information
sheet
Mental
Health Issues
Over the past 20 years one of the most critical
issues government and the community sectors
have been required to respond to is the mental
health of young Australians. Mental health
is a significant concern for millions of
Australians – young and old, either living with
a mental health problem themselves or caring
for another person.
Mental health is a major issue for populations
living in the most developed countries
of the world and is the second main reason
(after abuse and violence) for children and young
people contacting child helplines from countries
ranked in the top nine of the Human Development
1
Index (HDI) .
What is mental health?
Mental health and mental illnesses are
determined by multiple and interacting social,
2
psychological, and biological factors . Being
mentally healthy involves much more than just
not having a mental illness. Being mentally
healthy indicates a mind that embraces positive
attitudes rather than negativity – a state of
wellbeing in which a person can manage the
normal stresses of life, be productive and
contribute to their communities and form
meaningful relationships. Children and young
people who are not nurtured effectively nor given
the opportunities they need to successfully
develop their emotional as well as physical and
social lives, will find it difficult to get the most out
of life. Research demonstrates that people who
are mentally healthy are more productive, more
socially connected and more likely to achieve
3
their goals in life .
More than four million people had previously
experienced a mental health disorder but had
not had any symptoms for 12 months prior to
the survey. Of 16 million Australians aged 16-85
years, 45% (or 7.3 million) were found to have
had a mental health disorder at some point in
4
their life .
Young people are said to “carry the greatest
3
burden of mental illness” . This is because more
than 75% of all severe mental illnesses occur
prior to the age of 25. Just over a quarter (26%)
of people surveyed in 2007 aged 16–26 had a
mental health disorder compared to only 6% of
4
people aged 75–85 .
In a 2000 study that specifically targeted the
mental health issues of children and adolescents
aged 4–17 years, it was estimated that 14%
5
experience mental health problems .
Australian data on mental health
According to figures released in 2007 by the
Australian Bureau of Statistics (ABS) following
a national survey of the Australian population’s
mental health and wellbeing, one-in-five
(3.2 million) Australians aged 16–85 years
reported having a mental health disorder within
the previous 12 months.
Impact of mental health problems
The challenges of living life affected by a mental
health disorder cannot be overstated. Many
factors can combine to compound the negative
life experiences of those with poor mental health.
Children and adolescents with emotional and
behavioural problems have lower self-esteem
1
and are less likely to achieve in school and engage
productively with their peers than children with
5
fewer problems .
Further information on the topics of suicide and
self-injury can be found at:
Kids Helpline Suicide 2012 Information Sheet:
www.kidshelp.com.au/upload/22913.pdf
Kids Helpline Self-Injury 2011 Information Sheet:
www.kidshelp.com.au/upload/22902.pdf
Feeling socially excluded due to the stigma
attached to having a mental health disorder,
experiencing obstacles in obtaining everyday
educational and social opportunities and gaining
access to housing, goods and services can multiply
the impacts of poor mental health.
Risk factors
Specific indicators have been noted as risk factors
for the development of mental health disorders.
Studies have shown that people of lower socioeconomic status have higher rates of mental health
disorders, particularly depression and certain
9
anxiety disorders . Economically disadvantaged
young people, such as those who are unemployed,
are more vulnerable to mental health disorders
as they are more likely to experience insecurity,
hopelessness, rapid social change and risks to their
2
physical health .
Suicide and self-injury
Adolescents with mental health problems report
higher rates of suicidal ideation and other risky
6
behaviours including self injury and the use of
5
alcohol, tobacco, and other drugs .
The results of a community-based study suggested
that up to 30% of young people experience severe
suicidal ideation by 18 years of age. Young people
with persistent and severe suicidal ideation are
more likely to attempt suicide, and those who have
attempted suicide are at increased risk of later
7
completing suicide .
Family factors such as conflict, violence,
separation, step/blended families, single parenting
and poor parenting are some of the other most
commonly identified risk factors for mental
health problems among children and young
people. Physical, sexual and emotional abuse,
neglect and witnessing domestic violence are
particularly viewed as contributors. Other risk
factors associated with the development of mental
health problems include bullying and poor school
10
attachment .
