Adolescent mental health • 75% of all mental illnesses begin before 25 years of age Webinar An interdisciplinary case study panel discussion • 1 in 4 young people will have a mental health Adolescent mental health: depression, problem DATE: suicidality and cyber-bullying . November 12, 2008 • 30% seek professional help • 50% of the students with the most serious Wednesday 1 st December 2010 issues never get recognized Supported by The Royal Australian College of General Practitioners, the Australian Psychological Society, the Australian College of Mental Health Nurses and The Royal Australian and New Zealand College of Psychiatrists Depression & anxiety - the greatest burden of mental Depression disorders (AIHW 2007) • Most common in mid adolescence • 1 in 5 experience a diagnosable depressive disorder by 18 • most sufferers report delays of 5 to 15 years before they received treatment and care What does teenage depression look like? What else? • persistently sad and downhearted • teenagers appear to lose interest in life • when a painful or stressful event is over and s/he • take little pleasure in activities they used to enjoy doesn't bounce back, even though s/he wants to and generally become apathetic pick himself up, but can’t • have trouble thinking and concentrating • s/he remains tearful, sullen and out of sorts for two weeks or more • decline in academic performance at school is a dead giveaway 1
And still more signs.... Any physical signs? • withdraw from other people • depressed young people are often physically unwell • spend a lot more time in their room or on their computer • headaches, other aches and pains • may self medicate with alcohol, cannabis and/or • excessive tiredness and a lack of energy other drugs. • gain or lose a lot of weight Who provides the care? Who provides the care • GPs are fairly well distributed There are: • ~95 FTE per 100,000 in major cities & ~ 84 FTE in rural • ~25,000 GPs in Australia areas • ~ 22,000 psychologists • Psychologists are unevenly distributed • ~ 3,500 psychiatrists • ~90 FTE per 100,000 in major cities & ~33 FTE in inner • ~ 1,100 Medicare registered social workers regional cities • ~ 130 mental health Medicare registered OTs • Psychiatrists are very unevenly distributed • ~22 FTE per 100,000 in major cities and 6, 3, and 3 FTE in inner regional, outer regional, remote areas respectively Who provides the care GP role in mental health care • In 2007-2008 • First port of call, any and every health problem, • 3.5% of the Australian population saw a GP for mental life long care health treatment • Mental health assessment • 1.3% saw a private psychiatrist – Needs time (long consultations preferred) • 0.6% saw a private psychologist • Diagnosis • 1.6% attended a public mental health service – Sometimes clear from start, sometimes apparent over • Most people seeking mental health care will see time a GP • Management • Many will also need help from an allied mental – Depends on issue complexity and risk assessment health worker and/or psychiatrist 2
Role of psychologist: adolescent mental GP role in mental health care health treatment and care • Treat patient yourself and/or refer Psychologists are mental health professionals • Current referral options include who diagnose and provide psychological therapies and treatments. – Private psychologist or other allied mental health (Better Outcomes or Better Access) – Private psychiatrists • Common effective types of psychotherapy are – headspace (in some locations) • Cognitive Behaviour Therapy (CBT) – Community health services – Public mental health services • Interpersonal Therapy • Problems include: patient preference, local availability, waiting time, cost, eligibility Role of psychiatrist Collaboration - Does it matter? • Liaise with the GP, psychologist, other health providers, • Pros school staff as indicated – Multiple inputs are integrated • Provide a comprehensive biopsychosocial assessment to – Each person adds value to the next help formulate and accurately diagnose cases – Each person knows what the other is doing – Address multiple needs simultaneously rather than • Provide a management plan sequentially • Help with risk assessments • Cons – Time consuming • Provide opinion and follow-up about medication options – Uncertain evidence of benefit in mental health care • Provide feedback on formulation to family, • Do competent professionals need to work psychoeducation, psychotherapy, family therapy etc as together or just do their own job well? indicated or if unavailable elsewhere Collaboration Mental health collaboration: • What helps? Tim: a case study – Knowing the other professional ADOLESCENT MENTAL HEALTH – Easy to contact – Concise, prompt feedback – Case conference items, but not easy to use • What doesn’t help? – Not knowing the other professional – Little or no feedback – Inadequate role clarification, Mx advice, or contingency plan 3
Tim at the GP Tim at the GP • 17 year old year 11 student • Tim thinks Mo is a nag • Reluctant attendee • Some tension with father • Mo thinks he is irritable, argumentative, poor • Some tension with a school teacher academic performance • Recent fall out with friends • No PH but sensitive • No interest in school • FH Mo tense, father heavy drinker, paternal • No clear sense of future uncle bipolar • Complains of fatigue Tim at the psychologist Tim at the GP What is the balance of risk and protective factors in his 5 Worlds of an adolescent • Low risk of self harm Peer • Review one week world Inner School world world • Organise pathology in between • Schedule longer appointment Digital Family world world Encourage client to Assist client to participate in social identify the cognitive Tim at the psychologist recreational activities messages (negative self talk) Monitor diet that reinforced feelings of Short term goals Assess client’s need for helplessness & medication hopelessness • Psychological testing to evaluate the depth of the depression with Monitor sleep feedback to client & family • State the connection between rebellion, self destructive behaviours Learn to recognise Unhelpful self talk or withdrawal and the underlying depression – assess client’s Challenge and encourage the client’s Verbalise a feeling of being understanding acting out as avoidance of the real conflict involving loved and accepted by academic effort Learn to dispute family and friends unmet emotional needs unhelpful self talk • Teach the client the connection between angry, irritable behaviours and feelings of hurt and sadness Monitor participation in social and recreational Learn to replace Arrange for a tutor activities • Reinforce client’s open expressions of underlying feelings of hurt, unhelpful cognitions anger and disappointment with positive self talk that strengthens Encourage expression of • Specify what is missing in life to cause the unhappiness feelings of self negative feelings through acceptance, self • Specify what in the past or present life contributes to sadness artistic modalities confidence and hope Encourage school • Express emotional needs to significant others related extra-curricular activities • Implement positive self talk (CBT) to strengthen feelings of self Monitor drug and alcohol acceptance, self confidence and hope use 4
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