Debra Rickwood

This paper summarises an ambitious research agenda aiming to uncover the factors that affect help-seeking among young people for mental health problems. The research set out to consider why young people, and particularly young males, do not seek help when they are in psychological distress or suicidal; how professional services be made more accessible and attractive to young people; the factors that inhibit and facilitate help-seeking; and how community gatekeepers can support young people to access services to help with personal and emotional problems. A range of studies was undertaken in New South Wales, Queensland and the ACT, using both qualitative and quantitative approaches. Data from a total of 2721 young people aged 14–24 years were gathered, as well as information from some of the community gatekeepers to young people’s mental health care.Help-seeking was measured in all the studies using the General Help Seeking Questionnaire (Wilson, Deane, Ciarrochi & Rickwood, 2005), which measures future help-seeking intentions and, through supplementary questions, can also assess prior help-seeking experience. Many of the studies also measured recent help-seeking behaviour using the Actual Help Seeking Questionnaire. The types of mental health problems examined varied across the studies and included depressive symptoms, personal-emotional problems, and suicidal thoughts.The help-seeking process was conceptualised using a framework developed during the research program. This framework maintains that help-seeking is a process of translating the very personal domain of psychological distress to the interpersonal domain of seeking help. Factors that were expected to facilitate or inhibit this translation process were investigated. These included factors that determine awareness of the personal domain of psychological distress and that affect the ability to articulate or express this personal domain to others, as well as willingness to disclose mental health issues to other people.The results are reported in terms of: patterns of help-seeking across adolescence and young adulthood; the relationship of help-seeking intentions to behaviour; barriers to seeking help—lack of emotional competence, the help-negation effect related to suicidal thoughts, negative attitudes and beliefs about help-seeking and fear of stigma; and facilitators of seeking help—emotional competence, positive past experience, mental health literacy, and supportive social influences. The paper considers the implications of the findings for the development of interventions to encourage young people to seek help for their mental health problems, and concludes by identifying gaps in the help-seeking research and literature and suggesting future directions.

Despite the high prevalence of mental health problems and disorders that develop in adolescence and early adulthood, young people tend to not seek professional help. Young men and young people from Indigenous and ethnic minority groups tend to be those most reluctant to seek help. Young people are more inclined to seek help for mental health problems if they: have some knowledge about mental health issues and sources of help; feel emotionally competent to express their feelings; and have established and trusted relationships with potential help providers. Young people are less likely to seek help if they: are experiencing suicidal thoughts and depressive symptoms; hold negative attitudes toward seeking help or have had negative past experiences with sources of help; or hold beliefs that they should be able to sort out their own mental health problems on their own. Young people may seek help through talking to their family and friends, with family being more important for younger adolescents, and friends and partners becoming more influential later on. The professionals most likely to act as gatekeepers to mental health services for young people are school counsellors, general practitioners, and youth workers. Increasingly, Internet-based information and interventions are being used to engage young people in the help-seeking process.

The number of mental health apps (MHapps) developed and now available to smartphone users has increased in recent years. MHapps and other technology-based solutions have the potential to play an important part in the future of mental health care; however, there is no single guide for the development of evidence-based MHapps. Many currently available MHapps lack features that would greatly improve their functionality, or include features that are not optimized. Furthermore, MHapp developers rarely conduct or publish trial-based experimental validation of their apps. Indeed, a previous systematic review revealed a complete lack of trial-based evidence for many of the hundreds of MHapps available.To guide future MHapp development, a set of clear, practical, evidence-based recommendations is presented for MHapp developers to create better, more rigorous apps.A literature review was conducted, scrutinizing research across diverse fields, including mental health interventions, preventative health, mobile health, and mobile app design.Sixteen recommendations were formulated. Evidence for each recommendation is discussed, and guidance on how these recommendations might be integrated into the overall design of an MHapp is offered. Each recommendation is rated on the basis of the strength of associated evidence. It is important to design an MHapp using a behavioral plan and interactive framework that encourages the user to engage with the app; thus, it may not be possible to incorporate all 16 recommendations into a single MHapp.Randomized controlled trials are required to validate future MHapps and the principles upon which they are designed, and to further investigate the recommendations presented in this review. Effective MHapps are required to help prevent mental health problems and to ease the burden on health systems.

Predictors of the attitudinal measure of orientation toward help-seeking for emotional problems have been shown to include demographic, network, and personality variables. This research determined whether these same variables predict the behavioral outcome measure of help-seeking, both in general and from professional services in particular. Help-seeking in response to emotional problems was studied in a sample of Australian adolescents. General help-seeking was predicted by more symptoms of psychological distress, being female, availability of social support, knowing someone who had sought professional help, and the personality characteristics of high private self-consciousness and willingness to disclose mental health. When only those with evident emotional distress were considered, only gender and willingness to disclose remained significant predictors. These same variables did not account for those who sought professional help rather than relying upon their informal network. Level of psychological distress was the only significant predictor of professional consultation. Psychological symptoms and gender were shown to be more relevant predictors of the behavioral measure of help-seeking than network or personality characteristics.

A survey was made of 274 non-institutionalized persons aged 70 and over living in Hobart. The prevalence of dementia and of depression was measured by interviewing subjects using a modified version of the Geriatric Mental State Schedule (GMS) (Copeland et al. 1976) and the Mini Mental State Examination (MMSE) (Folstein et al. 1975). Rates of morbidity were derived from different diagnostic procedures. These were: diagnoses made by a psychiatrist (A.S.H.) directly from the interview schedules and audiotapes, and rated as mild, moderate or severe; the criteria laid down in DSM-III, converted into algorithms describing 3 degrees of severity; and the algorithms for pervasive dementia and depression proposed by Gurland et al. (1983), and from these authors' rational scales. In addition, the relation between scales for dementia and for depression and the diagnosed categories was examined. Some problems in applying these methods to aged persons in the community are discussed. It is concluded that more detailed specification of criteria is desirable if the comparative epidemiology of dementia and depression in old age is to advance.

Background: Despite a high level of research, policy, and practice interest in help-seeking for mental health problems and mental disorders, there is currently no agreed and commonly used definition or conceptual measurement framework for help-seeking.Methods: A systematic review of research activity in the field was undertaken to investigate how help-seeking has been conceptualized and measured.Common elements were used to develop a proposed conceptual measurement framework. Results:The database search revealed a very high level of research activity and confirmed that there is no commonly applied definition of help-seeking and no psychometrically sound measures that are routinely used.The most common element in the help-seeking research was a focus on formal help-seeking sources, rather than informal sources, although studies did not assess a consistent set of professional sources; rather, each study addressed an idiosyncratic range of sources of professional health and community care.Similarly, the studies considered help-seeking for a range of mental health problems and no consistent terminology was applied.The most common mental health problem investigated was depression, followed by use of generic terms, such as mental health problem, psychological distress, or emotional problem.Major gaps in the consistent measurement of help-seeking were identified. Conclusion:It is evident that an agreed definition that supports the comparable measurement of help-seeking is lacking.Therefore, a conceptual measurement framework is proposed to fill this gap.The framework maintains that the essential elements for measurement are: the part of the help-seeking process to be investigated and respective time frame, the source and type of assistance, and the type of mental health concern.It is argued that adopting this framework will facilitate progress in the field by providing much needed conceptual consistency.Results will then be able to be compared across studies and population groups, and this will significantly benefit understanding of policy and practice initiatives aimed at improving access to and engagement with services for people with mental health concerns.

The effect of social networking site (SNS) use on mental health has attracted growing scholarly attention, yet the nature of this relationship remains contentious. A systematic review was conducted to examine mental health outcomes associated specifically with the SNS, Facebook. A total of 65 articles met the inclusion criteria and were included in the review. Facebook use was associated with six key mental health domains: Facebook addiction, anxiety, depression, body image and disordered eating, drinking cognitions and alcohol use, and other mental health problems, albeit the strength and validity of these relationships varied. The review highlighted the multidimensional nature of Facebook use, and the subsequent importance of assessing specific SNS platforms or similar functions over platforms. The application of meta-analytic techniques is required to quantify the nature and direction of the relationships between Facebook use and mental health outcomes, as well as to identify pertinent moderators and individual difference factors.

This study aims to review the literature on barriers and facilitators to accessing and engaging with mental health care among young people from potentially disadvantaged groups, including young people identified as Aboriginal or Torres Strait Islander (ATSI); culturally and linguistically diverse (CALD); lesbian, gay, bisexual, transgender, queer, or intersex (LGBTQI); homeless; substance using; and youth residing in rural or remote areas.Fourteen databases were searched to identify qualitative and quantitative researches that examined barriers and/or facilitators to mental health care among the six groups of potentially disadvantaged young people.Out of 62 studies identified, 3 were conducted with ATSI young people, 1 with CALD young people, 4 with LGBTQI young people, 14 with homeless young people, 24 with substance-using young people, and 16 with young people residing in rural or remote areas. Findings generally confirmed barriers already established for all young people, but indicated that some may be heightened for young people in the six identified groups. Findings also pointed to both similarities and differences between these groups, suggesting that ATSI, CALD, LGBTQI, homeless, substance-using, and rural young people have some similar needs with respect to not only mental health care, but also other needs likely to reflect their individual circumstances.This systematic review highlights that young people from potentially disadvantaged groups have distinct needs that must be recognized to improve their experiences with mental health care. Future research of good methodological quality with young people is needed to increase accessibility of, and engagement with, mental health care.

Medical Journal of AustraliaVolume 207, Issue S10 p. S5-S18 Supplement Integrated (one-stop shop) youth health care: best available evidence and future directions Sarah E Hetrick, Sarah E Hetrick Orygen, The National Centre of Excellence in Youth Mental Health and The Centre for Youth Mental Health, University of Melbourne, Melbourne, VICSearch for more papers by this authorAlan P Bailey, Alan P Bailey Orygen, The National Centre of Excellence in Youth Mental Health and The Centre for Youth Mental Health, University of Melbourne, Melbourne, VICSearch for more papers by this authorKirsten E Smith, Kirsten E Smith Evolve Youth Services, Wellington, New ZealandSearch for more papers by this authorAshok Malla, Ashok Malla Department of Psychiatry, McGill University, Montreal, Quebec, CanadaSearch for more papers by this authorSteve Mathias, Steve Mathias Foundry, Department of Psychiatry, University of British Columbia, and FRAYME/CADRE Knowledge Network, Vancouver, British Columbia, CanadaSearch for more papers by this authorSwaran P Singh, Swaran P Singh Division of Health Sciences, University of Warwick, Coventry, UKSearch for more papers by this authorAileen O'Reilly, Aileen O'Reilly Jigsaw, The National Centre for Youth Mental Health, Dublin, IrelandSearch for more papers by this authorSwapna K Verma, Swapna K Verma Department of Early Psychosis Intervention, Institute of Mental Health, Singapore, SingaporeSearch for more papers by this authorLaelia Benoit, Laelia Benoit Sorbonne University and Maisons des Adolescents, Maison de Solenn, Cochin Hospital, Paris, FranceSearch for more papers by this authorTheresa M Fleming, Theresa M Fleming Department of Psychological Medicine, University of Auckland, Auckland, and Te Wāhanga Tātai Hauora, Victoria University of Wellington, Wellington, New ZealandSearch for more papers by this authorMarie Rose Moro, Marie Rose Moro Sorbonne University and Maisons des Adolescents, Maison de Solenn, Cochin Hospital, Paris, FranceSearch for more papers by this authorDebra J Rickwood, Debra J Rickwood headspace, National Youth Mental Health Foundation, Melbourne, VICSearch for more papers by this authorJoseph Duffy, Joseph Duffy Jigsaw, The National Centre for Youth Mental Health, Dublin, IrelandSearch for more papers by this authorTrissel Eriksen, Trissel Eriksen Youth One Stop Shop, Network of Youth One Stop Shops, Palmerston North, New ZealandSearch for more papers by this authorRobert Illback, Robert Illback REACH of Louisville, Louisville, Ky, USASearch for more papers by this authorCaroline A Fisher, Caroline A Fisher Allied Health – Psychology, Royal Melbourne Hospital, Melbourne, VICSearch for more papers by this authorPatrick D McGorry, Corresponding Author Patrick D McGorry pat.mcgorry@orygen.org.au Orygen, The National Centre of Excellence in Youth Mental Health and The Centre for Youth Mental Health, University of Melbourne, Melbourne, VICCorrespondence: pat.mcgorry@orygen.org.auSearch for more papers by this author Sarah E Hetrick, Sarah E Hetrick Orygen, The National Centre of Excellence in Youth Mental Health and The Centre for Youth Mental Health, University of Melbourne, Melbourne, VICSearch for more papers by this authorAlan P Bailey, Alan P Bailey Orygen, The National Centre of Excellence in Youth Mental Health and The Centre for Youth Mental Health, University of Melbourne, Melbourne, VICSearch for more papers by this authorKirsten E Smith, Kirsten E Smith Evolve Youth Services, Wellington, New ZealandSearch for more papers by this authorAshok Malla, Ashok Malla Department of Psychiatry, McGill University, Montreal, Quebec, CanadaSearch for more papers by this authorSteve Mathias, Steve Mathias Foundry, Department of Psychiatry, University of British Columbia, and FRAYME/CADRE Knowledge Network, Vancouver, British Columbia, CanadaSearch for more papers by this authorSwaran P Singh, Swaran P Singh Division of Health Sciences, University of Warwick, Coventry, UKSearch for more papers by this authorAileen O'Reilly, Aileen O'Reilly Jigsaw, The National Centre for Youth Mental Health, Dublin, IrelandSearch for more papers by this authorSwapna K Verma, Swapna K Verma Department of Early Psychosis Intervention, Institute of Mental Health, Singapore, SingaporeSearch for more papers by this authorLaelia Benoit, Laelia Benoit Sorbonne University and Maisons des Adolescents, Maison de Solenn, Cochin Hospital, Paris, FranceSearch for more papers by this authorTheresa M Fleming, Theresa M Fleming Department of Psychological Medicine, University of Auckland, Auckland, and Te Wāhanga Tātai Hauora, Victoria University of Wellington, Wellington, New ZealandSearch for more papers by this authorMarie Rose Moro, Marie Rose Moro Sorbonne University and Maisons des Adolescents, Maison de Solenn, Cochin Hospital, Paris, FranceSearch for more papers by this authorDebra J Rickwood, Debra J Rickwood headspace, National Youth Mental Health Foundation, Melbourne, VICSearch for more papers by this authorJoseph Duffy, Joseph Duffy Jigsaw, The National Centre for Youth Mental Health, Dublin, IrelandSearch for more papers by this authorTrissel Eriksen, Trissel Eriksen Youth One Stop Shop, Network of Youth One Stop Shops, Palmerston North, New ZealandSearch for more papers by this authorRobert Illback, Robert Illback REACH of Louisville, Louisville, Ky, USASearch for more papers by this authorCaroline A Fisher, Caroline A Fisher Allied Health – Psychology, Royal Melbourne Hospital, Melbourne, VICSearch for more papers by this authorPatrick D McGorry, Corresponding Author Patrick D McGorry pat.mcgorry@orygen.org.au Orygen, The National Centre of Excellence in Youth Mental Health and The Centre for Youth Mental Health, University of Melbourne, Melbourne, VICCorrespondence: pat.mcgorry@orygen.org.auSearch for more papers by this author First published: 20 November 2017 https://doi.org/10.5694/mja17.00694Citations: 112Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Summary Although mental health problems represent the largest burden of disease in young people, access to mental health care has been poor for this group. Integrated youth health care services have been proposed as an innovative solution. Integrated care joins up physical health, mental health and social care services, ideally in one location, so that a young person receives holistic care in a coordinated way. It can be implemented in a range of ways. A review of the available literature identified a range of studies reporting the results of evaluation research into integrated care services. The best available data indicate that many young people who may not otherwise have sought help are accessing these mental health services, and there are promising outcomes for most in terms of symptomatic and functional recovery. Where evaluated, young people report having benefited from and being highly satisfied with these services. Some young people, such as those with more severe presenting symptoms and those who received fewer treatment sessions, have failed to benefit, indicating a need for further integration with more specialist care. Efforts are underway to articulate the standards and core features to which integrated care services should adhere, as well as to further evaluate outcomes. This will guide the ongoing development of best practice models of service delivery. Citing Literature Supporting Information Filename Description mja2s5-sup-0001.pdfPDF document, 519.4 KB Supplementary material mja2s5-sup-0002.pdfPDF document, 385.4 KB Supplementary material mja2s5-sup-0003.pdfPDF document, 472.4 KB Supplementary material Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article. Volume207, IssueS10November 2017Pages S5-S18 RelatedInformation

