Submission by the Mental Health Commission of New South Wales

Mental Health Commission of NSW

NSW Youth Health Policy Consultation

Submission by the Mental Health Commission of New South Wales

October 2016

NSW Youth Health Policy Consultation
Submission by the Mental Health Commission of New South Wales1

TRIM Ref TD16/7058

Mental Health Commission of NSW

Table of contents

The Mental Health Commission of NSW

Question 1: Are there health issues that need to be particularly considered in the development of the NSW Youth Health Policy? Please identify and give brief reasons. (Please consider any recent feedback from consultation or engagement with young people.)

Question 2: What approaches do you think provide opportunities to improve access to health services for young people?

Question 3: Do you support the three proposed policy goals? Please outline any changes to the Goals needed to promote a stronger health response for young people in NSW.

Question 4: a) Will the proposed objectives and outcomes under Goal 1 support health services to meet the needs of vulnerable young people in NSW? If not, what changes are needed?

b) What new and existing strategies are needed to achieve the objectives and outcomes under Goal 1? (Please consider tools, service models, training, systems, resources and guidance needed by youth -specific and ‘mainstream’ services).

Question 5: a) Will the proposed objectives and outcomes under Goal 2 help to improve young people’s access to and experience of health services? If not, what changes are needed?

b) What new and existing strategies are needed to achieve the objectives and outcomes under Goal 2? (Please consider approaches, tools and resources that may be used at a local and/or statewide level)

Question 6: a) Will the proposed objectives and outcomes under Goal 3 help the NSW Health system to support young people to be healthy? If not, what changes are needed?

b) What new and existing strategies are needed to achieve the objectives and outcomes under Goal 3? (Please consider resources, programs and guidance that may be used at state and local levels)

7. Do you have any other feedback to be considered for the next NSW Youth Health Policy?

The Mental Health Commission of NSW

The Mental Health Commission of New South Wales (NSW) is an independent statutory agency responsible for monitoring, reviewing and improving mental health and wellbeing for people in NSW. It works with Government and the community to secure better mental health and wellbeing for everyone and to prevent mental illness, and to ensure the availability of appropriate supports in or close to home when people are unwell or at risk of becoming unwell.

In all its work, the Commission is guided by the lived experience of people with mental illness, and their families and carers. The Commission promotes policies and practices that recognise the autonomy of people who experience mental illness and support their recovery, emphasising their personal and social needs and preferences as well as broader health

The Commission works in three main ways:

Advocating, educating and advising about positive change to mental health policy, practice and systems in order to support better responses to people who experience mental illness, and their families and carers.
Partnering with community-managed organisations, academic institutions, professional groups or government agencies to support the development of better approaches to the provision of mental health services and improved community wellbeing, and promote their wide adoption.
Monitoring and reviewing the current system of mental health supports and progress towards achieving the Actions in the Strategic Plan, and providing this information to the community and the mental health sector in ways that encourage positive change.

Throughout this submission the term ‘disability’ is used broadly to encompass people who experience psychosocial disability.

Question 1: Are there health issues that need to be particularly considered in the development of the NSW Youth Health Policy? Please identify and give brief reasons. (Please consider any recent feedback from consultation or engagement with young people.)

Some further detail about the impact of mental health issues among young people is warranted. Mental health problems, alcohol use disorders and suicide and self-harm are the leading causes of burden of disease among young people in Australia.[i] American research has found that half of all anxiety, mood, impulse-control, and substance use disordersstart by age 14 and three quarters by age 24[ii].

Access issues for young people experiencing mental health problems are worth highlighting. ABS data cited in a report by Access Economics shows that only around 25% of people with mental illness aged 16-24 receive treatment (compared to 35% of the all-age population with mental illness).[iii]

Intentional self-harm is the leading cause of death among those aged 15-24 years. Suicide deaths for women aged 15-19 rose from 5.3 per 100,000 in 2014 to 7.8 per 100,000 in 2015. For men aged 20-24 the rate rose from 20.6 per 100,000 in 2014 to 22.5 per 100,000 in 2015. Aboriginal young people are particularly at risk. For Aboriginal and Torres Strait Islander people aged 15-24 the suicide rate for 2011-2015 was 40.0 per 100,000 compared to non-Indigenous rate of 10.3 per 100,000.[iv]

The needs of young people experiencing psychosis need to be clearly articulated. This includes their significant physical health needs as highlighted by the HEAL declaration.[v] This is a vital time to intervene to prevent longer term health problems and a projected reduced life expectancy.