Suicide is the main cause of premature death
among people with a mental illness. More than
10% of people with a mental illness die by suicide
8
within the first 10 years of diagnosis . An attempt
of suicide may also be a sign that a mental illness
is developing.
Self-injury is the deliberate damage of a person’s
own body in a way that is not intended to be fatally
harmful, often through cutting the skin or ingesting
substances believed to be non-lethal. Emotional
regulation and self-punishment are common
motivations for this behaviour and it tends to be
exacerbated during difficult times. Australian data
on self-injurious behaviour suggests that 2.6% of
Australians engage in self-injury within a 12 month
period and it is more common among adolescents
6
and young adults .
In the same study, it was found that self-injurers
were more likely to have a mental health condition
as well as a range of other issues including
substance use and suicidal ideation. While suicide
and self-injury are two separate phenomena there
is a degree of relatedness between the two as selfinjury was a strong predictor of attempted suicide
6
in the previous 12 months .
2
A strong correlation has also been reported between
homelessness and mental illness. A 2007 ABS
study revealed 484,400 people reported ever being
4
homeless . Of those, more than half (54%) had a
12-month mental health disorder. This was almost
three times the rate of 12-month mental health
disorders in people reporting they had never been
homeless (19%).
Protective factors
reluctant to access mental health services due to
fear of government authorities becoming involved
11
and children being removed from their families .
Furthermore, rural children and young people also
have lower rates of help-seeking for mental health
issues due to a number of issues relating to the cost
12
and accessibility of health services . In rural and
remote areas, males are particularly less likely to
13
seek assistance compared with males generally ,
who also have lower rates of help seeking behaviour
14
compared with females .
The Kids Helpline experience
A number of protective factors can help to
reduce the likelihood of lower-level psychological
difficulties developing into more severe mental
health problems. These protective factors can also
assist in the recovery process for those who have
already developed a mental health issue.
If the experience of abuse or neglect is considered a
risk factor for developing a mental health problem
then conversely, growing up in a safe and nurturing
environment tends to lead to better health
3
outcomes and less mental health problems . Social
relationships and networks can act as a protective
factor against the onset or recurrence of mental
illness and improve recovery from mental health
2
disorders .
Developing resilience in children and young people
can help to overcome existing risk factors as well
as enhancing their ability to cope with adverse life
events. Many approaches to resilience building
highlight the development of social and emotional
skills.
Help-seeking behaviour
While a significant proportion of young people
experience mental health problems, only some seek
help for their issues. Rates of help-seeking for those
who self-injure have been found to be particularly
low in spite of high levels of distress including
6
suicidal ideation and gestures .
It has been reported that only one-in-four young
people with a mental health problem receives
professional help. Even among young people with
the most severe mental health problems, only 50%
5
indicated they had received professional help .
Certain groups are particularly less likely to engage
in effective help-seeking strategies in spite of being
over-represented in statistics of mental health
problems.
Many Indigenous youth and their families are
3
Kids Helpline is an important service for children
and young people seeking information and support
relating to mental health issues. The ability to
contact confidential support 24/7 via telephone or
online is a valuable resource for young people wary
of asking for help from traditional sources such
as a family doctor or school teacher.
For clinical and accountability purposes Kids
Helpline counsellors collect demographic data and
create case notes related to the nature and outcome
of each counselling session held. De-identified
data can be used at an advocacy level to highlight
the issues of children and young people and to
give voice to their concerns to relevant policy and
decision-makers.
Contacts about mental health
Age, gender and cultural background
During 2011, there were 8,506 contacts from
young people aged 25 years or less where mental
health concerns were the primary reason for their
contact. At 13.2% of all counselling contacts, it
was the third most frequent reason young people
contacted the service in comparison to other types
of concerns. The rate of contacts to the service
where young people directly seek help about their
mental health has been increasing every year since
2006 when there were 5,226 contacts reported
by counsellors (9.2% of all direct help-seeking by
young people under 26 years of age).
