Developing an integrated substance use and mental health service in the specialised setting of a youth detention centre

Abstract

This article describes the frequency of co-morbid substance use and mental health problems of young people within the youth justice system and demonstrates that mental health and drug and alcohol services can be integrated and work effectively. The establishment of an integrated Mental Health Alcohol Tobacco and Other Drugs Service (MHATODS) to juveniles in detention represents a shift away from the traditional paradigm of separate services frequently found throughout Australia. The development of referral procedures and adolescent-focused treatment programmes that are tailored to the specific needs of this disadvantaged population are discussed. A wide-ranging literature review illustrates the consequences of the high prevalence of co-morbid substance use and mental health problems in juveniles within the youth justice system. A retrospective and descriptive account is given of the expansion of the MHATODS, including the recruitment of an Indigenous health worker, the incorporation of an automatic referral process for young people with substance use problems and the development of a brief four-session drug and alcohol counselling programme and a group relapse prevention programme. The proportion of Indigenous clients referred to MHATODS is now equitable to referrals of non-Indigenous youth. The introduction of an automatic voluntary referral process resulted in an increase in referrals for drug and alcohol assessment and counselling from 17% to 64% of total referrals. Of those young people commencing the drug and alcohol programme, 32% completed all sessions. While young people reportedly enjoyed the group programme, feedback from participants indicated that they felt vulnerable in a group setting. MHATODS recognises the limitations of the prevailing paradigm of separate service delivery for mental health and drug and alcohol treatment, and has developed an integrated treatment service for juveniles in detention. The service has expanded its referral base for substance use problems by employing an Indigenous health worker, and initiating an automatic referral process for young people admitted into detention who have a history of significant substance use. Early evidence indicates increased utilisation of drug and alcohol services by young people in detention.

Can music therapy engage patients in group cognitive behaviour therapy for substance abuse treatment?

“…Further analyses showed that the younger adults were as engaged as those aged over 25 years. This was an interesting finding, as it has been noted that it may take a long time to establish trust and rapport when working with young people [35,36]. The normal developmental period from late adolescence into young adulthood involves becoming independent from parents and other authority figures and working out one's own identity.…”

“…This was an interesting finding, as it has been noted that it may take a long time to establish trust and rapport when working with young people [35,36]. This was an interesting finding, as it has been noted that it may take a long time to establish trust and rapport when working with young people [35,36].…”

“…This was an interesting finding, as it has been noted that it may take a long time to establish trust and rapport when working with young people [35,36]. Indeed, it has been stated that young people learn better with activity-based experiential approaches [35,36]. This is a time of testing rules and taking risks.…”

Smoking behaviours among young people in custody in New South Wales, Australia

“…These findings suggest that smoking cessation programs in custody need to offer more than Nicotine Replacement Therapy alone, and include culturally and educationally appropriate information. Integrated tobacco, substance misuse and mental health programs for juvenile detainees, delivered by an Indigenous health worker, improves treatment utilisation and outcomes [27]. These sorts of programs can be trialled and evaluated in juvenile detention, targeting young women, Aboriginal young people, and young people with identified mental health problems who are at particular risk of heavy, current and aspirational smoking [28].…”

What’s in a label: social factors and health issues for a small group of Aboriginal people born in Brisbane, Australia

“…To better understand aggressive behaviour among Aboriginal adolescents, there is a need to evaluate the impact of adversity during adolescence on adolescent aggressive behaviour (not just in early childhood) (Farrington 1989;Høgh and Wolf 1983;Najman et al 2010;Wikström 1985), and previous onset of aggressive behaviour in early childhood (Farrington 1991;Lipsey and Derzon 1998;Loeber and Hay 1997;Piper 1985;Thornberry et al 1995;Tolan and Thomas 1995). Other potential mediators of aggressive behaviour include the influence of peer relationships (Farrington 1989;Moffitt 1993), racism and discrimination (Agnew 1992;Paradies et al 2008;Paradies and Cunningham 2009;Simons et al 2003), substance use (Hayatbakhsh et al 2008), mental health (Doolan et al 2012;Stathis et al 2006), performance at school (Farrington 1989;Maguin and Loeber 1996), family relationships and parenting styles (Capaldi and Patterson 1996;Cheah and Shepard 2011;Farrington 1989;Hawkins et al 1995;Kotch et al 2008).…”