Minds+At+Risk

Name: Jacqueline Wilson Student Number: n7535872 Tutor: Sophie Miller

**__ Minds At Risk __**
 * Topic **

The World Health Organization (2011) defines mental health as, “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”

**Artefact** [|http://www.sbs.com.au/insight/episode/index/id/257/Mental-Health#watchonlin]__e__ The artefact is an episode of the popular SBS TV series //Insight//, broadcast on Thursday 1st July 2010, and entitled //Minds At Risk.// Every week, Insight’s host Jenny Brockie guides the forum-format program through a lively debate on a selected topical issue, talking with a wide range of people: ‘experts’ in the field, representatives from government, industry and community groups and the people affected. //Minds At Risk// puts the spotlight on mental health, specifically focusing on the mental health of Australian youth. It involves a broad range of stakeholders – professionals like academics, government advisors and politicians, mental health patients and their families, both parents and kids in a compelling and somewhat harrowing piece of television. The episode casts a sharp eye over youth mental health in Australia.

**Public Health Issue**

Mental health is as a major public health issue. According to the National Survey of Mental Health and Wellbeing (Australian Government, 2007), 45.5% of Australia’s population will experience mental health problem at some point in their lifetime. Youth are identified as the most at-risk demographic and the onset of mental health disorders at an early stage can severely disrupt a person’s growth and development by eroding quality of life, self-confidence, independence, social and family relationships, education and employment.

The issue under discussion is how well Australia responds to the challenge of youth mental health and its many facets: societal attitudes, health care systems, funding and the need for change in each of these aspects.


 * Literature Review **

Mental health difficulties can include a wide range of disorders such as depression and mood disorders, stress, anxiety disorders, isolation and loneliness, deliberate self-harm, eating disorders, schizophrenia and psychotic disorders, suicide and many more (Reach Out, n.d.). The seriousness for Australia of this concerning issue, is well illustrated by statistics. In 2009, the financial cost to Australia of mental illness in people aged 12-25 years was $10.6 billion (Orygen Youth Health, 2009). Youth mental health clearly has a large impact on Australia’s total burden of disease: mental illness accounts for 55 per cent of the total burden of disease in the age group of 15-24 years (McGorry, Purcell, Hickie, &Jorm, 2007). It is estimated that three-quarters of mental health issues begin before the age of 25 and one in four young people will experience a problem in the next twelve months (Australian Government, 2011). Without treatment, there is a positive correlation with increases in morbidity and mortality rates: it has been recorded that 12 percent of 13-17 year old adolescents reported as having suicide ideations and 4.2 percent had actually made a suicide attempt (Department of Health and Ageing, 2009).

In light of this concerning information and based on clinical experience, Professor Pat McGorry, a leading psychiatrist and 2010 Australian of the Year, along with many of his peers, advocates early intervention as an appropriate response strategy. McGorry (2006) recognises that diagnosing young people is a challenge and can often be disguised as substance abuse, blends of mood, personality disorder and episodes of disturbance. Even after diagnosis, finding the specialist care is often prolonged and difficult. It is estimated that only one in four cases have received professional help. (Department of Health and Ageing, 2009).

Ronald C. Kessler, PhD, from Harvard Medical School in Boston, Massachusetts, identifies the very same problems in America as Australia. Confirming the conclusions of Professor McGorry, Dr. Kessler believes that, “Interventions aimed at prevention or early treatment need to focus on youth” (Kessler et al., 2005, pp. 593-602). Kessler (as cited in Mental Illness exacts Heavy Toll, Beginning in Youth, 2005) identified that the earlier the illness initiates, the longer the individual prolongs seeking help and the worse the illness becomes. And unfortunately the individuals who require the treatment the most, are the least likely to receive it. The National Institute of Mental Health (2005), made the finding that, although half of all lifetime mental disorders originate before the age of 14, there are extremely long delays between the onset of symptoms and treatment, sometimes decades apart.

A study conducted by Grigg, Herrman and Harvey (2002) investigated the duty/triage system in a Australian rural area to review procedure and policy. Results found that in most cases general practitioners were often not involved in the referral process with half of the patients having to refer themselves to the clinic. It was discovered that those not referred by a health professional were least likely to be assessed. Given that general practitioners treat most people with mental illnesses, finding they do not play a key role in this pathway raises concerns about clinics and policy.

