Mental health of young people in Australia

6 Service utilisation

Page last updated: October 2000

The survey attempted to answer two questions about service utilisation by children and adolescents with mental health problems in Australia. These questions were:

  • Are the needs of children and adolescents with mental health problems being met?
  • What barriers influence service use by children and adolescents?
Service use by children and adolescents is affected by factors that are different from those that affect adults. For example, children rarely seek help for themselves. Instead, parents or teachers commonly decide that a child should be referred for help. As a result, the attitude of these adults and their perceptions of children's problems have a substantial influence on whether or not children receive help. This pattern changes as children move into adolescence and take increasing responsibility for their own health care. Thus, it is necessary to have information about both adolescent and parental attitudes if service use by adolescents is to be understood.

Previous surveys have found that only a small proportion of children and adolescents with mental health problems attend specialised services to get help for their problems. It is unclear why this should be so. It is possible that sufficient services may not be available, or that parents are unaware of them if they are available. Alternatively, parents may feel that services are too expensive. A better understanding of the factors that influence service use is important if children and adolescents are to get help when it is needed.

In this chapter, service use is described for the following three groups:
  1. those who scored in the clinical range on the Total Problems scale of the Child Behaviour Checklist;
  2. those who met the criteria for one of the three mental disorders assessed in the survey; and
  3. those whose parents reported that they needed professional help for emotional or behavioural problems.
Top of pageEach of these three groups reflects a different approach to identifying children and adolescents in need of help for mental health problems. The first approach focuses on children and adolescents who are reported to have a large number of emotional and behavioural problems. It assumes that children or adolescents need professional help if they have a similar number of emotional and behavioural problems as those already attending services. The second approach is based on a clinical diagnosis of a mental disorder. This approach assumes that if children or adolescents have symptoms that meet criteria for a mental disorder, they are in need of help from professional services. The final approach is based on parents' perceptions that their children or adolescents need professional help for mental health problems. Inclusion of this latter group is important because not all of the parents of children and adolescents in the first two groups believe that professional help is needed.

The percentage of children and adolescents using services who met all three criteria simultaneously is also provided as an indication of the proportion of children and adolescents with severe mental disorders who received help.

Service use by children and adolescents
(i) Children and adolescents with mental health problems
(ii) Children and adolescents with mental disorders
(iii) Children and adolescents reported by parents to need professional help
(iv) Children and adolescents who met all three criteria defining a need for help
The level of emotional and behavioural problems among children and adolescents attending different services
Barriers to service use
Summary

Service use by children and adolescents

(i) Children and adolescents with mental health problems

The percentage of children and adolescents who scored in the clinical range of the Total Problems scale on the Child Behaviour Checklist and who attended one or more services for help with emotional and behavioural problems during the last six months is shown in figure 6.1. Overall, only 25% of these children and adolescents had attended one or more services. Most commonly the services were provided by family doctors, school-based counsellors and paediatricians.

Those in different age groups appeared to access somewhat different services. For example, 4–12-year-old children with mental health problems most frequently attended paediatricians and family doctors. In contrast, school-based counselling was the service most frequently used by adolescents.
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Figure 6.1 Percentage of 4–12 and 13–17 year olds scoring in the clinical range of the child behaviour checklist attending each service

Refer to the following text for a text equivalent of Figure 6.1 Percentage of 4–12 and 13–17 year olds scoring in the clinical range of the child behaviour checklist attending each service
Text version of Figure 6.1
This figure shows that 25% attended at least one service. Other figures in this description are approximate as they have been read from the graph.
ServiceAge group
4-12 years
Age group
13-17 years
Counselling in school
7.5
15.5
Family doctor
11
10.5
Paediatrician
11
4
Private psychologist/social worker
6
9
Other community health services
6
10.2
Other school-based services
4
2.5
Special school or class
4
2.5
Mental health clinic
2.4
7
Private psychiatrist
2.5
5
Hospital dept of psychiatry
2.4
2.7
Other hospital based outpatient services
2.5
2.4
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(ii) Children and adolescents with mental disorders

Figure 6.2 shows the percentage of children and adolescents with one of the three mental disorders who attended each service during the six months prior to the survey. Overall, 29% of children and adolescents with a mental disorder attended at least one service to get help during this period. The services most commonly used were counselling in schools, family doctors and paediatricians. Only 3% of the children and adolescents with a mental disorder had attended a mental health clinic, while only 2% had attended a hospital-based department of psychiatry.

