Safeguarding mental health of children, ensuring opportunity to thrive

Megan Mitchell

National Children’s Commissioner

Australian Human Rights Commission

Meeting of the Community Reference Group (Advisory group to the RCH Mental Health)

Ella Latham Theatre
Royal Children’s Hospital
50 Flemington Road
Parkville, Victoria

Tuesday 18 March 2014

1. Acknowledgments

Thank you Harry, Ric and Beth, and the Community Reference Group, for the invitation to speak to you today.

I also acknowledge the Traditional Owners and Custodians of the land on which this meeting takes place, the Wurunjeri People of the Kulin Nation.

It is a pleasure to be here in Melbourne, and to have the opportunity this week to connect with key professionals working in child health.

2. Introduction
It is now almost a year since I started in my role as National Children’s Commissioner.

So, I think it appropriate today that I reflect back on the priorities in my first year, and talk about some of the emerging themes from this early work, including a key area of work for me in the coming year on the mental health of children and young people.

It is opportune that I am here today in a forum devoted to the improvement of the mental health of children and young people and I am keen to learn from and connect with you on this issue.

As I will discuss, and as you all know, children’s mental health is closely related to their ability to enjoy their fundamental rights.

3. My role and the CRC

But first, what are children’s rights and how do they relate to my work?

As many of you will be aware, although there had been Children’s Commissioners and Guardians in the states and territories for a number of years, my appointment was as the first National Children’s Commissioner in Australia. This was a long awaited recognition that children need a strong advocate at the national level to ensure their interests, rights and wellbeing.

The legislation that governs my position – the Australian Human Rights Commission Act - gives me some tools to perform this role. They are

• promoting awareness of the human rights of children in Australia
• undertaking research, or educational or other programs, to promote respect for, and the enjoyment of children’s rights
• examining existing and proposed Commonwealth laws on whether they recognise and protect the human rights of children
• and, submitting a report to the Parliament each year about children’s rights in Australia.

Further, I may give particular attention to children who are at risk or vulnerable. And I am to consult with children, as well as other relevant people and agencies, as appropriate.

As many of you may be aware, the key international human rights treaty relevant to children’s rights is the Convention on the Rights of the Child, or the CRC as it is called.
It is the most comprehensive human rights treaty for children, covering a wide spectrum of economic, social, civil and political rights to be enjoyed by children (defined as those under the age of 18).

It recognises that children have human rights, like adults, but that they require special protection due to their vulnerabilities and age. Australia ratified the CRC in 1990, and in doing this promised to uphold the rights of all children in Australia.

4. The right to be heard

One of the guiding principles of the CRC is the right to be heard, outlined in article 12.

Article 12 gives to every child the right to have a say, the right to have their views taken into account, and the right for those views to be treated seriously.

For those children who are at risk or vulnerable – for example children in out-of-home care or in the juvenile justice system – this right is especially important. Not only is it an essential component in ensuring their safety within institutional systems, but it empowers children and helps to build their resilience and wellbeing.

However, I believe that having your views taken into account and being respected is important for the mental health of all children, not only those at risk.

5. The Big Banter

Because I believe strongly that children have a right to be heard, my initial priority as Australia’s first National Children’s Commissioner has been to hear from children and their advocates.

Between June and September last year I conducted a listening tour, called the Big Banter.

During the Big Banter I met face to face with well over 1,000 children and I heard from another 1,400 plus kids from my online survey and reply-paid postcards. I also heard from hundreds of children’s advocates.

This slide shows you a few of the things children and young people told me.

In general though, children have told me that the most important things to them are being able to be with family and friends. They enjoy their freedoms and being able to play, being active and having fun, but they also appreciate fair boundaries and rules.

They are particularly concerned about the level of violence and bullying in the community and would like to live in a world free from drugs, alcohol and smoking. And they see all these things as inter-related.

They worry that some children can’t afford to do or have the things they would like, and they want more things to be available for free. They want people to show more respect for one another and they want to be respected and listened to. And they definitely want to have a say.

The views of children expressed to me in the Big Banter are highlighted in my first Children’s Rights Report, launched in December last year.

6. The Children’s Rights Report

As I said earlier, one of my functions is to submit a yearly report on children’s rights in Australia. I will be using these reports to take stock of progress on children’s rights and highlight key priority issues, including for groups of children who miss out.

In this first report I have incorporated not only the views of children – through the Big Banter – but also the perspective of the UN Committee on the Rights of the Child, national frameworks and action plans and the views of people, like yourselves, who work with and for children.

