The term left holding the baby is defined by the Collins English Dictionary as “being put in a situation where you’re responsible for something, often in an unfair way because other people fail or refuse to take responsibility for it” (left holding the baby, n.d.). A feeling of having been left holding the baby could occur whenever
participants perceived they were unable to appropriately involve other service
providers in the care of young people to the necessary degree: “if they’re not going to follow-up [with referrals] then they’re on my plate, you know” (P15); “you can guarantee with those ones that don’t follow my request [for a referral to be actioned], they come back to me” (P23). The effect was that: “I have these kids who are not getting any support except from me” (P3). Of particular concern for participants was the co-occurrence of high stakes and left holding the baby:
She wasn’t getting support from her parents, they were not getting her to [mental health] services. She was just repeatedly self-harming, she was suicidal. I felt as if I didn’t know what to do with her, so it was quite scary. I also felt, ethically, like I needed to keep her on my radar, constantly. (P3) I was fairly unhappy at this point with the situation [the student’s untreated suicidality] … I did a lot of exploration to see who had done what, what the outcome was, etc. It’s been a lengthy process and one I've been fairly
disappointed with because I feel that too many agencies let this boy go…. I think he’s a very high risk little boy. (P28)
The referral of young people experiencing mental health problems to other services was described by participants as a key function, but this was not always easily accomplished:
It’s those children who come to you, and then you refer them but that process just doesn’t work for them. There are lots of reasons that doesn’t work, but it continues to not work with some children, and then they fall between the cracks. They keep bouncing back to you, so you do see them [again]. You might see them more than once a week, and you're [thinking] ‘wow, I'm not really sure what to do with you next.’ (P3)
Although participants sought to work collaboratively with school staff, parents, and other service providers, the willingness, capacity and availability of these key partners was a key influencing condition which is detailed in chapter four. Commonly, participants were left holding the baby because there were multiple barriers to young people receiving specialist assessment and support, both within and external to the school: “there are school psychologists at the school, although I find that they’re not as accessible, so the kids are bouncing back to us” (P26).
Another participant reported:
The parent wouldn’t take her [to the Child and Adolescent Mental Health Services appointment]. [The parent] said “she’s just doing it for attention.” I don’t work for Child and Adolescent Mental Health Services, so I don’t know. I rang the case worker and said… “Dad’s a fly-in-fly-out [worker]. Mum doesn’t drive. We think mum might have a mental health issue as well, just from things we picked up. You sent a report saying she didn’t turn up for her assessment.” (P31)
A sense of having been left holding the baby could be particularly strong when a student had a high utilisation of school nursing services, because the participant often had frequent, ongoing contact with the student and was sensitive to fluctuations in presentation and risk: “in schools you see the students for a longer period of time.
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You can observe and… you can see their interaction… Rather than them going to a particular psychiatrist’s office for a half hour appointment and… [the young person denying there’s a problem]” (P19).
Thwarted referrals and untreated mental health problems were significant
contributors to participant perceptions that they had been left holding the baby, but in some circumstances this could also occur when a young person was receiving
specialist mental health care. One participant recounted how they had phoned a student’s mental health service provider because they perceived an exacerbation in suicide risk:
I rang the Child and Adolescent Mental Health Services and said “what do you want me to do in this situation? The child has told me she’s got strong [suicide] ideation, she’s got past history, significant past history [of suicide attempts], she’s self-harmed, and she’s telling me that she doesn’t feel safe… I'm a bit worried about this.” He said “if she’s got a timeline [to die by
suicide], if she’s been on the internet trying to find ways to [suicide], [then contact us].” [I thought] How am I supposed to know whether or not [she’s been doing this]? … Do I feel really safe in myself about that one? No. (P18) When barriers to having young people cared for by specialist mental health services proved insurmountable, the feeling of having been left holding the baby was
inescapable:
She’s thinking [about], she’s planning [suicide]… Bless her disclosure
because she was being very honest, but now she’s very cagey [secretive]. She went to Princess Margaret Hospital for Children. Of course she was referred to Child and Adolescent Mental Health Services: she was a no-show [didn’t attend the appointment]. (P31)
Back in May he wrote a suicide note. He’s a 12 year old Aboriginal boy. From what I can gather… [he] lives with mum and a couple of other siblings, [and an] older sister who is known to me as well. I think life at home is pretty tough. I think mum is fairly unavailable… about a week after he wrote this suicide note mum disappeared to Bali [Indonesia] and a Department for Child
Protection and Family Support report was put in by our [school] psychologist because she felt that was concerning… [The boy] attended Child and
Adolescent Mental Health Services with his Year 10 sister. [He] attended on a couple of occasions, but mum wouldn’t engage so they discharged him. They discharged him into the care of the school psychologist…. who equally discharged him because she couldn’t get mum to sign consent [for her to see him]. So this little boy was then just flying in the ether really [no-one’s professional responsibility]. (P28)
It was not unexpected that the frequently chronic nature of the clinical and
professional stresses many participants experienced had a significant impact on their emotional wellbeing. This is detailed in the next section and was conceptualised as a
heavy toll.