A recent qualitative study of the experience of young people living with mental health and substance misuse disorders in two deprived urban areas in Ireland highlighted how early intervention in a primary care setting could potentially prevent the escalation of symptoms.1 Semi-structured interviews were conducted with 20 young adults (aged 16 to 25 years) attending health-care settings in areas of extreme social deprivation in the cities of Limerick and Dublin. The aim of the study was to examine the manifestation and experience of mental health and substance misuse disorders among the young people.
Respondents described initial feelings of anxiety, depression and worthlessness which they recognised as problematic but for which they did not seek help. These symptoms progressed to a point where they became debilitating, and as the young people developed additional issues. Substance abuse was a common issue, with some becoming addicted. Self-harm was another coping mechanism.
Despite the exacerbation of their symptoms, the young people described a reluctance either to seek help or to accept help when it was offered. This was particularly the case for those dealing with addiction. Deteriorating life circumstances such as homelessness were often the factor that motivated an individual to seek treatment.
The young people felt themselves losing control as addiction became a full-time occupation, as relationships broke down and as negative feelings and thoughts became overwhelming. Nearly half of all respondents had serious suicidal ideation. Many felt it would be impossible to get better, particularly when they had gone for a long time without treatment or support. They needed to be convinced to seek help and to keep living.
Respondents described feelings of shame, embarrassment and isolation. The majority had left school early and some had legal issues. Many were dependent on social welfare and struggling to engage with society. As a result of living in an area of urban deprivation, the norm for many included a troubled family, stressful life circumstances and a drug-taking culture. This made it more difficult for them to cope with their mental health and substance misuse issues.
The findings from this study outlined progressively deteriorating symptoms, social isolation and stigmatisation among the young people interviewed. It highlighted the need for interventions which enhance early identification and treatment of mental health and substance use disorders in young people living in urban deprived areas. These interventions need to be delivered in an environment that is accessible and acceptable. General practice was identified as a less stigmatising environment than others owing to its availability to and familiarity with disadvantaged young people, and its ability to provide young people who present with physical problems with support around their mental health and substance misuse issues.
(Margaret Curtin)
1 Schaffalitzky E, Leahy D et al. (2014) 'Nobody really gets it': a qualitative exploration of youth mental health in deprived urban areas. Early Intervention in Psychiatry. Early online. www.drugsandalcohol.ie/22191
