Creating a system of care for child mental health

MCRI researchers have identified a growing urgency to address child mental health and are working with our partners to establish how community-based health services can best tackle the issue in its earliest stage.

Growing community awareness of mental health issues is a welcome development; but when it comes to children, care and treatment developed for adults simply doesn't fit the bill.

With a wealth of research to back their case, MCRI's child mental health experts are working hard to advocate for addressing the issue early and in an age-appropriate manner.

MCRI Group Leader of Health Services Professor Harriet Hiscock says adult treatment services had been traditionally prioritised, overlooking the individual, social and economic benefits of targeting child mental health.

"Recent investments in adolescent mental health have enabled progress for those aged over 12, but there is increasing evidence that a comprehensive and sustainable approach to prevention and early intervention needs to focus on infants and children under 12," Prof Hiscock says.

"Evidence is mounting that a person's mental health is influenced by potentially modifiable early life experiences and despite the availability of effective treatments, our current service system is unable to meet the need, with many children receiving substandard care or missing out on support altogether."

The need is clearly seen in the long hospital outpatient waiting lists for children with developmental and behavioural issues, and in the national audit that found six of the top 10 diagnoses of children seeing paediatricians were mental health-related.

In addition to an insufficient service system, other barriers to effective care include stigma around mental health diagnoses; parents, teachers and other caregivers not knowing the signs to watch for or where to go for help; lack of clear and timely referral pathways; financial burden; and community concerns around the lack of programs designed to detect emerging mental health issues in young children.

But with half of all adult mental health conditions evident by age 14, it makes sense to reinforce childhood as an important opportunity for prevention and early intervention through a population health approach.

MCRI Theme Director of Population Heath and Co-Group Leader of Child Health Policy and Equity Professor Sharon Goldfeld says mental health and education have traditionally remained separate.

Yet her 2018 research of 302,000 Australian children in their first year of primary school showed an incontrovertible link between mental health and learning outcomes.

"Promoting early school success is easier and more cost effective than trying to fix a child's difficulties in the later years of their schooling," Prof Goldfeld says.

"Ideally there needs to be an integrated approach to helping any child with mental health difficulties, while also promoting competence – such as confidence and social participation – for all children within the school."

It is this eye towards challenging the status quo and pushing for a multidisciplinary, community-based approach to child mental health that has led to MCRI's role in the establishment of the Centre for Research Excellence in Childhood Adversity and Mental Health.

The $2.49 million CRE, funded by the NHMRC and Beyondblue, is aimed at creating an equitable system of care to tackle child mental health at a grassroots level.

"If you've experienced some form of adversity in childhood – which means everything from poverty through to domestic violence, housing or food insecurity, or drug, alcohol or gambling problems in the family – you are four to six times more likely to end up with a mental health issue as you progress into adolescence and adulthood," Prof Hiscock says.

Under the five-year CRE program, teams of researchers will examine the link between childhood adversity and mental health, examine existing services, analyse evidence-based best practice and develop and pilot health, education and social care service hubs in Wyndham (Victoria) and Marrickville (NSW) to address the gap.

Professor Sharon Goldfeld says the CRE aims to find solutions within existing community systems to help with the earlier identification of mental health issues and to provide further support when needed.

"The CRE will review community-based services such as antenatal care, maternal child health and early childhood education, asking questions such as 'what might happen if we co-locate them', or 'how do we get them talking to each other' and 'how do we better deliver what we already fund and provide?" Prof Goldfeld says.

"If we can show a service works, and it engages families, better detects adversity and delivers evidence-based care to reduce the effects of adversity, we will then think about how best to sustain it and how to spread to other locations and perhaps apply the model to other areas of the health system."