Medical Journal of AustraliaVolume 200, Issue 2 p. 108-111 Research headspace — Australia's innovation in youth mental health: who are the clients and why are they presenting? Debra J Rickwood BA(Hons), PhD, FAPS, Corresponding Author Debra J Rickwood BA(Hons), PhD, FAPS Professor of Psychology; and Chief Scientific Advisor [email protected] Faculty of Health, University of Canberra, Canberra, ACT. headspace National Youth Mental Health Foundation, Melbourne, VIC.Correspondence: [email protected]Search for more papers by this authorNic R Telford BSS, MSS, Nic R Telford BSS, MSS Evaluation Manager headspace National Youth Mental Health Foundation, Melbourne, VIC.Search for more papers by this authorAlexandra G Parker BA(Hons), MClinPsych, PhD, Alexandra G Parker BA(Hons), MClinPsych, PhD Director, <em>headspace</em>, Centre of Excellence headspace National Youth Mental Health Foundation, Melbourne, VIC.Search for more papers by this authorChris J Tanti BA, BSW, AMP, Chris J Tanti BA, BSW, AMP CEO headspace National Youth Mental Health Foundation, Melbourne, VIC.Search for more papers by this authorPatrick D McGorry MD, PhD, FRANZCP, Patrick D McGorry MD, PhD, FRANZCP Professor of Youth Mental Health Orygen Youth Health Research Centre, University of Melbourne, Melbourne, VIC.Search for more papers by this author Debra J Rickwood BA(Hons), PhD, FAPS, Corresponding Author Debra J Rickwood BA(Hons), PhD, FAPS Professor of Psychology; and Chief Scientific Advisor [email protected] Faculty of Health, University of Canberra, Canberra, ACT. headspace National Youth Mental Health Foundation, Melbourne, VIC.Correspondence: [email protected]Search for more papers by this authorNic R Telford BSS, MSS, Nic R Telford BSS, MSS Evaluation Manager headspace National Youth Mental Health Foundation, Melbourne, VIC.Search for more papers by this authorAlexandra G Parker BA(Hons), MClinPsych, PhD, Alexandra G Parker BA(Hons), MClinPsych, PhD Director, <em>headspace</em>, Centre of Excellence headspace National Youth Mental Health Foundation, Melbourne, VIC.Search for more papers by this authorChris J Tanti BA, BSW, AMP, Chris J Tanti BA, BSW, AMP CEO headspace National Youth Mental Health Foundation, Melbourne, VIC.Search for more papers by this authorPatrick D McGorry MD, PhD, FRANZCP, Patrick D McGorry MD, PhD, FRANZCP Professor of Youth Mental Health Orygen Youth Health Research Centre, University of Melbourne, Melbourne, VIC.Search for more papers by this author First published: 03 February 2014 https://doi.org/10.5694/mja13.11235Citations: 134Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Abstract Objectives: To provide the first national profile of the characteristics of young people (aged 12–25 years) accessing headspace centre services — the Australian Government's innovation in youth mental health service delivery — and investigate whether headspace is providing early service access for adolescents and young adults with emerging mental health problems. Design and participants: Census of all young people accessing a headspace centre across the national network of 55 centres comprising a total of 21 274 headspace clients between 1 January and 30 June 2013. Main outcome measures: Reason for presentation, Kessler Psychological Distress Scale, stage of illness, diagnosis, functioning. Results: Young people were most likely to present with mood and anxiety symptoms and disorders, self-reporting their reason for attendance as problems with how they felt. Client demographic characteristics tended to reflect population-level distributions, although clients from regional areas and of Aboriginal and Torres Strait Islander background were particularly well represented, whereas those who were born outside Australia were underrepresented. Conclusion: headspace centres are providing a point of service access for young Australians with high levels of psychological distress and need for care in the early stages of the development of mental disorder. Citing Literature Volume200, Issue2February 2014Pages 108-111 RelatedInformation

Mental ill health is now the most important health issue facing young people worldwide. It is the leading cause of disability in people aged 10-24 years, contributing 45% of the overall burden of disease in this age group. Despite their manifest need, young people have the lowest rates of access to mental health care, largely as a result of poor awareness and help-seeking, structural and cultural flaws within the existing care systems, and the failure of society to recognise the importance of this issue and invest in youth mental health. We outline the case for a specific youth mental health stream and describe the innovative service reforms in youth mental health in Australia, using them as an example of the processes that can guide the development and implementation of such a service stream. Early intervention with focus on the developmental period of greatest need and capacity to benefit, emerging adulthood, has the potential to greatly improve the mental health, wellbeing, productivity, and fulfilment of young people, and our wider society.

This study provides the first comprehensive empirical evidence of developmental changes in the social influences on seeking mental health care, both in-person and online, during the critical lifestages for mental health of adolescence and young adulthood.Main source of help-seeking influence was determined via self-report for all young people accessing youth-targeted mental health services in Australia for a first episode of care over a 12 month period during 2013. This comprised 30,839 young people who accessed in-person services and 7,155 clients of the online service.Results show a major developmental shift in help-seeking influence across the age range, which varied for males and females, and a striking difference between the online and in-person service modalities. The dominant influence online, regardless of age, was the young person themself. In contrast, for in-person services, the dominant influence during adolescence was family, but this changed markedly in late adolescence to favour self-influence, with a lessor, but still substantial effect of family. The influence of friends was surprisingly low.To support young people with mental health problems to access mental health care, the personal connection of parents and family needs to be engaged to encourage in-person service use through better mental health literacy, particularly for adolescents. In the online environment, ways to ensure that young people themselves are guided to appropriate services are required.

headspace is Australia's innovation in youth mental healthcare and comprises the largest national network of enhanced primary care, youth mental health centres world-wide. headspace centres aim to intervene early in the development of mental ill-health for young people aged 12 to 25 years by breaking down the barriers to service access experienced by adolescents and emerging adults and providing holistic healthcare. Centres have been progressively implemented over the past 12 years and are expected to apply a consistent model of integrated youth healthcare. Internationally, several countries are implementing related approaches, but the specific elements of such models have not been well described in the literature.This paper addresses this gap by providing a detailed overview of the 16 core components of the headspace centre model.The needs of young people and their families are the main drivers of the headspace model, which has 10 service components (youth participation, family and friends participation, community awareness, enhanced access, early intervention, appropriate care, evidence-informed practice, four core streams, service integration, supported transitions) and six enabling components (national network, Lead Agency governance, Consortia, multidisciplinary workforce, blended funding, monitoring and evaluation).Through implementation of these core components headspace aims to provide easy access to one-stop, youth-friendly mental health, physical and sexual health, alcohol and other drug, and vocational services for young people across Australia.

Understanding help seeking intentions and behaviour is fundamental to the identification of factors that can be modified to increase engagement in counselling. Despite considerable research on these variables, integrating prior research has been impeded by a lack of consistent and psychometrically sound help-seeking measures. The General Help-Seeking Questionnaire (GHSQ) was developed to assess intentions to seek help from different sources and for different problems. Using a sample of 218 high school students, the GHSQ was found to have satisfactory reliability and validity, and appears to be a flexible measure of help-seeking intentions that can be applied to a range of contexts.

Climate change is exacerbating climate variability, evident in more frequent and severe weather-related disasters, such as droughts, fires, and floods. Most of what is known about the possible effects of climate change on rural mental health relates to prolonged drought. But though drought is known to be a disproportionate and general stressor, evidence is mixed and inconclusive. Over time, like drought other weather-related disasters may erode the social and economic bases on which farming communities depend. Rural vulnerability to mental health problems is greatly increased by socioeconomic disadvantage. Related factors may compound this, such as reduced access to health services as communities decline and a "stoical" culture that inhibits help-seeking. Australia has the world's most variable climate and is a major global agricultural producer. Yet despite Australia's (and, especially, rural communities') dependence on farmers' well-being and success, there is very little-and inconclusive-quantitative evidence about farmers' mental health. The aim of this review is to consider, with a view to informing other countries, how climate change and related factors may affect farmers' mental health in Australia. That information is a prerequisite to identifying, selecting, and evaluating adaptive strategies, to lessen the risks of adverse mental health outcomes. The authors identify the need for a systematic epidemiology of the mental health of farmers facing increasing climate change- related weather adversity.

Abstract Online interventions are increasingly seen as having the potential to meet the growing demand for mental health services. However, with the burgeoning of services provided online by psychologists, counselors, and social workers, it is becoming critical to ensure that the interventions provided are supported by research evidence. This article reviews evidence for the effectiveness of individual synchronous online chat counseling and therapy (referred to as "online chat"). Despite using inclusive review criteria, only six relevant studies were found. They showed that although there is emerging evidence supporting the use of online chat, the overall quality of the studies is poor, including few randomized control trials (RCTs). There is an urgent need for further research to support the widespread implementation of this form of mental health service delivery. KEYWORDS: effectivenessmental healthonline counseling and therapyoutcome Notes Note. CBT = Cognitive Behavioral Therapy. Summary from Barak, Klein, and Proudfoot, Citation2009. Note. RCT = Randomized control trials. Note. RCT = Randomized control trials; STAI = State-Trait Anxiety Inventory; BDI = Beck Depression Inventory; CBT = Cognitive Behavioral Therapy; GHQ = General Health Questionnaire; SIS = Session Impact Scale; GAF = Global Assessment of Functioning. Additional informationNotes on contributorsMitchell Dowling Mitchell Dowling is a Doctoral Candidate, BPsych & BA, Hons (Psych), University of Canberra. Debra Rickwood Debra Rickwood, PhD, is a Fellow of the Australian Psychological Society (FAPS), Professor of Psychology, University of Canberra and Head of Clinical Leadership and Research at headspace National Youth Mental Health Foundation.

Many smartphone applications (apps) for mental health (MHapps) are available to the public. However, few have been the subject of a randomized controlled trial (RCT), and the change processes that are hypothesized to mediate claimed effects have not been previously studied. This RCT compared the efficacy of three publicly available MHapps to a waitlist control condition in a community sample, in which no MHapp was provided. The three MHapps included cognitive behavioural therapy (CBT) toolkit app MoodKit, mood tracking app MoodPrism, and CBT strategy app MoodMission. Participants were randomly allocated to each condition, completed a baseline assessment, downloaded their allocated MHapp, and completed a second assessment 30 days later, with n = 226 included in final analyses (81% female; M age = 34 years). Compared to the control condition, all MHapp groups experienced increases in mental wellbeing, MoodKit and MoodMission groups experienced decreases in depression, and no groups experienced effects on anxiety. Mediated regressions revealed that increasing coping self-efficacy, rather than emotional self-awareness or mental health literacy, was the underlying process contributing to effects on mental health for all three MHapps. MHapps appear to be an effective solution for improving public mental health, notably by improving users' confidence in their ability to cope.

To examine changes in psychological distress and psychosocial functioning in young people presenting to headspace centres across Australia for mental health problems.Analysis of routine data collected from headspace clients who had commenced an episode of care between 1 April 2013 and 31 March 2014, and at 90-day follow-up.A total of 24 034 people aged 12-25 years who had first presented to one of the 55 fully established headspace centres for mental health problems during the data collection period.Main reason for presentation, types of therapeutic services provided, Kessler Psychological Distress Scale (K10) scores, and Social and Occupational Functioning Assessment Scale (SOFAS) scores.Most headspace mental health clients presented with symptoms of depression and anxiety and were likely to receive cognitive behaviour therapy (CBT). Younger males were more likely than other age- and sex-defined groups to present for anger and behavioural problems, while younger females were more likely to present for deliberate self-harm. From presentation to last assessment, over one-third of clients had significant improvements in psychological distress (K10) and a similar proportion in psychosocial functioning (SOFAS). Sixty per cent of clients showed significant improvement on one or both measures.Data regarding outcomes for young people using mental health care services similar to headspace centres are scarce, but the current results compare favourably with those reported overseas, and show positive outcomes for young people using headspace centres.

World PsychiatryVolume 18, Issue 2 p. 140-141 PerspectiveFree Access Creating headspace for integrated youth mental health care Patrick McGorry, Patrick McGorry Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia Centre for Youth Mental Health, University of Melbourne, Parkville, Australia headspace, the National Youth Mental Health Foundation, Melbourne, AustraliaSearch for more papers by this authorJason Trethowan, Jason Trethowan headspace, the National Youth Mental Health Foundation, Melbourne, AustraliaSearch for more papers by this authorDebra Rickwood, Debra Rickwood headspace, the National Youth Mental Health Foundation, Melbourne, AustraliaSearch for more papers by this author Patrick McGorry, Patrick McGorry Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia Centre for Youth Mental Health, University of Melbourne, Parkville, Australia headspace, the National Youth Mental Health Foundation, Melbourne, AustraliaSearch for more papers by this authorJason Trethowan, Jason Trethowan headspace, the National Youth Mental Health Foundation, Melbourne, AustraliaSearch for more papers by this authorDebra Rickwood, Debra Rickwood headspace, the National Youth Mental Health Foundation, Melbourne, AustraliaSearch for more papers by this author First published: 06 May 2019 https://doi.org/10.1002/wps.20619Citations: 62AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat International momentum in global mental health reform is building, responding to overwhelming evidence of unmet need in high, middle and low income countries alike, and powerful economic arguments that mental health care represents the best value for money. Yet adequate investment remains an elusive goal, with the treatment gap as wide as ever1. We have long argued that new paradigms that dispel stigma, open up early access, safeguard hope, and build expertise and quality based on the best available evidence, must be embraced and scaled up in real world settings2. The growing success of prototypical evidence-based early psychosis models in many parts of the world has paved the way for a more definitive reform paradigm, one which links transdiagnostic early intervention with a decisive focus on young people. Early intervention to reduce the impact of potentially serious mental and substance use disorders is an achievable goal if we focus on the period of peak risk of onset. Young people aged between 10 and 24 years make up over a quarter of the world's population, and mental ill-health is their key health issue and leading cause of disability. Virtually all major mental and substance use disorders emerge during the transitional zone between puberty and mature adulthood but, despite being burdened by the highest incidence and prevalence of adult type mental disorders, young people have the worst access to health care. Society as a whole and health systems in particular have comprehensively failed our young people, and at a time when their mental health appears to be deteriorating. This paradox is finally beginning to be recognized, and progressive jurisdictions around the world are designing and scaling up novel youth and family friendly systems of care to address this serious public health problem2. "Integrated youth health care" is an enhanced primary care model offering "soft entry" to care with access barriers minimized. It provides a high capacity first step in stepped or staged care, with other pathways able to flow from this initial low stigma source. It is highly consistent with the global strategy long advocated by the World Health Organization, namely to build and blend mental health expertise within primary care platforms. The key features are: Youth (and family) participation and co-design at all levels, enabling youth-friendly, stigma-free cultures of care providing what young people and their families really need. Developmental appropriateness reflecting the epidemiology of mental ill-health and providing a good cultural fit for adolescents and emerging adults aged 12-25 years. Integration of mental health, physical health, alcohol and other drug, and vocational support. An optimistic early intervention approach offering safe, holistic, evidence-informed, proportional and stage-linked care, including risk-benefit considerations and shared decision-making, with social and vocational outcomes as the key targets. A single, visible trusted location, a "one stop shop" or "integrated practice unit"3 with providers organized as a dedicated team of clinical and non-clinical (e.g., peer worker) personnel providing the full spectrum of care around the young person and his/her family. Elimination of discontinuities at peak periods of need for care during developmental transitions, in particular demolishing the anachronistic and developmentally inappropriate "hard border" at age 18. Seamless linkages with services for younger children and adults. Reform began in Australia in 2006, with Australian government funding for ten headspace centres4. They have been scaled up through a series of funding rounds, reaching a total of 110 centres in early 2019. Centres are commissioned through a lead agency and local consortia, and have rapidly gained strong local community and political support from all sides and levels of politics. To June 2018, 446,645 young people accessed headspace centres, phone or online (eheadspace) services, with 2.5 million occasions of service delivered. In 2017-8, 88,500 young people accessed face-to-face headspace centre services, and 33,700 accessed online or via phone. headspace also offers suicide postvention services in high schools, and vocational recovery interventions online and face to face. Six early psychosis platforms linked to clusters of local headspace portals build on the primary care model with comprehensive evidence-based care for early psychosis in community settings. Independent evaluation of headspace centres confirmed that they provide much better access to young people, with very high levels of satisfaction and safety5. Outcome studies show that 60% of young people improve significantly either symptomatically, functionally or both6, 7. Despite this tangible success, which has inspired similar models internationally, headspace remains a work in progress. It offers mostly brief episodes of care, and the effect size for improvement in the total sample remains small to modest compared to usual (poorly accessed) care. There are several reasons for this. First, headspace is a treatment delivery system and offers the same treatment content as usual care, albeit more efficiently and in a single location. Second, capped funding and the lack of funding streams for key pillars, notably alcohol and other drug and vocational interventions, mean that tenure of care and model fidelity need to be strengthened. Third, outcomes for the large subset of more complex and unwell young people, whose needs can only be met by more intensive expert services, obscure the benefits for those with earlier presentations who are most likely to do well with this model by not progressing to more severe or persistent illness and functional impairment. headspace currently only provides access to a minority of the young Australians who need it. At least 132 centres could be justified on cost-effectiveness alone, with many more required for full national coverage5. Each region of Australia needs a cluster of headspace entry-level portals seamlessly linked to transdiagnostic specialized care integrating mental and physical health with alcohol and other drugs expertise, vocational interventions and online/digital health platforms. Assertive and intensive home-based care, and clinicians with expertise in complex syndromes (such as borderline, eating, mood and psychotic disorders) are missing elements, and interface with hospital-based services is therefore needed. Strong national oversight to assure integrative commissioning, stronger financial models, additional funding streams, longer tenure and greater depth of expertise will strengthen the capacity of the model. The youth mental health paradigm is in its infancy and will be driven by a dynamic blend of grassroots and professional leadership8. Early adopters, inspiring leaders, philanthropic visionaries and patrons have emerged in progressive regions of the world, notably Ireland, Canada, Denmark, Israel, the Netherlands, France, Singapore, and parts of England and California9. Child and adolescent psychiatry, still a seriously undersized speciality, has begun to recognize the need and opportunity for a paradigm shift, which it has labelled "transitional psychiatry". Momentum within and beyond the mental health field is building and could be decisive in paving the way for a wider revolution in mental health care. References 1 Patel V, Saxena S, Lund C et al. Lancet 2018; 392: 1553- 98. 2 McGorry PD, Goldstone SD, Parker AG et al. Lancet Psychiatry 2014; 1: 559- 68. 3 Porter ME, Lee TH. Harv Bus Rev 2013; 91: 50- 70. 4 McGorry PD, Tanti C, Stokes R et al. Med J Aust 2007; 187: S68- 70. 5 Hilferty F, Cassells R, Muir K et al. Is headspace making a difference to young people's lives? Final report of the independent evaluation of the headspace program. Sydney: University of New South Wales, 2015. 6 Rickwood DJ, Mazzer KR, Telford NR et al. Med J Aust 2015; 202: 537- 42. 7 Rickwood D, Paraskakis M, Quin D et al. Early Interv Psychiatry 2019; 13: 159- 66. 8 Timms H, Heimans J. New power: how it's changing the 21st century – and why you need to know. London: Pan Macmillan, 2018. 9 Hetrick SE, Bailey AP, Smith KE et al. Med J Aust 2017; 207: S5- 18. Citing Literature Volume18, Issue2June 2019Pages 140-141 ReferencesRelatedInformation

