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Community Partnerships for Young People why mental health system reform isnt enough Peter Ruzyla 10

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Title: Community Partnerships for Young People why mental health system reform isnt enough Peter Ruzyla 10


1
Community Partnerships for Young People why
mental health system reform isnt enough Peter
Ruzyla 10 October 2008
2
It takes a village to raise a child
3
The journey so far … Family life aint what it
used to be …
  • Industrial Age
  • mobile
  • nuclear family
  • fewer children
  • church / education
  • rise of big cities
  • social isolation
  • Information Age
  • global families
  • both parents work
  • internet and media
  • single parent families
  • peer group
  • service specialisation

4
Young People 1800s - Mini-Me 1900s -
Developmental psychology congnitive, emotional
and other developmental stages 1960s -
Emergence of adolescence as distinct
developmental stage rite of passage
pre- marriage 1980s - Adolescence as complex
developmental stages and tasks 2000s -
Prolonged adolescence
5
What does this mean for young people today?
Making Progress the health, development and
wellbeing of Australias children and young
people. Australian Institute of Health and
Welfare, 2008 a report of progress across a wide
range of health and social indicators over the
last 10 years.
How have Australian kids fared?
Anxiety Depression contribute 17 of male
Burden of Disease and 32 of female BOD.
Mental health disorders are the leading cause of
disability among young Australians aged 15 24
years and account for 50 of the Burden of
Disease in this age group.
10 of 15 19 year olds reported a mental or
behavioural problem
High levels of undiagnosed, untreated mental
health conditions
6
Contributing factors 1. Child abuse and
neglect
  • Is related to
  • poorer development
  • lower social competence
  • poorer school performance,
  • higher rates of teenage motherhood
  • poorer employment opportunities
  • socioeconomic disadvantage
  • higher likelihood of criminal offending later in
    life

7
2. Parental unemployment
  • 50 of all children in single parent households
    rely on welfare as sole source of income. cf 6
    in 2 parent families
  • financial stress
  • Worse physical, mental health and life
    satisfaction
  • Studies show relationship between joblessness,
    family conflict breakdown and child abuse

In comparison to other OECD countries Australia
has the second highest percentage of children
living in jobless families.
8
3. Homelessness
Census night 2006 34,100 children and
adolescents homeless One third of total
homeless population 22 more than in 2001 400
young people per day seek and are eligible for
SAAP housing.
  • Consequences include
  • gastroenteritis, bronchitis, asthma
  • depression and/or schizophrenia
  • risk of physical and sexual assault
  • increase in risk-taking behaviours
  • interruption or disruption of education

Associated factors Family violence, abuse,
relationship breakdown, mental illness ,
substance abuse
9
4. Access to affordable, quality childcare
Demand for childcare doubled between 1999 and
2005 and despite increase in number of places,
the level of unmet demand has stayed the same as
in 1999.
  • Positive impacts of accessible childcare include
  • creates social networks
  • reduces isolation of children and parent,
  • social and intellectual development opportunities
  • provides parent respite
  • early intervention in the case of developmental
    delay
  • provides opportunity for parent to obtain and
    maintain employment, thus break out of welfare
    dependency

10
Contributing factors 5. Access to pre-school
education
  • Attendance at pre-school improves
  • intellectual developments
  • language
  • social skills

Australias pre-school education attendance rate
ranked in bottom third of OECD countries in
2005.
11
6. Victim of Crime
95 of victimisation occurs between ages 10 -
14. Boys are 5 times as likely to be victims of
robbery than girls.
  • Reduces sense of
  • wellbeing
  • security
  • safety
  • feelings about the future
  • And can lead to
  • Diminished education attainment and social
    participation

For many children, child abuse and family
violence is the first experience of being a
victim of crime
12
7. Perpetrator of Crime
  • Children under Juvenile Justice supervision are
  • six times more likely to be boys than girls
  • 10 are under the age of 13 years
  • 49 times more likely to be Indigenous

Children whose first experience of being a victim
of crime through child abuse, family violence
and/or neglect are at a greater risk of becoming
later offenders.
13
8. Education retention rate
  • Early school leavers are less likely to
  • report positive physical or mental health
  • find stable, full-time employment
  • have a wide range of employment options

The education retention rate is about the same
over the past decade.
14
9. Teenage motherhood
Although trending downward, rates are more than 5
times higher for Indigenous teenage girls.
  • Associating factors
  • violence or sexual abuse history
  • unstable housing
  • poor school attendance or performance
  • poverty
  • absence of a positive father figure
  • Impacts
  • interrupted schooling
  • welfare dependence
  • unemployment and poverty
  • trans-generational impact on children

15
10. Participation in positive community activity
In 2007 approximately 7 of 15 19 year olds
were not involved in school or employment they
are at high risk of social exclusion.
  • Youth inactivity is linked to
  • dependence upon parents and welfare
  • family problems
  • substance abuse
  • physical and sexual abuse
  • violence and crime

16
11. Teen crime
Adolescence the peak period for being a victim or
an offender especially males
  • Teen crime is associated with
  • diminished education
  • suicidal ideation and behaviour
  • depression
  • being a victim of crime

Children and adolescents who have been victims
have a higher rate of offending this is an
internationally recognised trend.
17
Summary of trends Mental Health of 5 12 year
olds
  • Hospitalisation rates for mental health and
    behaviour disorders over a 10-year period has
    stayed around 178 per 100,000 population
  • Boys and Indigenous children are at an increased
    rate for hospitalisation for mental health
    problems and asthma

However, hospitalisation rates not a good measure
of childrens mental health problems as most a
treated by primary health care / GPs, or remain
undiagnosed and untreated.
18
Summary of trends Adolescents aged 13 19
years
Trend is that they are more likely to engage in
risky behaviours such as
  • substance abuse
  • dangerous driving
  • unsafe sex
  • This age group also experiences higher rates of
    violence
  • and injury.

