Hot Issues in Mental Health

Not much is new for young peoples’ mental health three years after the Royal Commission

From MHYFVic

The recent MHYFVic Annual General Meeting was fortunate to have had a presentation by Deputy Chief Psychiatrist, Dr Paul Robertson, outlining the changes for young people stemming from the recommendations of the Royal Commission. The full scope of the presentation can be viewed by downloading the pdf. However, this commentary focuses on the particular issue of the “missing middle” for our future advocacy.

The government’s regional specialist mental health programs are now called Area Mental Health and Wellbeing Services (AMHWS). AHMWS are the new CYMHS/ CAMHS. Dr Robertson gave the cautionary warning, “Infant, Child and Youth AMHWSs are developing plans that outline how they will reorganise themselves into the new age-based streams and expand their service offering. This reform is significant and will take time.”  

Not only time, but considerably more money and personnel. We are reassured, “DH is working with services to ensure there are clear arrangements for delivering Infant, Child and Youth Area Mental Health and Wellbeing Services in each area.”  “Funding is being provided to allow AMHWSs to see more infants, children and young people, and ensure they receive the right amount of treatment care and support they need.” Two warning bells are ringing. One is the potential sidelining of children’s services as a minority issue overwhelmed by the needs of adult services. The other is the “missing middle”.

It is difficult for minority groups like children to have their needs met. The warning bell here is that 22 adult AMHWS (and their Aged Care components), together with the augmented statewide services, also need funding competing with the 13 for young people.

The second warning bell is about the small start of the local mental health and wellbeing services intended to assist the “missing middle”. In the spectrum of mild, moderate and severe it has long been complained that whilst treatment services are usually available for the mild and severe cases it is difficult to access treatment for the missing middle (unless you have lots of money). Moderate degrees of mental disorders are too severe to respond to supportive measures but not severe enough to gain entry to specialist services.

However, research shows that just as many adverse outcomes, including suicides, occur in this large group as in the smaller group of severe disorders. Historical focus on the most “at risk” clients fails to help the large number of moderate degrees of disorder. The recommended new stratum of ‘local mental health and wellbeing services’ is designed to address that problem.

The concern is that whilst 50 -60 of these are being planned for adult services, only three are planned for the Infant, Child and their Families stream (plus relying on Headspace programs to cater for the Youth stream). Three, in contrast to 50-60, is absolutely inadequate. The three will be located at Brimbank/Melton, Southern Melbourne and Bendigo. They are to be welcomed, and we keenly await the evaluation of their benefit, but the need for them is already clearly documented. We know that statewide developments cannot all be achieved at once, but it is not too cynical to say that infants and children don’t vote, whereas adults do.

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