Fragmented services, long wait times and inadequate training prevents high-quality mental health care for children, clinicians say 

Fragmented services, long wait times and inadequate training are among the barriers preventing adolescents and children from receiving high-quality mental health care in Australia, according to clinicians in a new study.

The research, led by the Murdoch Children's Research Institute (MCRI) and published in the Australian and New Zealand Journal of Psychiatry, found with the mental health system struggling under major structural, training, resource and workforce issues, many vulnerable children were not receiving sufficient help that would likely improve their symptoms.

The clinicians surveyed have called for a system-wide shake-up, including improved access to child psychiatrists, mental health training, co-located support services and referral pathways and Medicare funding changes.

MCRI researcher Kate Paton said this was the first study reporting clinicians' perceptions of the major barriers faced by Australian children and their parents when seeking help for common mental health conditions.

The study of 143 clinicians involved child and adolescent psychiatrists, paediatricians, child psychologists and GPs from Victoria and South Australia.

The clinicians reported access to services was restricted by degree of severity and complexity of the condition, age ranges for specific services, system fragmentation with no roadmap to navigate, high out-of-pocket costs and lengthy waiting times.

A shortage of psychiatrists and psychologists, especially for children under 12 years, combined with lengthy waiting lists have led to clinician burnout, particularly in regional areas, the study found.

Ms Paton said the surveyed group wanted clearer referral pathways and better communication between clinicians as some had resorted to ad hoc arrangements.  

She said they also saw a need for better training, including practical experience working in public specialist mental health services and more support from child and adolescent psychiatrists for complex cases. 

Increased rebates for bulk billed services and changes to Medicare funding as the 'fee for service' concept limited opportunities for co-located staff and services to work together were also flagged.  

Melbourne GP Dr Scott Parsons said given GPs were often the initial contact for parents concerned about their child's mental health they were best placed to ensuring a timely and specifically tailored treatment plan but this rarely happened. 

"This can result in frustrated parents giving up or seeking alternative options due to the lack of a clear roadmap to the detriment of the child," he said.  

Dr Parsons said GPs had limited or no training in child mental health and those who have the confidence in assessing and managing some of the more common conditions such as ADHD were further hampered by Victorian regulations that prevented them from prescribing medication where required. 

Despite increased recognition and investment by governments in treatment, the prevalence of mental health disorders in developed countries has remained unchanged over the past 20 years. Data shows about 14 per cent of Australian children aged 4–17 years has a mental health problem.

MCRI Professor Harriet Hiscock said because half of all mental health conditions present before 14 years of age, access to high-quality mental health care for younger children was crucial. 

Professor Hiscock said with two major inquiries - the Productivity Commission into Mental Health and Victoria's Royal Commission into Mental Health Services - Australia was ideally poised to test new models of care and training to improve access to and quality of child mental health care. 

But she stressed the rise of telehealth may not deliver effective care for children and adolescents with complex mental health problems, which could increase due to trauma from COVID-19.

"With the pandemic, most clinicians have pivoted to telehealth," she said. "Anecdotally, this seems to suit many families and clinicians, but rigorous evaluations haven't been done and telehealth may just not deliver effective care for children and adolescents with complex mental health problems."

Researchers from the University of Melbourne, The Royal Children's Hospital and the University of Adelaide also contributed to the study.

Publication: Kate Paton, Lynn Gillam, Hayley Warren, Melissa Mulraney, David Coghill, Daryl Efron, Michael Sawyer and Harriet Hiscock. 'Clinicians' perceptions of the Australian Paediatric Mental Health Service System: Problems and solutions,' Australian and New Zealand Journal of Psychiatry. DOI: 10.1177/0004867420984242

*The content of this communication is the sole responsibility of MCRI and does not reflect the views of the NHMRC.

Available for interview: 

Professor Harriet Hiscock, MCRI Group Leader, Health Services
Dr Scott Parsons, Melbourne GP 

Media Contact: 

Bridie Byrne
MCRI communications specialist
+613 9936 6211/ 0403 664 416 

About MCRI

The Murdoch Children's Research Institute (MCRI) is the largest child health research institute in Australia committed to making discoveries and developing treatments to improve child and adolescent health in Australia and around the world. They are pioneering new treatments, trialling better vaccines and improving ways of diagnosing and helping sick babies, children and adolescents. It is one of the only research institutes in Australia to offer genetic testing to find answers for families of children with previously undiagnosed conditions.

Funding

The project's study design and conduct, data collection, management, analysis and interpretation were funded by National Health and Medical Research Council (NHMRC) Grant No. 1129957. H.H. is supported by NHMRC Practitioner Fellowship Award 1136222. D.F.'s position is funded by a Clinician Scientist Fellowship from MCRI. The Victorian Government's Operational Infrastructure Support Program support research at MCRI.