Abstract Aim Over the past two decades, the youth mental health field has expanded and advanced considerably. Yet, mental disorders continue to disproportionately affect adolescents and young adults. Their prevalence and associated morbidity and mortality in young people have not substantially reduced, with high levels of unmet need and poor access to evidence‐based treatments even in high‐income countries. Despite the potential return on investment, youth mental disorders receive insufficient funding. Motivated by these continual disparities, we propose a strategic agenda for youth mental health research. Method Youth mental health experts and funders convened to develop youth mental health research priorities, via thematic roundtable discussions, that address critical evidence‐based gaps. Results Twenty‐one global youth mental health research priorities were developed, including population health, neuroscience, clinical staging, novel interventions, technology, socio‐cultural factors, service delivery, translation and implementation. Conclusions These priorities will focus attention on, and provide a basis for, a systematic and collaborative strategy to globally improve youth mental health outcomes.

The authors aimed to evaluate changes in use of government-subsidized primary mental health services, through the Medicare Benefits Schedule (MBS), by young people during the first year of the COVID-19 pandemic in Australia and whether changes were associated with age, sex, socioeconomic status, and residence in particular geographical areas.Interrupted time-series analyses were conducted by using quarterly mental health MBS service data (all young people ages 12-25 years, 2015-2020) for individual Statistical Area Level 3 areas across Australia. The data captured >22.4 million service records. Meta-analysis and meta-regression models estimated the pandemic interruption effect at the national level and delineated factors influencing these estimates.Compared with expected prepandemic trends, a 6.2% (95% CI=5.3%-7.2%) increase was noted for all young people in use of MBS mental health services in 2020. Substantial differences were found between age and sex subgroups, with a higher increase among females and young people ages 18-25. A decreasing trend was observed for males ages 18-25 (3.5% reduction, 95% CI=2.5%-4.5%). The interruption effect was strongly associated with socioeconomic status. Service uptake increased in areas of high socioeconomic status, with smaller or limited uptake in areas of low socioeconomic status.During 2020, young people's use of primary mental health services increased overall. However, increases were inequitably distributed and relatively low, compared with increases in population-level mental health burden. Policy makers should address barriers to primary care access for young people, particularly for young males and those from socioeconomically disadvantaged backgrounds.

Climate change is escalating and will disproportionately affect young people. Research on the mental health consequences of worry or concerns related to climate change are so far limited. This study aims to evaluate the extent of climate change concern in young people aged 15–19, its association with various demographic factors and its impact on psychological distress and future outlook. Understanding the impact of climate concerns on young people's mental wellbeing is crucial for identifying effective measures and building resilience. Climate concerns, psychological distress, and future outlook were measured in the 2022 Mission Australia Youth Survey, Australia's largest annual population-wide survey of young people aged 15 to 19 (N = 18,800). Multinomial logistic regression models were used to map factors associated with climate concerns and assess whether climate concerns are associated with psychological distress and future outlook. One in four young people reported feeling very or extremely concerned about climate change. Climate concerns were higher among individuals identifying as female or gender diverse, or who self-reported a mental health condition. After controlling for confounding factors, we found those who were very or extremely concerned about climate change to be more likely to have high psychological distress than those not at all concerned (Relative risk ratio (RRR) = 1.81; 95% CI: 1.56–2.11), and more likely to have a negative future outlook (RRR = 1.52; 95% CI: 1.27–1.81). These associations were stronger among participants who reported to be gender diverse, Indigenous or from outer-regional/remote areas. This study identified associations between climate concerns, psychological distress, and future outlook among young people. Immediate attention from research and policy sectors to support climate change education, communication strategies and targeted interventions is urgently required to mitigate long-term impacts on young people's wellbeing.

It has been found that university students who were the least skilled at managing their emotions also had the lowest intention of seeking help from a variety of nonprofessional sources (e.g. family and friends). The present study sought to extend these findings by focusing on adolescents, examining a larger number of emotional competencies, and exploring the possibility that social support explains the relationship between emotional competence and help-seeking. A total of 137 adolescents (aged 16-18) completed an anonymous survey that assessed social support, emotional competencies, and intention to seek help from a variety of professional and nonprofessional sources. As expected, adolescents who were low in emotional awareness, and who were poor at identifying, describing, and managing their emotions, were the least likely to seek help from nonprofessional sources and had the highest intention of refusing help from everyone. However, low emotional competence was not related to intention to seek help from professional sources (e.g. mental health professionals). The significant results involving nonprofessional sources were only partially explained by social support, suggesting that even adolescents who had high quality support were less likely to make use of that support if they were low in emotional competence.

We examined whether adolescents who are poor at identifying, describing, and managing their emotions (emotional competence) have lower intentions to seek help for their personal-emotional problems and suicidal ideation, as observed in adult studies. We also examined whether age moderated the relationship between competence and help-seeking. Two hundred and seventeen adolescents completed measures of emotional competence, help-seeking, hopelessness, and social support. Results indicated that adolescents who were low in emotional competence had the lowest intentions to seek help from informal sources (i.e., family and friends) and from some formal sources (e.g., mental health professionals), and the highest intentions to seek help from no-one. There was one important age-related qualification: difficulty in identifying and describing emotions was associated with higher help-seeking intentions amongst young adolescents but lower intentions among older adolescents. Social support, hopelessness, and sex could not entirely explain these relationships. Thus, even those who had high quality social support had less intention to use it if they were low in emotional competence.

Emerging or early adulthood is the life stage spanning 18–25 years of age. In Australia, anxiety and affective disorders (often classifi ed as ‘common mental disorders’) are prevalent in this age group and suicide is also a concern. Professional mental health care can reduce the long-term impact of these mental health problems and protect against the development of severe forms of these disorders. However, up to three-quarters of young people with mental health needs do not seek professional help for their condition. This study aimed to examine the extent to which belief in the need for autonomy and intentions to seek help from informal help-sources act as barriers or facilitators to seeking help from a mental health service for symptoms of a common mental disorder and suicidal thoughts, in a sample of 641 emerging adults aged 18–25 years. For common mental disorders and suicidal thoughts, results reveal that the family of origin has an important influence on mental health service access among emerging adults, but also, that the growing independence and autonomy of emerging adults needs to be accommodated if mental health treatment services are to be accessible to this important age group.

Teachers are considered well placed to identify issues concerning students' mental health and well-being and can play a critical role in the helping process for their concerns. However, little is known about the views of teachers regarding their role in supporting student mental health and how well-equipped they feel to fulfil it. The aim of this study was to investigate teachers' perceived role breadth and perceived self-efficacy in supporting students' mental health. Interviews were conducted with 21 teachers from Canberra, Australia. Teachers viewed supporting student mental health as part of their role, though perceived a lack of knowledge and skills in mental health-related areas. They clearly emphasized the need to work within a well-coordinated pastoral care system. Additional training in mental health and clear role delineation within the school may assist teachers to feel better prepared to effectively and appropriately support student mental health.

Mental health outcome measures are used to monitor the quality and effectiveness of mental health services. There is also a growing expectation for implementation of routine measurement and measures being used by clinicians as a feedback monitoring system to improve client outcomes. The recent focus in Australia and elsewhere targeting mental health services to young people aged 12–25 years has meant that outcome measures relevant to this age range are now needed. This is a shift from the traditional divide of child and adolescent services versus adult services with a transitioning age at 18 years. This systematic review is the first to examine mental health outcome measures that are appropriate for the 12 to 25 year age range. MEDLINE and PsychINFO databases were systematically searched to identify studies using mental health outcome measures with young people aged 12 to 25 years. The search strategy complied with the relevant sections of the PRISMA statement. A total of 184 published articles were identified, covering 29 different outcome measures. The measures were organised into domains that consisted of eight measures of cognition and emotion, nine functioning measures, six quality of life measures, and six multidimensional mental health measures. No measures were designed specifically for young people aged 12 to 25 years and only two had been used by clinicians as a feedback monitoring system. Five measures had been used across the whole 12 to 25 year age range, in a range of mental health settings and were deemed most appropriate for this age group. With changes to mental health service systems that increasingly focus on early intervention in adolescence and young adulthood, there is a need for outcome measures designed specifically for those aged 12 to 25 years. In particular, multidimensional measures that are clinically meaningful need to be developed to ensure quality and effectiveness in youth mental health. Additionally, outcome measures can be clinically useful when designed to be used within routine feedback monitoring systems.

To describe the services provided to young people aged 12-25 years who attend headspace centres across Australia, and how these services are being delivered.A census of headspace clients commencing an episode of care between 1 April 2013 and 31 March 2014.All young people first attending one of the 55 fully established headspace centres during the data collection period (33,038 young people).Main reason for presentation, wait time, service type, service provider type, funding stream.Most young people presented for mental health problems and situational problems (such as bullying or relationship problems); most of those who presented for other problems also received mental health care services as needed. Wait time for the first appointment was 2 weeks or less for 80.1% of clients; only 5.3% waited for more than 4 weeks. The main services provided were a mixture of intake and assessment and mental health care, provided mainly by psychologists, intake workers and allied mental health workers. These were generally funded by the headspace grant and the Medicare Benefits Schedule.headspace centres are providing direct and indirect access to mental health care for young people.

Background Mental health interventions for young people are increasingly being delivered online. This is occurring due to an assumption that young people prefer online interventions because they address some of the well‐established help‐seeking barriers. Method A self‐report questionnaire investigating preferences for mental health care delivery was administered to a nonclinical sample of 231 young people aged 15–19. Results The strongest help‐seeking intention in response to a scenario describing symptoms of depression was for face‐to‐face services, followed by not seeking help at all. Only 16% expressed a preference for online treatment. Conclusion The assumption that a majority of young people will prefer online delivery of mental health treatment was not supported, although boys showed a stronger relative preference for online modes.

Parents play an important role in access to mental health care for children and adolescents. They are often the first to seek professional help, yet their help-seeking experiences are not well documented. This study investigates parents’ help-seeking for children and adolescents with emotional and behavioural problems. A thematic analysis of interviews with 15 parents showed three main themes describing the help-seeking experience: Pathways to mental health care; intra- and inter-personal infl uences; and the impact of service use experiences. Overall, parents needed to persist through an often arduous process to obtain appropriate mental health care for their children. They often found it difficult to understand the process to obtain help and encountered numerous obstacles. Greater focus on supporting parents in their critical role of identifying mental health problems in their children and gaining early access to appropriate mental health care is needed.

The adolescent and early adult years are periods of peak prevalence and incidence for most mental disorders. Despite the rapid expansion of Web-based mental health care, and increasing evidence of its effectiveness, there is little research investigating the characteristics of young people who access Web-based mental health care. headspace, Australia's national youth mental health foundation, is ideally placed to explore differences between young people who seek Web-based mental health care and in-person mental health care as it offers both service modes for young people, and collects corresponding data from each service type.The objective of this study was to provide a comprehensive profile of young people seeking Web-based mental health care through eheadspace (the headspace Web-based counseling platform), and to compare this with the profile of those accessing help in-person through a headspace center.Demographic and clinical presentation data were collected from all eheadspace clients aged 12 to 25 years (the headspace target age range) who received their first counseling session between November 1, 2014 and April 30, 2015 via online chat or email (n=3414). These Web-based clients were compared with all headspace clients aged 12 to 25 who received their first center-based counseling service between October 1, 2014 and March 31, 2015 (n=20,015).More eheadspace than headspace center clients were female (78.1% compared with 59.1%), and they tended to be older. A higher percentage of eheadspace clients presented with high or very high levels of psychological distress (86.6% compared with 73.2%), but they were at an earlier stage of illness on other indicators of clinical presentation compared with center clients.The findings of this study suggest that eheadspace is reaching a unique client group who may not otherwise seek help or who might wait longer before seeking help if in-person mental health support was their only option. Web-based support can lead young people to seek help at an earlier stage of illness and appears to be an important component in a stepped continuum of mental health care.

For mental health professionals to provide personalized early interventions, young people need to disclose sensitive information to a clinician they are unlikely to have yet formed a relationship with. We conducted in-depth qualitative interviews with 129 young people aged 12-25 years from several sites across Australia to gauge views on whether young people thought that an electronic psychosocial assessment tool could help them initially disclose personal information. Additionally, we were interested in whether young people from different demographic groups held similar views around using the e-tool. Results provided support for the use of an e-tool, with most young people stating that it could help in the disclosure of particularly embarrassing problems. The main advantages reported were that the e-tool would support disclosure without fear of judgment by health professionals, and would enable young people greater input in deciding what to focus on. Young people who held a preference to simply talk were most concerned about the clinician missing non-verbal cues. These findings highlight the value of incorporating electronic options within clinical practice, but also the need for health professionals to work within a flexible framework guided by the individual preferences of each of their clients.

Given the ubiquity and interactive power of smartphones, there are opportunities to develop smartphone applications (apps) that provide novel, highly accessible mental health supports. This paper details the development of a smartphone app, “MoodMission,” that aims to provide evidence-based Cognitive Behavior Therapy (CBT) strategies for mood- and anxiety-related problems, contributing to the prevention of clinically significant depression and anxiety disorders and serving as an adjunct to therapeutic interventions delivered by trained health professionals. MoodMission was designed to deliver strategies in the form of real-time, momentary responses to user-reported low moods and anxiety. The development process involved: (a) construction of a battery of strategies, (b) empirical evaluation, (c) a software and behavioral plan design and testing process, (d) user feedback, and (e) a public launch. A pilot study of 44 participants completed the Mobile Application Rating Scale (MARS; Hides et al., 2014) for usability testing and feedback. MoodMission was rated significantly higher than standardized health app norms on the majority of the domains, including Entertainment, Interest, Customization, Target Group, Graphics, Visual Appeal, Quality of Information, Quantity of Information, Visual Information, Credibility of Source, Recommendation to Use, Estimated Frequency of Use, and Overall Rating (Hedges’s g range 0.57–1.97, p < .006). Case examples illustrate the practical uses of the app. In addition to clinical applications, MoodMission holds promise as a research tool either as an augmentation to clinician-delivered therapy, or as a vehicle for standardizing client access to specific CBT strategies (e.g., in studies intending to study different change processes).

