Barriers to mental health care for Australian children and adolescents in 1998 and 2013–2014

Abstract

Objective: To assess changes in barriers to mental health care for children and adolescents over 16 years. Methods: We used data from two nationally representative surveys of Australian children and adolescents (4–17 years old), conducted in 1998 ( N = 4509) and 2013–2014 ( N = 6310). Barriers to care were assessed among parents who had reported a perceived partially met or unmet need for their child in the past 6 months in 1998, and the past 12 months in 2013–2014; barriers were similarly assessed among adolescents in relation to themselves. We addressed measurement inconsistencies between surveys by harmonising barriers to accommodate differences in wording and performing sensitivity analyses among those with a 1-month disorder to equalise the timeframes in which barriers were assessed. To assess change, we examined whether the rank order of the three most commonly endorsed barriers changed and whether the 95% confidence intervals (CI) around their estimates overlapped. Results: Similar proportions of parents reported a partially met or unmet need in 1998 (12.9%, 95% CI = [11.7, 14.0]) as in 2013–2014 (14.3%, 95% CI = [13.2, 15.3]), but the ratio of unmet to partially met need decreased from 3:1 in 1998 to 1:1 in 2013–2014. Top three parent-endorsed barriers (‘self-reliance’, ‘unsure where to get help’, and ‘cost’) were the same at both time points; ‘self-reliance’ decreased from 65.9% (95% CI = [61.1%, 70.7%]) to 34.9% (95% CI = [31.5%, 38.3%]). Top two adolescent-endorsed barriers (‘self-reliance’ and ‘concerned what others might think’) were the same at both time points, the third differed, but none of them decreased. Conclusion: Perceived unmet need for mental health care for children and adolescents may have decreased between 1998 and 2013–2014, but the gap in receiving sufficient care may have increased. Despite investments in community awareness and treatment during this period, key barriers seemed largely unchanged. For parents, the decrease in self-reliance may reflect a positive shift in beliefs about the potential benefits of treatment.

A cluster randomised controlled trial of a web-based youth mental health service in Australian schools

“…As outlined, the decline in help-seeking from adults was also likely to have been impacted by the availability of trusted adults and other systemic and structural barriers that inhibit access to professional care. 6 , 9 The baseline rates of help-seeking from adult sources were consistent with population norms. 1 , 9 While the reduction in adult help-seeking behaviour may have been caused by a weakened support network or negative past experiences, a plausible explanation may be found in the timing of the study.…”

“… 6 , 9 The baseline rates of help-seeking from adult sources were consistent with population norms. 1 , 9 While the reduction in adult help-seeking behaviour may have been caused by a weakened support network or negative past experiences, a plausible explanation may be found in the timing of the study. Baseline data was collected in Term 1 of the school year, after an extended period of school holidays.…”

“… 3 , 4 Many schools adopt a traditional “wait-to-act” approach in which various mental health personnel and supports are provided, but the onus is on students or parents to seek help, or on teachers to identify students in need. This model of care is negated by a range of barriers including poor mental health knowledge, stigma, students’ desire for autonomy, and a lack of mental health expertise among youth, their families [5] , [6] , [7] , [8] , [9] , and school staff. 10 Further, the extent and quality of mental health resources varies across schools.…”

The state of psychiatric research in the Asia Pacific region

“…Australia is a pioneer in youth mental health research and service delivery. Recent areas of research include the evaluation of school based initiatives (Hart, Cropper, Morgan, Kelly, & Jorm, 2020; Hoare et al, 2020), the use of technology (Byrne, Kotze, Ramos, Casties, & Harris, 2020), and access to care (Chatterton et al, 2019; Schnyder et al, 2020). The expansion of clinical services designed for youth (eg, Headspace Centers) and system changes have resulted in the establishment of large datasets to facilitate a transdiagnostic approach in understanding the development of mental illness in young people (Cross & Hickie, 2017; Lavoie et al, 2020).…”

Patterns and Predictors of Healthcare Use among Adolescent and Young Adult Cancer Survivors versus a Community Comparison Group

“…As survivors move further from hospital-delivered care, longer-term cancer survivors may therefore experience a similar gap in mental healthcare to their community-based counterparts. Unlike hospital-delivered psychosocial care, which is largely free for cancer survivors, financial cost becomes a significant barrier for AYAs accessing mental health support delivered in the community, for example through private-practice clinical psychologists [ 74 ].…”