Dr. Tony Bates:

I thank everyone for their interest, questions and compliments about Jigsaw, which are great to hear. Jigsaw is a community service for young people and we decided on the 12 to 25 age bracket rather than primary age because we know that that is the most vulnerable age for the emergence of mental health difficulties. It may not necessarily mean mental illness but it can become that. Mental illnesses start as anxiety and depression and, without care, they grow legs. During my 30 years in St. James's Hospital, I saw people constantly who had been through many admissions and who said, "If only I had seen someone at the age of 14 or 15". Schools can play a huge role in preventing serious mental disorders. We picked that age group because we felt that is where the system was weakest but where it needed to be strongest. Great work is being done in early years education but youth mental health was neglected until 2006. An organisation defines itself by what it does not do as much as by what it does. Jigsaw offers a great deal in areas. For example, we visited a school the other day and the manager from the Jigsaw project in Dublin city centre spoke to the staff and invited them and the students to visit the Jigsaw premises in order that young people would know where it is and that is accessible but also that Jigsaw could work in the school to help build capacity around understanding and confidence to engage with people. There is more than going on that just seeing people but they can be seen. They can self-refer and as one principal in Balbriggan said, the students know they can go to Jigsaw in the town and they do not have to tell the school staff or there can be a quiet word and they will go. We have striven to remove those barriers. There are many ways to do that with careful clinical governance and child protection measures. Best practice is observed.

The big question is where to begin. We have to begin with a consensus around what we would love to see happen in schools. We have to begin at the end, which is the vision. If we have a clear understanding of what we want to happen differently in schools, we will work to get there. Well-being is the wave that is breaking on the shores and it is the wave we have to work with at the moment. That is where energy, resources and money are being invested. It is the best thinking we have around mental health. It is funny that when we opened the Jigsaw centre in Galway, all the young people said we should not put well-being on the table. They said to us that if people are experiencing mental health problems and challenges, we need to let them know this is where they come and we have to change what mental health means. It is not mental illness but it is the more spiky end. Well-being is so attractive. Who does not want well-being? However, mental health is when everything gets heated and that is when people need help. We need not to be afraid of the phrase. It is not ideal but it is not mental illness. That is something else, which encompasses mental ill-health but it is not the same.

This has to be integrated within schools. Somebody has to be in charge. NEPS is the obvious body to pull together the threads. There are so many threads that it is like a spaghetti bowl. They are not even connected in any way; they are just all out there. There are many different developments in schools with people moving in with solutions. There are many magic bullets. It is noisy and crowded and more shared thinking is needed.

On the issue of the word "mental", we need a shared language and a way to talk about this. I am careful and I use generalised anxiety disorder. I am careful in so far as I can to use these words as adverbs, not nouns. People are anxious, depressed, frightened or angry but they do not have something. They can go on to have something but most of those we see are not there. We need a shared language that is not frightening for people. We all need that to be able to talk about these issues. Well-being is a lovely framework within which to have that but we need to recognise the kids we are most concerned about are at the dark end of the spectrum and we need to have language for them.