Back to table of contents Previous article Next article ArticlesFull AccessPatterns of Youth Mental Health Service Use and Discontinuation: Population Data From Australia's Headspace Model of CareZac E. Seidler, M.C.P., Ph.D., Simon M. Rice, M.C.P., Ph.D., Haryana M. Dhillon, Ph.D., Sue M. Cotton, M.App.Sc., Ph.D., Nic R. Telford, M.S.Sc., Juliet McEachran, Ph.D., Debra J. Rickwood, Ph.D.Zac E. Seidler, M.C.P., Ph.D., Simon M. Rice, M.C.P., Ph.D., Haryana M. Dhillon, Ph.D., Sue M. Cotton, M.App.Sc., Ph.D., Nic R. Telford, M.S.Sc., Juliet McEachran, Ph.D., Debra J. Rickwood, Ph.D.Published Online:13 Aug 2020https://doi.org/10.1176/appi.ps.201900491AboutSectionsView articleAbstractSupplemental MaterialPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View articleAbstractObjective:Young people (ages 12–25) experience the highest risk of developing mental disorders; however, their uptake of and engagement with treatment is low. The study explored sociodemographic predictors of attendance and discontinuation of mental health services in a large, population-based sample.Methods:Data were from the minimum data set collected from young people (ages 12–25) who attended headspace, Australia's National Youth Mental Health Foundation, from 2013 to 2017 (N=80,502). Data on key demographic and clinical variables and practitioner ratings of need for ongoing care were analyzed. Cox regression was used to examine the association between sociodemographic factors and rates of discontinuation based on practitioner-rated need for ongoing treatment.Results:The mean±SD number of sessions attended during the first episode of care was 4.6±4.4 sessions (median=3). Session-by-session discontinuation rates ranged from 14% to 19% across 10 sessions. The proportion discontinuing treatment before session 11 was 71.2%. Analysis of a subgroup (N=40,039) showed that 24% of those who discontinued treatment later returned to the same headspace center for a second episode of care. Those who were most at risk of discontinuation were older (ages 18–25), male, heterosexual, Aboriginal or Torres Strait Islander, and living in a rural location.Conclusions:Sociodemographic factors were found to be associated with treatment discontinuation, and some young people followed a pathway in and out of mental health treatment. Further exploration is needed to determine the appropriate length and type of care for specific sociodemographic groups and how best to tailor treatment accordingly.HIGHLIGHTSIn 2006, the Australian government funded headspace, the National Youth Mental Health Foundation, to better respond to the high prevalence of mental health problems among young people.Findings indicate that discontinuation from headspace is common and that targeted engagement protocols are needed for key groups, including those ages 18–25 and those identifying as male, heterosexual, or Aboriginal and Torres Strait Islander and those living in rural areas.A quarter of young people who discontinued treatment later returned to their headspace center for a second episode of care.Even though headspace was designed as an early intervention service, nearly half the young people who attended an intake self-reported severe levels of distress.There is increasing global attention focused on improving the mental health and well-being of young people (1). Young people ages 16 to 24 have the highest reported prevalence rates of many mental health conditions (2, 3), and effective treatment is hampered by a reluctance to seek professional care (2, 4). Barriers to help seeking experienced by young people are diffuse, including poor symptom recognition, difficulties navigating the system, financial limitations, and perceived stigma and embarrassment (5, 6). Particularly at-risk populations of young people in Australia include those with the following backgrounds: Aboriginal or Torres Strait Islander, culturally and linguistically diverse (CALD), and sexuality diverse (i.e., LGBTIQ), as well as those residing in rural or regional areas (7). Furthermore, across these groups, young men remain a particular challenge to reach, engage, and retain in treatment (8). The elevated suicide rate for young men (9) highlights the priority for gender-informed interventions and strategies to enhance engagement (10, 11).Efforts to reduce treatment gaps and structural barriers have increased accessibility of mental health care for young people (12). Nonetheless, for young people able to access mental health care services, an estimated 30%−75% will discontinue treatment early (13). Among adults in the general population, the estimated range is lower, from 20% to 40% (14, 15). This is a key issue for investigation, because untreated mental illness with onset during adolescence has been shown to persist into adulthood, with deleterious effects on education, employment, and psychosocial functioning (1, 16). Moreover, compared with young people who complete treatment, those who discontinue are more likely to have ongoing symptoms, future impairment or relapse, and lower treatment satisfaction and are less likely to seek help again (5, 17).Prior research exists in this area, but methodological shortcomings have included inconsistent definitions of discontinuation, mixed study settings, and restricted samples, which have made it difficult to accurately delineate the prevalence of discontinuation among young people (18). In most studies, treatment discontinuation has been defined by practitioner rating; that is, the young person ceases attending despite a practitioner's recommendation for ongoing treatment (e.g., 17). Others have defined discontinuation as the young person's failure to attend a set number of sessions (e.g., 19). Overall, the extant literature is limited by this practitioner-centric focus, largely disregarding the autonomous decision making of young people.Regardless of definition, research indicates that young people who discontinue treatment are most likely to do so within the first three sessions (20). Existing studies lack generalizability to most real-world settings, because they typically include young people with a single mental disorder and recruitment from a single geographical location or as part of a randomized controlled trial and involve manualized treatment with a finite end point (13, 17). Trials are important in demonstrating treatment efficacy. However, in exploring discontinuation rates, trials involve small and typically Caucasian cohorts (N<500), of high socioeconomic status, with more severe and single disorders, and from specific clinics (13). Thus larger and more diverse populations are needed to explore real-world discontinuation. In Australia, little research has been conducted in this area beyond Johnson and colleagues' (21, 22) study of 520 young people in community-based child and adolescent mental health services. Almost half the sample discontinued over 12 months, but no single factor was associated with discontinuation across diagnoses.The limited literature reports that young people who are older, have a CALD background, are socioeconomically disadvantaged, and are from single-parent households are more likely to discontinue (13, 18, 20, 23). Clinically, suicidal thoughts and increased psychological distress have been linked with increased rates of discontinuation (13). Other factors, such as gender, show mixed findings, which may be related to discontinuation in different settings (18, 20). Gender is particularly important among young people, because even though the need for mental health treatment is greatest at this time of life, 16- to 24-year-old males are the least likely of any age or gender group to access care, are less likely than young females to self-report experiencing any distress, and are the most difficult of any gender or age group to engage in treatment (3, 12, 24). Underpinning young men's problematic relationship with help seeking is poor symptom recognition and mental health literacy, as well as high levels of self-stigma and shame (10, 25). Evidence indicates that these poor help-seeking and therapeutic engagement rates may stem from a rigid conformity to dominant masculine ideals, including stoicism and self-reliance (26).In 2006, the Australian government funded headspace, the National Youth Mental Health Foundation, to better respond to the high prevalence of mental health problems among young people and provide a nationwide, early intervention service developed with their specific needs in mind. At headspace centers, young people can obtain free or low-cost, easy-access services to address their broad needs across mental and general medical health. The centers also provide vocational and substance misuse counseling, with links to local community and specialist services. The headspace model actively integrates youth participation and preferences. At the time of writing, 110 centers were operational across Australia, complemented by an online youth mental health service called eheadspace, making headspace the largest national network for youth mental health treatment worldwide (27).Referrals can be made by young people, family, friends, or health or community service providers. Young people typically undergo an initial intake assessment and are then provided treatment with one or more mental health practitioners (e.g., psychologist) depending on symptom severity for up to 10 subsidized sessions, including medication review where indicated. Services provided by headspace focus on early and preventive interventions, targeting symptoms prior to development of serious and persistent mental health conditions. However, since the inception of headspace, it has been argued that centers have been required to take on roles for which the model was not designed or funded, namely treatment of young people with complex and acute mental health issues (28). Examining patterns of attendance and discontinuation—in the context of presenting psychological distress and demographic factors—is important to identify areas where engagement could be strengthened.The aim of this study was to assess mental health treatment uptake, discontinuation, and potential service reengagement by young people attending headspace centers in Australia. We sought to inform efforts to improve treatment delivery, engagement, and outcomes, mindful of the cyclical and complex patterns of engagement, driven by the preferences and decision making ("experiential knowledge") of young people attending for support in accordance with their needs (29).MethodsDesign and Study CohortA retrospective cohort study was undertaken to identify and examine factors associated with discontinuation among young people ages 12–25 seeking help for the first time from headspace services across 100 centers in Australia. All participants accessed the service initially for a psychological, substance misuse, or situational concern. The headspace service user pathway generally includes a psychosocial intake assessment, undertaken by an intake worker. Young people who attended only this assessment were excluded from the sample. In Australia, 10 sessions annually is the standard cap for government-supported rebates for mental health treatment; however, a "minimally adequate" course of treatment is six services in any one referral—or fewer depending on the referral and the client's clinical need (30, 31). Given this government-supported cap and given that over 90% of the headspace population attended 10 or fewer sessions, this study described attendance rates beyond 10 sessions for the entire sample but reported only the results of session-by-session and cumulative discontinuation rates up to 10 mental health sessions.Data SourceThe study data represent a census of headspace clients, sourced from routine data collection. Headspace centers collect a minimum data set (MDS) from all clients, asking key demographic (e.g., age, sexuality, and education) and clinical (e.g., Kessler Psychological Distress Scale [K10] [32]) questions at assessment and subsequent service occasions. The treating practitioner completes a questionnaire after each service occasion, reflecting on client functioning, concerns, and future pathways in the service or referral to another provider.This analysis reports on data from 80,502 young people who accessed headspace for active mental health treatment (rather than intake assessment) with a mental health practitioner (e.g., psychologist, psychiatrist, or social worker) for the first time between April 1, 2013, and March 31, 2017 (a client flow diagram is included in an online supplement to this article).MeasuresDiscontinuation.A uniform definition of young person–initiated treatment discontinuation was applied. Following each session, the headspace practitioner classified the client's need for ongoing care across 19 options that were grouped under the following categories: continue treatment, not continue treatment, refer to another service, or met treatment goals. Clients who were classified as continue treatment but who did not attend the next session were defined as "discontinued" regardless of the number of sessions attended overall. "No discontinuation" was defined as instances in which the practitioner referred the young person to another service; noted that treatment goals had been reached; or noted that both had mutually agreed to terminate, even if therapy goals had only been partially achieved. Each young person had 90 days to reengage with headspace, after which this first episode of care was considered discontinued and no further sessions were included in this analysis of treatment engagement.Reengagement.Young people reentering treatment in the same headspace center from April 1, 2014, to March 31, 2017, for any duration or number of sessions following a previous discontinuation were classified as "reengaged." This secondary analysis was conducted with a subsample of young people, ages 12–24 (to exclude those ages 25 and older who were no longer within the age range of the service), who completed their first episode of treatment between April 1, 2014, and April 1, 2016, in order to focus on those returning to their headspace center for a second episode (see below). This approach allowed young people who discontinued in 2016 up to 12 months to reengage.Client CharacteristicsSelf-reported demographic characteristics included age (legal minors [ages 12–17] or adults [ages 18–26]), Aboriginal or Torres Strait Islander (identifying [yes or no] as Aboriginal or Torres Strait Islander), sexuality (identifying as lesbian, gay, bisexual, queer/questioning [LGBQ], or heterosexual-straight), geographical location (three categories [major city, regional, and remote] based on the person's postcode and compared with Australian Bureau of Statistics remoteness data), and gender (male or female).Clinical characteristics included K10 scores of psychological distress (32). K10 scores were grouped into four levels of psychological distress: likely to be well (scores 10–19), likely to have a mild mental disorder (20–24), likely to have a moderate mental disorder (25–29), and likely to have a severe mental disorder (30–50). These groups are informative bands with clear clinical significance. The external validity and interpretability of results are greater with these bands in mind. Given the large sample, grouping of the K10 continuous variable had little effect on statistical power.Statistical AnalysisDescriptive statistics were used to characterize the sample. Chi-square analyses evaluated differences in number of sessions attended grouped into four categories (one to three sessions, four to six sessions, seven to 10 sessions, and 11 or more sessions) and differences in grouped K10 scores (well, mild, moderate, and severe) across demographic groups. All chi-square tests were reported with standardized residuals to measure the strength of difference between observed and expected values. Bonferroni comparisons for column proportions were analyzed with adjusted p values, and Cramer's V effect sizes were reported based on Cohen's (33) criteria for all analyses.Life tables were constructed to quantify the number of individuals discontinuing treatment at each session and to create corresponding hazard and survival proportions at each treatment session. Multivariate Cox regression was used to examine associations between group-based demographic factors and discontinuation over time to estimate relative risk of discontinuation across groups. The predictor variables entered into this model were those without considerable missing data, deemed potential predictors of discontinuation both separately and together, and based on the extant literature. All variables were entered at the same time. Given the sample size, we opted for a conservative alpha level of ≤0.001 and report 99% confidence intervals. All analyses were replicated independently by two researchers (Z.E.S. and J.M.) to ensure consistency and accuracy in reporting. All analyses were conducted using IBM SPSS Statistics, version 24.ResultsSample CharacteristicsIn the study sample of 80,502 young people, 61% of participants were female, 17% identified as LGBQ, 8% identified as Aboriginal or Torres Strait Islander, and 62% lived in major cities (excluding missing data; Table 1). The mean±SD age of participants was 17.1±3.40 (range 11–26). The secondary reengagement analyses included a subsample of 40,039 young people, and the demographic profile of this subgroup was similar to that of the total sample.TABLE 1. Sociodemographic characteristics of young people who attended headspace between April 1, 2013, and March 31, 2017 (N=80,502)CharacteristicN%Valid %aGender Male28,16435.038.7 Female44,61755.461.3 Other or missing7,7219.6—Age 12–1745,26956.259.7 ≥1830,53737.940.3 Missing4,6965.8—Aboriginal or Torres Strait Islander No67,60984.092.4 Yes5,5936.97.6 Did not identify or missing7,3009.1—Sexuality Non-LGBQb57,33178.082.7 LGBQ11,98016.317.3 Undisclosed sexuality or missing11,1915.2—Rurality (based on young person's address) Major city46,84758.261.8 Regional28,01334.836.9 Rural9911.21.3 Missing4,6515.8—aThese percentages were derived from the number of respondents for whom data were available (excludes "missing").bLesbian, gay, bisexual, queer/questioning.TABLE 1. Sociodemographic characteristics of young people who attended headspace between April 1, 2013, and March 31, 2017 (N=80,502)Enlarge tableDistressPsychological distress, measured by the K10, was in the severe range for 49% of the sample (Table 2). A larger proportion of males than females scored in the well range (25% versus 13%), and the proportion of females with severe scores was significantly larger than the proportion of males with severe scores (54% versus 39%; χ2=2,213.70, N=70,594, df=3, p<0.001, V=0.18). Regarding age, a larger percentage of older clients (ages ≥18 ) scored in the severe range, compared with younger clients (ages 12–17) (56% versus 44%; χ2=1,663.83, N=71,539, df=3, p<0.001, V=0.15). Aboriginal or Torres Strait Islander young people were significantly more likely to score in the well range, compared with young people who did not identify as Aboriginal or Torres Strait Islander (21% versus 17%; χ2=65.00, N=71,303, df=3, p<0.001, V=0.03).TABLE 2. Scores on the Kessler Psychological Distress Scale (K10) of young people who attended headspace, by sociodemographic characteristicsaK10 distress groupbTotalWell (score range, 10–19)Mild (score range, 20–24)Moderate (score range, 25–29)Severe (score range, 30–50)CharacteristicN%N%SRcN%SRcN%SRcN%SRcGender70,594100 Male27,153396,7612528.04,664179.35,13119010,59739–22.1 Female43,441615,75813–22.25,92314–7.38,21119023,5495417.5Age71,539100 12–1742,875609,3622220.86,854165.77,83318–2.718,82644–14.0 ≥1828,664403,24511–25.43,82313–7.05,646203.315,9505617.1Aboriginal or Torres Strait Islander71,303100 No65,9549211,41117–1.89,84015−.112,559191.232,14449.4 Yes5,34981,138216.480515.287716–4.12,52947–1.4Total12,62117—10,68415—13,48519—34,78849—aDenominators for the percentages were the number of respondents for whom data were available. The row percentages may sum to greater than 100% because of rounding.bK10 possible scores range from 10 to 50, with higher scores indicating greater psychological distress.cStandard residual.TABLE 2. Scores on the Kessler Psychological Distress Scale (K10) of young people who attended headspace, by sociodemographic characteristicsaEnlarge tablePatterns of AttendanceOn average, participants attended a mean±SD of 4.6±4.4 sessions (median, three sessions; range, one to 35 sessions) and remained in the service for a mean of 119±111.18 days (median, 86; range, one to 1,160 days) or 17 weeks. More than half the participants (53%) attended one to three sessions, and the remaining young people attended four to six sessions (25%), seven to 10 sessions (14%), and 11 or more sessions (8%) (Table 3). Males were significantly more likely than females to attend only one to three sessions (χ2=227.36, N=72,781, df=3, p<0.001, V=0.06). Similarly, compared with younger clients, older clients were significantly more likely to attend only one to three sessions (χ2=62.81, N=75,806, df=3, p<0.001, V=0.03). Aboriginal or Torres Strait Islander clients were also significantly more likely than those who did not identify as belonging to these groups to attend only one to three sessions (χ2=221.32, N=73,202, df=3, p<0.001, V=0.06).TABLE 3. Session attendance patterns of young people who attended headspace, by sociodemographic characteristicsaSession attendance groupTotal1–34–6 7–10≥11CharacteristicN%N%SRbN%SRbN%SRbN%SRbGender72,871100 Male28,1643915,511557.27,02525–2.13,57213–5.02,0567–7.6 Female44,6176122,33450–5.711,580261.66,471154.04,232106.1Age75,806100 12–1745,2696023,41852–3.311,752263.46,235141.53,8649.6 ≥1830,5374016,663554.17,32224–4.14,00813–1.82,5448−.7Aboriginal or Torres Strait Islander73,202100 No67,6099234,44651–2.817,561261.59,583142.06,01991.6 Yes5,59383,416619.71,23322–5.458210–7.03627–5.7Total42,42553—20,22625—10,94214—6,9098—aDenominators for the percentages were the number of respondents for whom data were available. The row percentages may sum to greater than 100% because of rounding.bStandard residual.TABLE 3. Session attendance patterns of young people who attended headspace, by sociodemographic characteristicsaEnlarge tablePatterns of Treatment Continuation, Discontinuation, and ReturnIn Table 4, results are reported at each session, including the number of participants who discontinued and the hazard proportion, survival proportion, cumulative survival proportion, and number who completed 10 sessions. Across sessions 1 to 10 of mental health treatment, the session-by-session rate of overall discontinuation progressively decreased, ranging from 19% to 14% (see the bar graph in the online supplement). The treatment completion and external referral rate steadily increased from 4% to 9% by session 10.TABLE 4. Life table of treatment survival or discontinuation rates after each session among young people who attended headspaceSession countN entering sessionCompleters (N)aDiscontinuations (N per session)Proportion discontinued (hazard ratio)Proportion remaining in treatment (survival)Cumulative proportion remaining in treatment080,502———1.001.00180,5024,03114,953.19.81.81261,5182,41010,848.18.82.66348,2602,0058,178.17.83.55438,0771,5426,500.17.83.45530,0351,0605,620.19.81.37623,3551,6333,871.17.83.30717,8519872,475.14.86.26814,3899011,983.14.86.22911,5059611,596.14.86.19108,9487841,255.15.85.16aNo discontinuation, not referred on, not discharged.TABLE 4. Life table of treatment survival or discontinuation rates after each session among young people who attended headspaceEnlarge tableResults of the subgroup analysis of young people (N=40,039) who completed their first episode of treatment between April 1, 2014, and April 1, 2016, indicated that the proportion who discontinued and did not return to the headspace center during that period was 9% at its lowest (session 10), and 15% at its highest (session 1) (see online supplement). Of those who discontinued by session 11, 24% later returned for a second episode of care. Those who discontinued between sessions 2 and 10 in their first episode of care were significantly more likely than those who discontinued after only one session in their first episode to return for a second episode (26% versus 18%; χ2=150.58, N=30,397, df=1, p<0.001, V=0.07).Of the 80,502 young people in the sample, 71.2% (N=57,279) had cumulatively discontinued treatment after session 10. Of these, 45.0% (N=25,801) discontinued before session 3. The median-modal survival time for treatment was 4.5 sessions. Of all clients (not just those who discontinued), 17.0% (N=13,685) returned for a second episode of care at the same center within the timeframe of the data collection.A multivariable Cox regression of overall survival that examined predictors of discontinuation across treatment was conducted (Table 5). In this model, several factors were significant predictors of elevated risk of discontinuation from treatment, including older age, male gender, Aboriginal or Torres Strait Islander identification, rural setting (compared with major city), and heterosexual orientation (compared with LGBQ). Moreover, young people who self-reported moderate distress on K10 had significantly less risk of discontinuation from treatment, compared with those whose scores were in the well range.TABLE 5. Analysis of variables as predictors of treatment discontinuation from sessions 1 to 10 among young people who attended headspaceaVariableHazard ratio99% CIAge 18–25 (reference: 12–17)1.10*1.08–1.13Male (reference: female)1.08*1.06–1.12Aboriginal or Torres Strait Islander (reference: no)1.17*1.15–1.26K10 score (reference: well)b Mild.96.92–1.00 Moderate.94*.90–.98 Severe.99.96–1.02Rurality (reference: major city) Regional1.01.98–1.03 Rural1.22*1.08–1.38LGBQ sexual orientation (reference: heterosexual)c.86*.83–.88aModels are multivariate (all predictors were entered at the same time) and based on a survival framework (with person-session file).bK10, Kessler Psychological Distress Scale.cLGBQ, lesbian, gay, bisexual, queer/questioning.*p<.001.TABLE 5. Analysis of variables as predictors of treatment discontinuation from sessions 1 to 10 among young people who attended headspaceaEnlarge tableHigher-order two-way and three-way interactions (e.g., gender × age × K10) were analyzed but provided no additional predictive value.DiscussionWe aimed to explore the longitudinal patterns and predictors of attendance, discontinuation and reengagement in a large cohort of young people attending community-based, early-intervention mental health centers across Australia, headspace. Analyses indicated session-by-session rates of discontinuation ranging from 14%−19%. Overall, 71.2% of the 80,502 young people in the sample discontinued treatment by session 11, even though the treating practitioner noted in the MDS that he or she expected the young person to return for further treatment. Of note, under this model, government subsidization is capped at 10 sessions.Young people of male gender, older age, rural location, and heterosexual orientation and those who identified as Aboriginal or Torres Strait Islander were more at risk of discontinuing treatment. Moreover, young people who reported moderate distress at assessment had a lower risk of discontinuation, compared with those whose scores were in the well range. Further subgroup analysis revealed, however, that 24% of those who discontinued returned to the same center for a further episode of care within the data collection period.Although the overall discontinuation rate of 71.2% is in the higher range of previously reported rates of 30%−75% (13, 34), a number of explanations are possible, based on the methodology, setting, and sample. First, the measure of discontinuation was based on clinicians' recording in the MDS that the young person had a need for further care; however, this item was not designed to be a post hoc measure of discontinuation, and it thus may lack strong validity. Because the MDS does not include the young person's reasons for discontinuation, it was not possible to corroborate the clinician's report with the young person's experience. Therefore, the one-sided classification must be interpreted with caution. Discordance frequently exists between clinicians and young people and their families with respect to treatment goals and when they are achieved. With young clients, clinicians may be conservative when noting need for ongoing mental health support to reach clinical improvement. Young people themselves may place less importance on accessing continued mental health support, believing that they have obtained sufficient benefit (18). As a consequence, the young person and the family may discontinue treatment before obtaining the benefits expected by the clinician. Our study's strength in reviewing and illustrating session-by-session continuation and discontinuation rates sheds some light on this underlying complexity of attendance patterns and highlights the fluidity of decision making by service users over time.Previous studies of psychotherapy visits have shown that discontinuation rates at session 1 are typically much higher than rates at subsequent sessions, with an estimated 35% of clients not returning for a second visit (35). Therefore, the study reported here is unique in that headspace session 1 discontinuation rates were not markedly higher than rates for subsequent sessions. The reason for this positive initial uptake may be related to the purposeful integration of youth advocacy and codesign of the service by headspace (e.g., from layout to language used) to provide young people with a treatment setting that they fi