Mental health problems can have long-lasting and costly consequences for the individual and community.

“Given the exquisite developmental sensitivity of this phase of life, where psychological, social and vocational pathways and independence are being laid down, it is not surprising that mental disorders, even relatively brief and milder ones, can derail and disable, seriously limiting or blocking potential. Associated with mental disorders among youth are high rates of enduring disability, including school failure, impaired or unstable employment, and poor family and social functioning, leading to spirals of dysfunction and disadvantage that are difficult to reverse.”[vi]

Mental health issues for additional groups of vulnerable young people such as teenage parents warrant mention.

Given its prevalence, the health impacts of family violence; child sexual abuse and other forms of abuse; and neglect should be more explicitly included.

Question 2: What approaches do you think provide opportunities to improve access to health services for young people?

GP-based models of access to healthcare may not be realistic for all young people as most are not managing chronic conditions and some are highly mobile. E-health records are likely to be more accepted by this group who may use multiple and changing entry points to health services. Soft entry points and opportunistic interventions need to be provided such as co-locating primary health care with other youth friendly services such as education, health and welfare, and recreation services.

Access isn’t confined to service provision or availability but also appropriateness and approachability. Navigating the formal mental health system is still confusing, overly complex and sometimes traumatising especially for those experiencing more severe illness. The system is not designed with the needs of a young person in distress (or their loved ones) in mind.

Peers may be used to advantage in reducing barriers to accessing health services. These may be through formal peer support roles seen in some mental health services, but also through informal peer support and referral.

A friend is often the person who will first know that a young person is experiencing a mental health problem. This observation was the starting point for the 2014 report Support in tough times Encouraging young people to seek help for their friends published by the NSW Commission for Children and Young People and the Mental Health Commission of NSW. The report explored pathways from peer support to adult help for mental health problems and highlighted the roles of schools in facilitating these pathways. The research suggested that young people are more likely to seek adult help for friends in schools that focus on:

-building trust among young people and adults at school

-recognising young people as competent to provide support to their friends

-adhering to transparent school policies to protect student confidentiality

-showing they care about students’ mental health

-teaching practical skills and encouraging discussion of real issues

-taking proportionate action when problems are raised

-implementing a whole of school approach that accounts for student diversity

-developing staff skills and knowledge.[vii]

Peers and adults at schools clearly need to have the skills to appropriately connect a young person to help. However the adult that most young people will approach is a parent. This means that parents must be engaged in strategies to support the mental health and wellbeing of young people.

there is a clear need for parents to have the skills and knowledge to act appropriately when approached by a young person for help for a friend. Parents need to feel confident in identifying mental health issues, what support is required and how to access that support. Parents also need to be equipped with the knowledge of where support is available in the community – including support from school, a mental health service or other community organisation.[viii]

A systematic intervention for students and parents during high school to promote self-agency and help-seeking is warranted. Young people and their families need to be equipped with the language and conversational skills to have difficult conversations with their peers and children.

E-mental health initiatives and portals potentially support self-agency on a young person’s terms and in a way that is broadly accessible. The Mental Health Commission of NSW partnered with the Young and Well Cooperative Research Centre to trial an online stepped care system, Synergy. Synergy integrates a range of mental health and wellbeing apps and e-tools. Participants in the trial were able to customise their own ‘hub’ space, which includes data feeds from the apps they use tracking things such as sleep, exercise and nutrition. The Trial allows young people to engage with evidence based services in a confidential way at a time and location that is convenient to them. This work is now being continued by the Brain and Mind Centre at the University of Sydney. The NSW Youth Health Policy needs to have regard to these emerging platforms and how traditional health services can best utilise these and work in with them in terms of stepped care.

Question 3: Do you support the three proposed policy goals? Please outline any changes to the Goals needed to promote a stronger health response for young people in NSW.

