A dramatic increase in the number of children going to the emergency
department in mental health crises is evidence "the system is failing",
according to a group of leading adolescent and mental health experts.
In Victoria, there was a 46 per cent increase in the number of children presenting to the ED for self-harm, stress and anxiety, mood, behavioural and emotional disorders between 2008 and 2015, according to a recent study.
Similarly, in New South Wales, ED presentations among 10-19 year-olds for suicidal thoughts, self-harm and intentional poisoning increased by 27 per cent between 2010 and 2014, another paper has shown.
Writing today in the Medical Journal of Australia (MJA), Susan Sawyer from the Murdoch Children's Research Institute said the growing number of young people turning to the ED for mental health treatment should be seen as "canaries in a coalmine".
"[The increase] is clearly reflecting that the system is failing," Professor Sawyer said.
"In the context of the very major investments Australia has made in mental health care over the past few decades … there's some real questions this data raises about what we need to do differently."
Patrick McGorry, executive director of Orygen, the National Centre of Excellence in Youth Mental Health, said the findings highlight the significant gaps in adolescent mental health services and funding in Australia.
"The scale of the problem is extraordinarily big," Professor McGorry said.
"Mental health presentations to EDs are still way in the minority in comparison to physical health conditions, but seeing a more than three-fold increase in presentations in a seven-year period is clearly very concerning," Professor Sawyer said.
Self-harm presentations rose 53 per cent over the study
period (2008 to 2015), becoming the most frequently diagnosed mental
disorder in young people in Victorian EDs.
In New South Wales, a separate study found the rate of mental health presentations to EDs was highest among 15-19-year-olds, but had grown most rapidly for 10-14 year-old children.
"[The study] demonstrates an increase in the primary diagnosis of self-harm, suicidal ideation and behaviours, and intention poisoning," Professor Sawyer said.
"The real question is … why are these people presenting to emergency departments? At what level in our system is this reflecting failure?"
Professor Sawyer said we know little about the extent to which current services are meeting minimum clinical standards.
"While [the Government's youth mental health service Headspace] has increased access to mental health care … we know remarkably little about the effectiveness of that model of care, which is disappointing given the extent of investments that have been made," she said.
But Professor McGorry said government spending on mental health prevention had been "modest" in relation to the scale of the problem, and that Headspace centres were only resourced to address early stage and mild to moderate mental health concerns.
"If you want to prevent ED presentations for acute crises and so on, you've got to invest in more specialised care in the community," he said.
"In the primary care setting, you've got GPs and psychologists … and the duration of care is usually only a few sessions — five or six, maybe up to 10. It's OK for mild to moderate problems," he said.
"But if you come in with a more complex problem, you need a multidisciplinary team … and the public system is extremely under-resourced, and not able to provide that to most people who need it."
He said many young people end up in the ED as a result.
Professor McGorry said funding was urgently needed to develop "more specialised and assertive community programs" to back up the work of Headspace.
"That's the kind of structure that's missing – community hubs with multidisciplinary teams, more expertise and a longer tenure of care, so people can actually stay in the system for as long as they need to," he said.
"Emergency departments are a really important part of the service response to people with mental disorders," Professor Sawyer said.
"There needs to be commensurate response from EDs that does not detract from community mental health responses."
Last week, the Victorian Government outlined $101 million for six ED crisis hubs in their 2018 budget, including five in Melbourne, to respond to patients with drug, alcohol and mental health issues.
"I think the government's idea of having a separate type of ED for mental health presentations is actually quite good," Professor McGorry said.
"You need a more calming and supportive environment, not the kind of stressful, dramatic and often very disturbed scenes that you see in EDs."
Both experts added the need for a greater investment in alternative crisis services, and additional funding to existing crisis support lines such as Kids Helpline and Lifeline.
"We've started to tackle the problem but we've got an awful long way to go," Professor McGorry said.
In Victoria, there was a 46 per cent increase in the number of children presenting to the ED for self-harm, stress and anxiety, mood, behavioural and emotional disorders between 2008 and 2015, according to a recent study.
