esteem, poor communication skills and difficulties in social situations.

The World Health Organization (WHO) revealed that one in five of the worlds children and adolescents has a mental health disorder, and that half of all mental health difficulties begin before the age of 14. The majority of these cases remain unrecognised and untreated less than 10% receive treatment.

Youth Mental Health in Cayman

The National Drug Council (NDC) revealed that 13% of children and adolescents on-Island are affected by mental health concerns.

Children and adolescents with mental health conditions are particularly vulnerable to social exclusion, discrimination, stigma, educational difficulties and risk-taking tendencies. Dangerous behaviours such as binge drinking, using drugs, violent outbursts, committing crimes, self-harm and suicide can all become heightened due to mental health conditions. Suicide is the fourth leading cause of death among 15-29 year olds, and in the Cayman Islands, 1 in 6 adolescents have seriously considered attempting suicide.

These numbers are alarming and must be taken seriously. They reflect an urgent demand for better mental health services. This is not intended to place fear within our community, but rather to shine a light on the importance of this issue. There are many medical professionals, local organisations and government initiatives working to create accessible and readily available mental health services that focus on children and youth.

The Impact of COVID-19 on Youth Mental Health

COVID-19 has caused unimaginable loss, anxiety, trauma and isolation all around the world. Many families were pushed into financial crisis, numerous jobs were lost, people were kept away from loved ones, children missed routines and consistency and everything took place through a state of fear, panic and uncertainty.

The number of children and youths who are struggling with mental health has increased massively over the past three years and the demand for services to help and support our young people is at an all-time high. Dr. Lockhart (Cayman Islands Mental Health Commission chairman and psychiatrist at Behavioural Health Associates Cayman) explains that between 2019-2021 in Cayman, there has been an increase of 21% in the number of people who access mental health services; youth under 18 being the group most affected.

COVID-19 has had a significant impact on young people by disrupting their sense of normality, pushing them towards an online world, minimising their development of social skills and forcing them to miss important milestones (such as graduations, prom and college campus experiences). Dr. Lockhart believes that it will be a few years until we can fully grasp the impact of this pandemic on our young people.

Dr. Day (Consultant Clinical Psychologist at Aspire Therapeutic Services) has also noticed an increase in mental health referrals and a higher risk of suicidal ideations in young people as they are more socially isolated, have higher levels of anxiety and a lower desire to leave the house. The invisible threat of COVID-19 was not an easy concept for children to understand, and now that we are coming out the other side of the pandemic, the relaxing of rules can create feelings of worry and stress. These mental health issues will remain in our community long after the end of the pandemic, and young people need to know there are services available to them.

What Leads to Mental Health Issues?

There are many different factors that can lead to mental health concerns. The more risk-factors a young person is exposed to, the more their mental health will be impacted. The home environment is of great influence from birth. Living in poor conditions, witnessing violence or abuse, growing up around drug and alcohol use, lack of parental supervision and guidance, and being exposed to traumatic experiences can all affect a childs mental health from their early years.

Even when growing up in a stable and safe environment, children may face situations that will put their mental health to test such as struggling with friendships, feeling out of place during social interactions, dealing with bullies, or having low self-esteem. As explained by Dr. Lockhart, mental health challenges are not always social, sometimes chemical imbalances in the brain and genetic predispositions can create difficulties.

Children raised in a healthy and positive environment are still at risk of developing mental illnesses, even when parents do all the right things such as, creating a loving and supporting home, keeping up with teachers and school work, and being involved in the childs life. This is why its important for parents to know what to look for to ensure that action is taken as soon as possible.

Changes are a normal part of growing up and they are not always a red flag. As a parent, you know your child best. If you notice something is not quite right, be curious about it. Keep an eye on the changes, ask your child whats going on and seek professional help if you have concerns.

