The mental health of young people in Australia: key findings from the child and adolescent component of the national survey of mental health and well-being.

OBJECTIVE: To identify the prevalence of three mental disorders (Depressive Disorder, Conduct Disorder and Attention-Deficit/Hyperactivity Disorder), the prevalence of mental health problems, the health-related quality of life of those with problems, and patterns of service utilisation of those with and without mental health problems, among 4-17-year-olds in Australia. To identify rates of health-risk behaviours among adolescents with mental health problems. METHOD: The mental disorders were assessed using the parent-version of the Diagnostic Interview Schedule for Children Version IV. Parents completed the Child Behaviour Checklist to identify mental health problems and standard questionnaires to assess health-related quality of life and service use. The Youth Risk Behaviour Questionnaire completed by adolescents was employed to identify health-risk behaviours. RESULTS: Fourteen percent of children and adolescents were identified as having mental health problems. Many of those with mental health problems had problems in other areas of their lives and were at increased risk for suicidal behaviour. Only 25% of those with mental health problems had attended a professional service during the six months prior to the survey. CONCLUSION: Child and adolescent mental health problems are an important public health problem in Australia. The appropriate balance between funding provided for clinical interventions focusing on individual children and families and funding for interventions that focus on populations, requires careful study. The latter are an essential component of any strategy to reduce mental health problems as the high prevalence of problems makes it unlikely that individual care will ever be available for all those needing help. Clinical and population health interventions must take into account the comorbid problems experienced by children with mental disorders.

Death by hanging: implications for prevention of an important method of youth suicide.

AIM: The aim of this study was to identify factors associated with deaths by hanging among young people in Queensland, Australia. METHOD: An examination of coroner's reports for all deaths by hanging of people under 25 years of age that occurred in Queensland in the years 1995 and 1996. RESULTS: All cases were recorded as suicides. Most were males and a quarter were indigenous persons. Half the deaths occurred in regional or rural areas. Unemployment, the experience of personal loss, psychiatric illness and alcohol use were possible precipitating agents. Early warning signs were the onset of uncharacteristic behaviours and threats of suicide. CONCLUSIONS: The private nature of hanging means that there are rarely opportunities to prevent it in the period immediately before the fatal event. Earlier interventions will have to be considered. To prevent hanging as a means of suicide, we need to understand more about the difficulties experienced by some young men who are living in rural areas. We need more information about the cultural problems experienced by indigenous youths in their teenage years. Young people in the justice system may need personal support. There is a pressing need to determine if young people, especially in rural areas, have adequate access to the professional expertise needed to diagnose and treat mental disorders.

The National Survey of Mental Health and Wellbeing: the child and adolescent component.

OBJECTIVE: This paper describes the Child and Adolescent Component of the National Survey of Mental Health and Wellbeing. METHOD: The aims of the study, critical decisions in planning for the study, progress to date and key issues which influenced the course of the study are described. RESULTS: The Child and Adolescent Component of the National Survey of Mental Health and Wellbeing is the largest study of child and adolescent mental health conducted in Australia and one of the few national studies to be conducted in the world. Results from the study will provide the first national picture of child and adolescent mental health in Australia. CONCLUSIONS: Large-scale epidemiological studies have the potential to provide considerable information about the mental health of children and adolescents. However, having a clear set of aims, ensuring that the scope of the study remains within manageable proportions and paying careful attention to the details of fieldwork are essential to ensure that high-quality data is obtained in such studies.

Mental health promotion for young people: a proposal for a tripartite approach.

Child and adolescent mental health promotion programmes may be more effective if they include a combination of different approaches to health promotion rather than relying primarily on one approach. A group of complementary approaches that could be combined in a single programme include: (i) a community-wide media campaign to highlight the harmful effects of family discord on the mental health of young people; (ii) a school-based social skills programme to improve the social skills of young people; and (iii) a life skills programme to build the competence of young people "at risk' for developing mental health disorders. The potential value of this particular combination of approaches is discussed with the aim of facilitating the development of innovative new child and adolescent mental health promotion programmes in Australia.

Emotional health of Indonesian adoptees living in Australian families.

OBJECTIVE: To compare the prevalence of emotional and behavioural problems in adolescent adoptees from Indonesia living in South Australian families with that of adolescents living in the community and those referred to mental health clinics in South Australia. METHOD: Thirty-four Indonesian adoptees completed the Youth Self-Report and their adoptive mothers completed the Child Behaviour Checklist. The results on these instruments were compared with the scores of a community sample and a mental health clinic population. RESULTS: There was a striking similarity between scores on the Youth Self-Report and the Child Behaviour Checklist instruments for the adoption and community groups. Both these groups had significantly fewer problems than adolescents referred to mental health clinics. CONCLUSIONS: These results indicate that the outcome in terms of emotional and behavioural health for intercountry adoptions between Indonesia and Australia is favourable.

The mental health status of adolescents released from custody: a preliminary study.

OBJECTIVE: To describe the prevalence of mental health problems and the social circumstances of young offenders after their release from custody in a juvenile detention centre. METHOD: The subjects were 37 adolescents from an original sample of 101 adolescents who had been remanded in a juvenile detention centre in Adelaide, South Australia. The adolescents were evaluated at the time of their initial detention in custody and again 1 year later. RESULTS: The adolescents reported having a large number of social and mental health problems after their release from custody. One year after their release, 32% of the adolescents scored above the recommended 'cut off' score on the Youth Self Report. This represents a rate of disorder three to four times higher than that reported by adolescents in the community and is comparable to the rate reported by adolescents attending mental health clinics. CONCLUSIONS: Adolescents remanded in juvenile detention centres experience continuing mental health problems after their release from custody. As well, they experience considerable social dysfunction. There is an urgent need for more active therapeutic follow-up of these young people.