Broadly speaking, the three proposed policy goals are supported.

To strengthen their alignment with Living Well: A Strategic Plan for Mental Health in NSW 2014-2024, consider reversing their order. To maximise the effectiveness of the health system, our mental health response should start with supporting all young people to optimise their mental health through promoting the social determinants of health, peer and family support, and self-agency. A stepped care system must be provided for those young people who require primary or more specialised health care. The following figure from Living Well illustrates the shape of the response required by the current reform agenda.

Some small changes are suggested to the wording of the Goals to improve their strategic value. Additional words are shown in italics.

Goal 3: Young people are empowered and supported to optimise their health.

Goal 2: Young people experience health services as accessible, engaging and respectful

Goal 1: The health system responds assertively to the health needs of young people at higher risk of poor health

Question 4: a) Will the proposed objectives and outcomes under Goal 1 support health services to meet the needs of vulnerable young people in NSW? If not, what changes are needed?

b) What new and existing strategies are needed to achieve the objectives and outcomes under Goal 1? (Please consider tools, service models, training, systems, resources and guidance needed by youth -specific and ‘mainstream’ services).

The NSW Mental Health Commission supports the objectives and outcomes listed under this goal.

Cross agency partnerships are vital to the response required for young people with higher risk of poor health. A systems approach is required and cross-agency governance models should be explored at the local level. Juvenile Justice, Family and Community Services areas of responsibility are listed here, but more detail could be provided on how these agencies will work together and how current reforms are linked. Education has been left out. As was quoted in the Support in tough times report

“Schools … provide a near-universal platform on which to build improvements in the health and wellbeing of young people. For young people without supportive families, schools can sometimes be the first or only place where they can seek and receive the help they need.”[ix]

The NSW Youth Health Policy should support and be supported by the Wellbeing Framework for Schools. As reported on in One year on: Progress Report on the Implementation of Living Well: A Strategic Plan for Mental Health in NSW 2014-2024 the Wellbeing Framework package includes 236 additional school counsellors, in addition to existing expertise provided by more than 4000 specialist staff, including counsellors and specialists in learning and behaviour, and more than 100 specialist tutorial centres and special schools for students whose social skills or behaviour mean they cannot be appropriately educated at mainstream schools.

Networked Specialists Centres are a significant resource for Health to collaborate with. The Department of Education has established 21 Networked Specialist Centres (NSCs) across the state. Networked Specialist Centre Facilitators establish and maintain systemic, interagency relationships to build a sustainable network. Schools, with the support of a range of school-based support staff, can use this network to connect with government and non-government services. This enables schools to effectively and efficiently access and coordinate specialist supports for students where and when they are needed.

Vocational considerations are important for young people experiencing mental illness. For older young people partnerships with TAFE and universities are key. Links with Disability Employment services must be a consideration for mental health services. Partnerships with organisations such as SafeWork NSW will also assist in disseminating mental health programs for young workers.

Given the concerns about suicide rates among young people outlined in the response to Question 1, suicide prevention warrants a specific outcome and/or objective.

Question 5: a) Will the proposed objectives and outcomes under Goal 2 help to improve young people’s access to and experience of health services? If not, what changes are needed?

The Commission supports the objectives listed under this goal, in particular the focus on engaging service users in the design and evaluation of services. This is the most effective way to ensure that they are fit-for-purpose and experienced as accessible, engaging and respectful. This is obviously important for youth specific services, but also for high use ‘mainstream’ services such as emergency departments.

The Plan may also consider the role for tools to increase participation in one’s own treatment and care such as shared decision making tools. Evidence is being gathered for the effectiveness of these kind of tools.[x]

Across all goals the needs of young people from culturally and linguistically diverse backgrounds, including foreign students; and the needs of Aboriginal young people, need to be addressed. The particular vulnerabilities of these groups of young people need to be explored, the accessibility of services to these groups need to be addressed, and the most appropriate mechanisms and communications required to empower young people to be healthy need to be developed.

Question 6: a) Will the proposed objectives and outcomes under Goal 3 help the NSW Health system to support young people to be healthy? If not, what changes are needed?