In a recent Correspondence in The Lancet Planetary Health, Sampaio and Sequeria1 state that “climate anxiety is not yet considered a mental health disorder” and might be a risk factor for mental disorders, which is something that we contest. The authors further claim that “climate anxiety occurs mainly in lower-income countries located in areas that are more directly affected by climate change”,1 which we regard as doubly incorrect: first, there are no substantial differences in climate anxiety between countries with different average incomes,2 and second, it is misleading to aver that lower income countries are more directly affected by climate change.

Reducing the stigma of mental illness, increasing knowledge about mental health and improving help-seeking for mental health problems are essential areas of change targeted by mental health promotion interventions. A school-based programme aimed specifically at these areas is the Mental Illness Education programme, where people who have experience of mental illness give an interactive presentation to high school class groups. This article reports an evaluation of the Mental Illness Education programme (MIE) as implemented in the Australian Capital Territory (ACT). Using a case control design, 457 high school students were tested by self-report questionnaire before and after participation in the MIE-ACT programme. The results showed that the programme had a strong impact on increasing knowledge and a moderate impact on reducing stigma, but a weak impact on changing help-seeking intentions. Overall, the evaluation of the programme was positive, although areas of continuing challenge are identified.

Whether the help-negation effect as demonstrated for suicidal thoughts was also evident for depressive symptoms was investigated in three studies of young people from diverse urban areas. The studies involved a large sample of younger high school students (years 7 – 10), a sample of older high school students (years 8 – 12), and first year university students. A self-report questionnaire that measured help-seeking intentions, prior help-seeking experiences, and depression was administered. It was found that the strongest inverse association between level of depressive symptoms was with intentions to seek help from parents across all three samples. There was a consistent trend for students to report being more likely to seek help from no one as depressive symptoms increased. Evidence of the help-negation effect being present for depressive symptoms is discussed in terms of ways to encourage appropriate and effective help-seeking in young people.

Anxiety disorders are the most common mental health problems experienced by young people, and even mild anxiety can significantly limit social, emotional, and cognitive development into adulthood.It is, therefore, essential that anxiety is treated as early and effectively as possible.Young people are unlikely, however, to seek professional treatment for their problems, increasing their chance of serious long-term problems such as impaired peer relations and low self-esteem.The barriers young people face to accessing services are well documented, and self-help resources may provide an alternative option to respond to early manifestations of anxiety disorders.This article reviews the potential benefits of self-help treatments for anxiety and the evidence for their effectiveness.Despite using inclusive review criteria, only six relevant studies were found.The results of these studies show that there is some evidence for the use of self-help interventions for anxiety in young people, but like the research with adult populations, the overall quality of the studies is poor and there is need for further and more rigorous research.

Technology is increasingly being used in youth mental healthcare to support service delivery and improve health outcomes. The current study trialed a new electronic psychosocial application (myAssessment) that aims to provide a holistic assessment of relevant risk and protective factors in youth mental healthcare. The study aimed to determine whether myAssessment was acceptable to all users, and whether it affected: reporting of certain behaviors and ratings of self-disclosure; youth ratings of control, fears of judgmental reactions or time-efficiency; clinician ratings of time-efficiency or their ability to formulate a treatment plan; and the therapeutic alliance. The application was tested at a youth mental health service using a quasi-experimental two phase Treatment-as-Usual/Intervention design. Three hundred thirty nine youth and 13 clinicians participated across both phases. Reporting of behaviors, self-disclosure, youth control, judgmental reactions, time efficiency, ability to formulate treatment plans, and the therapeutic alliance were compared between groups. myAssessment was found to be widely accepted by both young people and clinicians. Use of myAssessment resulted in reporting of behaviors that were 2.78 through 10.38 times higher for a variety of substances (use of tobacco, alcohol, cannabis, sedatives, hallucinogens, and opioids), in identifying non-heterosexual sexual orientation, having had sex, an STI check, sex without a condom, having felt pressured to have sex in the past, having self-harmed, and in having put themselves in an unsafe situation. Participants who used the application also reported being less likely to lie on past experiences of being bullied, substance use, and self-harm. Use of the application resulted in improved youth ratings of time efficiency in session. The application was found to have no impact on youth control, judgmental reactions, formulation of treatment plans, or the therapeutic alliance. Electronic psychosocial assessments can increase rates of self-disclosure and, therefore, provide an earlier and more comprehensive picture of young people’s risks without negatively impacting the therapeutic alliance. Additionally, this type of technology has been shown to be widely accepted by both young people and clinicians and can improve youth beliefs that there is enough time in session to speak about what is most important to them.

Suicide of school-aged adolescents is a significant problem, with serious implications for students and staff alike. To date, there is a lack of evidence regarding the most effective way for a secondary school to respond to the suicide of a student, termed postvention [(Crisis 33:208-214, 2012), (Crisis 34:164-182, 2013)]. The aim of this study was to employ the expert consensus (Delphi) methodology to the development of a set of guidelines, to assist English-speaking secondary schools to develop a plan to respond to a student suicide, or to respond to a suicide in the absence of a predetermined plan.The Delphi methodology was employed, which involved a two-stage process. Firstly, medical and research databases, existing postvention guidelines developed for schools, and lay literature were searched in order to identify potential actions that school staff could carry out following the suicide of a student. Based on this search, an online questionnaire was produced. Secondly, 40 experts in the area of suicide postvention from English-speaking countries were recruited and asked to rate each action contained within this questionnaire, in terms of how important they felt it was to be included in the postvention guidelines. A set of guidelines was developed based on these responses. In total, panel members considered 965 actions across three consensus rounds.Five hundred fourty-eight actions were endorsed for inclusion into the postvention guidelines based on an 80% consensus agreement threshold. These actions were groups according to common themes, which are presented in the following sections: 1. Developing an Emergency Response Plan; 2. Forming an Emergency Response Team; 3. Activating the Emergency Response Team; 4. Managing a suspected suicide that occurs on school grounds; 5. Liaising with the deceased student's family; 6. Informing staff of the suicide; 7. Informing students of the suicide; 8. Informing parents of the suicide; 9. Informing the wider community of the suicide; 10. Identifying and supporting high-risk students; 11. Ongoing support of students; 12. Ongoing support of staff; 13. Dealing with the media; 14. Internet and social media; 15. The deceased student's belongings; 16. Funeral and memorial; 17. Continued monitoring of students and staff; 18. Documentation; 19. Critical Incident Review and annual review of the ER Plan; 20. Future prevention. Panel members frequently commented on every suicide being 'unique', and the need for flexibility in the guidelines, in order to accommodate the resources available, and the culture of the school community.In order to respond effectively and safely to the suicide of a student, schools need to undertake a variety of postvention actions. These are the first set of postvention guidelines produced worldwide for secondary schools that are based on expert opinion using the Delphi method.

AbstractThis study aimed to investigate coaches' awareness of mental health in youth sport, as well as their perceived role breadth and ability to support young people's mental health. Interviews were conducted with 13 sports coaches of young people aged 12–18 from Canberra, Australia. Interview transcripts were analysed using a combination of inductive and deductive qualitative content analysis. Coaches recognised that their role breadth allows them to be a useful source of support for young people's mental health by way of identifying concerns, facilitating help-seeking behaviour and promoting engagement in sports. Further training in mental health would boost coaches' ability to assist confidently and effectively, leading to benefits for young people's mental wellbeing and sporting experience. Coaches are in a position to positively impact young people's mental health, and set expectations for themselves to actively support young people in this way. Supporting mental health may be an area of future growth for the role of a youth sports coach.Keywords:: youth mental healthsports coachesmental health promotionrole breadthself-efficacy This article is part of the following collections: Special Collection of articles celebrating 60 Volumes of the International Journal of Health Promotion and Education

Mobile phone use while driving is a well-recognized area of concern. However, while texting/calling among young adult drivers has received much research attention, more research is needed regarding other phone functions used by young adults while driving. To explore mobile phone functions used by young adult drivers while driving. An online survey of 17–24 year old drivers (N = 612; 428 females) and focus groups with drivers aged (N = 18; 8 females) revealed that mobile phone use while driving was a very common behavior, with more full licence drivers compared with Learner/Provisional drivers using their phone to make/answer calls, send/read text messages and for internet browsing. This nature of mobile phone use while driving was varied, with phones commonly used for entertainment (e.g., to play music), to connect with others (via texting and/or voice calls) and for navigation. Young adults use a variety of functions on their phone while driving. It is important that young driver-targeted intervention efforts acknowledge that multiple functions of the mobile phone are used during the drive and it serves multiple purposes. Examining the inhibitors and facilitators of mobile phone use and its various functions while driving is needed, in addition to elucidating if the usage of particular mobile phone functions is similar across different driver cohorts.

Australia’s headspace initiative is world-leading in nation-wide youth mental healthcare reform for young people aged 12 to 25 years, now with 16 years of implementation. This paper examines changes in the key outcomes of psychological distress, psychosocial functioning, and quality of life for young people accessing headspace centres across Australia for mental health problems. Routinely collected data from headspace clients commencing an episode of care within the data collection period, 1 April 2019 to 30 March 2020, and at 90-day follow-up were analysed. Participants came from the 108 fully-established headspace centres across Australia, and comprised 58,233 young people aged 12–25 years first accessing headspace centres for mental health problems during the data collection period. Main outcome measures were self-reported psychological distress and quality of life, and clinician-reported social and occupational functioning. Most headspace mental health clients presented with depression and anxiety issues (75.21%). There were 35.27% with a diagnosis: overall, 21.74% diagnosed with anxiety, 18.51% with depression, and 8.60% were sub-syndromal. Younger males were more likely to present for anger issues. Cognitive behavioural therapy was the most common treatment. There were significant improvements in all outcome scores over time (P&lt;0.001). From presentation to last service rating, over one-third had significant improvements in psychological distress and a similar proportion in psychosocial functioning; just under half improved in self-reported quality of life. Significant improvement on any of the three outcomes was shown for 70.96% of headspace mental health clients. After 16 years of headspace implementation, positive outcomes are being achieved, particularly when multi-dimensional outcomes are considered. A suite of outcomes that capture meaningful change for young people’s quality of life, distress and functioning, is critical for early intervention, primary care settings with diverse client presentations, such as the headspace youth mental healthcare initiative.