Using these perspectives, my report discusses five emerging themes, which are central to ensuring the maximum protection of the human rights and fundamental freedoms of our children. They are:

• A right to be heard
• Freedom from violence, abuse and neglect
• The opportunity to thrive
• Engaged citizenship
• Action and accountability.

I have already spoken a little about the right to be heard. But I want to speak a little bit more today about two of these themes, which have a strong relationship to the mental health of children.

7. Freedom from violence

First, the importance of living free from violence, abuse and neglect has been consistently raised with me by children and children’s advocates, and is reflected in concerns at the national level and in the observations of the UN Committee on the Rights of the Child.

These concerns have also been reflected in the work of the Australian Human Rights Commission on violence, bullying and harassment, including the BackMeUp campaign on bystander action against cyber-bullying.

Article 19 of the CRC sets out children’s right to be protected from physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation, including sexual abuse.

And growing up without violence, abuse and neglect is fundamental to the wellbeing, growth and development of children.

And yet, as we know, the rates of child abuse, domestic violence and other violence impacting on children remain unacceptably high. Bullying in schools continues to be widespread, with studies consistently showing that at least a quarter of children experience serious bullying. Further, self-harm and suicide - a form of self-directed violence is significant problems for young people, and an issue which many have been keen to raise with me.

What is striking to me in my discussions with children and young people and their advocates is the impact on children of violence and abuse even when it is not directed at them personally. Many of the children I spoke to during the Big Banter revealed a surprising concern with safety, and the safety of their siblings and friends, in the context of both the physical and the online world.

Here are some of the things they told me.

Life would be better if nobody got hurt and children felt safe all the time.

Life would be better for children and young people in Australia if there was no drugs and violence. I’ve been beaten up and bullied. I complained about it but it didn’t fix the problem - 13 year old child from the Northern Territory

Life would be better for children and young people if there was no hitting - Child from Western Australia

I think we need to understand much better the impact of violence, abuse and neglect on the mental health of children and young people more broadly.

At the same time, we need to address the prevalence of physical and mental violence, perpetrated by adults and children themselves.

Recently a study of the mental health of almost 4500 high school students reported that 34 per cent of girls and 30 per cent of boys felt constantly under strain and unable to overcome difficulties. More than half had low levels of resilience and of those 43 per cent felt violence was an appropriate way to solve relationship issues.[1] And 16 per cent felt it was necessary to carry a weapon.

Australia is certainly aware of the problems of violence, abuse and neglect, and we have some excellent national initiatives which aim to coordinate government action nationally to address some of the issues involved.

However, as I outline in my report, there are some key areas where we can do more to address these problems.

1. We need to ensure that there are national targets and benchmarks in place which allow us to measure progress over time, as well as robust monitoring processes to learn what works, what must be improved and what must change.
    
2. We can encourage a proactive approach to issues of child safety, one that places a premium on prevention through enabling safe families, institutions, communities and places for children.
    
3. And, we need to build resilience and acknowledge agency among our children. This includes work to ensure greater protection of children in cyber space and equipping theme to be able to engage safely online.

8. The opportunity to thrive

The other theme to emerge from my report that has a significant relationship to the mental health of children is the opportunity to, not just survive, but to thrive.

Article 6 of the CRC sets out a child’s right to life, survival and development. There is no more critical right than this.

And yet in Australia there are clearly groups of children who fare far worse and who do not enjoy the same opportunity to thrive as other children in Australia. Many of these children find themselves streamed into the costly tertiary systems of juvenile justice and out-of-home care - invariably putting them on a path to replicate patterns of social exclusion and disenfranchisement through the generations.

Children’s advocates I spoke to were especially concerned about vulnerable groups of children, and had specific concerns for children in out of home care, children in the juvenile justice system, asylum seeking and refugee children especially those in immigration detention, children with disabilities, and children who are homeless.

While not expressed in these terms, many children I spoke to were also aware that there are some disparities between the circumstances of children and their families.

I have Asperger’s Syndrome. Life in primary school was very difficult. Life would be better if people that were different, disabilities, races, religions and any other differences, all accepted each other. If there was no bullying. If schools were supportive of kids with disabilities, especially invisible disabilities like Asperger’s Syndrome.
14 year old child from Victoria

Life would be better for children and young people in Australia if we were all treated with equality and we were all treated fairly. Life would be better if everyone learned the meaning of freedom.
10 year old child from Victoria

Life would be better for children if the government made sure every child had all the rights. I think every child should have food and water.
An Australian child

I believe that a key to building resilient children and breaking the cycle of disadvantage faced by vulnerable families, is investing in early intervention and prevention services across the nation.

