How can we strengthen the care of Australian children with complex mental health conditions?
Kate Paton & Harriet Hiscock, Australia, September, 2019
This short article has been adapted from the longer research article recently published in PLoS ONE: ‘Strengthening care for children with complex mental health conditions: Views of Australian clinicians’. Read the full article here.
The state of mental health care for Australian children
Improving mental health outcomes for children and young people has become a priority for governments around the world (Paton & Hiscock, 2019). Up to half of all Australian children and adolescents who meet criteria for a mental health disorder receive insufficient treatment (or no treatment at all), even though effective treatments are available (Hiscock et al., 2019).
What about mental health care for children with complex mental health conditions?
Children with complex mental health conditions are those whose care needs are affected by one or more mental health concerns. These children need access to multiple services (e.g. health services, social support, and education services) (Cohen et al., 2011). Examples of complex mental health conditions include Autism and Attention-Deficit/Hyperactivity Disorder (Brenner et al., 2017).
Children with complex mental health conditions are particularly at risk of inadequate treatment because input is generally needed from schools and community services as well as healthcare providers. In Australia, paediatricians, psychologists and child and adolescent psychiatrists are mainly responsible for mental health care for children with complex mental health conditions (Johnson et al., 2016).
The current qualitative study
Thirty healthcare professionals were asked their perspectives on barriers to and enablers of optimal care for children with complex mental health conditions in the current healthcare system. Attention-Deficit/Hyperactivity Disorder (ADHD) and Autism were used as examples of complex mental health conditions when conducting these interviews. Health professionals were from metropolitan, rural and remote areas of Australia, and consisted of:
- 13 paediatricians
- 10 child and adolescent psychiatrists
- six psychologists; and
- one health system professional from another background.
Participants were also asked for their views on what an ideal model of care for children with complex mental health conditions would look like.
Some of the barriers to optimal care that were reported by participants were:
- geographical diversity in Australia and the different roles the Federal and State governments play in funding healthcare
- differences in the way Medicare funds payments for the same services offered by different professions (e.g. telehealth consultations by paediatricians and psychiatrists can be claimed but telehealth services by psychologists cannot*)
- the amount of unpaid work undertaken by professionals doing case coordination when multiple professionals are involved in a child’s care (this cannot be claimed by all professions)
- reduced funding for public mental health services and the transfer of responsibility for some services to non-government organisations
- the numerous challenges involved with navigating the complex healthcare system for families and clinicians, including the lack of communication, collaboration and integration between the health and disability sectors; and
- transitioning from child and adolescent services to adult services.
Healthcare professionals also offered their views on factors that enable optimal care for children with complex mental health conditions. These included:
- Medicare funding (whilst recognising that it is not a perfect system)
- the ability of caregivers/families to act as advocates and care coordinators for their children; and
- learning from successful models of care, either across the same conditions in a particular state or in other health conditions (e.g. diabetes).
Of the 30 professionals, 10 worked in regional or rural settings. While this sub-group identified challenges associated with providing services in regional locations, they also recognised some potential benefits that may arise. For example, the proximity of service providers to each other in some regional areas, and the associated relationships that can develop, may help foster increased access to coordinated services.
What does an optimal model of care look like?
The practitioners interviewed also offered their perspectives on what an ideal model of care for Australian children with complex mental health conditions might look like. These professionals’ ‘ideal world’ would include:
- empowering parents and caregivers to advocate for their child, particularly given that caregivers are generally the common thread and the most consistent influence in a child’s life (e.g. parent mediated interventions, face-to-face or online peer support networks)
- multidisciplinary solutions where health and non-health-related services work together, preferably in a co-located setting
- expansion of existing support structures to assist parents in navigating the health care system (e.g. Autism Advisor roles)
- education about evidence-based tools and community resources that could assist parents/caregivers; and
- systems of care that focus on streamlined, coordinated services and cooperation between parents, health, disability and education sectors.
Implications and future directions
The study was the first to obtain and discuss the views of a sample of clinicians regarding the mental health care of Australian children with complex mental health conditions. It is important to recognise, however, that the study was not able to conduct an in-depth examination of the identified issues at local, regional or state/territory levels. Care should be taken when considering how generalisable the current findings may be to specific settings/locations.
Future research might explore how best to achieve the family and system level changes proposed by the sample of professionals interviewed, including evaluating the effectiveness of such approaches. Developing, implementing and evaluating the impact of integrated care models on child mental health, care access and costs will be a key future research priority of the study’s researchers (Paton & Hiscock, 2019).
*Medicare item numbers have subsequently been changed to make this available
Brenner, M., O’Shea, M., Larkin, P.J., Kamionka, S.L., Berry, J., Hiscock, H., … Blair, M. (2017). Exploring integration of care for children living with complex care needs across the European Union and European economic area. International Journal of Integrated Care, 17(2), 1–5.
Cohen, E., Kuo, D.Z., Agrawal, R., Berry, J.G., Bhagat, S.K., Simon, T.D., & Srivastava, R. (2011). Children with medical complexity: An emerging population for clinical and research initiatives. Pediatrics, 127(3), 529–38.
Hiscock, H., Mulraney, M., Efron, D., Freed, G., Coghill, D., Sciberras, E., … Sawyer, M. (2019). Use and predictors of health services among Australian children with mental health problems: A national prospective study. Australian Journal of Psychology.
Johnson, S. E., Lawrence, D., Hafekost, J., Saw, S., Buckingham, W. J., Sawyer, M., … Zubrick, S. R. (2016). Service use by Australian children for emotional and behavioural problems: Findings from the second Australian Child and Adolescent Survey of Mental Health and Wellbeing. Australian New Zealand Journal of Psychiatry, 50(9), 887-898.
Paton, K. & Hiscock, H. (2019). Strengthening care for children with complex mental health conditions: Views of Australian clinicians. PLoS ONE 14(4), e0214821.