Wicked problems

The first category in the basic social psychological problem of untenable burden was conceptualised as wicked problems. The term “wicked problems” was first used by Rittel and Webber (1973) to describe problems that have multiple causes, are not easily solvable and do not have a specific right answer. Rittel and Webber (1973) asserted that every wicked problem is unique and may be a symptom of another problem, making wicked problems difficult to describe. To add to the complexity, attempted solutions to wicked problems may lead to unforeseen outcomes that may not be reversible. As outlined in this section, the category wicked problems

conceptualises the complex circumstances with which young people frequently presented to participants.

By definition, wicked problems were not limited to what happened at school. Many participants described clinical cases that went well beyond the school walls, affected multiple systems in the young person’s life, were frequently ongoing and difficult to resolve:

I had this girl self-harming. Year 12 I think she might have been, and her family issues weren’t [being dealt with]. The father had left her to go to [location], left her in his house, with the older brother who [used] drugs. He didn’t provide money for her... She came in one day with [self-harm] cuts and [I] did all the appropriate things… we tried to link her up with Centrelink [government financial support], [and the] Department for Child Protection and Family Support because she was an older [student]. She just wanted to finish Year 12 but she didn’t have any [home] support. (P2)

Participants embraced the broad context and reported that caring for young people experiencing wicked problems aligned with community health nursing and the employer expectations of the role. For this reason, having an ecological

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isolation. It’s a child within a peer group, within a family, within the community and the school” (P31).

The extent of wicked problems not uncommonly took participants by surprise when they first commenced working as a secondary school nurse: “I wasn’t prepared for the scope of their problems” (P23); “I was not prepared to handle the amount of mental health… and [the seriousness of] mental health conditions that are coming though my door” (P11); “there’s a lot more mental health than I expected” (P3); “I didn’t realize there would be that much [mental health]” (P26).

Wicked problems ranged from highly stressful but transient life circumstances to

complex ongoing difficulties: “things like parents in prison, or parents dying or parents with mental health issues, things like that” (P5). The breadth of clinical concerns precipitated by wicked problems was significant:

[Presenting issues] can range from anxiety, suicidal [ideation], self-injury, bereavement, relationship breakdown, peer conflict, family issues at home, drug and alcohol dependant parents, exam stress, sexual health issues… just anything and everything that walks through the door, a really wide range. (P30)

Clinical cases frequently precipitated extensive interagency contact:

I do a lot of referrals to Child and Adolescent Mental Health Services [for] kids with self-harming, suicide ideation, anxiety [and] depression. [I’m] starting to see some more eating disorders now as well. [There are] disclosures of abuse - physical, sexual, emotional. [I’m] doing a lot of

reporting to [the Department for] Child Protection and Family Support. (P31) In some schools, the proportion of young people experiencing wicked problems was particularly high: “about 50-70% of students at the school [are] impacted by either poverty or [dysfunctional] family dynamics or substance use. It’s huge. It is huge” (P31). Several participants who had been employed as secondary school nurses for a long duration commented that the acuity and complexity of wicked problems had increased in recent years: “the nature of issues that young people are presenting with

has gradually become [more complex] … Over the last [few] years I've noticed that there’s more and more social [and] mental health issues” (P28). Another participant explained:

Starting off [as a secondary school nurse many years ago], it was, I wouldn’t say rare, but… very infrequent that I got the assessments that I get now. The students that I get now… the degree where they’re socially, emotionally, mentally [impacted]… The issues I would say, have increased [in acuity and complexity]. (P2)

To gain insight into young people’s wicked problems participants reported undertaking a structured adolescent psychosocial assessment. It was typically through this assessment that wicked problems were uncovered. Consistent with the term wicked problems, the psychosocial assessment often indicated a range of inter- related concerns: “most of these kids it’s not just one thing. It’s a majority of

different things that are pulling them down” (P17); “it’s often not just one thing, it’s often a huge lot of things together” (P29).

For many young people, complex difficulties at home precipitated mental health problems: “a lot of the kids’ mental illness is situational, it’s family-based that they’re coping with” (P10); “a lot of it [impacts] their mental health because there’s so much stuff happening in the homes” (P20); “the parents have got drug issues or [are] alcoholic, [there are] abuse or relationship issues. [Young people’s] problems seem to stem from that” (P1). Significant reports of family and domestic violence were not uncommon:

Dad hit the [son] and he flew into the shower glass. It didn’t smash, but… the sisters have come to school absolutely shaken because they thought [the father] was going to kill him, that he was going to get cut, because [the father] kept on punching him. (P31)

A commonly cited factor in young people’s mental health problems were parents who were unable to provide sufficient effective parenting to their young person:

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They might have parents who are so incapacitated and so overwhelmed with everything that they’re not given any guidance, and this is where I find a lot of students with mental health issues… They don’t have good parenting. (P21)