This study examined the reliability and validity of the Childbirth Self‐Efficacy Inventory (CBSEI) (Lowe 1993) in a sample of 100 Australian women. Consistent with US data, the measure was shown to have high internal consistency. Validity of the instrument was determined by applying self‐efficacy theory (Bandura 1982), which predicts that parity should have the largest effect on childbirth self‐efficacy, followed by knowledge, then support and finally anxiety. Results revealed that having a prior good birth experience and knowledge about childbirth had significant effects on childbirth self‐efficacy. A factor analysis was performed to determine whether the original factor structure of this instrument held for Australian women. While outcome expectancies and self‐efficacy expectancies emerged as distinct factors, the results showed that Australian women did not differentiate between active and second‐stage labour. Rather than the two stages of labour emerging as dimensions of the CBSEI, two externally focused coping strategies were revealed.

Adolescence and young adulthood are often turbulent periods in a person's life.There are high rates of accidental deaths, suicide, mental health concerns, substance use, and sexual experimentation.Health care professionals need to conduct holistic assessments of clients in these developmental life stages to identify psychosocial risks and provide targeted early intervention and implement prevention strategies.The most useful psychosocial assessments for most health care professionals are those that can provide a complete picture of the young person's life and circumstances.This article identifies psychosocial assessment instruments that can be used as an initial assessment and engagement tool with the general population of young people presenting for health care.We review the psychometric properties of each of the instruments, determining what type of instrument is most acceptable to young people, whether any can increase disclosure and improve engagement between young people and health professionals, and whether they have predictive utility.The search strategy complied with the relevant sections of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.A total of 89 published articles were identified, covering 31 different assessment instruments.Results indicated that those that were self-administered were most acceptable to young people, although it is unclear whether pen-and-paper or computer formats were preferred.Most psychosocial assessments can improve rates of disclosure and enhance engagement between young people and health professionals; however, worryingly, we found evidence that clinicians did not always respond to some of the most serious identified risks.Only for one instrument was there any mention of predictive utility.Future research should employ longitudinal approaches to determine the predictive utility of psychosocial assessments and focus on whether the use of new technologies can improve rates of disclosure.

Background: Young men experiencing mental ill health report the lowest rates of professional help-seeking of any demographic group across the lifespan. This phase of life (i.e. adolescence and emerging adulthood) also corresponds to a period of disconnection from healthcare services for young men.Aims: The present exploratory qualitative study aimed to identify barriers and facilitators to mental health care, as identified by a sample of young help-seeking men and staff involved in mental health service provision.Method: Interviews and focus groups were undertaken with 25 young males (mean = 18.80 years, SD = 3.56) and four service providers. Participants were recruited from headspace enhanced primary care early intervention centres in Australia.Results: Thematic analysis indicated four overarching barriers and facilitators. The identified barriers were male role expectations, talk therapy as unknown territory, difficulties navigating the system and intake processes. The identified facilitators were positive initial contact, effective cross-sector partnerships, availability of male practitioners and use of targeted messaging.Conclusions: Given the ongoing low rates of help-seeking, high rates of suicide and other adverse outcomes for young men, priority research and clinical attention is needed for this group. Recommendations are offered for future research, including suggestions for implementation of targeted strategies addressing gender-based health needs.

Rationale: Many young people turn to music as a way of exploring and managing their moods and emotions. The literature is replete with studies that correlate music preferences and mental health, as well as a small but increasing interest in uses of music to promote well-being. Recent studies have shown that music use is often unconscious, thus difficult to influence without therapeutic conversations. No study has yet tested whether it is feasible to increase awareness of music use in young people who tend to ruminate with music, and test whether increased awareness can reduce distress. Design: This feasibility study aimed to determine whether involvement in a brief music-based intervention was engaging and acceptable to a small sample of young people, and whether their levels of distress decreased and insight into music uses increased. A mixed methods approach was adopted, merging scores of distress and self-reported experience of the intervention to foster interpretation. Results: Convergent analysis of the different data forms suggests that at least some of the measurable decreases in distress captured for all of the participants were related to participation in the sessions, according to the self-report of a number of the young people in interviews. This is demonstrated through descriptive data compiled under two key themes (Agency and Changed Uses) and illustrated through three case examples that were drawn largely from the words of the young people. Conclusion: This feasibility study suggests that young people’s relationship with music provides a powerful platform for leveraging engagement in services and improvements in distress, when well timed and carefully scaffolded.

Objective: The aim of the current study was to explore the progress and depth of counselling processes used during online chat sessions, and their relationships to the number of sessions attended and client treatment outcomes. Method: Transcripts from 49 online clients were analysed using the Counselling Progress and Depth Instrument. Psychological distress, life satisfaction, and hope measures were collected prior to the participant’s fi rst session and again 6 weeks later providing treatment outcomes. Results: Overall, progress and depth scores were higher for clients who attended multiple sessions and associated with greater alleviation in clients’ psychological distress. Problem clarifi cation and action planning processes were both correlated with reductions in psychological distress. Conclusions: Findings imply that advancing through more of the stages of counselling in greater depth may help improve client outcomes from online counselling.

headspace centres comprise a significant innovation in community-based youth mental health service delivery in Australia. This paper examines the service activity of the first headspace centres to determine common and unique practice characteristics across headspace centres in this new approach to mental health service delivery.Data come from quarterly progress reports provided by the first 30 headspace centres during the 2010-2011 financial year. The information from 120 reports was analysed qualitatively using thematic analysis techniques to determine the types of activities reported by centres against key performance indicators.The main finding was the large number and wide range of centre activity. This heterogeneity may be explained in part by the diversity of communities across Australia and the importance that headspace places on addressing the specific needs of the local community as well as drawing upon the existing capacity that is available within a community. The most common activities were community engagement, building local partnerships and providing a youth friendly environment. There was a particularly strong focus by the majority of centres on establishing and supporting a Youth Reference Group to guide centre development and implementation.The progressive upscaling of headspace centres across Australia provides a unique opportunity to observe how a significant reorientation in health service delivery is implemented in practice to meet the needs of diverse communities. Further investigation of the headspace experience will provide critical lessons for other countries investing in new approaches to youth mental health.

This cross-sectional study explored the hope and expectations of young people accessing an online chat counselling service, as these common therapeutic factors have not yet been investigated in the online environment. Participants included 1033 young people aged 16–25 years, mostly young women, who completed an online questionnaire available through the online mental health service's homepage. Findings showed that online clients had low levels of hope, high treatment outcome expectations, high levels of psychological distress, and low levels of life satisfaction. Hope and expectations were barely associated and about two-thirds of respondents reported low hope but high expectations. Only hope, however, was found to be related to psychological distress and life satisfaction, with higher hope being protective. Expectations, discordance between hope and expectations, and amount of online services received were not associated with psychological distress or life satisfaction. The low levels of hope and high levels of psychological distress, but high expectations, of young people accessing online counselling reveal challenges for this approach.

• Intentions to send/read text messages while driving were examined. • Extended theory of planned behaviour used to identify psychosocial predictors. • Past behaviour and descriptive norms were key predictors of intentions. • Support for additional predictors of perceived risk and anticipated regret. • Relationship between risk and sending intentions mediated by anticipated regret.

Background Online youth mental health services are an expanding approach to meeting service need and can be used as the first step in a stepped-care approach. However, limited evidence exists regarding satisfaction with online services, and there is no standardized service satisfaction measure. Objective This study implemented an online youth mental health service satisfaction questionnaire within eheadspace, an online youth mental health service. The aims were to test the questionnaire’s psychometric properties and identify current levels of satisfaction among service users, as well as to identify client and service contact characteristics that affect satisfaction. Methods Data were collected from 2280 eheadspace clients via an online questionnaire advertised and accessed through the eheadspace service platform between September 2016 and February 2018. Client and service contact characteristics, potential outcomes, and session and service feedback data were collected. Results The service satisfaction questionnaire demonstrated high internal consistency for the overall satisfaction scale (alpha=.95) and its three subscales: session satisfaction, potential outcomes, and service satisfaction. A three-factor model was the best fit to the data, although including a higher order unidimensional construct of overall satisfaction was also a reasonable fit. Overall, young people were very satisfied with eheadspace (mean 3.60, SD 0.83). Service characteristics, but not client characteristics, were significantly associated with satisfaction. Young people were more satisfied with eheadspace when they had greater engagement as evident through receiving esupport rather than briefer service provision, having a longer session and greater interaction with the clinician, and not previously attending a face-to-face headspace center. Conclusions The online youth mental health service satisfaction questionnaire developed for and implemented in eheadspace showed good psychometric properties. The measure is brief, has good internal consistency, and has a clear factor structure. The measure could be adapted for use in other online youth mental health services. The young people using eheadspace and completing the feedback survey were highly satisfied. Greater engagement with the online service was shown to be associated with greater satisfaction. No specific client demographic groups were shown to be more or less satisfied.

Young drivers exhibit high levels of risky driving behaviour, including texting while driving (TWD). The aim of this study was to examine the influence of personality (rash impulsivity, reward seeking), fear of missing out (FOMO) and mobile phone involvement (MPI) on frequency of TWD. Six hundred and twelve young drivers aged 17 to 24 years completed an online survey including these measures, and frequency of sending and reading TWD in the prior week. Rash impulsivity and reward seeking, as well as MPI, predicted both modes of TWD, while FOMO only predicted sending. In addition, rash impulsivity, reward seeking and FOMO all had significant indirect effects on sending and reading TWD via MPI. Findings highlight the importance of considering indirect relationships of personality via MPI on phone use while driving.

Objective In recognition of a service gap between hospital inpatient and community-based care, a range of mental health services have been developed to provide treatment and support for people with mental illness outside the inpatient setting. Acute and subacute residential services provide care for individuals experiencing episodes of acute mental illness and provide transitional services to assist people in their reintegration into the community. This article provides a systematic review of studies evaluating the effectiveness of these alternative services. Methods A systematic review of the literature was conducted by searching MEDLINE, PsycINFO, CINAHL, and Cochrane with no years specified to identify studies that have evaluated the clinical effectiveness, user satisfaction, or cost-effectiveness of acute or subacute residential treatments. Outcome data were extracted from quantitative studies, and themes relevant to service satisfaction were extracted from qualitative studies. Results A total of 26 studies were identified that evaluated the effectiveness of acute or subacute residential services. Most studies of acute residential units demonstrated clinical improvements equal to those of inpatient units and similar readmission rates, as well as cost benefits. User satisfaction was generally higher for clients of acute residential units. Only three studies examined subacute units, a number not sufficient to evaluate the effectiveness of these services. Conclusions Acute residential mental health services offer treatment outcomes equivalent to those of inpatient units, with users reporting high satisfaction. Acute residential services offer a cost-effective alternative to inpatient services. Further research is needed to determine client groups that will benefit most from these alternative services.

AbstractBackgroundYoung people represent a vulnerable age group for mental health concerns and tend not to seek help. Exploring factors that influence young people's engagement in therapy and clinical outcomes is crucial. This study examined the relationships between young people's expectations, preferences, and actual experience of therapy on their clinical outcome, mental health care service use, and help‐seeking intentions. Gender and age effects were also explored.MethodsA quantitative prospective research method was utilised. Participants included a total of 228 young people aged 12 to 25 years who completed an initial survey on contact with a youth mental health service and 102 who completed an online follow‐up survey 2 months later.ResultsResults showed that young people's actual experiences of therapy and their preference to be personally committed to therapy were positively associated with the outcome variables. No significant associations were evident for initial expectations. No age or gender effects was found.ConclusionsThese initial findings suggest that initial expectations may not be well formed for youth and appear not to be relevant to young people's engagement or outcomes, and are less important than motivation and actual experiences. Youth‐focused mental health services need to ensure a positive early experience to promote early intervention and relapse prevention.AbstractDisplay full sizeKey words: client expectationspreferencesservice usetherapyyoung people Funding: None.Conflict of interest: None.Funding: None.Conflict of interest: None.NotesFunding: None.Conflict of interest: None.

Routine monitoring of depression symptoms and suicide risk is essential for appropriate treatment planning and risk management, but not well implemented by clinicians. We developed a brief online monitoring tool to address this issue.To investigate whether the online tool can feasibly improve monitoring; whether it is acceptable and useful for young people and their clinicians; and to determine whether a shorter tool could be implemented.In a naturalistic longitudinal cohort study, 101 young people with depression completed the online tool on a tablet, prior to their consultation. Their results were immediately available to their clinician. Clients and clinicians answered questionnaires about acceptability and usefulness.The tool was feasible to implement. Young people and clinicians found the tool acceptable and useful for understanding symptoms and risk. A brief three-item suicidal ideation screening measure correlated well with a validated measure of suicidal ideation.The online tool facilitates the quick exchange of key information about suicide risk, allowing clinicians to immediately address this. This level of responsiveness is likely to improve treatment outcomes. The brief version allows full integration into clinical practice to support clinicians managing those at risk of suicide.

Online counselling is a rapidly growing field and, while there is emerging evidence of its comparative effectiveness, there has been little research into what techniques are being applied in practice and which clients will most likely benefit from this medium. Using a focus group methodology, this study examines the experiences of 19 online clinicians employed by a youth mental health service, investigating their perception of online clients, views on their counsellor roles, the approaches and techniques they employ, and the unique aspects of counselling in an online environment. Overall, online clinicians perceived their clients as presenting with highly complex problems and a high level of psychological distress. They noted online clients would most often use the service once or twice, and that some would use online chat as an adjunct to face-to-face counselling. The online clinicians described various roles, including: assessments, gatekeeping, providing emotional support, and therapeutic interventions. According to the online clinicians, they used a variety of techniques online, but favoured person-centred techniques, as these helped keep the clients engaged with the service. Areas of further research and implications for practice are discussed.

Access to Allied Psychological Services (ATAPS) was introduced in 2001 by the Australian Government to provide evidence-based psychological interventions for people with high prevalence disorders. headspace, Australia's National Youth Mental Health Foundation, was established in 2006 to promote and facilitate improvements in the mental health, social wellbeing and economic participation of young people aged 12-25 years. Both programs provided free or low cost psychological services. This paper aims to describe the uptake of psychological services by people aged 12-25 years via ATAPS and headspace, the characteristics of these clients, the types of services received and preliminary client outcomes achieved.Data from 1 July 2009 to 30 June 2012 were sourced from the respective national web-based minimum datasets used for routine data collection in ATAPS and headspace.In total, 20,156 and 17,337 young people accessed two or more psychological services via ATAPS and headspace, respectively, in the 3-year analysis period. There were notable differences between the clients of, and the services delivered by, the programs. ATAPS clients were less likely to be male (31 vs 39%) and to reside in major cities (51 vs 62%) than headspace clients; ATAPS clients were also older (18-21 vs 15-17 years modal age group). There was some variation in the number and types of psychological sessions that young people received via the programs but the majority received at least one session of cognitive behavioural therapy. Based on limited available outcome data, both programs appear to have produced improvements in clients' mental health; specifically, psychological distress as assessed by the Kessler-10 (K-10) was reduced.ATAPS and headspace have delivered free or low-cost psychological services to 12-25 year olds with somewhat different characteristics. Both programs have had promising effects on mental health. ATAPS and headspace have operated in a complementary fashion to fill a service gap for young people.

Background: Having someone close die through suicide or another form of traumatic death is a distressing event in the lives of adolescents, putting them at risk of grief and mental health ramifications. As most research in this field has been focused on intrapersonal grief reactions, this study aimed to broaden the perspective by exploring the impact of the death through an interpersonal lens. Methods: The study involved individual and group interviews with bereaved adolescents (n = 20) and parents of bereaved adolescents (n = 18), and thematic analysis of the data. Results: The analysis yielded three themes: (i) the death is a life-changing experience, (ii) the death differentiates you from your peers, and (iii) the death impacts on the family system. Conclusions: The study revealed the devastating impact of the deaths on adolescents, their relationships with peers and the family system. Adolescents’ grief must be understood within the context of their agency and their immediate social environment. The findings clearly indicate that support for bereaved adolescents should incorporate the familial context.

