Sian Lloyd¹, Craig Hodges¹, Matt Dixon, Dr Lena Sanci² and Dr Lyndal Bond ³
¹ National Youth Mental Health Foundation
² Department of General Practice, University of Melbourne
³ Centre for Adolescent Health, Royal Children’s Hospital, Melbourne
beyondblue Victorian Centre of Excellence
Project completion year
The Young People’s Health Service (YPHS) is the only primary health care service specifically for young people who are homeless in central Melbourne. The service is free and staffed by nurses, doctors and counsellors. YPHS runs a clinic from Frontyard Youth Services, which provides a collection of services in Melbourne for young homeless people.
Mental health is the third most common reason for presentation at YPHS. Consequently, in addition to counselling undertaken by the nurses and general practitioners, a dedicated counselling service is provided by a social worker three afternoons per week.
Depression and anxiety are the main mental health issues seen by the counsellor. YPHS, by incorporating a mental health service within a primary health care service, provides a unique service model. This model has been running for approximately seven years, but until this study, had not been formally evaluated.
The main aim of the project was to evaluate the mental health service provided at YPHS. The research included:
- a literature review
- qualitative semi-structured interviews with young people who access the mental health services at YPHS and with YPHS staff
- a focus group interview with representatives from other services offered at Frontyard.
Key themes explored in the study included:
- What factors influence young people successfully accessing YPHS mental health service?
- What are the pathways to and from YPHS mental health service?
- What are the past experiences of young people of other mental health services?
- Is YPHS mental health service meeting the needs of young people? What’s working? What’s not working? What needs to be improved and how?
- Is the model of mental health provision at YPHS an example of good practice and if so how can this model be replicated by other providers?
Young people reported that the mental health service is approachable, non-judgemental, confidential and respectful. They like and trust the staff and particularly like the approach that the service takes. They feel listened to and gain practical strategies to improve their situation and mental health. The service is accessible with regard to cost and location. Some young people reported that they met the counsellor before their appointment and that this helped to allay their fears about attending their appointment.
Young people reported that they did not like the waiting room, the counselling room and that the counsellor is not in every day.
Staff at YPHS and other staff from Frontyard recommended that:
- the service be available every day
- there should be drop-in services rather than appointment-based
- and all staff receive further training in mental health.
They also noted that relationships are improved with external mental health services.
In terms of what young people want from a mental health service, key factors included:
- to be listened to
- to build a relationship with the counsellor and get to know them before disclosing very personal information
- to be able to go at 'their own pace'
- to feel respected
- to gain practical strategies for dealing with their issues.
Implications for policy and practice
The findings from the study enabled the development of a model for the pathways to and from a mental health service based within a primary health care service.
To maximise accessibility and acceptability to young people, referral from one service to another service provider should be supported by giving information to the young person about who they will see, as well as the details about time and place of service and cost.
Mental health services should be underpinned by key approaches, such as allowing the young person to go at their own pace and providing practical strategies.
As a result of the study, several changes have been made to YPHS mental health service:
- The counselling room has been redecorated to be more welcoming and warm.
- The service also provides a drop-in service one afternoon a week.
- The study raised the profile of the service within Frontyard and improvements were made to referral practices.
However, further work is required on improving relationships with external mental health services.
The study also provided evidence to support the continuation of the service and has allowed the service to maintain its flexibility in approach.
About the researchers
Sian Lloyd has worked in the area of adolescent health for over 10 years. Her interest in youth health issues began in the UK in her role as Public Health Manager in the NHS and continued when she migrated to Australia. She has conducted several research projects focusing on issues facing marginalised youth.
Craig Hodges has worked in the field of adolescent health for the past 15 years in a variety of settings including primary health care, mental health and acute care. In recent years, he has taken on a leadership role in program planning and evaluation with regard to adolescent health programs. His interests include policy development and analysis, mental health interventions in primary care and building the capacities of communities to develop appropriate interventions which target young people.