headspace Edinburgh North 20/02/17 Youth Mental Health
Acknowledgement of Country
We would like to acknowledge the traditional custodians of this land and pay our respects to the Elders both past, present and future for they hold the memories, the traditions, the culture and hopes of Indigenous Australia.
WHO IS HERE ?
Overview of headspace • Aims to promote and support early intervention for young people aged 12-25 with mild to moderate mental health and substance use disorders • Cover key areas – mental health, vocational/employment, accommodation/housing, substance use • headspace Edinburgh North – main site at Peachey Road + outreach spokes at Wynn Vale + Salisbury Twelve-25 • Keep up to date https://www.facebook.com/HeadspaceEdinburghNorth/
Statistics
Snapshot of youth mental health
The Problem - Facts • National Survey of Mental Health and Wellbeing - more than a 1 in 4 young Australians (aged 16-24) have experienced a mental disorder in the past 12 months. (2007) • Onset - Nearly half of all lifetime mental health disorders emerge by age 14 and 75 percent by age 25 • Young people have the highest incidence and prevalence of mental illness across the lifespan. • Major contributor to the burden of disease in young people
Disease Burden across Age
The Problem - Facts • Teenage females almost twice as likely as boys to be experiencing anxiety and depression • Higher rates among those who identified as from Aboriginal or Torres Strait Islander background and those who indicated they had a disability • Higher rates also among the GLBTIQ community • Suicide is the leading cause of death for young people aged 15 to 24 years (ABS 2010b)
The Problem - Facts • Increasing incidence of mental health difficulties in young people • Earlier onset associated with more chronic and long term illness (longer episode duration, increased suicidality and need for hospitalisation) • Long term effects not only on the young person but families and society • Long term effects (life outcomes) on workforce participation, income, lower economic living standards • Association with impaired work productivity, absenteeism, educational failure, poor family functioning
The Problem - Facts • Treatment rates for mental illness remain low • Analogy – physical illness (80 – 90 percent of cases gain access to care) compared to 38 percent for mental disorders in Australia • Less than 40 percent comfortable in seeking help • Less than 1 in 4 individuals aged 16-24 diagnosed with a mental health disorder utilised mental health services in the previous year, with this most pronounced amongst young males (Mission Australia, 2014)
Only 13% of young men and 31% of young women access the mental health care they need
MEDIAN AGE OF ONSET OF MENTAL ILLNESSES Type of Disorder
Median age of Onset
Anxiety
15 years
Depressive
25 years
Eating
18 years
Substance
18 years
Any disorder
18 years
Anxiety and Depression: the two most common mental illnesses affecting young people.
Anxiety •Prevalence - Anxiety disorders affect 15-25% of young Australians aged 1624 in any 12 month period. •Symptoms - Feeling fearful or worried - Feeling restless or “on edge” - Feeling irritable or angry - Avoidance of situations - A range of physical symptoms
•Causes - Biological, psychological and social factors
Anxiety at home •A young person may show some signs or symptoms of anxiety that a parent
or carer may notice such as: • Difficulty sleeping • Changes in eating patterns
• Reporting feeling sick such as headaches or nausea • Avoiding activities, even those that were once enjoyed • Obsessive thinking or compulsive behaviours • Reporting chest pain or breathing difficulties • Panic attacks.
Anxiety at school •At school, an anxious young person may:
•Have issues with attendance •Avoid working with new people
•Be well behaved and quiet •Demand extra time from teachers •Fail to hand in work on time because the work is perceived as “not good enough” •Complain of illness before tests or presentations
Depression •Prevalence - In Australia, about 1 in 4 young people will have experienced depression by the end of adolescence. •Symptoms - Feeling sad or numb - Losing enjoyment in activities - Feeling worthless or guilty - Feeling tired or low in energy - Changes in sleeping or diet •Causes - Biological, psychological and social factors
Depression at home •A young person may show some signs or symptoms of depression that a parent or carer may
notice such as: • Not going out with friends or family as much • Socially isolative behavior • Reduced self confidence • Upset or irritable mood • Complaining of sickness or feeling ill • Changes in sleep patterns • Weight loss or gain or change in appetite • Misusing alcohol or other substances.
