What stops Korean immigrants from accessing child and adolescent mental health services?

BACKGROUND: Access to child and adolescent mental health services by ethnic minorities has been poorly studied. Despite rapid growth of the immigrant Korean population, evidence indicates that few Korean families utilise these services in New Zealand. Those that do tend to present late and with significant morbidity. We sought to understand barriers to service access from Korean parents' perspectives. METHOD: Seven focus groups were undertaken with 31 Korean parents of children aged 18 and under. The focus groups were semi-structured, held in the Korean language and utilised two case scenarios of common childhood/adolescent mental illnesses around which a set of broad, open-ended questions were posed. All conversations were audiorecorded, transcribed and translated into English. Thematic analysis was conducted using NVivo software. RESULTS: Both attitudinal and structural barriers were identified. Attitudinal barriers included attribution of mental illness to external stressors or parenting problems, social stigma, denial or normalization of children's behaviour, fear of family disempowerment, and mistrust of public mental health services. Structural barriers included parents' lack of information regarding available services, logistical difficulties in access, communication difficulties, concerns over the quality of translators, and cultural competence of service providers. CONCLUSION: Significant barriers prevent Korean immigrant families from accessing child and adolescent mental health services in New Zealand. Measures to improve access, for example by countering stigma, are urgently required.

Adolescent admissions to adult psychiatric units: patterns and implications for service provision.

OBJECTIVE: The aim of this study was to investigate patterns of child and adolescent admissions to an acute adult psychiatric unit in a rural city. Correlates of admissions were then considered in terms of service reform for this vulnerable, under-resourced group. METHOD: The study reviewed consecutive clinical records of children and adolescents who were admitted to an acute general psychiatric inpatient unit over a 6 year period (N = 332). RESULTS: Patients generally experienced numerous pre-admission psychosocial stressors; there were many abuse histories and/or juvenile justice involvement. The principal diagnosis was varied and comorbidity was common. Maori patients were over-represented. The majority of admissions occurred out of working hours and more than half came from rural areas. There was high usage of the Mental Health Act on admission. Common causes of admission were self-harm and suicidal behaviour. The majority of the admitted adolescents required follow up by child and adolescent mental health services after discharge. CONCLUSION: We identified several reform possibilities, including up-skilling emergency and adult mental health staff in child and adolescent mental health, exploration of alternatives to admissions and specialist service coverage.

Mentoring young researchers: can the Donald J Cohen Fellowships model be applicable and useful to Australasian psychiatry?

OBJECTIVES: To describe the experience with the Donald J Cohen Fellowship program of the International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP) and examine whether this model may be applied by the RANZCP to attract and support young researchers in Australasia. METHODS: The program at the September 2006 IACAPAP conference included 50 young researchers, 16 mentors and 8 'host fellows', and consisted of exclusive poster sessions, daily small-group mentoring meetings, oral presentation of selected papers, and a summary and feedback session. RESULTS: Informal feedback from mentors, mentees and conference organisers was very positive. CONCLUSIONS: A proposal about funding, participants and activities is presented. This suggests that a mentoring model similar to the Donald J Cohen Fellowship program can be easily conducted in Australasia. Implementing a program of this type would give College Fellows, the Australian Medical Council, the Commonwealth Government and other relevant organizations a clear message that the RANZCP is seriously committed to fostering and supporting research.