19
Adolescents aged 13 19 years
  • Whats getting better?
  • Reduction in
  • hospital bed stays for schizophrenia
  • hospital bed stays for substance abuse
  • smoking rates
  • alcohol and drug use at long term harmful levels
  • unemployment rates
  • Juvenile Justice supervision orders
  • Whats getting worse?
  • Hospitalisation due to
  • traffic accidents
  • intentional self-harm
  • assault
  • hospital bed stays for mood disorders
  • hospital bed stays for behavioural syndromes

20
The paradox of the new youth is improved
physical and material wellbeing, hand in hand
with earlier onset of depression. … Mental health
issues are also associated with young people who
are forced by homelessness, poverty or abuse into
growing up fast and early.
… Schizophrenia and psychosis are one component
… but theres a lot of other stuff depression
and anxiety, substance abuse, personality
disorders. Yet our health system hasnt
responded well. Weve got a much bigger issue
here
Professor Patrick McGorry
Melbourne Age 27 September 2008
21
Key determinants for mental health and wellbeing
of children and young people
  • safe and nurturing early childhood
  • economic, food and housing security
  • freedom from violence, abuse and neglect
  • access to social, language and other
    developmental opportunities
  • supportive schooling and educational achievement
  • good transition from school to work
  • no or limited exposure to crime
  • preparation for and planned parenthood
  • social participation

The Australian Institute of Health and Welfare
report points to these factors as being critical
to improving the mental health of children and
young people, all of which lie outside of the
mental health systems capacity to provide
22

Solving wicked problems
  • Wicked problems are
  • difficult to define
  • have inter-dependent and multi-causal factors
  • unstable
  • interventions lead to unforeseen consequences
  • have no clear solution
  • socially complex
  • intersectoral responsibility
  • require significant behaviour changes
  • characterised by chronic policy failure

Tackling Wicked Policies 2007, Australian
Public Service Commission, 2007 …require
innovative, comprehensive, non-linear,
collaborative solutions.
Rittel Webber 1973
23

Chaos theory and wicked problems
  • most problems are connected to other problems
  • no single solution
  • every solution generates unpredictable effects
    and unintended consequences
  • data is usually uncertain or missing
  • multiple views on the problem and contradictory
    solutions
  • economic and political constraints on what can be
    done
  • numerous possible intervention points
  • great resistance to change
  • problem solvers are often out of contact with the
    problem and potential solutions

Robert Horn
24
Is mental health a wicked problem?
  • mental health interventions involve a range of
    correlated factors
  • none of them are causative
  • each is complex
  • interactive
  • spread across society
  • straddle all areas of government responsibility
  • They include …
  • individual attributes
  • family circumstances
  • mental health of family members
  • school, education and skills development
  • social and peer group development
  • employment
  • poverty and socioeconomic disadvantage
  • abuse and neglect
  • interactions with the justice system
  • substance abuse
  • media, community and culture

25
How should wicked problems be approached?
  • need to take a big picture view develop holistic
    strategies
  • manage inter-relationships between the factors
  • work collaboratively across departments and
    agencies
  • engage community
  • focus on what works rather than try to fix what
    doesnt work
  • adopt a long-term focus

26
Who would a mental health plan include?
All sectors have a responsibility to work in ways
that promote mental health and to work
responsibly with other sectors.
27
What might a plan look like?
The good news … there are already things being
done that we know work.
Our challenge … to bring the emerging solutions
together, strengthen and join up strategies and
create stronger evidence for what works.
Where to start? By encouraging and doing more
of
  • supporting mothers and babies
  • supporting families at risk
  • strengthening connections between schools,
    families and communities
  • support secondary schools to engage and retain
    young people
  • social, recreational, sporting and artistic
    engagement
  • working with the media and entertainment industry
  • health, welfare and support services to develop
    collaborative partnerships for the mental health
    of young people

28
Scottish Mental Health Plan
  • Glasgow a post industrial city substantial
    proportion of population from households where
    no-one had worked for three generations
  • mental health problems at extreme levels
    violent crime, education rates, hospitalisation,
    alcohol drug use, suicide, etc

Significant improvements seen across all these
indicators in the past five years, including a
reduction in hospital bed stays for mental health
problems.
Improving mental health had little to do with
increasing access to mental health services it
was all about creating secure and dignified
housing, improving education and employment and
working in partnerships across all sectors,
including family services, education, health and
the police.
Calum Macleod, 2006 Head of Mental Health Greater
Glasgow Clyde Health Service
29
Te Raukura Mental Health and Alcohol and Other
Drugs Improving outcomes for children and
youth
Achieving positive outcomes for children and
youth will depend on whole of health and whole of
government efforts across the primary, secondary
and tertiary continuum. … influencing the broader
health determinants through sustained
intersectoral collaboration.
Te Raukura symbolises pride and inner strength
New Zealand Government, Ministry of Health
report, 2007
30

It takes a whole village to raise a child!
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