Jigsaw provides missing pieces of youth mental health service

However, many young people are left waiting for up to 18 weeks to be seen due to a spike in demand since the pandemic

'No problem too small': Youth mental health service Jigsaw helps 12- to 25-year-olds with a wider range of issues than Camhs, which deals with the 2% of people who have severe and complex needs. Picture: iStock

Young people needing to avail of a youth mental health service are having to wait up to 18 weeks for their first appointment, its CEO has warned. 

Joseph Duffy says soaring demand for Jigsaw's service, coupled with staff retention challenges, means that waiting times have jumped from just a few weeks to more than three months in Cork City — which has the longest wait time.

Jigsaw, which caters for young people aged 12 to 25, has seen a huge spike in demand since the pandemic, with 68% of their cases linked to anxiety.

Jigsaw operates online and through telephone, but also offer face-to-face appointments at 14 centres around the country.

Up to July the wait time across the Munster centres was 18 weeks in Cork city, 13 weeks in Limerick city, seven weeks in Thurles, Tipperary and five weeks in Tralee, Co Kerry.

Demand at each centre was high last year, with Cork recording 2,746 sessions attended, 2,044 in Tralee, 1,864 in Limerick and 1,617 in Thurles.

Mr Duffy said demand is growing in larger towns and cities in particular. 

“Young people are not put on a waiting list, they are given a time and that time might in two weeks, three weeks or three months. That’s a forecast, and if we have any cancellations or there’s a change, we can usually bring that forward,” he said.

“But we know that the sooner we see them, the better the outcome is.” 

Young people are screened to assess who can wait or who needs immediate support, with potential for referral to acute services if necessary.

In addition to a spike in demand, gaps in the staffing roster at some centres is also contributing to the waiting times. Mr Duffy said this is often linked to Jigsaw’s status as a Section 39 organisation, part-funded by the HSE and public or corporate donations.

“This is being looked at and it is a real challenge,” he said.

“At the moment if a staff member comes to work with us in Jigsaw, we can’t pay the same as they would get in the HSE in terms of pension. We can start off on the same salary and base it on the HSE pay scales, but we haven’t got the money in terms of standard pay increments.” 

Advertisements for therapists at three centres are on the Jigsaw website this week, seeking people with a background in one of these areas; psychology, mental health nursing, social work, occupational therapy or psychotherapy.

“We’ve got very good support from the HSE, but we need more support for our existing services, and then we would also need new money for new services,” he said.

He called for more focus on ‘integrated services’ as was highlighted in the Mental Health Commission report on youth mental health services last month.

This could include “a referral pathway for young people, that would make a difference,” he said, so teens could be more quickly referred to the most appropriate service.

Pay issues affecting all Section 39 agencies are under dispute by SIPTU, Forsa and the Irish Nurses and Midwives Organisation with Government departments, HSE and Tusla at the Workplace Relations Commission.

'It's important to see that Camhs is just one part of youth mental health' 

Funding for youth mental health services needs to address everyone’s needs, and not only the children with the most severe needs, the CEO of the youth service Jigsaw has said.

Jigsaw CEO Joseph Duffy: ‘The feedback from teachers was they were trained in college to teach a particular subject but now they need to teach the whole person.’ Picture: Moya Nolan

Joseph Duffy is proud of the help Jigsaw offers thousands of young people, and would like to see this need more widely recognised.

“What’s concerning me now is youth mental health is becoming synonymous with Camhs and Camhs with youth mental health,” he said, referring to the HSE’s Child & Adolescent Mental Health Services.

“It’s really important to bring back the lens and see that Camhs is just one part of youth mental health.”

The HSE estimates that the Camhs specialist service is only suitable for 2% of children — those with severe and complex needs.

“We know that about two thirds of young people are doing well, they’ve got a good adult in their lives, and would probably benefit from mental health literacy support, or supports in the community,” he said.

“About 2% need Camhs, so there’s about 30% in between that really need a primary care intervention, and that is where Jigsaw comes in. The difficulty is most of our attention focuses on the 2%, and most of our funding focuses on the 2%.”

Jigsaw has 14 centres as well as national online and phone services, supported by the HSE, but he argues they need to expand.