Signs to Look Out For

Mental health difficulties can look different in everyone, here are some signs to look out for:

• Sudden and drastic changes in behaviour
• Extreme mood swings
• Symptoms of extreme sadness or anxiety
• Bursts of anger and aggression that seem out of character (frequent tantrums, irritability)
• Arguing/fighting out of the ordinary
• Abnormal sleeping patterns (excessive sleeping (fatigue), or difficulty sleeping (insomnia)
• Avoiding or missing school
• Decline in school performance
• Use of drugs and/or alcohol
• Loss of interest in favourite pastimes or activities
• Changes in eating habits (loss of appetite, refusing food, or overeating)
• Frequent headaches or stomach aches without cause
• Social withdrawal (spending extended periods of time alone)

What Can Parents Do? Tips to Support your Childs Mental Wellness

Create a safe, supportive, positive environment. The most important thing for a child is feeling loved and cared for. Creating a space where they feel safe and supported increases their sense of belonging, self-worth and self-esteem.

Encourage good physical health. Good physical health promotes good mental health. Healthy eating habits, regular exercise and adequate sleep are essential to a childs wellbeing.

Foster open and honest communication. Its important for children to feel safe coming to you with their fears, concerns and problems. Keep an open mind and be a good listener without judgement they will appreciate it.

Model healthy coping skills. Help your children learn how to regulate their emotions in a healthy way. Taking deep breaths, being active, doing art activities, thinking positive thoughts and playing with a pet are all great coping techniques for children. Share your coping methods with them: what works for you might work for them!

Watch out for behaviour changes. Its normal for a childs behaviour to change as they grow through developmental stages. However, if they become overly withdrawn or isolated from family and friends, it may be a sign that they are struggling to process a situation or feeling on their own. Check in with them and let them know you are there to support them however they need it.

Create a routine at home. Uncertainty about day-to-day schedules can create a lot of stress and anxiety in a childs life. Structure and routine can provide some comfort and reassurance (something as simple as a weekly movie night, or scheduled meals).

Talk about feelings and emotions regularly. Rather than just saying your day was good, talk to your child about the different emotions you felt throughout the day and how you handled them. This teaches them that feelings are normal, it gives them the vocabulary to explain their own emotions, and provides them with tools to regulate themselves.

Include them in decision making. Find ways to include them in simple decisions like whats for dinner, what they wear or which movie to watch. This makes them feel valued and important. It teaches them that they have a voice and gives them confidence to use it.

Stay involved in their life and encourage their interests. Show curiosity in what they do and what is important to them, and encourage them to explore their interests. Not only will this boost their confidence and self-esteem, it will also make it easier for parents to notice arising concerns.

Reach out to a professional. Even though parents play an important part in the mental health of their children, they cannot replace professional help. Mental health practitioners are here to assist and support in every way. Early identification and early intervention can make an incredible difference at a young age, dont be afraid to reach out for help!

Don't forget that parents need support too. Supporting a child with mental health difficulties can be stressful, exhausting and overwhelming. Parents are more helpful to their children when they take care of themselves. Professional help can provide an outlet for parents to release their emotions and gain skills to better support their children.

Fighting Stigma

While there has been an incredible shift in public perception in regards to mental health disorders since the very first World Mental Health Day in 1992, this increased awareness must continue to fight stigma. The World Health Organization estimates that two thirds of people suffering from mental illness choose to avoid seeking help for their condition due to the stereotypes, prejudice and discrimination that result from misconceptions of mental health. Spreading information about mental health helps break down the stigma and normalises help-seeking behaviours.

Other reasons that prevent people from seeking assistance in Cayman are lack of affordable services, financial limitations and insufficient health care coverages. Mental health services are expensive and many young people dont have the financial resources to afford them. Mental health coverage is limited and often not enough for long-term treatment. Government funded services exist, but can have long waiting times and are not always easily accessible.

The Alex Panton Foundation runs a Financial Assistance Programme which provides financial aid to young people seeking mental health support. For more information and support please contact assistance@alexpantonfoundation.ky.

New Mental Health Projects in Cayman

Despite the alarming situation in Cayman, the good news is that there is soon to be more quality, youth focused mental health support available.