This was one of the strongest themes to emerge in my meetings with child advocates, and is supported by a large body of research.

The work commissioned by the Benevolent Society in 2013, Action Early Changing Lives shows that it is important to do more to tackle issues for children early on, before they become difficult to fix and expensive for the community. Evaluations of some early intervention programs in the US found that children who were at risk of poor outcomes, who participated in early intervention, and whose parents received extra support with parenting, were more likely to finish school and find higher paying jobs, and were less likely to be involved in crime, compared with those children who did not receive extra support.

While there are some promising individual models across the, overall, current investment in early intervention, prevention and family support across is patchy, poorly integrated and uncoordinated.
We also need to get better at identifying and focusing on the most marginalised and vulnerable children, and, to do so we need much better reporting and data collection.

As National Children’s Commissioner I will work during my term to progress these issues. However, these challenges will require collaboration, shared vision and purpose, and ongoing commitment to the ideals that are given expression through the CRC.

9. Focus on self-harm

I am also currently planning a more targeted project as part of my workplan for this year focusing on self-harm and suicidal behaviour among children and young people.

Addressing self-harm clearly relates to all of the five themes outlined in my report in some way.

For many young people there is a strong connection between bullying and abuse by peers, and self-harm and suicide of children and young people, as suggested by soe recent tragic cases reported in the media.

This connection was also reflected in the content of the short videos created by 13 to 17 year olds for the Commission’s two BackMeUp competition on taking positive action against cyberbullying, conducted in 2012 and 2013.

While limited data exists in Australia to adequately monitor trends or differentiate aspects of self-harming behaviour in children, the data that we do have is disturbing.

The number of suicide deaths by children and young people is small but significant as a proportion of all deaths within this age group. It is a leading cause of death for young people 15-24 years. For example, in 2011, 27.8% of all male deaths aged 15-24 were due to suicide.[2] While there are likely to be more children under this age who have died by suicide this information is not readily available.

Aboriginal Torres Strait Islander young people 15-19 years old are more likely to die by suicide than other young Australians.[3] And while youth suicide rates nationally have been slowly decreasing since 1997, there has been a confronting increase in the rates of youth suicide in places like the Northern Territory. For example, between 2006 and 2010, the rate of suicide for Aboriginal and Torres Strait Islander young people aged 10-17 increased 160%.

The number of young people who die by suicide in Australia each year is relatively low compared with the number who self-harm. It is difficult to estimate the rate of self-harm as hospital separation data is the main source of information about self-harm and evidence suggests that only around 10% of young people who self-harm present for hospital treatment. Further, it is estimated that the number of young people who have engaged in self-harm is 40 -100 times greater than those who have died by suicide. In 2011 terms, this suggests the rate of self-harming is somewhere between 4,600 and 11,500 a year.

Of the 553 hospital separations of children for intentional self-harm in 2010-2011, 82% involved girls. This is a 20% increase in self-harm hospitalisations among girls since 2000-2001.[4]

Again, there may be certain groups of children and young people who are more vulnerable to self-harming behaviours than others. Growing Up Queer, a recent report released by the Young and Well Cooperative Research Centre, highlighted significantly high rates of bullying and self- harming experienced by young LGBTI people.

In addition, the Australian Human Rights Commission has recently highlighted the high incidence of self-harming associated with vulnerable groups of detained asylum seekers, including children, in its 2013, Asylum Seekers, Refugees, and Human Rights: Snapshot.

Through this new project, I hope to learn from the experiences of children and young people, as well as from families, educators and expert practitioners about how we can better understand, prevent, monitor and respond to self-harming and suicidal behaviour in Australia.
 

10. Conclusion

I hope that today I have given you some food for thought about some of the key human rights issues facing children and young people in Australia, and some of the strategic areas where I believe we can work together to improve their health and well-being.

Again, thank you for the opportunity to speak today. I believe that there is time for discussion, and I welcome an opportunity to hear your thoughts.

Thank you.

[1] Resilient Youth Australia survey, reported in The Age, 9 March 2014.
[2] ABS, Causes of Death Australia 2011, Cat No 3303.0, 
[3] Australian Bureau of Statistics. (2013). Causes of Death, Australia, 2011. Cat No. 3303.0. Belconnen, ACT: Commonwealth of Australia. The rates for young men are 4.4 times, and for young women 5.9 times, that of non-Indigenous.

[4] Australian Institute of Health and Welfare, A picture of Australia’s children 2012, Cat No PHE 167 (2012), p 91.