Services Needed

Prior to the Commission of Inquiry into the Closure of the Barrett Adolescent Centre, the full suite of services for adolescents with severe and complex mental health issues offered through Queensland Health (beyond CYMHS) were through Children’s Health Queensland’s statewide Adolescent Mental Health Extended Treatment Initiative.  These were:

Assertive Mobile Youth Outreach Services (AMYOS)

Multidisciplinary mental health clinicians deliver treatment in either the family home or the community. Currently in north Brisbane, south Brisbane, Redcliffe/Caboolture, Logan, Gold Coast, Darling Downs, Rockhampton, Townsville, and Cairns.

Adolescent day program units

Young people with social difficulties and a history of school refusal or exclusion can receive intensive individual/ group therapy and extended treatment options. Currently at north Brisbane, the Lady Cilento Children’s Hospital (south Brisbane), Toowoomba and Townsville.

Youth residential rehabilitation units (Youth Resi)

Long-term accommodation and recovery-oriented care provided by NGOs in partnership with mental health specialists. Aims to teach young people the life skills they need to maintain independence and emotional well-being; develop and maintain links with the community, their family, and social networks; as well as providing education and work opportunities. Currently in south Brisbane, Cairns and Townsville.

Subacute beds

Medium-term, 24 hours per day, seven days per week care in a safe, secure, structured, hospital-based environment with access to onsite schooling. Currently at the Lady Cilento Children’s Hospital (south Brisbane).

Proposed future services

Step Up / Step Down Units
Short-term residential treatment in purpose-built facilities that are delivered by mental health specialists in partnership with NGOs for those who require a higher intensity level of treatment and care to reduce symptoms that cannot be adequately provided in the community (Step Up), but do not require acute inpatient care. This intensive safe and supportive sub-acute residential community program also operates as Step Down – enabling early discharge from acute  inpatient units .

Following the election of the current state government, the Youth Mental Health Commitments Committee was established to look into extended inpatient care – particularly with respect to the gaps in services for those aged 18 to 24 – in order to honour the pre-election commitment to a 22-bed facility by Queensland Labour.

We’re also looking and costing up other options; for instance, potentially three seven-bed units, two units of, say, 10 beds each, where they might be. We’re looking at mapping of services across the State in terms of population mapping. We’re then going to undertake service mapping of where units or services should be across the state, and we’re doing that in parallel and in anticipation of the Commission’s findings so that a body of work would already be completed beforehand so that we can – so that any decisions in  terms of future services may be expedited.

Dr Stephen Stathis, Youth Mental Health Commitments Committee
11 March 2016 (during Oral Hearings of Barrett Adolescent Centre Commission of Inquiry)

When the Commission of Inquiry’s report was presented to the Queensland government in June 2016, the Premier and Health Minister indicated that all six recommendations in the report would be acted upon. Those were:

  1. Review legislation that establishes the devolved Hospital and Health Service model in Queensland Health
  2. Improve service agreements Queensland Health uses to contract services provided by non-government organisations
  3. Improve the availability and use of evaluations to inform clinical interventions in mental health
  4. Consider a new building in south-east Queensland offering a range of mental health services for young people, including bed-based services
  5. Improve transitions for adolescents moving into adult mental health services
  6. Improve coordination between services designed to support young people who have both an intellectual disability and mental illness.

A Steering Committee to oversee the implementation of the recommendations was set up in August 2016 under Deputy Director-General of Queensland Health, Dr John Wakefield. Working groups have undertaken planning on each of the individual recommendations with consumer and carer representatives on relevant groups.

In October 2016, the Queensland Premier, Annastacia Palaszcsuk, announced that a new 12-15 bed facility would be built in the grounds of Prince Charles Hospital at Chermside in Brisbane’s northern suburbs. The Health Minister, Cameron Dick, underlined the importance that the new centre was sustainable and embedded in the system. Since then, workshops have been held to draft a design and Model of Care for the new facility. The workshops encouraged input from clinical and education professionals as well as young people and carers/family members whose lives are affected by severe and complex mental health issues. Consultation was also undertaken through regional forums across Queensland.

As regards those Recommendations other than that referring to a new facility i.e. #4, a number of organisations have been engaged to compile and report on the current status of those issues and make recommendations on desired outcomes and the processes to achieve those. Consumer and carer representatives have been involved in discussions on all the Recommendations.

It is hoped that those with expertise in this area – through lived experience or clinical knowledge and practice – will continue to focus on what is needed achieve the best outcome for young people who have high, complex and enduring clinical and support needs. A longer term inpatient treatment, rehabilitation and education option is a vital element but it is also a priority that such a service exists within a fully integrated and comprehensive system of care that meets the needs of ALL young people with mental health issues at EVERY stage of recovery and every level of severity. And to create and then continually evolve such a system, organised and purposeful research must be underway across all aspects of service provision. Methods (e.g. the use of available and emerging technologies) must be explored to access greater input from those whose illness continues to isolate them – not only in order to gather evidence that might prevent future generations from having to endure the multiple effects of severe and complex mental illness, but to establish therapeutic connections that can continue to engage young people and their families in treatment, education and other support services. In addition, greater understanding of the reality of living with the issues of severe and complex adolescent mental illness must be actively facilitated across numerous groups. This would include Emergency Department staff, local GPs/mental health specialists whose experience has never been with the severe and complex adolescent cohort, educators and the wider public. When the multiple daily limitations and challenges begin to be understood by all those who have contact with those affected, improved service is surely inevitable. So consumers/carers undertaking to share personal stories that describe their own experiences through the development of resources and training materials should be supported and facilitated wherever possible. 

Services are needed. But so much more will be essential. Structures, systems, education, research projects – and the funding required to to undertake these – must be considered alongside specific service options. Important as what becomes available will always be, it is equally important to ensure that it is delivered in the most appropriate way and continues to evolve to match the needs of those whose struggle has been overlooked for so long.