Our Troubled Youth – Some Answers

Dr Lane Hinchcliffe is a medical doctor, composer, singer and pianist as well as the Managing Director and Program Co-ordinator of Project 15. Lane thinks of his work with adolescents as a passion, which came to him indirectly while working during his university years as a school boarding house master. Project 15 takes training sessions for school staff and students on site and also works through a clinic Lane calls a “Health Hub” in Adelaide’s Glenelg. On Tuesday 10 March 2015, Lane Hinchcliffe joined Wendy McCarthy AO, Chair of Headspace, Matt Noffs, Founder of the Street University and David Cole, Founder, The Balanu Foundation to speak on his experience of helping Australia’s troubled youth. The paper which follows is an edited transcript of Lane Hinchcliffe’s address

OUR TROUBLED YOUTH – SOME ANSWERS

LANE HINCHCLIFFE

Several years ago, I was overseas on placement in Scotland. I was doing a term in paediatrics. And I remember being called to the emergency department one afternoon. I was called to see a 14 year-old lad, who’d been brought in by ambulance having been witnessed to have a seizure at home. As I entered the bay, the nurse grabbed me and gave me a warning – he was in a foul mood. That was an understatement. Moments later I found myself trying to strike up some form of conversation with what appeared to be a brick wall. Getting nothing in return, and finally in a state of desperation, I looked at the boy’s mother who said something I’ll never forget – “You see that’s why I didn’t even know if he was having a fit like, cause he’s such a wee shite.”

Teenagers. They can make us laugh and they can make us cry. It’s a privilege to be here today, I’ve flown from Adelaide where I work to talk about a topic which I’m passionate about. To be honest I fell into the field of adolescent health by accident.

I grew up here, in Sydney. I was a keen musician as a student and loved school. I went overseas for a year and got into medicine before moving to South Australia. In my second year of university, I took a job as a residential tutor in a boarding house. There were 140 boys and girls, aged about 11 to 18. Within six months of working there, I was in charge of the junior dorm consisting of 12 boys aged 11 to 14.

I want to tell you about one of these young lads – I’ll call him Tom. He was a nice kid, quiet, a little bit different. He liked to read, he was interested in trains and computers. He was 11 years old when he started boarding. The year got under way and I saw that Tom was a great kid. About three months in, though, his demeanour started to change. It became clear that he didn’t get on so well with the other boys, and it was having an effect on his emotions. He was getting angry quite easily. We noticed he was getting into fights at school. His grades were starting to slip. His parents were worried; I was worried. Then one night when he wasn’t sleeping, he said the most dreaded words you could hear a 12 year-old at that point say – “I wish I was dead”.

I bumped into Tom just a few weeks ago. He’s now 22 years old; he’s doing really well. This story has a good ending. While we were talking, he was very happy and in his own words he said, “The difficult times seem like an eternity ago now.” Funnily enough, I remembered them so vividly. I was a medical student, I felt out of my depth. I really had very little training or formal experience in adolescent health of any kind. The least I could do was support this kid and work with him individually.

Interestingly, talking to Tom a few weeks ago, he said something which took me aback and was quite lovely feedback. He said, “The support you gave me at that time of my life really helped me pull through a difficult time.”

I graduated from medicine and I left my job at the boarding school. I loved working in the school. I learnt so much from working there before getting into the field of medicine. Over the years that I’ve been a doctor, I’ve ended up working in general practice. But I’ve been fortunate enough to work in various different areas. I did some paediatrics for three years, some mental health, reproductive health and some work in indigenous areas outside Darwin.

It’s been a terrific journey. But ever since I left the school, there was one thing I felt was lacking in my career. I had a passion to focus and do something proactive in the area of adolescent health, which I felt wasn’t being met in my job in the hospital.

So in 2008, I came up with an idea for a program called Project 15. Project 15 was really a very simple idea. It was centred on the thought that maybe we could bridge some of the gap between health and education. We could send doctors or health professionals into schools to work one-on-one with students, teachers and parents to try and bridge that gap. We could also offer up-to-date health education resources.

Over the last six years, this program has grown. In 2008, I established the company and the business Project 15. The team grew. Last year, I had three or four people on-staff working part time. We had 15 schools on our books and I was delivering a number of talks to schools and to students on a regular basis. At the end of last year, we took a bit of a plunge. Our team decided it was time to expand further. So, about three months ago, we opened doors to a new medical clinic in Glenelg in South Australia. We call it the Health Hub Adelaide.

The Health Hub has been my dream to compliment Project 15. It is a GP practice with a particular focus on the adolescent community. Adolescent health is certainly an amazing area to work in but the challenges are substantial, not least of all because of the issue of accessibility.

When we started Project 15, the aim was very simple; it was to begin a proactive approach to supporting young people. In other words, rather than waiting for them to come to me, I was going out to them. It worked. After a number of sessions I I found that one or two of the students from those talks would come into my clinic in the following weeks and say, “Oh I heard you speak and I’d like to talk.”

