Opening the Doors

Working with young people with mental health issues

Overview of the needs & issues

Adolescence is a critical time of development in terms of social and emotional well-being. Mental health issues can seriously impact on young people's successful transition to adulthood, education and employment opportunities, and the ability to maintain relationships.

Young people with a mental health issue have many things in common with other young people, however they face additional challenges and difficulties.

Mental health issues affect not only the young person, but also their family.

Help-seeking behaviour

There is a negative stigma attached to mental illness, and mental wellbeing is rarely discussed in society.

There is a low awareness of early warning signs which means that they are often missed by the person experiencing them, their friends or their family.

Many young people are reluctant to seek help for mental health issues. Young people may not want to admit that something is wrong, they may be fearful of the unknown, may not understand the nature of a mental illness or fear being labelled. These pressures mean that young people may not seek help as early as they should. 15

Diagnosis involves identifying an illness based on the symptoms, what brought about the illness and how long symptoms last. It can be difficult to diagnose a psychotic episode if it is the first occasion because a period of observation is required for diagnosis. Some practitioners are reluctant to make a formal diagnosis until the young person reaches the age of 18. Many young people with a mental illness may not yet have a diagnosis. 6, 10

Appropriate services
In a recent NSW study of young people's access to health services, concerns about confidentiality and feelings of shame and embarrassment in disclosing concerns were identified as the biggest barriers to young people seeking help. 4, 15

Young people also identified a lack of knowledge about available services. Almost none of the young people involved in the study knew about health centres, and many believed that GPs were only suitable for physical ailments. 4

Young people who want to access a GP may not realise that they are eligible for their own Medicare card from the age of 15, and as a result they may fear that their parents will find out that they have visited a GP. Even when young people do have their own Medicare card there may not be a bulk billing service in their area. 15

The key to encouraging young people to seek help is the development of trust. Young people are far more willing to seek help from service providers who they have developed a trusting and respectful relationship with. Respect, dignity and a non-judgemental manner are regarded very highly by young people.   4, 5, 6, 30, 31, 33

Young people feel most comfortable in environments that are welcoming and relaxing and where they can witness other young people in attendance." 31

In many cases young people may confide in youth workers who they have developed rapport and a trusting relationship with. Youth workers can then assist young people to seek appropriate care and support from qualified health professionals.

Other barriers in accessing services
Young people may experience barriers in accessing non-acute services such as counselling if they are required to make appointments several weeks in advance.

As a result of symptoms of mental health issues young people may feel hopeless and helpless and this can reduce their chances of attending appointments and participating in assessment procedures. 15, 32, 33

Young people with mental health issues often experience severe crisis, transition and upheaval in their life in addition to the normal challenges of adolescence.

Youth workers can support young people to access services by providing practical support such as transport to the service and attending with the young person if the young person does not feel confident enough to attend on their own. 32

Young people also face barriers in accessing youth services if their behaviour is disruptive. A young person displaying challenging behaviour may be turned away from services without due consideration being given to their circumstances or alternatives for support. While this is true of most disadvantaged young people, it is particularly pertinent for those young people with a mental health issue.

Dual diagnosis
The term dual diagnosis is often used to refer to people who have a mental illness (particularly a psychotic illness) and problematic use of alcohol and/or drugs. 6

People with a mental health issue are more likely to have problematic use of alcohol and/or drugs. Similarly people who have problematic use of alcohol and/or drugs are more likely to have a mental health issue. 6

There are a range of possible explanations for dual diagnosis:

• One condition may cause the other, for example the use of recreational drugs such as cannabis can contribute to the onset of mental illness in people who has a genetic predisposition.
• One condition may indirectly lead to the other, for example someone may use alcohol or other drugs to deal with worrying effects of mental illness such as hearing voices.
• Each condition may develop from different causes but interact with each other.
• Both conditions may be caused by a common factor, for example childhood emotional trauma. 6

People with a mental health issue often take drugs for the same reasons as those who do not have a mental health issue, eg: to feel good, to relieve anxiety or stress, to increase confidence, for socialising, as part of a celebration, peer group activity, boredom, for excitement or experimentation, to sleep or to have fun. 6

People with a mental health issue may also use alcohol or other drugs for other reasons including: to self-medicate, to reduce the side effects of their medication, to adopt a more socially acceptable explanation (drunk, smashed) for their behaviour, or to regain a sense of self that has been subdued by medication. 6

It can be difficult for practitioners to determine which symptoms can be attributed to mental health issues and which symptoms can be attributed to alcohol and/or drug use.

Alcohol and or drug use can compromise the effectiveness of medication and increase the symptoms of mental health issues.

Many young people with dual diagnosis find it difficult to find secure accommodation. It can be extremely difficult to address issues in a young person's life when their primary need for housing and safety is not adequately addressed.

Referral pathways

Traditionally mental health professionals and youth workers have not worked together in an integrated way.

It is important to be aware of mental health services in your local area, the programs they provide, referral pathways and how you can best assist young people to access appropriate care.

Service entry points
Young people with a mental health issue may come into contact with a range of professionals, acute and non-acute services.

If a young person is experiencing a mental health issue, they will generally come into contact with people who have built trusting relationships with them but who don't necessarily have specialist mental health training. 15

These people and organisations include:

• youth, community and welfare services, Centrelink, accommodation agencies, cultural organisations, sporting clubs and religious groups
• informal supports, including family, teachers, employers and friends
• the education sector, including schools and TAFE colleges
• police, juvenile justice health service, and care and protection services
• health services, including general hospitals and emergency departments. 15

Some of these provide immediate support to a young person experiencing a mental health issue. They can provide referral and linkages to specialist mental health services. They can also provide early intervention through programs, activities and case management. They can assist a young person in recognising that their behaviour may be indicative of a mental illness. 10

Sometimes these people and organisations fail to either recognise the illness or respond appropriately. 15

Young people may come into contact with professionals and services that have some mental health training, but are not part of a multi-disciplinary team, eg. GPs, private psychologists, counsellors, nurses etc. These types of interventions can be provided in the community and school settings. They tend to focus on assessing the problem and finding appropriate treatment. 15

A young person who has been diagnosed with a serious mental health illness will require care involving multi-disciplinary team approaches by specialist mental health services which address highly complex and enduring problems. Only about 2% of the general population need this level of support. Whilst the aim is to keep the young person in the community setting through day programs, clinics and partial hospitalisation, sometimes acute residential care is required. 15

Specialist mental health care is available through mental health services which focus on assessment and treatment services for people with severe and complex mental disorders. 15

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