Depression at school •At school, a depressed young person may: • Not complete work or not work to their usual standard • Miss classes or days at school • Not want to engage in classroom discussions or struggle to concentrate and communicate
• Snap at or start fights with other students or teachers • Feel tired or have low motivation to engage in activities.
• In 2013, 2,522 Australians died by suicide • Suicide was the 14th leading cause of all deaths in Australia • On average, 7 Australians die by suicide each day • Suicide is the biggest killer of young Australians aged 15-24 and accounts for more deaths in young people than car accidents • Also the leading cause of death for Australians aged 25-44 Males
Females
Impact of suicide
What is the impact of suicide?
• Young people considering suicide often feel very isolated and alone. • They may feel that nobody can help them or understand them. • They might start to believe that suicide is the only way out of the difficulties they are experiencing.
Suicide
Why do young people consider suicide?
• Some situations can be very hard for young people to cope with and may lead to thoughts of suicide, including: • Family changes (e.g. parents separation) • Life changes (e.g. moving house/ town) • Pressure from work or study • Pressure from friends, family • Family or relationship problems (e.g. break-up) • Bullying • Violence/ abuse • Body image • Questioning sexuality • Onset of mental health issues • Exposure to suicide
Risk factors for suicide
Why do young people consider suicide?
• Not everyone living with a mental illness struggles with thoughts about suicide. • In fact, many young people are able to go about their daily lives without other people knowing they have a mental illness. • Sometimes when people are going through a tough time, their resources to cope can be reduced, which can lead to them thinking about suicide.
Mental Health vs Illness
How is suicide related to mental illness?
Effects of mental health problems on a young person
What areas in a young person’s life would be affected by their mental health or substance use problems? • • • • • •
Developing a stable sense of self Establishing and maintaining a peer group Achieving independence from parents and family Cultivating romantic interests Acquiring independent living skills Preparing for productive work
Increases the risk of: • • • •
Disrupted school and work prospects Loss of social supports Unstable accommodation Illegal activities
Understanding young people
Activity “When I was young…”
When I was young Take a moment to recall when you were either 14 or 19 years old….. Consider the following questions : • How did you spend your time? • Who were you spending time with?
• What did you most enjoy doing? • What was important to you? • What concerned you the most? • What was your relationship with your family like? • Who did you trust to talk to or confide in?
Defining adolescence The World Health Organisation (WHO) definition: ADOLESCENCE is 10-19 years old YOUTH is 15-24 years old
In practice, the terms ‘adolescent’, ‘young person’ and ‘youth’ are often used interchangeably Adolescence is much more than just an age-defined period of time: it represents a period of profound changes….
Adolescent Development Biological
Cognitive
Psycho-social
Cognitive Development The brain is still developing during adolescence and early adulthood. The last part of the brain to develop is the pre frontal cortex responsible for executive functioning: • Planning • Prioritising
• Organising thoughts • Suppressing impulses • Weighing consequences
Barriers to accessing help early INDIVIDUAL Concerns about stigma, disclosure of “embarrassing� mental health issues, and lack of confidentiality (Booth et al., 2004) Negative attitudes toward seeking assistance from professionals and the belief that individuals should be able to solve their own problems (Sawyer et al., 2000) A lack of knowledge of mental health problems and available professional assistance
(Jorm et al., 2007)
SERVICE LEVEL
Barriers to accessing help Lack of available mental health services A fragmented and early complex mental health service system (MHCA, 2005)
The failure of services to meet the developmental and mental health needs of young people (McGorry et al., 2007; Tylee et al., 2007)
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Activity “What’s it mean for me as a practitioner?”
Would the questions you ask a young person in early adolescence differ to that of a person who is in the middle and late stages of adolescence? What type of questions would you use for the different stages of adolescence? What communication strategies and other interventions could practitioners use when working with early, middle, and late adolescents?
What’s it mean for me?