In 2011, the 8,506 counselling sessions specifically
about mental health issues tended to be held with
older clients. Forty-six percent of mental health
related counselling was with young people aged
19-25 years compared with all types of problems
where only 31% of clients were in this age group.
Adolescence and young adulthood is a critical
time for the social and emotional development of
young people and most mental health conditions,
including depression, substance abuse, anxiety
disorders and psychoses, have their peak onset
during this stage. Receiving assistance at this age
is crucial as the long-term consequences of not
responding to first episodes of mental illness can
lead to social, emotional, physical and cognitive
10,15
difficulties throughout adulthood .
Kids Helpline is aware of the significant barriers
young people can experience when seeking formal
psychiatric assessment, diagnosis and treatment.
Therefore, all contacts to the service are informally
assessed for signs of mental health problems
regardless of the issue the young person is
contacting about or whether they yet have
a formal medical diagnosis.
Males generally make less contact with Kids
Helpline for counselling for all problem types
(18% in 2011). However, they are consistently
under-represented in help-seeking for mental
health concerns, making only 12% of those
contacts in 2011.
The result of this assessment activity is that in
2011, Kids Helpline counsellors recorded another
17,930 contacts (in addition to the 8,506 specific
contacts requesting assistance for mental health
related concerns) that included information leading
a Kids Helpline counsellor to assess that mental
health issues were a complicating factor in a young
person’s life.
Twenty-five percent of young people contacting Kids
Helpline for counselling for any type of problem are
from culturally and linguistically diverse (CALD)
backgrounds (not including Indigenous Australians).
However, young people from CALD backgrounds are
comparatively less likely to contact for assistance
specifically with mental health problems (20%).
Rates of contacts for mental health problems from
Indigenous young people are consistent with their
rates of contact for all kinds of problems (2%). This
data is shown in Figure 2.
Figure 1 Proportion of counselling contact specifically about mental health.
12
10
Figure 2 Cultural background
13.2%
11.5%
9.2%
10.0%
10.7%
% Counselling Sessions
% Counselling Sessions
13.0%
14
8
6
4
2
0
2006
2007
2008
2009
2010
2011
Year
80
73.0% 78.0%
ALL PROBLEM TYPES
70
MENTAL HEALTH CONCERNS
60
50
40
25.0%
30
20
10
0
20.0%
2.0%
Does not identify
as Indigenous
or CALD
Other CALD
Cultural Background
4
2.0%
Indigenous
Medium of contact and location
Related concerns
In 2011, almost one third of counselling sessions
were delivered through online media compared
with telephone (32% vs 68%). However, those who
sought counselling specifically for mental health
issues used online media slightly more frequently
(38%).
During counselling, children and young people
frequently raise multiple issues of concern.
Generally, these additional issues will be linked
to the primary reason for the contact and bring a
deeper understanding of the issues impacting on,
and being impacted by, the mental health of young
Australians.
Figure 3 Mental health contacts by modality
12.2%
25.9%
Phone
Web Counselling
Email
61.9%
More than one quarter of mental health related
contacts were from rural and remote communities.
This is consistent with the average rate of contacts
for all types of problems from regional areas.
Frequency of contact
Children and young people seeking counselling
from Kids Helpline may only require once-off
or occasional support from a counsellor. Others
may require ongoing support or even a case
management plan that provides for more
holistic support in the form of wrap around care,
particularly for complex issues where the client is
at risk of harm. Children and young people who
sought support related to mental health in 2011,
were more likely to be supported in an ongoing way
or with a case management plan compared with
the average for all types of problems. This data
is shown in the graph below.
In 2011, 35% of contacts regarding mental health
had an additional concern recorded. The most
common factors compounding young people’s
mental health problems were relationships
with family members (13%) and the difficulties
they experienced in trying to manage their own
emotions and behaviours (26%). Significantly,
almost 13% were contemplating suicide and/or
had previously attempted suicide. Eight percent
were struggling with eating behaviours, while
relationships with partners and child abuse were
compounding the mental health problems of young
people in another 6% and 5% respectively.
