Professor Ian Hickie1
Associate Professor Nicholas Glozier1
1 Brain and Mind Research Institute
2 NSW Association for Youth Health
Project completion year
There are 14 youth health services in New South Wales, with each of these services being targeted towards disadvantaged young people, particularly those at risk of experiencing a housing crisis, mental illness, drug and/or alcohol misuse and involvement in the juvenile or adult justice systems. There has, to date, been an absence of research investigating how effective youth health services are at assisting this marginalised group. This project aimed to look at the impact these programs have on the youth health service setting and the mental health and wellbeing of those who attend these services. Furthermore, it endeavoured to evaluate if the programs within these youth health services lead a young person with mental illness to receive more specialised assistance elsewhere.
This project had two main objectives:
- To provide a cross-sectional analysis of the types of programs and services young people are accessing across the five targeted youth health services.
- To examine the longitudinal impact of NSW Youth Health Services on young people with, or at risk of, mental illness.
Two specific areas of inquiry were addressed by the research:
- Change in mental health over time
- Change in social functioning and social connectedness (as it relates to mental health) over time.
172 young people representing four NSW Youth Health Services were assessed on a series of measures designed to assess psychological distress and social functioning and connectedness. They were also asked a number of questions relating to patterns of service usage, including why they had attended the service and whether they found the service ‘’helpful’‘. Participating young people were followed up twice, at three and six months and asked to complete the same questionnaires. Some consenting young people were also asked to take part in a one-on-one interview to share their experience with health services in detail. Four young people participated in these interviews.
Young people indicated that they visit NSW Youth Health Services for a variety of reasons. The most common reason was for ‘basic needs’, with 40.5 per cent indicating that they visited the service for food vouchers, clothes washing and financial assistance. In addition, 29.6 per cent stated that they utilised the service as a ‘drop in’ service. Further, 33.3 per cent indicated that they attended for medical appointments and 34.5 per cent for counselling. Other young people stated that they visited the service to use the internet café or various health promotion activities.
Complexity of needs
Most young people presenting to NSW Youth Health Services do not present with one specific ‘need’ as such. Instead, many young people present with multiple and complex needs. 49.9 per cent of young people stated that they identified with two or more problems (mental health, drug and alcohol, physical health and relationship problems). 16.4 per cent stated that they identified with all four of the problems listed.
Over twenty seven per cent (27.8 per cent) of young people indicated ‘very high’ levels of psychological distress as measured by the K10 . This compares to only 2.4 per cent of the general population, suggesting that a significant number of young people presenting to these services are experiencing high levels of general psychological distress.
Within NSW Health, there has been a clear delineation between NSW Youth Health Services and Mental Health Services. Our findings suggest that this delineation may not be representative of what is occurring on a service level, as many young people with mental health issues are accessing NSW Youth Health Services.
Young people’s perceptions of NSW Youth Health Services
Generally, young people indicated that they found the service ‘helpful’ in assisting them with their needs. Specifically, 52.2 per cent of young people stated that they found the service ‘helpful’ as opposed to ‘unhelpful’ in assisting them with a drug and alcohol problem; 80 per cent found the service ‘helpful’ in assisting with a physical health problem; and 82.5 per cent with a mental health problem.
During the interviews, young people stated that they were concerned about what will happen to them once they reach the age of 25 years (upper age limit of these services). Many young people feel that there are very few, if any, services available for them once they reach 25 years.
Overall it appears as though many young people find NSW Youth Health Services ‘helpful’, however worry that they will not receive the same degree and quality of support once they leave the service.
The difficulty in obtaining longitudinal data was due to the transient nature of this population. After three months, 28 per cent returned to complete follow up. After another three months, no young people completed follow up. Most SMS messages and emails ‘bounced back’, with a much smaller number going through with no reply or response. It seems that many young people change numbers/emails addresses frequently, suggesting that in addition to having complex needs and being highly distressed, these young people experience limited stability.
This research was carried out within a context of significant change and restructure within NSW Health. As a result, this project did not receive support from the higher structures within NSW Health. There was also a perception that this research was not appropriate and should have been conducted within ‘Mental Health’ instead of ‘Youth Health’, once again highlighting a false delineation between the two.
In addition, NSW Health have also recently standardised the way in which research is carried out, which caused significant confusion for the research governance offices representing various area health networks. This significantly hampered the site approval process, and is also the reason why only five sites participated.
Implications for policy and practice
This research provides evidence that young people value a range of programs and attend NSW Youth Health Services for a variety of reasons. This is critical given the significant restructuring by NSW Health over the past year, especially with regard to Youth Health Services. Many services have experienced a reduction in resources. Our findings clearly show the importance of program diversity in engaging marginalised young people. The findings must be considered in the context of recent and ongoing changes in NSW Health and acknowledgement that this research project did not receive the high level support from NSW Health that was initially anticipated. Clinical service provision in youth health services must be based on evidence-based practice-research is a critical component of policy development to inform implementation. As such, research must be supported in a clinical context to inform clinical service provision and policy development.
A significant number of young people attending these services experience high levels of general psychological distress compared with the general population. Clinicians working with this population must have the relevant skills, training and support to enable them to identify and manage young people presenting with distress. This may mean additional training and supervision of existing staff, as well as better communication and clearer referral pathways between these services and mental health and drug and alcohol services. Discharge planning is also important, as young people stated that they worried about where they would go once they reach the age of 25.
The findings provide support for the important role of NSW Youth Health Services in engaging and assisting marginalised and at risk youth. Through this research, young people were given the opportunity to provide important feedback about the service they attend. The benefit of this to young people is that by, giving them the opportunity to give important feedback, key stakeholders and service providers can use this information to inform their decision-making process regarding funding and resource allocation.
Key findings highlight the important role of staff training and support to enable clinicians and staff to confidently work with the young people attending NSW Youth Health Services. The delineation between Youth Health Services and Mental Health Services needs to be reconsidered in light of the fact that a significant number of young people accessing these services are significantly distressed and identify with a having a mental health issue. As such, mechanisms must be put in place to support clearer referral pathways and communication channels between service providers, especially mental health and drug and alcohol services.