A Key Message: Understanding young people Knowledge of adolescent development is essential for practitioners to:
• understand the behaviours and concerns of young people • engage and communicate effectively with young people • identify young people at risk of unhealthy development and in need of intervention
Risk and protective factor framework + HEADSS
Risk factors for child and adolescent mental health problems Social Family
Biological Exposure to toxins in pregnancy Family history Head trauma Birth complications Psychological Learning disorders Maladaptive personality traits Abuse and neglect Difficult temperament
Inconsistent care giving Poor family discipline Family conflict Death of family member
School Academic failure Inadequate education Bullying
Community Community disorganisation Discrimination Exposure to violence
Protective factors for child and adolescent mental health problems Social Family Biological Normal physical development Good physical health Good intellectual functioning Psychological Ability to learn from past experiences Good self-esteem Problem-solving ability Difficult temperament
Family attachment Positive involvement in family Rewards for involvement
School Opportunities for involvement Academic achievements reinforced Identity with school
Community Connectedness Opportunities for leisure Positive role models
Risk & protective factor framework • Helps us to better understand young people at risk of health problems and to guide appropriate interventions • Risk factors increase the likelihood that an individual will develop health or psychosocial problems • Protective factors diminish the likelihood of these problems occuring
• Similar risk and protective factors impact on different mental health outcomes • Protective factors tend to “counteract” the effects of risk factors for problem behaviours
Key message: Risk and protective factors Assessment of risk and protective factors and behaviours is
vital to assess a young person’s risk status and to develop appropriate interventions
Stressors
Support
Risk Factors
Coping Skills
Vulnerability
Protective Factors
The headspace Psychosocial Screening Framework Adapted from the HEADSS screening framework (Goldenring & Rosen, 2004)
https://headspace.org.au/assets/Uploads/ headspace-psychosocial-assessment.pdf Ten different psychosocial domains Questions progress from less to more sensitive domains
The headspace interview covers 10 domains
• Home and Environment • Education and Employment • Activities • Alcohol and Other Drugs • Relationships and Sexuality • Conduct difficulties and Risk-taking • Anxiety • Eating • Depression and Suicide • Psychosis and Mania
PLUS final subsection: • Summary (Strengths and Difficulties) and Goals
S-U-P-P-O-R-T S creen U nderstand response P ositive reinforcement P rovide concern O ffer key messages R esources/referrals T elephone or visit as follow-up Ozer et al., (2001)
key messages: Psychosocial screening “If you don’t ask, you won’t know…” and an opportunity to provide assistance to a young person may be lost The headspace Psychosocial Screening Framework provides a comprehensive and flexible approach to early detection of health risks and behaviours
Communicating with young people
Engaging & communicating with young people What concerns might a young person have at an initial appointment? • Stigma • Confidentiality & trust • Not knowing what to expect from practitioner or service • Effectiveness of help available • Referral details or process What can a practitioner do to address or alleviate these concerns? • Seek to engage and build rapport • Use active listening and attending skills • Anticipate, normalise and discuss concerns • Provide information • Dispel myths • Instil hope
Communication skills Active listening skills Attending behaviours Questions • Open-ended • Focused • Closed Ask permission before enquiring about sensitive issues Compliment the young person
Communicating With Young People Case Study Michelle is 17 and in year 12. She has been very depressed lately, not being able to sleep and is crying all of the time. She cant remember the last time she really enjoyed herself. She feels very much under pressure because she wants to get into university but then can’t see the point if this is what her life is going to be like.
Michelle has lost the ability to cope, even with small things and she has distanced herself from her friends because they just end up fighting. Michelle doesn’t see the point in life anymore and just wants to die. Michelle feels that she wants to kill herself.
Helpful Questioning techniques: • Ask ‘normalising’ type questions • Ask ‘multiple choice’ type questions • Ask ‘scaling’ type questions • Ask ‘effects and regrets’ style questions
• Let them teach you a few things • Suggest an explanation and invite the young person to agree or disagree • Ask a ‘three wishes’ type question • Instill ‘hope’ in the young person
Key message: Communicating with young people Effective engagement and communication skills are essential for practitioners working with young people