The teenage girl took her own life after spiralling into depression, anxiety and obsession about her school work and academic ability. A coroner has found her school should have canvassed more mental health treatment options with her parents. Photo / File
The teenage girl took her own life after spiralling into depression, anxiety and obsession about her school work and academic ability. A coroner has found her school should have canvassed more mental health treatment options with her parents. Photo / File
Warning: This article discusses suicide, self-harm, and other mental health problems. If you need help, contact Lifeline on 0800 543 354 or text 4357 (HELP).
An Auckland school has been told by a coroner to review its “policies, procedures and guidelines” around “distressed” students after a teenage girl took her own life following an “increasingly pressure-driven spiral” over her studies and her fear of failing or falling behind classmates.
The 15-year-old took her own life at her family home in 2020, two years after she started suffering anxiety around her schoolwork.
Her mother and school staff were aware she was struggling and steps had been taken to help. including engaging a private psychiatrist, but Coroner Alexander Ho said other public health system treatment options were not canvassed and if they had the girl may still be alive.
However, he said no one associated with the girl or her care should feel any “fault” over the tragic outcome.
She had been unable to provide an answer to a question and felt she had let her team down which led her to question her overall academic ability.
In early 2019 her mother contacted her school, concerned that since the competition the girl had been depressed and talked about suicide.
Further, following a family holiday overseas, the teen was “stressing” about being “lagging behind” her international peers.
A school guidance counsellor saw the girl later that week, reporting she was “quiet and seemed tired and flustered”.
The teen claimed her mother was “overreacting” and did not want to be pulled out of class for counselling appointments as that would mean she had even more study to catch up on.
Coroner Alexander Ho. Photo / Ministry of Justice
A week later she saw the counsellor again.
She was “nervously shaking” about upcoming tests and said she was not sleeping well, worried about “not doing enough”.
“She felt sad, upset and frustrated about not performing well enough to excel. She was disheartened about her future,” Coroner Ho explained.
“She wanted to be perfect in everything she did and felt that the situation she was in was not perfect.”
The counsellor suggested further expert help and was going to refer her to the local mental health services, but ended up recommending a private psychiatrist because the teen was “insistent on medication” because she was “impatient and frustrated with herself for making slow progress in getting well”.
He saw the girl soon after and diagnosed her with “moderately severe” depression, anxiety and “perfectionistic obsession” with her studies.
He assessed her as at low risk of harm towards self and others “while she was well supported by her mother and opting to engage in treatment”.
But he noted that her risk could change “commensurately” if she were to disengage from treatment or continue to struggle with academic stressors and her own disappointments.
He proposed “trial therapy sessions” and medication to help with her anxiety.
“[Her] mood did not improve. She continued to struggle with significant crying episodes of anxiety but did not acknowledge that she had an illness or needed treatment,” Coroner Ho said.
“She refused to return to see [the psychiatrist]. She tore up paintings that she had done at home as she felt they did not meet the standards she had set herself.
“She lost a [sports] game at school which worsened her feelings of anxiety. Her absences from school increased.”
The psychiatrist increased the teen’s medication and her mother reported a “significant improvement in mood”.
The teen agreed to see him once a month in relation to her medication but still would not engage in therapy.
“[He] encouraged [the teen] to continue ongoing engagement with her school counsellor and to enjoy her studies and hobbies without overindulging in her perfectionistic nature and drive to overachieve,” the coroner said.
The teenager was a perfectionist and wanted to do well academically. She started to spiral when she felt she was "lagging" behind her peers. Photo / 123RF stock image
The girl missed a lot of school because of her mental health issues and was concerned she would not pass her assessments.
It was suggested she attend an alternative school to catch up but she refused, wanting to go back to “normal” and paranoid her “classmates would think negatively of her absence”.
In 2020 she went back to her original school but Coroner Ho said things “did not start well”.
She was upset when she did not qualify for an extension class and disclosed she had stopped taking her medication over the summer holidays.
At a meeting with the school dean and counsellor she was “flustered and embarrassed”, maintaining she was “fine” and did not want to talk about her issues as it had not helped in the past.
“[She] was reportedly adamant that counselling was not necessary and she did not want to see a counsellor at school,” Coroner Ho said.
Days later, the teen took a day off school to spend time with her mother.
They enjoyed breakfast together, played with their family pet and watched funny videos online.
The girl then requested a specific meal for lunch and when her mother went out to fetch it, she took her own life.
Coroner Ho said there was no doubt the teenager intended to take her life, and formally ruled her death a suicide.
“[She] placed considerable pressure on herself to succeed and to do well… she had perfectionistic tendencies,” he said.
“The evidence also shows that she was worried about where she was placed academically compared to her peers and what her peers might think of her.
“Unfortunately, the more pressure [she] placed on herself to do well and to meet the predetermined standard she had set for herself, the heavier her mental load and the greater the stress she would have placed upon herself.
