One in five New Zealand adolescents or teens will suffer from a depressive disorder by the time they're 18. So let's do something about it, says John Kirwan, who discusses parental concerns and the importance of "stepping up'' with Shane Gilchrist.
When John Kirwan was a butcher's apprentice, he knew how to respond to a customer's request, could map out a carcass and make a precise cut.
When he was an All Black winger, he was rather good at finding a way through or around an opposition's defence, be it from set-play instructions or instinctive counterattack.
Now, he is a father of three. And here's the rub: he wants to better chart what's going on in the heads of his eldest, daughter Francesca (20) and teenage sons Niko and Luca.
In recent years, Kirwan has used his profile to encourage people to speak about mental health issues. His 2010 book, All Blacks Don't Cry, detailed his struggle with depression and anxiety and provided advice for others dealing with similar problems.
Having been involved in television campaigns and worked with the Mental Health Foundation, Kirwan has now turned his gaze to teenage mental health, particularly depression and anxiety.
His new book Stand By Me is intended as a useful guide for parents, caregivers and teachers, in fact anyone concerned about the wellbeing of young people in their care.
''There's no way I want to be the parent who says, `I know what I'm doing', because I don't,'' Kirwan explains in a recent phone interview before his forthcoming visit to Dunedin to speak on the subject.
''All I want to be able to do is provide some information to help people understand what their kids are going through, then have some experts provide advice on what could be done.''
Engaging the nous of clinical psychologists Dr Elliot Bell and Kirsty Louden-Bell and collaborating, again, with writer Margie Thomson, Kirwan doesn't just ask ''the big questions'' facing some families; his book also offers a range of approaches to dealing with teenage mental health issues.
''I had a mental illness, but I still don't know how to parent for mental `wellness'. I want to parent in a manner that if things are going wrong for my kids I'll see it and know what to do.
''I'm pretty dumb, so I thought it was important to get some experts on the subject involved. It's important that people get the right information.
''As part of my research for this book I spoke to a range of young people and their parents or caregivers, asking questions and seeking everyday, real insights.''
The story of Kirwan's mental illness is well-documented but worth repeating nonetheless. He says it hit him ''like a truck'' when he was 23, an age when his life looked - at least on the outside - so good.
''I was an All Black, at the top of my game ... yet inside of me I had doubts about how good I was,'' he writes in Stand By Me.
''I was always super-critical of myself. That was part of what made me a good player, but I understand now that it was also out of control, and underneath it all I had a massive fear of failure.
''Over the next three years the panic increased and I developed full-on depression, until eventually came the terrible, terrifying day when I couldn't get out of bed ... I had what people might call a mental breakdown.
''Depression took my confidence and, as a rugby player, I don't believe I ever really got my confidence back 100%. It seemed to come from nowhere, but now I realise there were early warning signs.''
Kirwan wonders if that breakdown had its roots in childhood. He recalls going on a camp to Hunua, south of Auckland, at the age of 10 or 11 but having to go home after a few days.
''I was with all my mates, in a beautiful place with nothing to do but have fun for a few days, but I was sobbing. I wanted to go home, and Mum had to drive out and get me. Mum said, `You're just homesick'.
"I reckon a lot of people thought I was a real sook. But was it the first signs of anxiety?''
He notes that camp facility would have had a first-aid box brimful of sticking plasters, bandages and disinfectant. But what about the first-aid box for a child who's crying because of a fear of the unknown, feeling helpless and afraid? How should parents react to such events?
Well, talking about it is a pretty good start.
''It's about having the capacity to teach children how to deal with things mentally when they get older. If they say, `Dad, I'm freaking out a bit', I might reply, `Well, that's OK. These are the three or four things you need to do'.
''If you can identify the signs as well as awareness of what's going on - I mean talking about it as a normal thing, just like dealing with a strained muscle - then they can get through.''
It's called resilience, Kirwan says, adding such a concept shouldn't be confused with the idea of ''hardening up''. In fact, we should be doing the opposite.
''I don't want to be in a situation where my kids can't lean on me when something crops up. I need to know about those times I need to intervene when they aren't prepared to.
