A better fit: Improving the access and acceptability of youth mental health services (Orygen policy briefing)

orygen.org.au A better fit Improving the access and acceptability of youth mental health services The acceptability of mental health services to young people, especially for those young people currently not accessing services, needs to be improved if greater service reach and delivery is to be achieved. Many of the issues are not new, but new solutions are needed to increase access to services and improve their acceptability among young people. Issues Informed service design Young people not accessing services need to be reached by researchers and service providers to learn what a relevant and acceptable service would look like to them. Young people also need to be engaged in the design, implementation and evaluation of mental health services to improve the acceptability of services. New entry points Acceptable and appropriate mental health care needs to be available to young people at whichever point they access the health system. The 'no wrong door' approach has focused on equipping the wider health service with the skills and knowledge to recognise mental ill-health and facilitate young people's access to services. The next step is to develop in-reach programs in the community and expand outreach services to reach more young people. Time and place Young people's preferences for the location of a service, opening times and environment are determinants of service accessibility and acceptability. Peer workforce Young people who have an experience of accessing services and receiving treatment for mental ill-health can facilitate the engagement of other young people. The experience of peers can complement the learned expertise of health professionals. Youth Mental Health Policy Briefing http://www.orygen.org.au

Five people are sitting around a table. They all have notebooks in front of them and they appear to be studying together. There is large windows behind the group that let in lots of light outside.

2 A BETTER FIT – IMPROVING THE ACCESS AND ACCEPTABIITY OF YOUTH MENTAL HEALTH SERVICES Technology To realise the potential role of technology in expanding service delivery and reach will require Commonwealth leadership. The existing initiatives of researchers, health professionals, digital developers and services need to be nationally coordinated. Development should be informed by evidence from relevant digital and technology products used by young people (i.e. gaming). Taking action The primary actors for leading changes to improve access and acceptability of services are Primary Health Networks, through the commissioning of services, and state and territory health departments who are responsible for specialised mental health services. Mental health services that appeal Providing mental health services is not sufficient to ensure interventions are delivered to young people who need them. Services need to be acceptable to young people, including particular population groups which may have additional needs that will shape the design and delivery of an acceptable service. Help-seeking among young people with particular needs is often delayed until crisis point 1. The World Health Organization (WHO) differentiates between access: being able to obtain health services that are available, and acceptability: being willing to obtain those services 2. Young people are less likely to engage with services they do not think fit them or their perceived mental health needs. The prevalence of mental ill-health among young people is higher than their rates of service access. A 2015 national study found that 65.1 percent of 12–17 year olds with mental disorders had accessed services 3. An earlier 2007 national study found that less than a quarter of 16-24 year olds (23 percent) with a mental disorder had accessed mental health services 4. The time gap between these surveys and the different age ranges studied prevent any comparative conclusions and highlight the need for a national survey of 12-24 year olds. This policy brief examines access and acceptability in terms of barriers young people face accessing mental health services and facilitators that support engagement. Policy opportunities are identified with the aim of improving the ability and willingness of young people to obtain mental health services. Barriers and facilitators Barriers need to be identified and steps taken to remove or attenuate them. Facilitating factors need to be strengthened to improve the accessibility and acceptability of mental health services for young people. Personal As individuals, young people can face a number of personal barriers when attempting to seek help for their mental health. Some barriers are widely experienced while others may be determined by a young person's particular context or identity. Young people from population groups with particular needs frequently experience multiple personal barriers 5. Despite past work to reduce stigma and increase awareness and trust, these factors can still present barriers for young people. Awareness A lack of awareness of available services has been widely identified as a barrier for young people in Australia 6 and internationally 7. In Australia, a 2014 national survey found that more than a third (39.3 percent) of adolescents (13–17 years) with a mental disorder were not sure where to get help 3. Lower levels of service awareness is linked to confidence to seek help 8. Psychoeducation and mental health literacy have been successful in supporting help-seeking by young people 9, 10. Targeted programs are required to increase awareness among population groups with particular needs. Trust Trust is a cornerstone of accessible and acceptable mental health services. Confidentiality, trust, and anonymity were the most frequently reported treatment-related barriers identified by young people from a range of population groups 6. Concerns about confidentiality are a barrier to access and, correspondingly, a confidential service is seen as improving the acceptability of a service and as a facilitator of young people's access 5.

3A BETTER FIT – IMPROVING THE ACCESS AND ACCEPTABIITY OF YOUTH MENTAL HEALTH SERVICES Developing trust is a challenge for mental health services as there is often no pre-existing relationship with a young person. Young people attending headspace for the first time reported wanting to trust the therapist they saw more than they expected they would be able to 11. Providing information about psychological treatment and endorsement from people who have received the treatment previously (see peer workforce section on page 7) has been found to increase openness to early intervention services (among all patients not just young people) 12. Among young people from culturally and linguistically diverse communities, positive perceptions of a health professional's expertise increased confidence in help-seeking 13. Among refugee communities, distrust of services can be ameliorated by demonstrating a political understanding of a refugee's experience in their home country and settlement country 14. If an interpreter is needed to work with a young person, however, establishing trust and confidentiality may be made more difficult 14. Stigma Stigma continues to be a barrier to help-seeking among young people 10. Personal experiences of stigma include misconceptions about mental ill-health and available services, and fears a young person may hold about getting help. While stigma is a common barrier, different groups of young people can experience particular forms of stigma. Sexuality diverse young people have identified