PROVIDING SERVICES FOR THOSE AFFECTED BY SEVERE AND COMPLEX MENTAL HEALTH ISSUES IN YOUNG PEOPLE REQUIRES AN HOLISTIC AND INTEGRATED APPROACH
Young people – and those that care for them – must receive treatment, education and training that meets their individual needs with the focus being to enable them to be as well as possible and as high-functioning as possible to enter adult life.
A patient is a person. That person is a past child and a potential adult. That person can also be a son/daughter, brother/sister, friend, student, boyfriend/girlfriend, aspiring worker in a particular field, user of technology/social media and transport, lover/loather of particular music, sport, art, faith, TV, film, books, hobbies and more. They could also have some physical/medical challenges, a lack or excess of experience in something and their own personality and character traits. In addition, they might be part of a community/geographical region with its own cultural and practical concerns. All these things will influence their ability to progress when dealing with their mental illness so should inform the services provided.
So any service must be part of an integrated network that includes:
- Treatment (ranging from community, residential and hospital services for Children, Adolescents, Families and Adults and including drug and alcohol treatment/rehab)
- Training for Independent Living
- Justice/Legal Support services
- Financial/Disability Support Services
- Housing/Accommodation Support
- Vocational/Academic Consultation, Training and Service Provision
as appropriate for the individual.
These services must have regular, formalised lines of contact and established forums for communication not only to provide the best service to ‘consumers’ but to provide professional support for practitioners dealing with individuals whose lives encompass the full range of fields of operation and need. Treating a mental illness cannot be done in isolation from the other aspects of a patient’s life so having an understanding of the person as a whole is the most effective way to achieve progress.
Collaboration between professionals and agencies will inform ongoing service provision and, as well as providing a more streamlined experience for consumers, ensure professional support for service providers. And families and/or significant people in the lives of the young people will be involved wherever possible.
Clear, well-established referral pathways need to be identified with key agencies, to ensure appropriate involvement of relevant agencies.
In addition, Services for Young People should have strong links to Children’s and Adult services as well as with the providers that meet the range of needs – Housing, Employment, Vocational Training, Disability Services etc. – that young people have. This will not only ensure effective continuity of care but is an efficient approach, ensuring that contradictory or repetitious approaches aren’t undertaken and the time and efforts of professionals is not wasted. Ideally such services should have a stream of specialist staff that are trained to understand the issues of transitioning to adult services, and the issues facing young people with complex mental health conditions making this transition. These people would be the key contacts for other services engaging in the necessary interagency collaboration on issues related to this young person. It is completely inappropriate and potentially destructive and damaging for a person working in housing or employment for example, to be imposing adult expecations and demands on these young people who are ‘adult’ in chronological age only.
COMPLEXITY AND SEVERITY
Publicly, individual diagnoses like depression or anxiety are widely known and there is a growing understanding both professionally and within the general community that these are serious illnesses that require the right treatment and support. But the young people who are dealing with severe and complex mental health issues can be encountering a unique mixture of (sometimes conflicting) challenges. This group are suffering from:
“various combinations of developmental trauma, major psychiatric disorders and multiple comorbidities, high and fluctuating risk to self, major and pervasive functional disability, unstable accommodation options, learning disabilities, barriers to education and training, drug and alcohol misuse. … a cohort in the main characterised by high, complex and enduring clinical and support needs.”
Kotzé and Skippen, 2014
For mental health issues in young people, public/private services range from treatment options through CYMHS, Headspace, and private clinical consultations to online resources and short hospital stays for acute issues. But young people with severe and complex mental health issues are likely to have found these ineffective. So there must be other options that address the issues of severity and complexity directly and have the capacity to build a recovery model to meet individual needs and circumstances. The range of services would include at least:
- Day Programs
- Step-Up / Step Down Services (SUSD)
- Assertive Mobile Youth Outreach Services
- Residential Rehabilitation Units
- Adolescent Extended Treatment Centres (with specialised education on-site)
Each one of these must specifically target those between the ages of 13 and 25 and be properly connected/interactional to allow the supported and effective movement between services.
Essential for the effectiveness of this integrated system is that all services are well documented and functionally linked and and it allows for entry at any level, and movement between levels as appropriate. Accessible mapping should illustrate government, private and NGO services and their connections to allow the public and community practitioners to connect with individual or a group of services when needed.