Report on Dr. Alan Rosen's address to HKA (13 Jun 06)
We were very blessed indeed to be able to hear from Dr. Rosen at our June meeting. His main topic addressed the subject of Youth and Mental fitness, and how we should be making mental health services more 'user friendly' to youth.
Suggested was a 'one stop shop' , perhaps even located in a shopping centre, where young people and adolescents could 'drop in', some on an appointment basis, and receive mental health care.
What was required, said Dr. Rosen, was a more approachable mental health service, with practising clinicians demonstrating an accepting and 'culturally aware' approach to youth; an environment in which the young felt at ease, which was less formal and which met them at their point of need; that did not require of them targets that were for them currently unreachable.
The benefits of such a service, as had been demonstrated from the one currently running in Geelong, Victoria (ORYGEN, now JIGSAW) were considerable, the most obvious being that the mental health services were accessing individuals who would not normally be receiving treatment, however urgently required. Statistics indicate about 60% of persons with a mental illness have no contact with health services for their illness.
The other huge advantage was that young people were treated so much earlier and therefore their prognoses were so much better. The 'user friendly' approach meant adolescents were able to receive the Early Intervention facilities that have proven themselves so beneficial and so vital to maintaining and working towards optimum health.
Further, locating services in accessible centres, such as shopping centres, resulted in a reduction of STIGMA which has been proven to be so damaging and sometimes more so than the mental illness itself. Everyone was being educated in this way, including the general public, the consumers and the physicians themselves.
Dr Rosen indicated that currently the main barriers for accessing Youth were: transport; over-formal settings that were non-youth friends; no flexible hours; not enough consultation time; mixed age groups; non-affordable service with lack of bulk-billing; not confidential; not sensitive to youth priorities; included an exposure to chronicity and consequent fear for their futures; culture insensitive; gender orientated; drug /homeless/ goth subcultures; cultural interface and diversity; needed health care independent of family; feel fear, anxiety, shame (not coping at age requiring them to be 'cool'); limited knowledge of how bulk -billing operated or how they could request it, especially in regard to mental health.
Dr. Rosen then asked the audience for in-put as to how an 'Ideal Mental Health service provision for Youth' would look. He suggested a Mood Gym (there was already one operational) which facilitated cognitive, behavioural therapy.
A computer program which could be worked on by the youths themselves was already available (www.moodgym.org) which is now offered through the University of Melbourne. Peer support workers, who could lead from from service to service. Have a 'human' face; be located in smaller spaces; Be less frantic. Non-dismissive. Sometimes attitude in Emergency Departments: "Oh! You Again! Taking up space" with the implication that it was 'just a crisis' and 'not an emergency'.
Dr. Rosen said that the time had come where traditional 'child services' were no longer separated from 'adult services' and they needed to become pro-active and have the ability to visit the consumer; to calibrate developmental life-stage issues and to integrate them holistically in the mental health service to include interpersonal, recreational and vocational outcomes.
He further made the point that a Prodrome Service needed to be provided which could monitor and treat individuals in the early stages of their mental health difficulties. Also that an 'Exit Strategy' needed to be built in to the mental health system, so that the consumer could look forward to a better future, even given the fact that at times of unwellness they might need to access the service again.
Dependency needs needed to be Titrated; There needed to be a feeling of graduation and celebration on achieving wellness; there was a need to Restore or Complete a ‘rite of passage’.
JIGSAW Model 1 derived from CLOCKWORK Model: Victoria: Opened 9.4.2005.
The present JIGSAW model found that presentations were:
with the proviso that 60 - 70% of all presentations had a co-morbidity with drug and alcohol. Age Group: 15 - 21 years. Premises: Shopping Centre.
Single point of contact intake process: One set of medical records; Crisis Management Plan; One Stop Shop.
Dr. Rosen indicated that research and current practice suggested that doctors were/are prepared to give of their time to such an endeavour, when all the 'external' structure and expenses were set up and paid for; in other words the doctors themselves provided and had responsibility for clinical services alone and the costs and setting up of the infrastructure were born by the State.
Report Compiled by Jane Woodall |
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© Hornsby Ku-ring-gai Association 2009  |