I've [had] him seen at [the] Child and Adolescent Mental Health Service. They’ve all said “[there’s] nothing wrong with him.” [The mother’s] got another child that he babysits. There’s little parental involvement with that [child]… it’s a parenting issue really. (P18)

Looking at the kids and the way that they’ve been brought up at home. The parenting, the drug and alcohol use, the trauma, the abuse, the neglect. I see that that’s gone on for a long time, a lot of years. Parents have gone through the same as well [had a similar upbringing]. (P7)

One participant illustrated how a young person could appear to be provided for but was actually lacking in essential parental input:

Mum was a lawyer, dad was [a] doctor or surgeon. They were never home. He had the credit card to do whatever he wanted, order in whatever he wanted, so he ordered in his weekly dose of cocaine as well. (P6) Not unexpectedly, family breakdown was a common source of grief for young people because it typically resulted in having less access to the non-resident parent. For some young people, a single parents’ efforts to put food on the table led to ramifications that were more significant:

Her mother is fly-in-fly-out [flying to a remote area of Western Australia for employment] … away for four weeks and home for one. From the time I met her when she was only 14, she was living at home by herself, with the aunt- neighbour down the street who helped, but she actually had the house to herself. She had no one else in the house, four weeks out of five. (P3) Although family breakdown did not always reflect family dysfunction, the consequences of a fractious family breakdown could have particularly significant effects on the mental health of young people:

One student we have has been going through a Family Court case for some time. She has panic episodes at school and out of school. She is seeing someone externally [for treatment], but we still have her on our books [for support at school]. (P22)

At the extreme end, some young people found themselves homeless in the context of family breakdown:

She’s Year 10, so she’s 15. She lived with her mother and [her] parents are [separated]. She lived with her mum and they fell out [became estranged, prompting the girl to leave her mother’s home]. Dad doesn’t want her, he told the teachers he doesn’t want her… She’s a wreck. I’ve seen her, she looks absolutely terrible… [with] self-harm wounds up both her arms. (P29)

Some young people were attempting to cope with the permanent absence of a parent, and presentations for grief and bereavement were common:

He’s Year 10. Very sadly last year his dad died very suddenly. Within a very short period of time his grandfather, who also lived with him died… He didn’t want to talk about it, he just wanted to go along as normal…But it seems he hasn’t been coping. We weren’t aware until he just stopped coming to school. (P19)

Other young people were bereaved as a result of parent suicide:

We have a little Year 8 boy [who] has a really difficult family life. His mother has killed herself. He has [attention deficit hyperactivity disorder], he lives in a difficult family situation with his dad. He’s grossly overweight, he gets picked on, he picks on people, he fights, he’s in trouble at school. (P29) Some participants expressed feeling quite surprised at the home lives some young people reported: “I’m blown away by the number of children that are living in circumstances that are really quite detrimental to their wellbeing” (P31); “I did [find it] quite surprising to realise what some young people have [to deal with], what they're home lives look like… that they can function and get on with life to some degree” (P24).

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Children in the care of the state (the Department for Child Protection and Family Support) were frequently known to participants because an interagency

Memorandum of Understanding required all children in state care to have an annual health assessment which was conducted by participants: “we get a lot of students under the care of the Department for Child Protection and Family Support, [in] foster care or living with other families” (P16). Although participants reported that many children in the care of the Department for Child Protection and Family Support were living in stable and supportive homes, this was not always so. One participant described a young woman she worked with who had experienced multiple out-of- home placements as a child, became a mother while still an adolescent and had her own child removed in a scenario that threatened to repeat her life story:

I've come across a couple of teenagers who have babies now. One was really poignant in that the girl had had 34 foster homes. [Then she] had had her own baby, and within two days of taking that baby home, [the] baby is in foster care. (P7)

Knowledge about the home circumstances of a young person typically led participants to view the young person’s behaviour through a different lens:

It frustrates me [that] they get those labels of being a ratbag and rebellious kid. You’re privy to know what goes on at home, [and] you feel like saying to people “you know what? If you lived in that life you’d be behaving the same way.” (P24)

Home lives were not the only source of stress for young people. Academic demands were also a cause of young people’s problems: “our students are very high achievers and put a lot of pressure on themselves to achieve. They compare themselves to others, which is never good. We also have parents put a lot of pressure on students” (P19). Similar concerns could arise at the other end of the continuum:

We have students in Year 10, with a reading level of about Year 3. A good proportion of those students can't read the West Australian [newspaper]. Around 40% of our Year 10 students [15-16 year olds], of which we have around 300… are not at the reading level of an 11 year old child. (P22)

As demonstrated by the quotes above, there were multiple complex contributors and consequences of young people’s wicked problems, and these young people often required intensive and ongoing support.