Alex's Place Youth Mental Health Hub

The Alex Panton Foundation has teamed up with the Ministry of Health to create Alex's Place, a safe space for young people struggling with mental health

Dr. Lam is happy to share that Alex's Place is a comfortable and youth friendly centre provides care and support to children and adolescents (ages 10 20) experiencing mental health issues. It as a place where young people in crisis can find the support and guidance they need in an age-appropriate manner and without judgement.

24-h Kids Helpline

The Alex Panton Foundation is working on the creation of an interactive online space (due to open early 2023). In collaboration with the Crisis Centre, they are developing a 24-h Kids Helpline with text and phone support. This service will allow young people to reach out for help while remaining anonymous at any time of the day or night. Dr. Lam is hopeful that this new helpline will guide children and youth to the new Hub.

Sea Change

Cayman's new long term residential mental health facility, called Sea Change, is due to open in 2023 and will be available to young adults age 18+. Envisioned to be a Therapeutic Farm Community, it's an alternative to the traditional hospital. This 53,980sq ft space, located in the East End, encompasses multiple treatment areas and a suite of nine six-bedroomed cottages. Residents will engage in meaningful, shared work experiences, from gardening and animal care to cheese making and woodworking, as well as music and crafting along with psychiatric consultation, to strengthen their vocational skills, social aptitude, and emotional competency. This model has been demonstrated to improve medication compliance, reduce symptoms and relapses, impart job readiness and build self-esteem.

Through the Lens of our Youth: Alannas Story

Alanna Warwick-Smith is a young Caymanian who has lived with depression most of her life. After many years of fighting for her mental health, she has found ways to cope and live with her difficulties. Her journey was full of ups and downs, and she has worked very hard to be where she is today.

It all started when she was diagnosed with depression at the age of 11. Her mother noticed something was not right, and together they headed to the hospital. The ER was the most accessible and affordable place to take someone in a crisis, although it was not fit for children struggling with their mental health. At the hospital, Alanna was referred to a child psychiatrist, who has been by her side ever since. Mental health therapy was very expensive back then (and still is today), and growing up in a middle-class family made it very difficult for Alanna to keep therapy consistent. Even with her mother paying for premium health care, she was only able to afford a psychiatrist visit once every three months.

Alanna was given her first prescription of anti-depressants when she was 13. Due to limitations in mental health coverage, she did not receive the amount of professional assistance she needed. Because of this, she was unable to gain a full understanding of her diagnosis, resulting in an infrequent use of her medication. Her mother was always there for her, supporting her in every way she could. But as Alanna said, parents are not trained for this, sometimes they dont know what to do. They need help and guidance too.

Life got worse before it got better, and at the age of 16 Alanna attempted to take her own life. It was a dark period for her, filled with blurry memories and tough moments, but one thing Alanna will never forget is her mothers presence through all of it. It was her job to protect her daughter and advocate for her, and she did. She stood up for Alannas mental health, she taught her not to be ashamed of her struggles and she gave her a safe space to talk, release her emotions, and be truly herself. With time, strong will and endless support from her mother, Alanna built herself back up one step at a time.

Alanna is now 26, she still copes with depression but has found ways to live with it. She is proud of who she has become, in all of her beauty and all of her flaws. This is the hand that Ive been dealt, she says, and I learned how to live with it. While telling her story, Alanna mentions her mother often. Thanks to her, I am alive today. In a world where no one else understood her, and where she could not receive the help she needed, her mother was there and that was enough to save her.

Life is short, but also so so long. When youre young, you dont realise how much life is ahead of you. With a brave heart and a love for life, Alanna keeps moving forward. The younger version of herself must be so proud!

About the Author

Allie is a Guidance And Counseling KG-2 Counselor at Cayman International School.

She has a Masters degree in Child & Youth Care with a background in mental health therapies, child development and counselling.

She is passionate about supporting the development of young people and enabling them to reach their full potential.

Where to Get Help

The following clinics can provide help if you or your child is struggling with their mental health. You can also contact your GP/Family Doctor.