This is the first study to describe psychometric properties of the Kessler Psychological Distress Scale (K6) in a large cohort of help-seeking young people presenting to primary mental health care services. The aim was to determine whether the K6 was appropriate for monitoring outcomes in such settings. 1067 young people were recruited from Australian headspace services. We examined dimensionality of the K6, measurement invariance, and how the K6 correlated with the the Patient Health Questionnaire-9 (PHQ-9)and the Generalised Anxiety Disorder-7 Scale (GAD-7). Standardised Response Mean (SRM) and Cohen's d effect size (ES) were used to examine 3-month stability of the K6. The best-fitting model was a two-factor model: (i) nervous and restlessness; and (ii) hopeless, worthless, depressed and effort. Measurement non-invariance was observed for sex and age groups. K6 strongly correlated with the PHQ-9 and GAD-7. The K6 was less sensitive to change compared to these other two measures. There was some support for the K6 being a screener for young people presenting to primary care; however, there issues arise with its use as an outcome measure. These issues include measurement non-invariance, concern about the dimensionality and focus of items, and its sensitivity to change.

Abstract Australia’s headspace initiative is world-leading in nation-wide youth mental healthcare reform for young people aged 12 to 25 years, now with 16 years of implementation. This paper examines changes in the key outcomes of psychological distress, psychosocial functioning, and quality of life for young people accessing headspace centres across Australia for mental health problems. The design was a single-arm, observational study using routinely collected data from headspace clients commencing an episode of care between 1 April 2019 and 30 March 2020, and at 90-day follow-up. All 108 of the fully established headspace centres across Australia were included, with 58,233 young people aged 12-25 years first accessing headspace centres for mental health problems during the data collection period. Main outcome measures were self-reported psychological distress and quality of life, and clinician-reported social and occupational functioning. Most headspace mental health clients presented with depression and anxiety issues (75.21%). There were 35.27% with a diagnosis: 21.74% diagnosed with anxiety, 18.51% with depression, and 8.60% were sub-syndromal. Cognitive behavioural therapy was the most common treatment. There were significant improvements in all outcome scores over time (P&lt;0.001). From presentation to last service rating, over one-third of young people had significant improvements in psychological distress and a similar proportion in psychosocial functioning; just under half improved in self-reported quality of life. Significant improvement on any of the three outcomes was shown for 70.96% of headspace mental health clients. After 16 years of headspace implementation, positive outcomes are being achieved, particularly when multi-dimensional outcomes are considered. A suite of outcomes that capture meaningful change for young people’s quality of life, distress and functioning, is critical for early intervention, primary care settings with diverse client presentations, like the headspace youth mental healthcare initiative.

Abstract Background Substance use remains a barrier to recovery for young people accessing early intervention services for psychosis. While correlates of use have been explored in populations experiencing a first episode of psychosis (FEP), sample sizes have been small and less research assesses cohorts at ultrahigh risk of psychosis (UHR). Methods This study uses data from a naturalistic cohort including UHR and FEP participants ( N = 1252) to elucidate clinical correlates of use in the past 3 months of any illicit substance, amphetamine-type stimulants (ATS), cannabis, and tobacco. Moreover, network analysis based on use of these substances and additionally alcohol, cocaine, hallucinogens, sedatives, inhalants, and opioids was completed. Results Young people with FEP used substances at significantly higher rates than those at UHR. High concurrence of use was seen between substances. In the FEP group, participants who had used any illicit substance, ATS, and/or tobacco had increased positive symptoms and decreased negative symptoms. Young people with FEP who used cannabis had increased positive symptoms. In the UHR group, participants who had used any illicit substance, ATS, and/or cannabis in the past 3 months showed decreased negative symptoms compared to those who had not. Conclusion A distinct clinical picture of more florid positive symptoms and alleviated negative symptoms seen in those who use substances in the FEP group appears muted in the UHR cohort. Treating young people at UHR in early intervention services represents the earliest opportunity to address substance use early to improve outcomes.

Research on trends in youth mental health is used to inform government policy and service funding decisions. It often uses interviewer-administered surveys, which may be affected by mode effects related to social desirability bias. This study sought to determine the impact of survey administration mode on mental health measures, comparing mode effects for sensitive mental health measures (psychological distress and wellbeing) and non-sensitive (physical activity) measures.Data were from two large national community samples of young Australians aged 12-25 years conducted in 2020 (N = 6238) and 2022 (N = 4122), which used both interviewer-administered and self-report modes of data collection.Results showed participants reported lower psychological distress and higher wellbeing in the interviewer-assisted compared with the self-report mode. No mode effects were found for the non-sensitive physical activity measures. No interaction between mode and gender was found, but an age group by mode interaction revealed that those in the 18-21 and 22-25-year age groups were more strongly affected than younger adolescents.These findings suggest underestimates of mental health issues from interview survey formats, particularly for young adults. The results show how even a weak mode effect can have a large impact on mental health prevalence indicators. Researchers and policy makers need to be aware of the impact social desirability bias can have on mental health measures and consider taking steps to mitigate this effect.

Synopsis In a community sample of the elderly (N = 274) in Hobart, Tasmania, cases of dementia and depression were ascertained by the Canberra Geriatric Mental State and the Mini Mental State Examination. Social relationships and support were examined by means of the Interview Schedule for Social Interaction. The elderly had fewer social relationships than younger adults, but were more content with what they did have. Elderly women had more affectional ties than elderly men. The presence of offspring in the same town increased the number of close ties and of social relationships, but was more important for men than for women. Persons with cognitive impairment or an established dementia reported that they had less social interaction than they would like. Depressed subjects reported having markedly less social interaction than the mentally healthy elderly, but did not complain that it was too little. This study provides a systematic description of the social environment of the elderly, both in mental health and in states of depression or impaired cognition.

Abstract Client expectations about mental health services relate to the client's and the therapist's role, the therapeutic process and therapeutic outcomes. Research with adults shows that such expectations affect service engagement and clinical outcomes. Aim: The present study investigated expectations for adolescents and young adults, which have not been adequately investigated and may partly explain the reluctance of young people to seek professional help. Methods: Participants included 20 young people aged 12–24 attending their initial session at a youth mental health service, who were interviewed immediately prior to their initial session. Data were analysed using qualitative methods to draw main themes around each of the four expectancy types. Results: Overall, the strongest theme was that young people were unsure of what to expect from attending a mental health service. The key theme for expectations of their role as a client was readiness for therapy, and for the therapist's role the key themes were who they expected to see, the directiveness and likeability of the therapist, and the type of help they expected they would receive. The young people expected that the therapy process would involve simply talking and expected their engagement to be dependent on how much they liked their first few sessions. Outcome expectations were non‐specific and the theme of hopefulness was most evident. Conclusion: As unrealistic and unmet expectations can lead to poorer engagement and outcomes in therapy, the study highlights a need for young people to be better informed about what to expect when coming to mental health services.

Teachers and youth sports coaches are in prominent positions to support young people and their mental health. However, the way these professionals perceive their roles is likely to be a powerful influence on such behaviour. This article investigates and compares the effect of four types of role perceptions—role breadth, instrumentality, efficacy, and discretion—on teachers' and coaches' engagement in helping behaviour that supports young people's mental health through promotion, prevention, and early intervention. An online survey was completed by 117 teachers and 131 coaches. Results from three multiple group path analyses revealed role breadth, instrumentality, and efficacy significantly influenced teachers' and coaches' helping behaviour. The extent to which role perceptions predicted helping behaviour did not differ between teachers and coaches. Assisting teachers and coaches to carry out promotion, prevention, and early intervention behaviour increases young people's access to mental health support and may help to reduce the burden of mental health problems among Australian young people.

Abstract Background Online individual chat counselling is an emerging treatment modality that appears to be an effective method of providing single sessions of counselling to young people. Aims This study aimed to investigate the effects of online counselling over a 6‐week period and whether this was affected by the number of sessions attended or having sought additional help. Furthermore, this study aimed to explore the effects of congruent and incongruent client hopes and expectations upon treatment outcomes. Method This study used a naturalistic prospective design, measuring online clients’ levels of psychological distress, life satisfaction, hopes, and expectations and tracking the number of sessions they attended or whether they sought additional help during the 6‐week period. Complete data were collected for 152 young people aged between 16 and 25 years. Results After 6 weeks, participant levels of psychological distress and life satisfaction were not significantly affected by the amount of online counselling received or by having sought additional treatment. However, participants who attended one or more online sessions reported significantly higher levels of hope 6 weeks later than those with no online counselling. Furthermore, participants with low hope but high expectations at the commencement of counselling reported significantly increased hope after 6 weeks. Conclusions The implications of these findings are discussed.

Peer support programs offer a promising approach to addressing the high levels of stress and psychological distress reported by university students. However, few studies have considered the impact of implemented programs on the wellbeing and skill development of student facilitators. This study examines the experiences of student facilitators of a guided peer support program for reducing and preventing stress and low mood in student participants. Benefits to student facilitators, anticipated and actual, include the development of skills and experience in group facilitation, and a greater sense of community and belonging. While challenges exist in establishing initiatives, peer support and mentoring programs can offer valuable benefits by increasing wellbeing and fostering skill development for both participants and student facilitators. It is important that university-based peer support programs consider the student facilitator experience in both program development and evaluation and ensure training addresses facilitator concerns, prepares students adequately for the role, and considers the benefits for individual professional development.

Introduction. Young people’s participation in their own mental healthcare requires ways for them to provide feedback to their clinicians on how they are experiencing their treatment. Key dimensions of session experience are willingness to attend, feeling listened to and understood, working on issues important to them, feeling hopeful for the future, and feeling that things are improving in their lives. This study reports on young people’s session experiences over time and by key demographics for headspace youth mental health services. Methods. The sample comprised 16,484 young people aged 12 to 25 years who commenced an episode of care at one of the 150 headspace centres between 1 July 2021 and 30 June 2022 and who had attended at least two services. Data were collected via the routinely collected headspace minimum data set. Results. Overall, young people reported very positive session experiences over all the session dimensions. Few demographic differences were found: session ratings were more positive for young adults (18+ years) compared with adolescents (under 18 years). Scores on all five dimensions improved with more visits, and willingness to attend and working on issues important to the young person were strong predictors of service engagement. Better session experience scores were associated with more positive ratings of quality of life. Conclusion. Young people experience their headspace sessions very positively, and more positive experiences are associated with better service engagement and quality of life. Routinely collecting session feedback gives young people a valuable way to participate in and inform their own care.

Journal Article The beta test of an electronic supermarket Get access R Henderson, R Henderson * Centre for Applied Psychology, University of Canberra, Belconnen, ACT 2616, Australia *Corresponding author. E-mail: ron@science.canberra.edu.au Search for other works by this author on: Oxford Academic Google Scholar D Rickwood, D Rickwood Centre for Applied Psychology, University of Canberra, Belconnen, ACT 2616, Australia Search for other works by this author on: Oxford Academic Google Scholar P Roberts P Roberts Centre for Applied Psychology, University of Canberra, Belconnen, ACT 2616, Australia Search for other works by this author on: Oxford Academic Google Scholar Interacting with Computers, Volume 10, Issue 4, November 1998, Pages 385–399, https://doi.org/10.1016/S0953-5438(98)00037-X Published: 01 November 1998 Article history Received: 30 May 1997 Revision received: 31 October 1997 Accepted: 28 February 1998 Published: 01 November 1998

It is proposed that social capital, a societal‐level construct, can be measured at the individual level. This ‘personal social capital’ is a psychological construct defined as a logically linked sequence of social behaviours: community participation, social support and trust in others. Individuals who have more personal social capital will participate in their communities more and have more social support, greater trust in others and less psychological distress than those with less. It was also predicted that social values would influence levels of personal social capital, indirectly influencing distress. Structural equations modelling revealed that, within the construct of personal social capital, the strongest predictor of distress was community trust. Harmony values also directly predicted distress, while security values had an indirect effect via reduced community participation, social support and community trust.

Young people aged 12—25 are now widely recognised to be the highest risk group for the development of mental health problems and mental disorders. Many health policies and interventions aim to address this high level of need, yet major barriers still remain to young people's timely access to the services they require to support their mental health. Fundamentally, young people prefer not to seek traditional professional help and, compounding this reluctance, sufficient resources are not available to provide the level and types of face-to-face service they require. Young people have a wide range of needs to promote their mental health, from basic information to high-level ongoing clinical support. As computer-mediated communication is an integral and accepted part of life for today's young people, appropriate information and communication technology (ICT) options supporting mental health must be facilitated. Such interventions are being developed at a rapid pace, and the field would benefit from a framework to incorporate these trends. It is time to examine what types of intervention are being developed, where the evidence for their effectiveness is accumulating, and the challenges and gaps that are emerging. This paper applies a mental health promotion approach to the developing field of ICT interventions for youth mental health, using the spectrum of interventions for mental health as a framework to examine current and potential opportunities.

Youth mental health has become an important focus of health service reform in Australia, through Federal government funded initiatives such as headspace National Youth Mental Health Foundation. Underpinning the success of such initiatives is the availability of an appropriately skilled health workforce. This paper describes some of the major health workforce needs of the headspace initiative, and presents current data on the availability of key workforce components – youth workers, social workers, psychologists, mental health nurses, general practitioners and psychiatrists. Workforce shortages in many of these fields are evident and impact on the successful implementation of headspace, and other mental health service reforms.

Abstract Aims This study aimed to determine the psychometric properties of the headspace youth (mental health) service satisfaction scale (YSSS), a 14‐item purpose‐designed scale for use with adolescents and young adults attending headspace centres, and to examine the level of satisfaction with headspace centre services and the client characteristics that predict this. Methods There were 21 354 eligible headspace clients who had received more than one service over the 12‐month data collection period during 2013–2014, and 12 436 (58%) completed a satisfaction scale. headspace clients could optionally self‐complete the satisfaction scale at the beginning of visits 2, 5, 10 and 15. Clients' demographic and clinical characteristics were also recorded. Results Factor analysis identified a four‐factor solution for the scale and internal consistency of the subscales was acceptable to excellent. Satisfaction with headspace was high and increased over time for those who completed the scale multiple times. Several demographic and clinical characteristics predicted the likelihood of completion and level of satisfaction, with younger age shown to be a persistent predictor of lower satisfaction. Conclusions Client satisfaction with headspace is high and increases with ongoing engagement. Development of the headspace YSSS contributes a new client satisfaction scale with tested psychometric properties for adolescents and young adults engaged in mental health services, providing an essential tool for youth mental health services to routinely evaluate the experiences of young people accessing their services.

Information Communication Technologies (ICT) have resulted in positive outcomes in a range of clinical studies, however, most have not had widespread subsequent uptake, partly because they were not developed with all stakeholder requirements in mind. In the current study, we engaged stakeholders in the concept development stage of a project to transform a psychosocial assessment into an ICT-enabled format. By engaging the stakeholders in this early process we were able to identify a range of software functionalities that are likely to improve the applicability for users, as well as identify possible barriers to implementation.

Background: Sub-acute residential mental health services provide care for people who are not acutely unwell but require more support than generally available when living in the community. Little is known about how these services facilitate recovery and whether these facilitators differ for clients entering from the community (step-up) or from inpatient settings (step-down).Aim: To identify features of a sub-acute residential service that have assisted step-up and step-down clients in their recovery.Method: Semi-structured interviews were conducted with 16 step-up and 21 step-down clients. Interview transcripts were examined using an inductive, semantic content analysis approach.Results: Themes identified included the community context, personal support, the formal program offered and assistance in personal recovery processes, with the level of support for these themes differing for step-up and step-down clients.Conclusions: Step-up and step-down clients have differing needs to be addressed in a sub-acute service. These services can better meet the needs of clients if they are aware of the setting the client has come from and tailor their services accordingly. Step-up clients prefer support in developing social skills and illness management techniques; step-down clients prefer a less structured environment with assistance in living skills and personal processes of recovery.

Background Subjective cognitive difficulties are common in mental illness and have a negative impact on role functioning. Little is understood about subjective cognition and the longitudinal relationship with depression and anxiety symptoms in young people. Aims To examine the relationship between changes in levels of depression and anxiety and changes in subjective cognitive functioning over 3 months in help-seeking youth. Method This was a cohort study of 656 youth aged 12–25 years attending Australian headspace primary mental health services. Subjective changes in cognitive functioning (rated as better, same, worse) reported after 3 months of treatment was assessed using the Neuropsychological Symptom Self-Report. Multivariate multinomial logistic regression analysis was conducted to evaluate the impact of baseline levels of and changes in depression (nine-item Patient Health Questionnaire; PHQ9) and anxiety symptoms (seven-item Generalised Anxiety Disorder scale; GAD7) on changes in subjective cognitive function at follow-up while controlling for covariates. Results With a one-point reduction in PHQ9 at follow-up, there was an estimated 11–18% increase in ratings of better subjective cognitive functioning at follow-up, relative to stable cognitive functioning. A one-point increase in PHQ9 from baseline to follow-up was associated with 7–14% increase in ratings of worse subjective cognitive functioning over 3 months, relative to stable cognitive functioning. A similar attenuated pattern of findings was observed for the GAD7. Conclusions A clear association exists between subjective cognitive functioning outcomes and changes in self-reported severity of affective symptoms in young people over the first 3 months of treatment. Understanding the timing and mechanisms of these associations is needed to tailor treatment.