Figure 6.2 Percentage of children and adolescents with a mental disorder attending each service

Refer to the following text for a text equivalent of Figure 6.2 Percentage of children and adolescents with a mental disorder attending each service
Text version of Figure 6.2
The figure shows that 29% attended at least one service. Other figures in this description are approximate as they have been read from the graph.

Percentage of children and adolescents with a mental disorder attending each service:
  • Counselling in school - 14%
  • Family doctor - 13%
  • Paediatrician - 11%
  • Private psychologist/social worker - 8.5%
  • Other community health services - 8%
  • Other school-based services - 4.5%
  • Special school or class - 4%
  • Mental health clinic - 2.5%
  • Private psychiatrist - 4%
  • Hospital dept of psychiatry - 2%
  • Other hospital based outpatient services - 2.5%
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(iii) Children and adolescents reported by parents to need professional help

The percentage of children and adolescents whose parents reported that their child or adolescent needed professional help and who had attended a service in the previous six months is shown in figure 6.3. Altogether, 45% of these children and adolescents had attended a service during the previous six months. The pattern of services used was very similar to that reported by parents of those with mental health problems and mental disorders.

Figure 6.3 Percentage of children and adolescents whose parents reported that their child/adolescent needed professional help for an emotional or behavioural problem, attending each service

Refer to the following text for a text equivalent of Figure 6.3 Percentage of children and adolescents whose parents reported that their child/adolescent needed professional help for an emotional or behavioural problem, attending each service
Text version of Figure 6.3
The figure shows that 45% attended at least one service. Other figures in this description are approximate as they have been read from the graph.

Percentage of children and adolescents whose parents reported that their child/adolescent needed professional help for an emotional or behavioural problem, attending each service:
  • Counselling in school - 23%
  • Family doctor - 19.5%
  • Paediatrician - 15%
  • Private psychologist/social worker - 14%
  • Other community health services - 11%
  • Other school-based services - 5.5%
  • Special school or class - 5.5%
  • Mental health clinic - 6.5%
  • Private psychiatrist - 4.8%
  • Hospital dept of psychiatry - 4.9%
  • Other hospital based outpatient services - 4%
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(iv) Children and adolescents who met all three criteria defining a need for help

The percentage of children and adolescents attending services who had a mental disorder and who scored in the clinical range on the Child Behaviour Checklist and whose parents reported that they needed professional help is shown in figure 6.4. This group represents children and adolescents who met all three criteria used to identify a need for services. Overall, only half this group had attended a service to get help with their problems. Of these, approximately 50% had attended a family doctor, a paediatrician or had received counselling at school. Only 17% of these young people had attended a psychiatrist, mental health clinic or hospital-based department of psychiatry.

Figure 6.4 Percentage of children and adolescents with a mental disorder and a score in the clinical range on the child behaviour checklist and a parent report that the child/adolescent needed professional help, attending each service

Refer to the following text for a text equivalent of Figure 6.4 Percentage of children and adolescents with a mental disorder and a score in the clinical range on the child behaviour checklist and a parent report
Text version for Figure 6.4
The figure shows that 52% attended at least one service. Other figures in this description are approximate as they have been read from the graph.

Percentage of children and adolescents with a mental disorder and a score in the clinical range on the child behaviour checklist and a parent report that the child/adolescent needed professional help, attending each service:
  • Counselling in school - 24.5%
  • Family doctor - 27%
  • Paediatrician - 25%
  • Private psychologist/social worker - 19%
  • Other community health services - 13.5%
  • Other school-based services - 6%
  • Special school or class - 9%
  • Mental health clinic - 8%
  • Private psychiatrist - 7.5%
  • Hospital dept of psychiatry - 5%
  • Other hospital based outpatient services - 5.5%
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The level of emotional and behavioural problems among children and adolescents attending different services

Table 6.1 shows the level of emotional and behavioural problems experienced by children and adolescents attending different service types. Seventy-five percent of those attending specialised mental health services had a very high level of problems, while only 41% of those who received counselling in schools had this level of problems. Approximately 60% of those attending family doctors, paediatricians and private psychologists or social workers had a very high level of problems.