The difficulty is that, even though we’re in quite a central location and with good public transport, accessibility is still an issue. For teenagers to get to us, I have to assume they can either catch public transport or have the bus fares. So this year we’re trying a slightly new approach. We’re going to the schools and running clinics on site. We’re working with two particular schools at the moment. In those schools, we are implementing both the Project 15 program (proactive work meeting and talking to students, education sessions and working with staff) alongside me and a nurse going out once a week to run a clinic on sight, where we open doors.

On a good day, I can get 20 students rolling through the door. And it can be for all sorts of things – a skin condition they want to talk about, small worries about asthma, a sporting injury but there’s always those few who will come in and actually take the plunge and say, “Since you’re here, and since I heard you speak, I’m just going through this bit of a stage; I’d just like to have a chat.”

The discussion topic tonight begs the question as to why we started with Project 15. Where was the need and what was the need? When we talk about our troubled youth, the first thing that comes to my mind is what I have heard many times – people saying, “Teenagers today are so different from what they were 30 years ago.” The other comment is, “Depression in teenagers is so much more common than it was 30 years ago.” It poses the question, when we talk about our troubled youth, of whether this is a new issue? Or is this an issue that has been around since the beginning of time for societies, but the recognition today is reflective of our society? Is it an issue that’s likely to get better, worse, or stay the same?

I’d like to digress for a moment to talk about a particular figure in the area of psycho-social development. You may have heard of the psychologist Erik Erikson, whose theories on ego development are still world renown. In fact, he’s got one particular theory that surrounds the development of adolescents, where he places a huge emphasis on the role of society and culture playing on the development of adolescence through that period of 12-18 years. This is the time of transition from being a child to an adult. And, as we’re dealing with adolescent health today, we’ll hear common things about self-esteem, mental health issues, drug and alcohol abuse, or risk-taking sexual behaviour. What is it about our current environment that seems to make these issues so much more prominent today than perhaps they seemed 30 years ago?

It’s probably quite obvious, but let me make a few points. The technological age we live in is becoming so much more sophisticated by the day. Not only do we have our mobile phones as a phone device, they’re also a portable internet connection, a storage device, a high resolution still and video camera. Phone apps can actually help us locate our phones within centimetres of where they are if mislaid. They can help us locate a person carrying a phone.

When I was working in the school boarding house, I remember so-called dirty magazines, probably from the 1990s or beyond. They have been superseded by far riskier material on the internet that is readily available to 14-15 year olds. We talk about self-esteem as an issue. At the same time, I have a 13 year-old boy who’s holding an FHM magazine where everything on the front cover and inside boosts the idea that beauty is a visual thing. And yet we tell our teenagers that it’s the inside beauty that matters. Sometimes, we underestimate the intuition that they have and the fact that they can see the hidden messages that come through, particularly in the media.

Statistical studies at the moment suggest our young ones are being exposed to more explicit material at a younger age. In fact, the average age of first exposure to pornography for boys now is about 12 years old. Some studies suggest that one in three ten year-olds have admitted to having seen quite explicit material. We are in a very different era from what we were 30 years ago. Material and media resources are accessible. This is where we are, this what we’re living with, and dealing with.

I have patients who have a lot of issues around self-esteem and depression. But at the core of it is an initial photo they took of themselves and sent to their boyfriends, a photo that’s now gone viral around the internet to thousands and hundreds of thousands of people; a photo that will never be reclaimed and we have no idea how far it’s gone.

So what’s the solution? It’s a difficult one. I’m certainly not going to trivialise the issue by coming up any idyllic answer. But whatever we do as a society, in a health profession, it’s important to take small but significant steps towards something sustainable – rather than a quick fix. When I started Project 15, I was looking at an idea around the macro and the micro level. On the macro scale, we’re looking to try to implement new systems and programs at the community, state and federal level. To looking at how we can better support our teenagers, parents and schools. How we can work with the changing environment so that we can keep up with the demand that our young people face. Importantly, how we can continue to bridge that gap between health and education sectors?

But on the micro scale – and this is where it gets really interesting – we need to remember that each individual is unique. Just as that young boy, Tom, was whom I spoke about earlier. As a GP, I cannot use a one-size-fits-all model. It doesn’t work. Yes, it’s a demand on resources to take time with every individual patient, and sometimes I have up to 20 teenagers I’ll be working with on a weekly basis at any one time. But, at the end of the day, it’s weighing up the difference between the quality and quantity of the turnover of those patients.

My goal, through Project 15, has been to try and empower young people to embrace their individuality, support them on their journey of self-discovery and embrace and empower them to see that sometimes what we perceive as weaknesses can also be strength of character.

I’d like to finish with a story, a very simple and beautiful story. It epitomises the message that we aim for with our Project 15. And certainly where I practice as a GP. I want you to imagine a beach stretching for miles and miles in each direction. Along the shore, are hundreds upon thousands of starfish. They’ve all been washed up by the tide, each one stranded on the sand. A man walks along picking them up one by one, throwing them back into the ocean. Somebody questions him, “What are you doing?” “I’m saving the starfish”, he says. The person is bewildered, “Are you crazy? There are thousands upon thousands of these scattered for miles and miles. You could walk along this beach for a day and it wouldn’t make a difference.”

The man smiles, as he picks up a starfish and throws it back into the ocean, “Well, it made a difference to that one.”