Purpose Timely access to effective treatment is a primary goal for mental health services; however, when demand exceeds available resources, services may place clients on a waitlist or restrict services. This paper aims to identify approaches used by mental health services to manage service demand and waitlists. Design/methodology/approach A review of research literature between 2009 and 2019 was conducted using the Medline, PsycINFO, CINAHL, Embase and Cochrane databases. Articles were screened and assessed against inclusion criteria and the methodological quality of included studies was assessed using the Mixed Methods Appraisal Tool. Findings In total, 20 articles were located that met the inclusion criteria. Five demand management approaches were identified, namely, walk-in models, triage processes, multi-disciplinary care, patient-led approaches and service delivery changes. Research limitations/implications This review identifies effective approaches that services can consider adapting to their local setting; however, further research is needed to demonstrate the clinical effectiveness of services provided under these models. Originality/value This review makes a valuable contribution to mental health care service delivery by detailing the strategies that services have adopted to manage demand and, where available, comparative outcomes with traditional service delivery models.

Purpose Internet child abuse material (I/CAM) offences negatively affect children in our own communities and in the wider virtual world. This study aims to understand the differentiation between online (internet) and offline (contact) offenders. The development of the Estimated Risk for Internet Child Sexual Offending (ERICSO), a proposed instrument for I/CAM offenders, incorporated a case study component to test on a known offender before the tool is applied to a wider sample. Design/methodology/approach The case study approach provides a unique opportunity for researchers to consider reflections from an I/CAM offender. These insights provide unique perspectives on areas for further exploration, including suggestions for consideration in the assessment and treatment of I/CAM offenders. Findings Mr A is a male convicted of possessing I/CAM with previous convictions for contact child sexual offending. During the development of the ERICSO, Mr A provided commentary on proposed questions based on his experiences as an offender and his communications with other offenders. Mr A’s feedback was generally consistent with current research findings, with notable suggestions in recognising the importance of differentiating between fantasy/reality, violence/voyeurism and the role technology plays in I/CAM offences. These reflections will be considered in conjunction with ongoing development and validity studies of the ERICSO to contribute to the targeted assessment and risk-relevant treatment for I/CAM offenders. Originality/value The use of a case study in the development of a proposed assessment instrument provides a unique perspective to improve ecological validity.

Abstract Purpose Use of alcohol and other substances is a multifaceted issue impacting young people across multiple life domains. This paper aims to elucidate patterns of substance use and associated demographic and clinical factors among young people seeking treatment for their mental health. Methods Young people (12–25 years old) were recruited from five youth-specific primary mental health (“ headspace ”) services in Australia. Self-reported substance use and harms in the past 3 months were measured using WHO-ASSIST. Network analyses were conducted to evaluate interrelationships between use and harms associated with different substances. Subgroups were then identified based on whether participants reported using high centrality substances, and associated demographic and clinical factors were assessed with multinomial logistic regression. Results 1107 youth participated. 70% reported use of at least one substance in the past 3 months, with around 30% of those reporting related health, social, legal or financial problems. Network analysis highlighted substantial interconnections between use and harm indicators for all substances, with amphetamine-type stimulants (ATS) and cannabis being high central substances. Higher levels of substance use and harms were reported in subgroups with ATS or cannabis use and different risk factors were associated with these subgroups. Conclusions Findings highlight the importance of screening for substance use in youth primary mental healthcare settings, offering a key opportunity for early intervention. Clinicians should be aware of the inner connections of use and harms of different drugs and the role of cannabis and amphetamine use as a marker for more substance use profiles.

We describe a research program to advance youth mental health service research in Australia, addressing two core knowledge gaps: the lack of available routine outcome measures and lack of understanding of how to assess and monitor complexity and heterogeneity in illness presentation and trajectory.Our research identifies better routine outcome measures (ROM) that are: designed specifically for the developmental nuances of the 12-25-year age range; multidimensional; and meaningful to young people, their carers, and service providers. Alongside much-needed new measures of complexity and heterogeneity, these tools will inform service providers to better meet the needs of young people presenting with mental health problems.

The field of early psychosis has undergone considerable expansion over the last few decades and has a strong evidence base of effectiveness. Like all areas of healthcare, however, early psychosis services need to more consistently deliver higher quality care to achieve better outcomes for patients and families. A national clinical research infrastructure is urgently required to enable the sector to deliver the highest quality care and expand and translate evidence more quickly and efficiently. This paper describes the establishment of the Australian Early Psychosis Collaborative Consortium (AEPCC) that aims to achieve this.AEPCC is the first of its kind in Australia (and internationally). It will deliver the required clinical research infrastructure through the implementation of a clinical quality registry, clinical trials and translation network, and lived experience network. AEPCC will provide a critical resource to better understand the state of early psychosis care, and trial new interventions on a scale that has not previously been possible in Australia.

Evaluating service quality and satisfaction is central to the provision of accessible and developmentally appropriate youth mental health services. However, there are limited suitable measures and a lack of published evidence on the psychometric properties of measures to assess young people's satisfaction with youth mental health services. The headspace Youth (Mental Health) Service Satisfaction Scale (YSSS) was designed and implemented to assess young people's satisfaction with headspace mental health services in Australia. This study examined the reliability and factor structure of the YSSS in a youth mental health service in Ireland.The sample comprised 1449 young people (66.2% female) aged 12-25 years (M = 16.48, SD = 2.97). Participants completed the YSSS after their final brief intervention session through Jigsaw-The National Centre for Youth Mental Health. Confirmatory factor analysis (CFA) was performed on one- and four-factor models to test findings from previous studies. Reliability was also examined.CFA supported a single-factor structure of the YSSS, and all items were suitable for inclusion. The internal consistency of the measure was deemed acceptable (α = 0.89).Findings suggest that the YSSS is a reliable measure for monitoring satisfaction with youth mental health services in an Irish context. The measure demonstrated a unidimensional construct of satisfaction. These findings support the broader application of the YSSS and add to existing knowledge on measuring satisfaction within youth mental health services.

Evidence for the effectiveness of crisis helplines is limited by inappropriate and inconsistent outcome measurement. The aim of this study was to develop a core outcome set that reflects the most relevant and important outcomes to help-seekers accessing a crisis helpline via any delivery mode (e.g., phone, SMS text, online chat). We used a three-panel Delphi method to compare and integrate the views of three expert groups: people with lived experience of accessing crisis helplines (n=32), researchers with experience assessing crisis helpline outcomes (n=25), and crisis helpline supporters (n=58). Across two online survey rounds (89% retention rate), participants rated the importance of 33 potential outcomes for help-seekers accessing a crisis helpline. Participants also provided open-text comments and suggestions. Outcomes that reached consensus (≥75% agreement) by at least two panels were included in the core outcome set. Ten outcomes met the criteria for inclusion in the core outcome set. In order of importance, these were: distress, feeling heard, suicide risk, connectedness/support, hopelessness, overwhelm, non-suicidal self-injury risk, service experience, helplessness, and next steps. Participants self-selected and were mainly from English-speaking countries. We recommend future outcome and evaluation studies minimally measure and report the 10 outcomes identified in this study. Assessing an agreed set of meaningful outcomes will improve comparability and facilitate a deeper understanding of crisis helpline effectiveness. More work is needed to determine how best to assess these outcomes in the crisis helpline context.

Abstract Purpose Many young people are reluctant to seek support for mental health concerns and a preference for self-reliance has been identified as a key barrier. Yet, the conceptualisation and measurement of self-reliance is not well understood. This study examines the meaning of self-reliance as it affects young people’s help-seeking, with an emphasis on the role of trust (both in self and in others). Method 30 Australian young people aged 18–25 years were interviewed. Reflexive thematic analysis, using both inductive and deductive approaches, was used to construct themes about the relationships between trust, self-reliance, and help-seeking for young people. Results Participants identified that both self-reliance and help-seeking exist on a continuum from insufficient self-reliance to extreme self-reliance and excessive help-seeking to unwillingness to seek help. Trust was a key component of self-reliance, and a balance between trust in self and trust in others is necessary for self-reliance to be adaptive and appropriate help-seeking to occur. To maintain this balance, young people felt that a level of self-awareness was necessary. Conclusion A high level of trust in self is considered to increase self-reliance, whereas a high level of trust in others increases help-seeking behaviours. Understanding the role of trust in self-reliance informs developmentally appropriate ways to address self-reliance as a barrier to mental health help-seeking for young people. [216 words]

Adolescents bereaved by suicide and other traumatic death may experience strong grief reactions and increased risks of mental health problems and suicidal behaviour. As timely access to professional help can be critical, it is essential to understand how counselors perceive suicide bereavement in adolescents and how they work with this population. This study aimed to examine the perspectives of counselors ( N = 34). Eleven participated in an individual semi-structured interview and 23 others in group interviews. Thematic analysis yielded three themes: (1) Building a relationship with the bereaved adolescent, (2) Offering support tailored to the needs of the grieving adolescent, and (3) Offering strengths-based and sustainable support. Counselors’ skills, attitudes, content-related expertise, and approaching the adolescent’s grief within their developmental context were deemed essential for building a therapeutic relationship and offering viable support. The findings may inform good practices in counseling bereaved adolescents to facilitate positive mental health outcomes.

ABSTRACT ABSTRACT This study applied the theory of planned behavior to adolescent smoking. The theory maintains that attitudes, subjective norms and perceived behavioral control predict intentions to smoke. These intentions predict smoking behavior, along with a direct effect of perceived behavioral control. In a sample of two hundred eighty-five 15- and 16-year-old students, the theory of planned behavior was shown to provide a comprehensive theoretical model to account for the predictors of adolescent smoking. The study farther examined the effects of self-efficacy in other domains on the predictors of smoking. Students with lower conduct/morality self-efficacy had more positive attitudes toward smoking, normative influences that approved of smoking and greater perceived behavioral control to smoke. The results are discussed in terms of potential points of intervention to discourage adolescent smoking.

Abstract For young people still at school, the school setting is vital to their mental health and wellbeing. Not only does the school environment have a direct and indirect impact on mental health, it provides an opportunistic setting in which to identify and respond to emerging mental health problems. To do this effectively, schools and school staff must work in collaboration with the young people themselves, their families, and other support services within the community, particularly primary health care services, including general practice. The importance of developing effective partnerships and care pathways between schools and the primary health care sector is being increasingly acknowledged, and initiatives such as MindMatters Plus GP have advanced our understanding in this area.

This paper provides an overview of current trends in the mental health problems of Australia's youth and adolescents. It presents information derived from the most recent and comprehensive Australian surveys of youth mental health, and provides international comparisons and views from professional practice where relevant. An update of trends for the most common and significant mental health problems is required to understand the mental health issues most likely to be encountered when working with young people, and as justification of the focus on intervening early for this age group.

This study investigated the intentions of community gatekeepers, youth workers and coaches to refer young people to mental health professionals, and examined the factors that influence the advice gatekeepers give to young people concerning helpseeking for mental health problems. The Theory of Planned Behaviour (TPB) was used as a framework, and gatekeepers' attitudes, subjective norms and perceived behavioural control were expected to predict referral intentions. These constructs were expected to mediate the effects on referral intentions of past referral behaviour, own help-seeking intentions, perceived helpfulness of mental health services and emotional competence. Youth workers (N = 92) and coaches (N = 47) completed a self-report questionnaire that measured intentions to refer young people to sources of help and factors that influence those intentions. Path analysis revealed that the TPB constructs did not effectively predict gatekeepers' referral intentions. Rather, past referral behaviour, perceived helpfulness and own help-seeking intentions had direct influences on referral intentions, collectively accounting for 39% of the variance in gatekeepers' intentions to refer. The results are discussed with regard to practical implications for helping young people seek the mental health support they need.

Abstract Aim: This paper considers the priorities for policy to promote youth mental health in Australia. The Ottawa Charter is applied as a conceptual framework to determine current strengths and future priorities across the entire spectrum of interventions for mental health promotion. Methods: The five platforms of the Ottawa Charter are used to categorize some of the major initiatives that promote youth mental health. Areas of strength and major gaps within each platform are identified. Results: Australia was shown to be at the forefront of many youth mental health promotion initiatives, particularly in the service reorientation and personal skills platforms of the Ottawa Charter. Conclusions: While significant progress has been made in some areas of youth mental health promotion, areas of critical need for policy focus were: oversight of all public policies for their impact on youth mental health; more supportive environments for youth and better interconnection with mental health care; community action to support the youth voice; investment in resources for parents and families; ensuring quality inreach and outreach to provide young people with positive mental health messages and improve mental health literacy; and embedding and expanding effective innovations in youth mental health services reorientation.

Interventions that aim to improve social problem-solving skills can significantly reduce the severity of anxiety and depression symptoms in young people. Anxious and depressed individuals often have a negative orientation to problem solution which acts as a barrier to implementing problem-solving skills. Research with older adults suggests that symptoms impair problem-solving abilities through cognitive processes associated with the development of anxiety and depression. In this study we extend previous investigations by assessing the extent to which specific cognitive distortions and symptoms of anxiety and depression are associated with negative problem orientation (NPO) in a sample of 285 young adults aged 18–25 years. Results found that cognitive distortions and depressive symptoms were strong predictors in a regression model that explained approximately half of the variance in NPO. Results also found that the relationship between cognitive distortions and NPO was strengthened as depressive symptoms became more intense. The distortion ‘You think you know what the future will bring; you expect disaster and gloom’ had the strongest individual association with NPO and depressive symptoms. Implications for enriching prevention and early intervention initiatives for young adults are discussed.

Abstract Aims This study aimed to develop a comprehensive measurement tool for assessing client satisfaction at a youth mental health service. Methods We developed a scale based on existing scale items and by generating new items, before undertaking revisions and item reduction in consultation with an expert panel composed of researchers, clinicians and consumer representatives. This draft scale was then pilot tested in seven enhanced primary care youth mental health services across A ustralia. Results A total of 215 respondents completed the scale. C ronbach's alpha (α = 0.953) demonstrated excellent internal consistency, and exploratory factor analysis suggested that the scale measures a global construct of satisfaction. Conclusions Through a rigorous and participatory process involving key experts, service providers and service users, this study has resulted in the development of a scale that can appropriately measure the level of user satisfaction with youth‐friendly early intervention services.

Objective: The aim of this study was to investigate participation in employment, education, or training among a national cohort of young people presenting to youth-specific mental health services across Australia, and identify the key demographic and clinical correlates of non-participation.Method: Clinician and self-reported demographic and clinical characteristics were ascertained for 57,644 young people aged 15–25 years presenting to a national youth-specific mental health service between 1 April 2013 and 31 March 2015, including level of participation in education, employment, or training in four categories (not participating, not in the labour force, partial participation, and full participation).Results: The results showed that these young people are very vulnerable to non-participation in employment, education or training. Characteristics most strongly associated with non-participation were being Aboriginal or Torres Strait Islander, male, homeless, diagnosed with a substance use disorder, or having a neurodevelopmental disorder in young adulthood.Discussion: The results extend understanding of the major risk factors associated with non-participation in employment, education, or training for help-seeking young people. Distinct patterns emerged across the three non-participation groups suggesting that support must be tailored to individual needs. Supporting those who experience mental illness to re-engage is essential to buffer against the long-term impacts. Holistic, integrated services that can incorporate mental health and vocational services are crucial for prevention, early intervention, and treatment.

The aim of this study was to assess clients' and service providers' perspectives on changes in mental health after an admission to a residential recovery-focused, sub-acute service, in Australia. Clients were either step-up clients, entering the service directly from the community, or step-down clients who were transitioning from an inpatient unit to home. During the 30-month period of data collection (August 2011 to January 2014) all clients (N = 102) were invited to participate in the longitudinal study and 41 clients consented to be involved (38% response rate). At admission and exit, participants completed the Behaviour and Symptom Identification Scale (Basis-32) and service providers completed the Life Skills Profile-16 and Health of the Nations Outcome Scales. Follow-up data 3 months after exit were available for 12 clients, including the Basis-32 and a self-report measure of quality of life (Assessment of Quality of Life 8-dimension). Both client groups reported positive improvements between admission and exit in the areas of relation to self and others, psychosis, daily living and presence of depression or anxiety symptoms. Service providers reported gains for clients in the areas of self-care, level of symptoms and presence of social problems. At 3 months, clients generally reported positive quality of life, although there was no significant change in symptoms and functioning. This study demonstrates that after an admission to a sub-acute service, step-up clients experience an improvement in their symptoms and functioning, have avoided a hospital admission and are well enough to return home. Step-down clients also experience further improvements in their symptoms and functioning, indicating that the service has assisted them in their transition to independent living after a hospital admission. Sub-acute residential units provide a continuation of care for inpatients preparing to return home, and people with a mental health problem living in the community who experience an escalation in symptoms and prefer an alternative to hospital.