Fortunately the Australian government began to listen to the experts and, in 2006, initiated a basic mental health care program, supporting the early intervention model embodied by Orygen, with dedicated funding for Headspace, a youth-specific support and information service funded by the Commonwealth Government providing advice about general health, mental health and counselling, alcohol and drug use and education and employment (Headspace, 2011). A modest start was made April 2006 with National Action Plan on Mental Health 2006-2011 funding which saw only $28.1 million dedicated to new early intervention services for parents, children and young people, with majority of funding focused on other areas (COAG, 2006).

The evidence of Australia’s system for responding to youth mental health problems indicates a system transitioning from a weak start to a more effective future. Although Australia’s youth mental health response may take time to improve, parents, community groups and mental health care practitioners have expressed extreme frustration at the slow rate of change. This is all too evident in //Minds at Risk// which echoed calls for major system change, requiring funding increases in the order of billions rather than millions.

Subsequent to the //Minds at Risk// screening in 2010, we have seen a clear shift in policy direction and scale of funding. The National Mental Health Reform announced in May 2011 provided a new budget for 2011-2016 with a whole different objective: $491.7 million was allocated to the mental health of children and young people to provide more funding to Headspace, increasing the number of Early Psychosis Prevention and Intervention Centres (EPPIC) and to increase the Family Health Support Services (Australian Government, 2011). Priorities are beginning to change with the realisation that early intervention is the most vital step in mental health.

This initiative has been further bolstered with the COAG meeting on August 19, 2011. A number of mental health experts had the chance to discuss priorities meant for the reform. On top of the talk about the budget there was the vital step of agreeing to begin work on a National Partnership Agreement on mental health, which would work to set up a support system, and a Ten Year Roadmap which will aim to employ a vision for the future (COAG, 2011).

**Cultural and Social Analysis**

Youth mental health is an issue which has far-reaching impacts at all levels of Australian society and all geographic areas - cities, regions, rural and isolated communities. Professor John Mendoza, former CEO of the Mental Health Council of Australia believes there is a massive under-investment in Australian mental health services. He identifies mental illness as a major contributor to poor housing, unemployment levels, social exclusion, poor health and family breakdown (Mendoza, 2006).

It has been demonstrated that socio economic factors can play a major role in a child’s life and strongly influence mental health patterns. For example, a study conducted by the mental health branch of the Commonwealth Department of Health and Aged Care (2000), observed that children living with their original parents have fewer disorders than those living with a sole parent or step/blended parents. Additionally, children with a lower weekly household income presented much higher numbers than those with greater incomes.

Societal attitudes figure prominently in the mental health story - a significant contributing factor to mental health problems is stigma. Social stigma is when an identity is flawed, tainted or devalued in the eyes of other individuals or societies (Quinn, Kahng & Crocker, 2004). Although mental health is now more public than ever (due in part to the artefact and other similar exhibits), it remains a social stigmatizing condition. Stereotypes that surround mental health greatly devalue the individual, who is perceived as lacking intelligence, less socially acceptable, mentally disorganised, more erratic, hazardous and dirty (Quinn, Kahng & Crocker, 2004). Heflinger and Hinshaw (2010), state that stigmatisation of mental illness can create barriers to accessing appropriate care that has the potential to limit any further improvements in the service provision of youth mental health.

Much of the focus of youth mental health is on urban youth. However the problem is dire in rural and remote communities where mental health disorders are 28% more prevalent among youth compared with their metropolitan counterparts (Community Matters, 2010). These communities are smaller, lack privacy for individuals and feature culture barriers. Mental health disorders account for 10% of the total health burden for Aboriginal and Torres Strait Islanders (Vos, Barker, Begg, Stanley & Lopez, 2009). This is largely due to the fact that these areas cite a higher incidence of self-harm, violence, mortality rates, lower education levels, limited health services and a high risk of smoking and alcohol consumption.

It is significant and symbolic that Patrick McGorry should have been named 2010 Australian of the Year. Described as a leading international researcher, clinician and advocate for the youth mental health reform agenda, McGorry is cited for “his extraordinary 27-year contribution to the improvement of the youth mental health sector” (which) “put Australia at the forefront of innovation in the prevention and treatment of mental illness” (Australian of the Year, 2010, para. 1 & 2). The citation represents not just recognition of McGorry’s major contribution but seems to signify a new national profile and recognition for youth mental health.