Similarly, in New South Wales, ED presentations among 10-19 year-olds for suicidal thoughts, self-harm and intentional poisoning increased by 27 per cent between 2010 and 2014, another paper has shown.
Writing today in the Medical Journal of Australia (MJA), Susan Sawyer from the Murdoch Children's Research Institute said the growing number of young people turning to the ED for mental health treatment should be seen as "canaries in a coalmine".
"[The increase] is clearly reflecting that the system is failing," Professor Sawyer said.
"In the context of the very major investments Australia has made in mental health care over the past few decades … there's some real questions this data raises about what we need to do differently."
Patrick McGorry, executive director of Orygen, the National Centre of Excellence in Youth Mental Health, said the findings highlight the significant gaps in adolescent mental health services and funding in Australia.
"The scale of the problem is extraordinarily big," Professor McGorry said.
Dramatic jump in mental health cases in EDs
Research into mental health diagnoses in Victorian EDs found the number of young people presenting with mental disorders had increased disproportionally to those with physical disorders — 46 per cent compared to a 13 per cent increase in people with physical problems."Mental health presentations to EDs are still way in the minority in comparison to physical health conditions, but seeing a more than three-fold increase in presentations in a seven-year period is clearly very concerning," Professor Sawyer said.
In New South Wales, a separate study found the rate of mental health presentations to EDs was highest among 15-19-year-olds, but had grown most rapidly for 10-14 year-old children.
"[The study] demonstrates an increase in the primary diagnosis of self-harm, suicidal ideation and behaviours, and intention poisoning," Professor Sawyer said.
Headspace not resourced for acute issues
Professor Sawyer said the increase in ED presentations suggests the current capacity of Australia's healthcare system to respond to acute mental health concerns is inadequate."The real question is … why are these people presenting to emergency departments? At what level in our system is this reflecting failure?"
Professor Sawyer said we know little about the extent to which current services are meeting minimum clinical standards.
"While [the Government's youth mental health service Headspace] has increased access to mental health care … we know remarkably little about the effectiveness of that model of care, which is disappointing given the extent of investments that have been made," she said.
But Professor McGorry said government spending on mental health prevention had been "modest" in relation to the scale of the problem, and that Headspace centres were only resourced to address early stage and mild to moderate mental health concerns.
"If you want to prevent ED presentations for acute crises and so on, you've got to invest in more specialised care in the community," he said.
Lack of specialised services
A lack of specialised mental health services means young people with acute and complex mental disorders are left with few options, Professor McGorry said."In the primary care setting, you've got GPs and psychologists … and the duration of care is usually only a few sessions — five or six, maybe up to 10. It's OK for mild to moderate problems," he said.
"But if you come in with a more complex problem, you need a multidisciplinary team … and the public system is extremely under-resourced, and not able to provide that to most people who need it."
He said many young people end up in the ED as a result.
Professor McGorry said funding was urgently needed to develop "more specialised and assertive community programs" to back up the work of Headspace.
"That's the kind of structure that's missing – community hubs with multidisciplinary teams, more expertise and a longer tenure of care, so people can actually stay in the system for as long as they need to," he said.
More funding for prevention and crisis care
While Professor Sawyer and Professor McGorry agreed only community-based prevention programs would stem the tide of mental health presentations, they said more should be done to equip EDs to better manage adolescents in crisis."Emergency departments are a really important part of the service response to people with mental disorders," Professor Sawyer said.
"There needs to be commensurate response from EDs that does not detract from community mental health responses."
Last week, the Victorian Government outlined $101 million for six ED crisis hubs in their 2018 budget, including five in Melbourne, to respond to patients with drug, alcohol and mental health issues.
"I think the government's idea of having a separate type of ED for mental health presentations is actually quite good," Professor McGorry said.
"You need a more calming and supportive environment, not the kind of stressful, dramatic and often very disturbed scenes that you see in EDs."
Both experts added the need for a greater investment in alternative crisis services, and additional funding to existing crisis support lines such as Kids Helpline and Lifeline.
"We've started to tackle the problem but we've got an awful long way to go," Professor McGorry said.
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