“It’s a really big issue,” he said. “When I first started working with the organisation, we would have had to go out to communities and sell Jigsaw, because people didn’t really understand this concept of ‘you can walk in off the street and have young people’s mental health supported immediately’. But when we opened up in Wicklow and Tipperary during the pandemic, we very quickly got to full capacity in those.”

Decreasing stigma around asking for help and growing awareness of what Jigsaw can do, especially since the pandemic, are linked to rising demand.

Young people’s suggestions have made the service attractive, he said including: “the approach, the atmosphere, the welcomingness, even the place we are positioned in in the community, our referrals process.

“We take direct referrals from young people — there’s no barriers to that.”

Jigsaw works with education sites and sport organisations, with funding of varying amounts including from Lidl and the Late Late Toy Show Appeal.

“We would run courses or short training sessions for teachers on what is mental health, how to support a young person,” Mr Duffy said. “The feedback from teachers was they were trained in college to teach a particular subject but now they need to teach the whole person.”

“We’ve developed a whole school model called One Good School, that looks at the whole school environment.”

Future plans including working with apprentices and people who drop out of education.

 

'Everything came crashing down at once. I knew I needed support'

Sometimes you can live with stress and sometimes just one more thing like the death of a beloved dog can tip you into needing help, and that’s what happened to Niamh Fennell as a teenager.

Niamh Fennell who now works with Jigsaw is a former service user: ‘It was mostly stress-management, low mood, not being able to function on a day-to-day basis.’ Picture: Moya Nolan

She is just one of thousands of young people helped by Jigsaw youth mental health service since its foundation in 2006.

“I was probably about 15 or 16 at the time when I realised that I was struggling a little bit with stress management, and my mental health on a day-to-day basis was quite low,” she said.

“I was finding it quite hard to manage at school, with peers or friends. It was mostly stress-management, low mood, not being able to function on a day-to-day basis.”

When she was around 17 her dog Ruby died and she said: “I think everything came crashing down at once. I knew I needed a little bit of extra support.”

She attended Jigsaw Dublin South West but said that, going by her interactions with other young people, the approach is similar everywhere. Jigsaw has 14 centres and also offer help virtually.

“It was hard to make that decision,” Ms Fennell said.

“I’m 23 now but at that time mental health was still a bit stigmatised, there were not so many young people talking about mental health.”

She waited just two weeks for an appointment, and found the sessions effective.

“It was really really friendly,” she said.

“The reception area was really colourful, it had mindfulness colouring books and different bits and pieces in. The room was done out like a mini-sitting room, it wasn’t like going to see a doctor.”

She had seven sessions including one with her parents.

“It was a wrap-up session, and they were able to help verbalise what was going on, the steps and tools that I had learned in the sessions, to my parents so my parents had an understanding of where I was,” she said.

She found this helpful as, at the time, she did not have the vocabulary to explain all this.

“I think maybe parents sometimes go ‘oh my God, this is really serious’ or think it could be more acute,” she said.

“Where at the time it wasn’t acute mental health — I just needed a little bit of extra support.”

Now working in the Jigsaw national office, having started as a youth volunteer, she said teenagers are more self-aware now, often because of social media platforms such as Tiktok.

“Jigsaw changed my life,” she said. “I think people are more aware of Jigsaw, but maybe don’t understand exactly what they can do. I think more needs to be done in terms of talking about early intervention.”

She urged: “When things get a little bit tough or when things aren’t going as smoothly, it’s OK to go for help then as well — you don’t have to let it go into crisis.”

From anxiety to suicidal ideation, 'no issue is too big or too small' for Jigsaw

There is no problem too small or too big for a Jigsaw session, clinical manager Jennifer Misener said, having seen a range of issues successfully treated.

Jennifer Misener, clinical manager of the Jigsaw service in Galway: ‘The more that we’re open about [mental health], it reduces stigma so people who do need it can come forward.’ Picture: Ray Ryan

Walking into the Galway centre, young people see yellow armchairs, multi-coloured rugs, bright murals on the walls, and not a white coat in sight.

“This is completely deliberate, and completely driven by young people,” she said. “Young people gave us feedback that they felt sometimes going to different services could feel too cold, that it could feel like a clinic so they gave us feedback about wanting the vibrant colours.”