''How do you prepare a 17-year-old if they are not really talking and their girlfriend drops them? They might either cruise through the episode and look back but, at that age, their world might also collapse.''
One in five New Zealand adolescents or teens will suffer from a depressive disorder by the time they're 18, according to the various reports referenced throughout Stand By Me. Recent scientific advances, including brain-scanning procedures, have allowed experts to look at the structure of the brain and to see how it changes through the years. And what is apparent now is that the adolescent brain is not fully developed: it is still physically maturing until we're in our early 20s.
In teenage brains, the connections between different areas of the brain develop unevenly. As a consequence, the capacity for strong emotional responses and emotionally driven behaviour tends to develop before problem-solving, critical thinking, impulse control, judgement and reasoning abilities.
Add in hormonal changes, and the impulsiveness and risky behaviour associated with teens starts to make sense.
''Risk-taking is not a bad thing. It just needs to be channelled in the right way,'' says clinical psychologist and co-author of Stand By Me Dr Elliot Bell, who works as a lecturer and researcher at the University of Otago's School of Medicine and Health Sciences in Wellington and has a private practice in the capital.
For example: getting drunk and driving a car is clearly not good. Nor is the uncontrolled impulse that's involved in suicide. However, taking a risk on the sports field, or auditioning for a role in a school play, can bring rewards.
''Positive risk-taking is an important part of adolescence. We need to create environments where they can explore and experiment without harming themselves and others,'' Dr Bell says.
Parental concern aside, another key reason Kirwan embarked on his latest project was because he wanted to understand the environment(s) in which New Zealand teens now roam.
''I don't think we adults have any awareness of what their world looks like. The phrase, `back in my day' doesn't work any more,'' Kirwan says.
According to Prof Gluckman's report and ''Youth '12 Overview: The Health and Wellbeing of New Zealand Secondary School Students in 2012'' (an ongoing research project completed, roughly, every five years), teenagers are negotiating a fast and constantly changing world. Money, marketing, alcohol, drugs, bullying, disadvantaged environments, physical and/or sexual abuse, sexual identity, split households, ethnic diversity, lack of parental time, the rise of celebrity culture and social media ... all are factors.
Yet differentiating between ''normal'' levels of anxiety and sadness, and depression and anxiety as mental health issues can be a challenge for parents, Dr Bell notes.
''In some ways it's a matter of degree. Beyond a certain point, anxiety and depression reduce our ability to function in daily life, and at that point they become mental disorders or illnesses. They both cause enormous mental distress.''
More than 80% of adolescent depression and anxiety disorders are left untreated, according to Prof Gluckman's report. The authors of Stand By Me
emphasise that's a recipe for future misery, because recurrence rates for depression are high. There's a 70% chance of a further episode within five years. Each depressive episode increases the probability of another.
''The earlier it's identified and treatment can begin, the better the chance of success, and the better the chance that our young people will not experience further episodes,'' Dr Bell says.
So what can parents or caregivers do?
''One of the take-home messages we are trying to convey is that if a parent or caregiver notices a change in behaviour that doesn't seem right or reactions that seem disproportionate to the circumstances ... they are indicators that something might be up,'' Dr Bell says.
''It is then important to engage a young person in conversation. There are some really good resources available to help parents start those conversations.
''The next step is getting help. We suggest a helpful first port of call is the GP. They are able to screen out other physical health conditions that could complicate the picture. They are able to refer on to the right people.
''Psychologists generally start with `talk therapies', addressing lifestyle changes and general support networks before looking at medication. But some teens do need medication, which should be carefully administered and monitored.''
Often, it's not an either-or scenario. Some people need the physical boost that medication can provide (for example, being able to sleep) in order to be able to engage in psychological therapies that do require some degree of concentration or focus.
Medication can have its place, Dr Bell says, noting a combination of medicine and therapy can be highly effective in treating anxiety and depression, especially when treatment begins early.
''Psychological treatments involve a degree of learning. People learn about their symptoms, the warning signs, triggers and how to respond.
