Eastern Health CAMHS Conference

1
Eastern Health CAMHS Conference
Paul Smith Director Operations Mental Health and
Drugs Division
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Overview

• The story so far
• Setting the scene
• Vulnerable young people
• How services are working
• Client pathways
• Where are we going
• Mental Health Reform Strategy
• Challenges

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Setting the scene

• We know that mental health problems are the major
  cause of disability (70) in children and young
  people.
• Around 14 per cent of 4-17 year olds have a
  mental health problem rising to 27 percent of
  18-24 year olds.
• 75 per cent of all serious mental health and
  substance use disorders start before the age of
  25
• Mental health problems are common among those
  involved with statutory services and their
  parents Police, CP and YJ.
• Almost one in five deaths in young people between
  the ages of 15-24 result from suicide.
• Mental health problems are associated with early
  school leaving higher rates of physical
  problems

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Children of parents with a mental illness

• Approx 22 of children living in Australia have a
  parent with a mental illness
• In Victoria approx nearly 35,000 children live in
  households where a parent has a severe mental
  illness (18,500 families)
• 25-50 of these children will experience some
  psychological disorder as they grow up
• Risk is greatest in single parent families
• These children and families often become involved
  with other services

5
Children in out of home care

• 65 of children in residential care at abnormal
  risk of mental health disorder
• 46 of children in foster care at abnormal risk
  of mental health disorder
• 59 exhibit levels of disturbance higher than
  that of mental health outpatient clients
• Indigenous children are 12 times more likely to
  be in out of home care

Source Audit of clients of residential care, 10
April 2006 Audit of clients in home based care,
November 2005 both internal DHS research AIHW,
Child Protection Australia, 2006/07
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Parental risk factors for children in OoHC
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Harm associated with drinking
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Youth Justice

• 60 of young people on youth justice orders have
  mental health problems
• 30 of all clients (51 of young women and 53 of
  dual order clients)
• 23 of clients diagnosis for
• Between 60 and 80 of all YJ clients use alcohol
  or other drugs in a problematic way
• Indigenous young people represent 10 of all
  those on youth justice orders

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• A snapshot of mental health service responses for
  children and young people

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A range of service responses

• CAMHS
• Adult 16yrs including youth early psychosis
  services and Orygen Youth Health (15-24yrs)
• PMHEITeams
• PDRSS
• Take 2
• Early childhood
• Schools
• SSSOs
• School nurses
• Community Health

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The scale of investment

• Program
• CAMHS
• Youth early psychosis
• Take 2
• SSSOs (Schools)
• MBS related investment
• does not include services provided through the
  Adult Mental Health Services such as CAT, PMHEI
  or PDRSS (18yrs)

• Funding (approx)
• 63 million (08/09)
• 8 million
• 6 million
• 60 million
• 56 million

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Average per capita funding on specialist public
mental health services by age group
13
Better Access MBS psychiatrists
14
Better Access MBS psychologists
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Commonwealth funded MBS expenditure per capita
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Gaps in specialist service responses
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Age at Initial Registration 1-17 yrs
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Age at Initial Registration by Gender
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Age at Initial Registration by Gender
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Diagnostic profile CAMHS clients
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Legal Status
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Legal Status
23
Referral Source
24
Referral Source by Gender
25
Adolescent Inpatient admissions
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Inpatient bed occupancy
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• Where we are going

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Mental Health Reform Strategy

• A better system of mental health care
• Promotion and prevention
• Increased numbers with a broader range of
  problems being seen earlier
• Early in life, early in pathway, early in
  recovery
• Intersectoral responses
• A system of mental health care

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Strategic priorities

• Priority focus on children, young people and
  families
• Early in life
• Early in illness
• Early in episode
• Focus Area 1 Promotion and prevention
• Focus Area 2 Early Intervention

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Focus areas for reform

• Prevention
• Early intervention
• Access
• Specialist care
• Complex clients
• Workforce
• Partnerships

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Service reform principles

• Outcome Focus
• Reform agenda
• Shared responsibility
• Early intervention
• Recovery orientation
• Consumer-centred approach
• Evidence based planning and practice

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A multi-level response

• Universal services
• Early childhood
• Schools
• Early intervention
• Age appropriate platforms (eg headspace)
• Tertiary
• Strengthen and expand
• New 0-25 year old services
• Address CAMHS/ Adult divide
• Vulnerable
• Better regionally based responses (CP and YJ)
• Families
• Perinatal mental health
• Enhanced FaPMI

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Scope of reform

• Build on promising services
• Better age-appropriate integrated responses
  across clinical and PDRSS
• New early intervention services for 0-12 and
  12-25 years with primary care
• Age-appropriate partnerships
• Better respond to vulnerable young people
  including child protection and youth justice
• More systematic help for families and children
• Addressing the mismatch in investment

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Involving consumers and carers

• A consumer-centred approach is one of the service
  reform principles.
• Reform needs to be planned with and for
  consumers, carers and families.
• Adequate advocacy and participation mechanisms to
  be implemented for children, adolescents, young
  adults and their families.

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Demonstration projects

• Seeding mental health reform
• Two four-year projects (2008-2012)
• One rural, one metropolitan project
• Need to develop or strengthen partnerships within
  and between services
• Subject to a current tender process

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The challenges

• Service redesign and innovation
• CAMHS looking in
• CAMHS looking out
• Better service linkage and integration
• Children
• Youth (the CAMHS/ Adult interface)
• A broader range of service responses
• Management and co-ordination of the system
• State, C/wealth and local government
• Measuring performance and outcomes
• Workforce

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Workforce

• Translating evidence into practice
• New competencies
• Regional planning
• Identifying areas of need high risk
• Mapping services
• Developing care pathways
• Assessment and treatment
• New models consistent with the needs of a changed
  system
• Partnerships consultation
• Working as part of a system
• Supporting a system of care