**Artefact Analysis**

In essence, //Minds at Risk// highlights a state of emergency in youth mental health and the need for radical system overhaul. It reveals how the old paediatric, or mainstreaming model of care leads to inept system response to psychosis, with tragic consequences and contrasts this with Professor McGorry’s early intervention strategy, which embraces a modern, evidence-based step-care model (support, engagement and understanding). It demonstrates the success of this transition from a hospital to a community-based strategy in engaging and addressing youth mental care needs, describing the new approach as “youth friendly, soft entry and low stigma, backed by real expertise and multidisciplinary care” (McGorry, 2010).

//Minds at Risk// provides a thorough, and at times harrowing, case study-based forum on youth mental health in Australia – highlighting first-hand experience of families, victims, patients and health care sector workers. Jennifer Brockie is excellent at bringing out risk factors and early signs pertaining to mental illness and at eliciting people’s needs in crisis. The program makes an important contribution to changing societal attitudes, encouraging open debate and communication about a sensitive topic: “the really good thing about tonight is that people are not hiding or covering up, but being open”( McGorry, 2010).

Creating awareness about youth mental health is crucial. Given subsequent developments (set out in literature review section), //Minds at Risk// was ground-breaking, dramatic and challenging: a milestone in TV journalism which has raised the profile and debate of youth mental health in Australia. It was topical and timely.

In the process of finding the extensive research accompanied in this review, I found my knowledge and passion for the topic growing. Mental illness is a huge health area of concern not only in Australia but worldwide. Youth mental health is of personal interest for myself and most of my university peers, being in the prime age group at risk. Most people know a family member or a friend who has or is suffering from a mental illness. I feel it is often viewed as a taboo topic and that is where I would love to see change in the future.

**Reference List**

Australian Government. (2007). National survey of mental health and wellbeing. Retrieved October 20, 2011 from []

Australian Government. (2011). Headspace: National youth mental health foundation. Retrieved October 24, 2011 from [|www.health.gov.au/internet/mentalhealth/publishing.nsf/Content/headspace-1]

Australian Government. (2011). National Mental Health Reform. Retrieved October 30, 2011 from []

Australian of the Year. (2010). Professor Patrick McGorry, mental health expert. Retrieved October 28, 2011 from []

COAG. (2011). Council of Australian Governments Meeting. Retrieved November 01, 2011 from []

COAG. (2006). National Action Plan on Mental Health 2006-2011. Retrieved October 25, 2011 from []

Commonwealth Department of Health and Aged Care. (2000). //Child and adolescent component of the national survey of mental health and well-being.// Retrieved from []

Community Matters. (2010). //Section 4: Rural and remote issues.// Retrieved from []

Department of Health and Ageing. (2009). ResponseAbility: Mental illness facts and statistics. Retrieved September 2, 2011 from[]

Grigg, M., Herrman, H., Harvey, C. (2002). What is duty/triage? Understanding the role of duty/triage in an area mental health service. //Australian and New Zealand Journal of Psychiatry, 36//(6), 787-791. Retrieved from []

Headspace. (2011). What we do. Retrieved October 31, 2011 from []

Heflinger, C. A., & Hinshaw, S. P. (2010). Stigma in child and adolescent mental health services research: Understanding professional and institutional stigmatization of youth with mental health problems and their families. //Administration and Policy in Mental Health and Mental Health Services Research, 37//(1-2), 61-61-70. doi:10.1007/s10488-010-0294-z

Kessler, R., Berglund, P., Demler, O., Jin, R., Merikangas, K., & Walters, E. (2005). //Archives of General Psychiatry, 62,// 593-602. Retrieved from []

Mendoza, J. (2006). Mental health at a critical moment.//Impact,//(10324321), 10-10-11. Retrieved from []

McGorry, P. (2006). Reforming youth mental health. //Australian Family Physician, 35//(5), 314. Retrieved from []

<span style="font-family: Arial,Helvetica,sans-serif;">McGorry, P., Purcell, R., Hickie, I., & Jorm, A. (2007). Investing in youth mental health is best buy. //Medical Journal of Australia, 187//(7), 5-7. Retrieved from []