''While it is never a good thing to experience mental illness, there is potential for what is referred to as `post-traumatic growth', that sense of being changed in some positive way, and having greater empathy and a better sense of what's important in life.''
Parents need to look after themselves, too. After all, they need to be in good psychological shape in order to support their child through tough times.
And parental ambitions sometimes have to be altered.
Kirwan uses sport as a metaphor (''It's the easiest way for me to explain things ...''). ''You know what I did last week? I spent it at a national soccer tournament with my son, who is captain of Sacred Hearts. He has never played rugby. He doesn't hate the game, but he's a soccer man.
''I didn't really understand the game until he started playing it at the age of 5.''
His point? Parental love means stepping up, being close and engaged with a child and, importantly, re-evaluating one's own goals.
Be patient, too, Kirwan urges.
''When I had depression I really thought I would never get myself back as a person. I'm quite sure that parents of kids with mental illness fear that they won't get their child back.
''Understand that what they've got is an illness, and with the right help it will pass and they will get better. You will get your child back although, sure, both they and you will have changed and grown as a result of their experiences.
''Having anxiety and depression was the worst thing that ever happened to me, and at the time I didn't see how things could ever get better.
''But I made it through and I'm glad to be the person I am now, definitely with more self-knowledge and more compassion for others.''
IN CONVERSATION
John Kirwan, in conversation with Ron Palenski, in conjunction with the Otago Daily Times and Paper Plus, Golden Centre Mall, Sunday, October 5, 6pm-8pm. Tickets $20 (TicketDirect or Paper Plus). Email your questions for John Kirwan to answer on the night to standbyme@penguin.co.nz with ''Dunedin'' in the subject line.
Stand By Me, by John Kirwan (with Elliot Bell, Kirsty Louden-Bell and Margie Thomson), is published by Penguin ($40).
SIR JOHN
Sir John Kirwan was an All Black from 1984 to 1994. Following his playing career, he became an advocate for depression awareness in New Zealand, fronting a high-profile television campaign and writing the memoir All Blacks Don't Cry.
Having coached the Italian and Japanese national rugby teams, he is now the head coach of the Auckland-based Super Rugby franchise the Blues.
He is also a husband and father of three. In the 1989 New Year Honours, he was appointed a Member of the Order of the British Empire, for services to rugby. In the 2007 Queen's Birthday Honours, Kirwan was appointed an Officer of the New Zealand Order of Merit for services to mental health, and in the 2012 Queen's Birthday and Diamond Jubilee Honours, he was appointed a Knight Companion of the New Zealand Order of Merit, for services to mental health and rugby.
He was also inducted into the New Zealand Sports Hall of Fame in 2012.
THE BLUES
Depression is characterised by constant feelings of sadness or dullness or - particularly in adolescents - anger and irritability. Thinking becomes pessimistic and negative.
Anxiety is characterised by overwhelming and irrational worry, dread and fear.
Both can get to the point where they are immensely disabling for the person experiencing them. They can be isolating and overwhelming for all of those involved.
''Rumination, or preoccupation with what has happened in the past, is often a hallmark of depression,'' Dr Elliot Bell explains.
''With anxiety, it is catastrophic worry, a concern about what might happen in the future.''
Various studies have revealed the extent to which anxiety and depression co-occur in individuals.
The longitudinal Dunedin Multidisciplinary Health and Development Study, which is following 1037 people born in 1972 and 1973, acknowledges the prevailing notion that anxiety usually precedes depression for people who experience them both.
However, the opposite can also happen. Just as people can get depressed about their anxiety, they can get anxious about their depression. At other times both might just develop together. In the Dunedin longitudinal study, 72% of lifetime anxiety cases had a history of depression, and 48% of lifetime depression cases had a history of anxiety.
GIVEAWAY
The Otago Daily Times has three copies of John Kirwan's new book Stand By Me to give away. To go in the draw for one, write your name, address and daytime phone number on the back of an envelope and send it to Stand By Me, ODT Editorial Features, PO Box 181 Dunedin, or email playtime@odt.co.nz with Stand By Me in the subject line. Include your name, postal address, and daytime contact number.
