Mental health service use by Australian children

Melissa Mulraney, Australia, July 2018

This short article is part of a series highlighting presentations at the Australian Institute of Family Studies 2018 Conference that focused on child mental health or children at risk of experiencing mental health difficulties.

The first national Australian Child and Adolescent Survey of Mental Health and Wellbeing in 1998 reported that approximately 14% of young Australians had mental health difficulties. Of those children, only 25% had seen a health professional for their mental health problems1. These findings led to a number of key reforms at national and local levels to provide services for children and their families. The reforms included:

  • the introduction of schemes such as Better Access to Mental Health Care, which provides funding through Medicare for mental health treatment
  • the creation of headspace, an initiative providing mental health services for those aged 12–25 years, and
  • the initiation, development, and refinement of student wellbeing programs within many schools.

The second Australian Child and Adolescent Survey of Mental Health and Wellbeing (known as the Young Minds Matter survey) took place in 2013–14. A total of 6,310 families participated in the survey and parents again reported on their children’s use of services for mental health. There seemed to be an increase in service usage as 50% of children with mental health difficulties had accessed services in the prior 12 months2. While we believe that the increase is commendable, there is still a long way to go before all children who need help access it. Furthermore, despite the rise in both the availability of services and the proportion of children accessing them, the prevalence of mental health difficulties in Australian children remains the same3.

One theory as to why the population prevalence of mental health disorders has not decreased, despite the increased investment in and availability of resources, is that the quality of services has not improved4. In the Young Minds Matter survey, 79% of parents reported that their child needed help, but only 35% said that their needs were fully met5. We note that it’s difficult to know how much care children receive for their mental health problems, as the majority of research reports only on whether a child has accessed care. We don’t know how many times a child accessed services, for how long, or whether the treatment received was evidence based. In addition, the majority of research relied on retrospective parental recall of services, which is not as reliable as prospectively measuring service use.

The Longitudinal Study of Australian Children (LSAC) is a nationally representative study of the development of Australian children. It provides a unique opportunity to understand how children have accessed mental health services over the last decade. Since 2004, the study has followed roughly 10,000 children biennially. At each wave of the study, parents (and now children) complete surveys about children’s wellbeing and their social, economic and cultural environments. In addition, LSAC has a measurement of some child health service usage through linkages to the Medicare Benefits Scheme and Pharmaceutical Benefits Scheme. This allows the lifetime mental health service use of Australian children to be examined in an objective and prospective manner for the first time.

At the upcoming Australian Institute of Family Studies (AIFS) conference, we’ll present an analysis of this lifetime mental health service use. For this presentation, we grouped children based on the emotional and behavioural symptoms they have experienced in their lifetime. We identified four distinct groups of children:

  • those with low symptoms
  • those with initially high symptoms that decline over time
  • those with moderate symptoms that increase over time, and
  • those with persistently high symptoms that worsen over time.

Our presentation will focus on this last group’s service use, including the frequency, type (i.e. which health professionals) and intensity of services accessed. The findings show that while most of these children have accessed mental health services at some point, the number of times they have visited a health professional is low, particularly before the age of 12.

Dr Melissa Mulraney is scheduled to present ‘Emotional behaviour difficulties across childhood and mental health service use: Findings from a longitudinal Australian population-based study’ at 11.30am on Thursday, 26 July 2018, as part of the AIFS 2018 Conference: What matters most to families in the 21st century?

Dr Melissa Mulraney is a Postdoctoral Research Fellow in the Health Services research group at the Murdoch Children’s Research Institute and an Honorary Research Fellow in the Department of Paediatrics at the University of Melbourne.

1. Sawyer, M. G., Arney, F. M., Baghurst, P. A., Clark, J. J., Graetz, B. W., Kosky, R. J., … Zubrick, S. R. (2001). 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. Australian & New Zealand Journal of Psychiatry, 35(6), 806–814.
2. 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.
3. Sawyer, M. G., Reece, C. E., Sawyer, A. C., Johnson, S. E., & Lawrence, D. (2018). Has the prevalence of child and adolescent mental disorders in Australia changed between 1998 and 2013 to 2014? Journal of the American Academy of Child & Adolescent Psychiatry, 57(5), 343–350.
4. Jorm, A. F. (2014). Why hasn’t the mental health of Australians improved? The need for a national prevention strategy. Australian & New Zealand Journal of Psychiatry, 48(9), 795–801.
5. Johnson, S. E., Lawrence, D., Sawyer, M., & Zubrick, S. R. (2017). Mental disorders in Australian 4- to 17-year olds: Parent-reported need for help. Australian & New Zealand Journal of Psychiatry, 52(2), 149–162.