“The likely result was that [she] found herself trapped in an increasingly pressure-driven spiral from which she was unable to escape.”
The teen started to suffer anxiety about her academic performance and eventually saw a psychiatrist. Photo / File
Coroner Ho said “considerable efforts” by those surrounding the teen to “support her and do what they thought was best”.
“It is through no fault of any of these individuals that ultimately [she] made the decision that she did,” he assured.
“People who take their own lives usually do so as a result of a complex range of factors.”
Coroner Ho said he understood why the school counsellor did not refer the teen to the local publicly funded mental health services, but that should have been canvassed further.
He sought advice from Jennifer Goddard, an expert with 25 years’ experience in school counselling and a Master’s degree in Health Science, specialising in causes of stress for students.
She reported that the counsellor should have completed the referral for the teen because her “initial level of risk and distress was significant enough to prompt referral to publicly funded services”.
“Such services are fully resourced with doctors, psychiatrists and specially trained nurses and other staff,” Coroner Ho said.
“A counsellor cannot force a child or a parent to accept a particular referral. However, Ms Goddard opined that given [the teen’s] young age [the counsellor] had a duty not to simply accept [her] view without more but to advise [her] of the best course of action and formulate an acceptable plan.
“A distressed young person is not the best judge of the most appropriate course of action and will need appropriate support and advice.
“Ms Goddard considered that [the counsellor] might have been too ready to accept [the teen] and her family’s preference of private pharmacological treatment without the benefit of a full and frank discussion about all available alternatives.
“Had [the teen] been referred to publicly funded services, Ms Goddard would have expected an immediate response albeit with a possible delay in [her] being seen, depending on the pressures on those services at the time.
“This may have varied if [she] was signalling acute distress or was assessed as being at high risk of self-harm.
Coroner Ho said it was “impossible to know” whether that referral would have made a difference to the teen or saved her life.
“However, it would have been prudent for the public referral to have been subsequently revisited, and for [her] parents’ attention to have been drawn to publicly funded services as an alternative or complement to the private pharmacological treatment,” he ruled.
“To be clear, it is not always the case that a public referral should always be completed in light of student and/or parent opposition. The guiding principle will always be the course of action which is in the best interests of the student.
“However, what is important is to ensure that parents are fully apprised of their options... and ensuring that both school and parents are of the same understanding as to the information presented and digested.”
The teen refused counselling but was given medication as she wanted to get well sooner and get on with her schooling. Photo / File
Coroner Ho said it appeared there may have been a “disconnect” between the school and the teen’s parents between what the counsellor thought they understood and what they did understand.
The death was an “important reminder” that both sides needed to be “clear about the information that has been imparted” and that all available options were “fully canvassed”.
Goddard told the coroner she had identified “potential gaps” in the school’s monitoring of the teen after she began seeing the psychiatrist.
While the lines of responsibility “may have become blurred” there were “enough risk factors listed” in the teen’s case to warrant “continuous close supervision” by her school.
However, Coroner Ho said such monitoring might not have changed the outcome.
“School holidays, including the lengthy end-of-year break, also impacted the school’s ability to continuously monitor [her],” he said.
“[She] was reluctant to engage with professionals... as a student who was used to being successful, [she] would have suffered a huge loss of confidence which would have affected her ability to function and to make progress. This may have affected [her] willingness to accept an intervention which she considered suitable.”
The coroner also said it was impossible to know the extent she had “covered up her difficulties” - either out of embarrassment or the wish to shelter her family from anxiety or disappointment.
Further, there did not appear to be any overt indications at or around the time of the teen’s death of increased suicidal risk.
Given that in the two days before she died the teen and her mother told the counsellor she was “fine”, there was “no apparent or new reason” for her to have been referred to urgent crisis services.
The girl's mother went to get lunch and she took her own life in the family home. Paramedics could not revive her. Photo / NZME
Coroner Ho made a number of recommendations, saying the teen’s death should “prompt” the school to “review its policies, procedures and guidelines in respect of distressed students” to ensure three things:
There are appropriate provisions in place to ensure that students and their parents are made aware of all available support options, including publicly funded services;
Guidance staff are reminded to discuss with students and their parents all available and appropriate support options even where one support option is indicated or preferred by the student or their parent;
There are clear criteria for when the school’s responsibility for monitoring the student’s health and well-being commences and ceases, and the level of monitoring required during that period of responsibility.
“I make the specified recommendations... that, in my opinion, may, if drawn to the public attention, reduce the chances of the occurrence of other deaths in circumstances similar to those in which the death occurred,” Coroner Ho said.
“[The school principal] acknowledged these comments and stated that the school guidance department under senior management team leadership would continue to review policies, procedures and guidelines to manage suicidal ideation and risk.
“[She] noted that the department had a new head of department and several new team members and that this was an ideal time to reflect and review their documentation in relation to this area of support and care.”
