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Getting it Right CYMHS into the 21st Century

Getting it Right CYMHS into the 21st Century. Graham Martin OAM MD, FRANZCP, DPM g.martin@uq.edu.au. Comparative Size. What we need to address. Some principles The health of children in Australia today The changing face of mental health services

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Getting it Right CYMHS into the 21st Century

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  1. Getting it RightCYMHS into the 21st Century Graham Martin OAM MD, FRANZCP, DPM g.martin@uq.edu.au

  2. Comparative Size

  3. What we need to address • Some principles • The health of children in Australia today • The changing face of mental health services • My own experiences of successful CAMH services • Some recommendations for • clinical approaches, • partnerships, and • prevention

  4. Some Principles

  5. A Model of InterventionNIH - Patricia Mrazek & Robert Haggerty, 1994

  6. On Trajectories

  7. Resources and Prevention “Although therapeutic intervention is humane, desirable, and rewarding to....both therapists and clients, it does....little or nothing to reduce the number of new cases (the incidence) of any particular disorder” George Albee, 1982

  8. Hierarchy of Needs Need for Self-Actualisation Personal Growth and Fulfilment Basic Biological and Physiological Needs Air, Food, Water, Shelter, Warmth, Sex, Sleep Need for Self-Esteem Achievement, Affection, Responsibility, Reputation Social Needs - Belonging Family Affection, Relationships, Work, Group relationships Need for Safety and Security Protection, Security, Order, Law, Limits, Stability Abraham Maslow,‘Motivation and Personality’, 1954) eg McKelvey/Vietnam

  9. Rose’s Theorem • A large number of people at small risk may give rise to more cases of disease than a small number of cases at high risk • A population strategy of prevention is necessary where risk is widely diffused through the whole population. Geoffrey Rose, The strategy of preventive medicine. Oxford University Press, 1992

  10. Population-based Approach Mortality threshold Move population risk Population Low High Suicide risk eg The lead smelter

  11. The Health of Children in Australia Today

  12. Australia’s Gross Domestic Product Source: ABS Year Book, 2001

  13. Source: Steve Keen, Uni Western Sydney

  14. What we spend on Mental Health • $3 billion dollars direct costs per annum • $6 billion dollars indirect costs pa • New monies: • $1.9 billion Commonwealth • ‘Matched’ by States/Territories • Most will go to services although some is earmarked for prevention

  15. Australia’s Young People • 4 million children (20% population) • Indigenous 179,000 (4.5% children) • Overseas-born 230,000 (6% children) • 65% live in major cities • 2.8 million adolescents (14% population) • Indigenous 84,000 (3.2% young people) • Overseas-born 430,000 (16% young people) • 70% live in major cities

  16. Future Predictions of Proportions Source: ABS Historical time series data; Population projections for Australia 2002-2102

  17. Divorce 1950-2001 Australian Institute of Family Studies

  18. Changes in our 5.5 million Families over time Median weekly income for couple families: $1,167 Median weekly income for lone parent families: $412 Source, AIHW

  19. Social Exclusion “Social exclusion happens when people or places suffer from a series of problems such as unemployment, discrimination, poor skills, low incomes, poor housing, high crime, ill health and family breakdown” (British Social Exclusion Unit 1997) Harding et al., 2006. NATSEM

  20. Ann Harding et al., 2006. NATSEM, University of Canberra

  21. % Children in Bottom/TopSocial Exclusion Deciles(ABS 2001 Census) Harding et al., 2006. NATSEM

  22. Child Care • 1 in 2 children under 12 used some form of child care in 2002 • 25% in formal care; up from 19% in 1993 • 383,000 children using long day care in 2004 • (9.6% of all children) nearly triple 1991 • 160,800 children using outside school hours care • more than triple 1991 • 60% of all 4 yr olds in Australia attended preschool in 2002 Source, AIHW

  23. Homelessness (2003-04) • 52,500 children <17 years accompanied a parent or guardian seeking help through Supported Accommodation Assistance Program (SAAP). • 45% of them were under 5 years old • 11,200 sought assistance unaccompanied • 83% of them were 15 to 17 years old • Family conflict/ breakdown was stated as the main reason. Source, AIHW

  24. Increase in Child Abuse Across Australia: • Reported cases of child abuse rose from 91,734 to 115,471 during the period 1995/6-2000/01 • Number of children placed in out of home care rose from 14,078 to 18,241 during the period 1997 - 2001

  25. Child Sexual Abuse • Depression in adults and sexualised behaviors in children are well-documented outcomes. Putnam, 2003. JAACAP, 42,3 :269-278 • Severity of reported CSA significantly related to severity of symptoms in all four core sectors of borderline psychopathology (affect, cognition, impulsivity, and disturbed interpersonal relationships), the overall severity of borderline personality disorder, and the overall severity of psychosocial impairment. Zanarini et al., 2002. J. Nerv. & Mental Disease, 190,6: 381-387

  26. Effect of CSA - meta-analysis • Average unweighted and weighted effect sizes for each of the respective outcome variables were .50 and .40 for PTSD, .63 and .44 for depression, .64 and .44 for suicide, .59 and .29 for sexual promiscuity, .41 and .16 for victim perpetrator cycle, and .24 and .19 for academic performance. Paolucci, 2001 J.Psychol, 135,1:17-36.

  27. Child Sexual Abuse • A parental history of depression, mania, or schizophrenia had a two to threefold increase in the rates of physical, sexual, or any abuse. • Parental history of antisocial disorder increased risk of exposure to any abuse (OR 7.5) Walsh et al., 2002. CA&N, 26,1:11-22

  28. YOUNG SEXUAL OFFENDERS • Juvenile offenders account for almost 20% of all arrests related to sexual offences • 60-80% adult sexual offenders began offending as adolescents • Original attachments and level of social skills may hold the key to change Holmberg, 2000, Diss. Abst. • MST may be helpful Swenson et al., 1998. Child Maltreatment, 3:4, 330-8

  29. Odds Ratios† Predictors Suicide Attempts (GIRLS 13.5 years) DEPRESSION 2.9 2.7 5.2 HOPELESSNESS 3.3 24.0 SUICIDE RISK SUICIDE ATTEMPT SEXUAL ABUSE 2.7 ANTISOCIAL 2.5 3.3* 5.5 4.5** DRUG ABUSE † adjusted for family dysfunction, significance p<.001, except ** p<.01; * p<.05

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