Table 6.1 Percentage of children and adolescents attending each service by level of emotional and behavioural problems

Very high level
of problems
High level
of problems
Moderate level
of problems
Low level
of problems
Private Psychiatrist or Mental Health Clinic or Hospital-Based Department of Psychiatry
74.8
11.6
11.1
2.5
Other Hospital-Based Outpatient Service or Other Community Health Services
65.2
23.0
8.6
3.2
Family Doctor
62.9
18.7
13.6
4.7
Private Paediatrician
60.1
24.1
13.2
2.6
Special School or Class
60.0
22.3
17.6
0.0
Private Psychologist/Social Worker
59.8
23.0
9.4
7.8
Other School- or Education-Based Services or Counselling
41.3
28.7
19.4
10.6

Barriers to service use

Figure 6.5 shows the reasons parents gave to explain why children and adolescents who, despite meeting all three criteria for needing help, did not attend a professional service to get help. Parents of children and adolescents who met only one of the criteria gave similar explanations. Approximately 50% of the parents reported that help was too expensive or that they didn't know where to get it. Forty-six percent of parents thought that they could manage the emotional or behavioural problems of their child or adolescent on their own. A slightly smaller percentage reported that they asked for help but didn't get it or had to wait too long for an appointment. Only 6% of parents reported that the stigma of obtaining help ('being afraid of what your family or friends might think') kept them from getting help.
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Figure 6.5 Barriers to obtaining help

Refer to the following text for a text equivalent of Figure 6.5 Barriers to obtaining help

Text version of Figure 6.5

Figures in this description are approximate as they have been read from the graph.

Barriers to obtaining help:
  • Help to expensive - 50.5%
  • Didn't know where to get help - 47%
  • Could handle problem - 45%
  • Asked for help but didn't get it - 42%
  • Had to wait a long time - 37%
  • Child didn't want to attend - 24%
  • Service too far away - 23%
  • Thought treatment wouldn't help - 21%
  • Other reason - 17%
  • Afraid of what people think - 4%
  • Problem transient - 3%
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Summary

Only a minority of children and adolescents with mental health problems receive professional help. Even among those who met all three criteria used to identify a need for help, only half had attended any service during the previous six months and only 17% had attended a mental health service. Parents reported that practical issues such as the cost of attending services, not knowing where to get help, and long waiting lists were the major obstacles to getting help. Concern about the attitude of others was identified as a barrier by only a minority of parents.

Parents identified counselling in schools as one of the services most frequently used by children and adolescents. This finding is consistent with the results of other recent international surveys, and it emphasises the key role school-based services play in providing help for children and adolescents with mental health problems (Verhulst & van der Ende, 1997). For that reason, it is important to ensure that school-based counsellors are properly trained in the assessment and management of young people's mental health problems and that they are closely linked to specialised mental health services.

Family doctors and paediatricians were the other services commonly used by children and adolescents with mental health problems. This study does not include information about the extent to which parents and young people understand the different roles of school-based services, family doctors, paediatricians and specialist mental health services. However, since these are the key services from which help is sought for mental health problems, it is important that they clearly define their roles and that specialist mental health services establish close supportive links with general practitioners, paediatricians and school-based services.

Most children and adolescents attending mental health services have a very high level of problems. However, only a very small proportion of all children and adolescents with problems receive help from specialised mental health services. The findings of this study pose a major challenge for scarce mental health services. It is unlikely that there will ever be enough of these services to provide direct care to all children and adolescents with problems. In the light of this, mental health services should be encouraged to experiment with alternative models of service delivery that combine direct care, consultation to primary health care or school-based services, and both universal and targeted prevention programs. These service models should be carefully evaluated to determine their effectiveness in reducing the prevalence of mental health problems in designated communities and in alleviating the impairment associated with these problems. There is a great need to identify the optimal mix of promotion, prevention, consultation and treatment interventions that can provide cost-effective help for young people and their families in Australia.