Like all 14 Jigsaw centres, they help people aged 12 to 25. Over-18s can self-refer, and younger people can self-refer with parental consent, and referrals come through schools, GPs, or other pathways.

While staff may appear casual, they are trained and qualified to the same level as their HSE counterparts.

“We always say for Jigsaw there is no problem too big or too small, “ she said.

“That could be something such as a breakup or all the way up to somebody who might be feeling suicidal.”

Anxiety is the most common concern nationally she said, with 68% of cases linked to anxiety and low mood the second most common issue.

“It’s [anxiety level] really high, and that is what people are coming through for, especially after the pandemic,” Ms Misener said. “I know we don’t talk about pandemic as much in the media, but we definitely still have the impact coming through the doors.”

For example, young people say they lost friendship circles or cannot get motivated to return to sport, she said. Among the rising numbers, they are seeing one worrying change.

“We’re finding young men are seeking help less often,” she said. “It used to be quite an even divide where it was 60% young females and 40% males. Now that is starting to shift a bit where it’s 70% women and 30% males. We don’t know exactly what the story is behind that yet.”

However, therapists also see a “wide range of change” for young people attending.

“We have seen people come in with severe anxiety, and we thought ‘would this need to go Camhs’ direction’,” she said, referring to a HSE service. “But they are able to have six to eight sessions consecutively, receive some cognitive behavioural therapy, homework, and guidance, and then be able to bring that level of anxiety down to where they are back to functioning.”

Overall, she is convinced Jigsaw works because it helps with unmet needs.

“I think its good to put everything in the open,” she said. “Jigsaw is one of those things that if you don’t need it, that’s fine. But if you need it, it’s there.”

“Maybe not everybody will need a mental health service, but the more that we’re open about it, it
reduces stigma so people who do need it can come
forward.” 

'I was experiencing panic attacks. I was sick. I was skipping school' 

When Sophie Kathryn needed help at 15, she was told she was not severely ill enough for a HSE service but she found answers with youth mental health service Jigsaw.

Sophie Kathryn, who formerly used Jigsaw’s therapy service, now works on research at the organisation’s national office. Picture: Moya Nolan

Young people needing help may think Child & Adolescent Mental Health Services (Camhs) is their only option, but as that specialist service is only suitable for 2% of the youth population, Sophie is not alone in going elsewhere.

She credits an “incredible” therapist at Jigsaw for helping her cope with stress linked to financial pressures for her family and the Junior Certificate.

“I was experiencing panic attacks, though I didn’t know this at the time,” she said. “I had ringing in my ears, I was sick. I was a very social person and I loved school but then I was skipping school loads.”

When she had a panic attack in front of her mother, she took Sophie to their GP where they heard she was not severely ill enough for Camhs.

“On our own, we found Jigsaw and went up there,” she said. “There wasn’t much of a waiting list at the time, I was only about two weeks waiting. They were able to help with my anxiety, my stress and with breathing techniques.”

She jokes now that she thought the Junior Certificate was the end of the world until she went to the North Fingal Jigsaw service.

“I had a really incredible councillor called Debs, she’s moved on now but she was absolutely fantastic,” Sophie said.

She had between eight and 10 sessions, and went back for ‘top-up’ sessions later.

“It made the world of a difference,” she said. “I went back to school again, I was seeing my friends, I had a life again that I didn’t have for about a year I was stuck with all of that.”

She started volunteering with Jigsaw in 2019 and, as a youth advocate, is involved now with research at Jigsaw’s national office.

“The main thing for young people is anxiety and low mood, that’s the same across different service and all age groups,” she said, urging teens to get in touch with Jigsaw.

“People might put it off and say ‘ah I’m not as bad as my friend or someone else down the road’ and you don’t really value your own mental health.”

She supports plans to expand saying limited access for LGBTQI+ teens in rural communities came up in recent discussion.

“I know there were a lot of people from more rural areas, so Donegal and Cork but the rural areas of those counties, are especially far away. So whether it’s Jigsaw or other services, they physically can’t get the support,” she said.

More generally she said: “I know it’s especially hard for young men in rural areas.

“They struggle to see themselves in these services asking for help. They think it’s not for them or they don’t know anyone who’s been.”