Strengthening assessment and response to mental health needs for Aboriginal and Torres Strait Islander children and adolescents in primary care settings: study protocol for the Ngalaiya Boorai Gabara Budbut implementation project.

INTRODUCTION: Opportunities for improved mental health and wellbeing of Aboriginal and Torres Strait Islander children and young people lie in improving the capability of primary healthcare services to identify mental healthcare needs and respond in timely and appropriate ways. The development of culturally appropriate mental health assessment tools and clinical pathways have been identified as opportunities for strengthening workforce capacity in this area. The Ngalaiya Boorai Gabara Budbut implementation project seeks to pursue these opportunities by developing and validating a psychosocial assessment tool, understanding what services need to better care for your people and developing resources that address those needs. METHODS AND ANALYSIS: The project will be governed by a research governance group comprising Aboriginal service providers, young people, and researchers. It will be implemented in an urban health service in Canberra, and regional services in Moree, Wollongong, and the Illawarra regions of New South Wales Australia. The validation study will follow an argument-based approach, assessing cultural appropriateness and ease of use; test-retest validity; internal consistency, construct validity and the quality of decisions made based on the assessment. Following piloting with a small group of young people and their caregivers (n=10), participants (n=200) will be young people and/or their caregivers, attending one of the partner services. The needs assessment will involve an in-depth exploration of service via an online survey (n=60) and in-depth interviews with service providers (n=16) and young people (n=16). These activities will run concurrently. Service providers, researchers and the governance group will codesign resources that respond to the needs identified and pilot them through the participating services. ETHICS AND DISSEMINATION: The Aboriginal Health and Medical Research Council of NSW Human Research Ethics committee (#1769/21) has approved this project. Informed consent will be obtained from all participants and/or their caregivers (with assent from those aged <16 years) prior to participating in all aspects of the study. Research dissemination will occur through participating health services, academic journal articles and conference presentations.

Systematic review of barriers and facilitators to accessing and engaging with mental health care among at-risk young people.

INTRODUCTION: This study aims to review the literature on barriers and facilitators to accessing and engaging with mental health care among young people from potentially disadvantaged groups, including young people identified as Aboriginal or Torres Strait Islander (ATSI); culturally and linguistically diverse (CALD); lesbian, gay, bisexual, transgender, queer, or intersex (LGBTQI); homeless; substance using; and youth residing in rural or remote areas. METHODS: Fourteen databases were searched to identify qualitative and quantitative researches that examined barriers and/or facilitators to mental health care among the six groups of potentially disadvantaged young people. RESULTS: Out of 62 studies identified, 3 were conducted with ATSI young people, 1 with CALD young people, 4 with LGBTQI young people, 14 with homeless young people, 24 with substance-using young people, and 16 with young people residing in rural or remote areas. Findings generally confirmed barriers already established for all young people, but indicated that some may be heightened for young people in the six identified groups. Findings also pointed to both similarities and differences between these groups, suggesting that ATSI, CALD, LGBTQI, homeless, substance-using, and rural young people have some similar needs with respect to not only mental health care, but also other needs likely to reflect their individual circumstances. DISCUSSION: This systematic review highlights that young people from potentially disadvantaged groups have distinct needs that must be recognized to improve their experiences with mental health care. Future research of good methodological quality with young people is needed to increase accessibility of, and engagement with, mental health care.

The services provided to young people through the headspace centres across Australia.

OBJECTIVES: To describe the services provided to young people aged 12-25 years who attend headspace centres across Australia, and how these services are being delivered. DESIGN: A census of headspace clients commencing an episode of care between 1 April 2013 and 31 March 2014. PARTICIPANTS: All young people first attending one of the 55 fully established headspace centres during the data collection period (33,038 young people). MAIN OUTCOME MEASURES: Main reason for presentation, wait time, service type, service provider type, funding stream. RESULTS: Most young people presented for mental health problems and situational problems (such as bullying or relationship problems); most of those who presented for other problems also received mental health care services as needed. Wait time for the first appointment was 2 weeks or less for 80.1% of clients; only 5.3% waited for more than 4 weeks. The main services provided were a mixture of intake and assessment and mental health care, provided mainly by psychologists, intake workers and allied mental health workers. These were generally funded by the headspace grant and the Medicare Benefits Schedule. CONCLUSIONS: headspace centres are providing direct and indirect access to mental health care for young people.

headspace - Australia's innovation in youth mental health: who are the clients and why are they presenting?

OBJECTIVES: To provide the first national profile of the characteristics of young people (aged 12-25 years) accessing headspace centre services - the Australian Government's innovation in youth mental health service delivery - and investigate whether headspace is providing early service access for adolescents and young adults with emerging mental health problems. DESIGN AND PARTICIPANTS: Census of all young people accessing a headspace centre across the national network of 55 centres comprising a total of 21 274 headspace clients between 1 January and 30 June 2013. MAIN OUTCOME MEASURES: Reason for presentation, Kessler Psychological Distress Scale, stage of illness, diagnosis, functioning. RESULTS: Young people were most likely to present with mood and anxiety symptoms and disorders, self-reporting their reason for attendance as problems with how they felt. Client demographic characteristics tended to reflect population-level distributions, although clients from regional areas and of Aboriginal and Torres Strait Islander background were particularly well represented, whereas those who were born outside Australia were underrepresented. CONCLUSION: headspace centres are providing a point of service access for young Australians with high levels of psychological distress and need for care in the early stages of the development of mental disorder.

Promoting youth mental health: priorities for policy from an Australian perspective.

AIM: This paper considers the priorities for policy to promote youth mental health in Australia. The Ottawa Charter is applied as a conceptual framework to determine current strengths and future priorities across the entire spectrum of interventions for mental health promotion. METHODS: The five platforms of the Ottawa Charter are used to categorize some of the major initiatives that promote youth mental health. Areas of strength and major gaps within each platform are identified. RESULTS: Australia was shown to be at the forefront of many youth mental health promotion initiatives, particularly in the service reorientation and personal skills platforms of the Ottawa Charter. CONCLUSIONS: While significant progress has been made in some areas of youth mental health promotion, areas of critical need for policy focus were: oversight of all public policies for their impact on youth mental health; more supportive environments for youth and better interconnection with mental health care; community action to support the youth voice; investment in resources for parents and families; ensuring quality inreach and outreach to provide young people with positive mental health messages and improve mental health literacy; and embedding and expanding effective innovations in youth mental health services reorientation.