<span style="font-family: Arial,Helvetica,sans-serif;">McGorry, P. (2010, July 1). Insight, Mental Health [video file]. Retrieved from [|http://www.sbs.com.au/insight/episode/index/id/257/Mental-Health#watchonline] <span style="font-family: Arial,Helvetica,sans-serif;">Mental Illness exacts Heavy Toll, Beginning in Youth. (2005). //US Fed News Service, Including US State News.// Retrieved October 31, 2011 from [|http://proquest.umi.com.ezp01.library.qut.edu.au/pqdweb?][|index=0&did=1273018521&SrchMode=1&sid=1&Fmt=3&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1320040636&clientId=14394]

<span style="font-family: Arial,Helvetica,sans-serif;">Orygen Youth Health. (2009). Ten billion reasons to invest in youth mental health. Retrieved September 2, 2011 from[] <span style="font-family: Arial,Helvetica,sans-serif;">Quinn, D., Kahng, S., & Crocker, J. (2004). Discreditable: Stigma effects of revealing a mental illness history on test performance. //Personality and Social Psychology Bulletin, 30//(7), 803-815. doi: 10.1177/0146167204264088

<span style="font-family: Arial,Helvetica,sans-serif;">Reach Out. (n.d.). Mental health difficulties. Retrieved October 31, 2011 from []

<span style="font-family: Arial,Helvetica,sans-serif;">The National Institute of Mental Health. (2005). Mental illness exacts heavy toll, beginning in youth. Retrieved October 21, 2011 from []

<span style="font-family: Arial,Helvetica,sans-serif;">Vos, T., Barker, B., Begg, S., Stanley, L., & Lopez, A. (2009). Burden of disease and injury in aboriginal and torres straight islander peoples: the indigenous health gap. //International Journal of Epidemiology, 38(2),// 470-477. doi: 10.1093/ije/dyn240

<span style="font-family: Arial,Helvetica,sans-serif;">World Health Organization. (2011). Mental health: a state of well-being. Retrieved October 24, 2011 from []

**Learning Engagement and Reflection Task**

<span style="font-family: Arial,Helvetica,sans-serif;">Students Page: ‘Seriously, R U OK?’- http://healthculturesociety.wikispaces.com/%27Seriously%2C+R+U+OK%3F%27

<span style="font-family: Arial,Helvetica,sans-serif;">Your artefact analysis gave a clear and entertaining description of what the video aims to portray. The ‘public health issue’ section flowed very well and had a number of interesting statistics that coincided effectively with the message you were trying convey. In researching a similar topic to you, I found it interesting that you found men the most at risk gender demographic. I found that women aged 16-24 have twice the prevalence of twelve month affective disorders compared with men of the same age group (Australian Bureau of Statistics, 2007). Women are more likely to seek professional help than men, so in the long term men would probably suffer from a mental illness longer, possibly explaining the variance in suicide rates. But it just goes to show that there are certain aspects of both men’s and women’s lives that offer us different experiences and every individual responds to external forces in a uniquely. I found your section on ancient history very interesting and it gave me an alternative insight on mental health that I never thought to consider. I enjoyed reading your work, great choice of topic/artefact, worthy execution and thank you for the enjoyable piece.

<span style="font-family: Arial,Helvetica,sans-serif;">Australian Bureau of Statistics. (2007). //National survey of mental health and wellbeing: Summary of results.// Retrieved from []

<span style="font-family: Arial,Helvetica,sans-serif;">Students Page: Mental Health in Australia- Issues Divisions Perceptions- http://healthculturesociety.wikispaces.com/Mental+Health+in+Australia+-+Issues+Divisions+Perceptions

<span style="font-family: Arial,Helvetica,sans-serif;">I really like the artefact you have chosen, it was a sound basis to construct your assignment around. You covered all demographic areas well, discussing age, gender, geographic location and Aboriginal and Torres Strait Islanders. After watching your artefact, I believe the assignment would have benefitted from a consistent emphasis on youth, but you demonstrated extensive quality research into the public health topic and it all ran quite well. In looking at youth mental health myself, I similarly found that one in four young people will experience a problem in the next twelve months ( Australian Government, 2011). Youth mental health is such a huge public health issue in Australia and there needs to be a bigger emphasis on early intervention. I also identified the same ‘most at-risk’ demographics as you did, being youth and aboriginals and I enjoyed reading the research you found around those areas. Well done on your piece of work.

<span style="font-family: Arial,Helvetica,sans-serif;">Australian Government. (2011). Headspace: National youth mental health foundation. Retrieved October 24, 2011 from [|www.health.gov.au/internet/mentalhealth/publishing.nsf/Content/headspace-1]