Approaches to delivering child and adolescent mental health services: the South Australian experience.

Approximately 10% of children and adolescents experience mental health programs, however only a small proportion receive specialised help. Identifying approaches which can provide a balanced and effective service for the large number of children and adolescents with problems is currently a major challenge for child and adolescent mental health services in Australia. In South Australia, following a review in 1983, child and adolescent services were reorganised into two separate but closely related services. This paper draws on experience in South Australia over the last decade to identify approaches which can be employed in six key areas that significantly influence the effectiveness of child and adolescent mental health services. The paper also describes the specific features which were included in the South Australian child and adolescent mental health service to address these issues.

Attempted suicide in Adelaide and Perth: changing rates for males and females, 1971-1987.

OBJECTIVE: Official rates of attempted suicide in Perth, in 1971-1972 and 1986-1987, were examined, with the aim of documenting changes in the age and sex distribution of persons who attempted suicide over the 15-year period. In addition a survey of all patients presenting to the Royal Adelaide Hospital between 1986 and 1988 aimed to determine whether or not the official figures accurately reflect the number of presentations for attempted suicide. DESIGN AND SETTING: Rates of attempted suicide were calculated from the Hospital Morbidity Data for hospitals in the Perth Statistical Division and from the Inpatient Separations Information System (ISIS) for hospitals in the Adelaide Statistical Division. Rates were expressed for each sex as annual age-specific rates per 100,000 population. The data were age-standardised by the direct method. A survey was completed of all patients presenting to the Royal Adelaide Hospital between 1986 and 1988 after attempted suicide. The findings were compared with the official figures for the Royal Adelaide Hospital and were used to estimate the actual rate of attempted suicide in the Adelaide Statistical Division. RESULTS: In Perth the rate of attempted suicide for males increased from 93 per 100,000 in 1971-1972 to 137 per 100,000 in 1986-1987. The increase was most striking in the age groups 15-19 and 40-44 years. The rates for females decreased from 214 per 100,000 to 195 per 100,000. In Adelaide, from 1986 to 1987, between one-fifth and one-third of persons who attempted suicide and presented to the Royal Adelaide Hospital were not recorded in the ISIS. In 1988, two-thirds were not recorded. We estimated that the real rate of attempted suicide for males in Adelaide was about 180 per 100,000 and for females was about 250 per 100,000. CONCLUSIONS: Our understanding of the epidemiology of attempted suicide is largely based on data which are now out of date. The Perth findings of a 47% rise in rate among males and a 9% fall among females suggest that attempted suicide is no longer a behaviour more associated with females than males. The Adelaide survey data demonstrate that official rates for attempted suicide underestimate the extent of the phenomenon in the community by a significant margin. An attempted suicide register is suggested as a method of overcoming this problem.

An enquiry into death and dying at the Adelaide Children's Hospital: a useful model?

As a result of a desire amongst the hospital staff to improve the management of dying children and their families, a four person subcommittee was appointed to investigate this area of care. Nineteen persons were interviewed (15 hospital staff members and four parents) and 12 written submissions were received (10 from staff and two from parents) over a 10 week period. An analysis of one year's deaths of Adelaide Children's Hospital patients showed that most took place in the hospital and about one in five were at home. Nearly 60% occurred in children aged 0-5 years, 15% in those aged 6-10 years, 15% in those aged 11-15 years, and 13% in children aged more than 15 years. The four commonest causes of death were: cancer (27%), congenital abnormalities (19%), sudden infant death syndrome (SIDS) (16%), and trauma (11%). Sudden unexpected deaths are most common, particularly for infants. Recommendations included improved privacy for families and friends; more sensitive body viewing, mortuary, autopsy and funeral arrangements; and better in-service education for staff and information giving for families. Areas of insufficient staff support were identified and the appointment of a specialist palliative care clinical nurse consultant was proposed. Stronger links with palliative and hospice care teams, general practitioners and community nurses were suggested. Addressing the issues of living and dying, and working through the stages of grief are integral parts of long term clinical care. The need for good continuity of psychosocial support was a recurring theme. More awareness of the availability of the specialised pain relief service was required. Ethical issues should be addressed as part of the general development of education and information services. The advantages and limitations of the enquiry are discussed and the model is proposed as a potentially useful one for both paediatric and adult palliative care and hospice care service development.

Adolescents in custody: hidden psychological morbidity?

Seventy-eight adolescents admitted to Adelaide's youth remand centre provided social data and completed the Youth Self Report (YSR) checklist. Most came from chaotic social backgrounds and were without education or family support. Nearly 40% of remanded adolescents scored above the recommended cut-off scores of the YSR, a figure four times greater than that found among adolescents living in the community. This figure was comparable with that reported by adolescents attending child psychiatric services in Adelaide.

Should sex offenders be treated?

The question of whether sex offenders should be punished or treated is currently receiving serious attention from health, welfare and correctional authorities. Considerable enthusiasm is being expressed for the apparent advantages of treatment. It has been argued that treatment of offenders is more likely than punishment to reduce further offending and is consequently better for the community and more cost effective. This review looks at some of these issues, especially as they affect young sex offenders.

Gender-disordered children: does inpatient treatment help?

Treatment guide-lines for gender-disturbed children currently are unclear. This clinical report describes eight children with cross-gender behaviour who were treated in an inpatient unit for children. The short-term outcome and long-term clinical observations are provided, which indicate a generally good outcome. The findings may have both practical and theoretical significance because they suggest that some gender disorders may be determined by intrafamilial interactions which are correctable.