The rate at which self-injury was reported in
mental health related counselling sessions was
41%, much higher than the average rate across all
counselling issues (21%). In addition, 1,612 mental
health related counselling sessions led to young
people revealing they were experiencing thoughts
of suicide. This proportion of suicidal thinking is
also much higher than the average for all types of
counselling issues (19% vs. 13%).
Figure 5 Issues associated with mental health concerns
Emotional Behavioural
Managment
26.0%
Family Relationships
13.0%
Suicide Behaviours
and Issues
13.0%
% Counselling Sessions
Figure 4 Types of support
MENTAL HEALTH
ALL PROBLEM TYPES
40%
36.0%
35%
30%
32.0%
31.0%
25%
20%
15%
21.0%
17.0%
10%
14.0%
5%
0%
0
8.0%
6.0%
Partner Relationships
Child Abuse
5.0%
Relationships with
Peers
4.0%
Self-Image
4.0%
Study and Education
Issues
26.0%
23.0%
Related concerns
Eating Behaviours or
Weight Issues
4.0%
Grief and Loss
3.0%
0
First Time
Occasional
Ongoing
Case
Managed
5
5
10
15
20
% Counselling Contacts
25
30
35
Suicidality and self-injury
factors, impacts of having a mental health disorder,
associated management issues and information on
how Kids Helpline responds to young people’s needs
were highlighted.
In addition to the recording of the primary reason
for the young person’s contact, Kids Helpline
counsellors also conduct assessments, where
appropriate, of whether the client is struggling with
self-injuring behaviours or thoughts of suicide at
the time of the contact. Of the 64,442 counselling
sessions with children and young people for all
types of problems in 2011, 13,508 sessions involved
the client reporting they were engaging in deliberate
self-injury. In 8,383 counselling sessions the young
person reported they were experiencing thoughts
of suicide at the time of the contact. These reports
of serious risk have been increasing with a rise of
204% for reports of thoughts of suicide, and 59%
for reports of self injuring behaviour since 2006.
Three main groups of young people were identified
as motivated to pick up the phone or write to Kids
Helpline for help with mental health concerns.
Some young people were starting to experience
worrying signs and symptoms and were looking
for answers about what might be causing them.
Counsellors trained to recognise potential mental
health problems talked with the young people
about broad indicators of mental health disorders.
They were generally encouraged to see a doctor
or specialist mental health service to receive a full
mental health assessment.
Figure 6 Self-injury and suicidality trends
A second group may have received a formal clinical
diagnosis at some point prior to their contact with
Kids Helpline, but were not in current treatment.
These clients may have been re-experiencing
symptoms that were having a major effect on their
life. Counsellors would talk with them about their
anxieties or distress relating to their diagnosis or
medication, educate them about the benefits of
re-engaging with the formal mental health system
if required, and frequently provide actively managed
referrals back to their treatment team.
16,000
13,508
Self Injury
14,000
Current Thoughts Suicide
12,000
Number of Contacts
11,072
10,000
8,472
8,498
7,710
8,166
8,000
8,383
6,829
6,000
4,000
2,750
3,289
3,991
4,564
A third group of clients were seeking additional
support to complement the therapy and treatment
being currently received in face-to-face services.
As these services were often accessible during
business hours only, Kids Helpline was able to
provide support (including crisis response) and
encouragement with the clients’ therapy and case
plans after hours. Consultations might be held with
the treating doctor, psychiatrist or therapist to
ensure that information and communications with
shared clients was as consistent as possible across
all agencies involved. Kids Helpline refers to this
model of service delivery as “wrap-around-care”.
Of those who specified having a particular mental
disorder diagnosis, the range of disorders reported
in order of frequency was:
2,000
0
2006
2007
2008
2009
2010
2011
Although suicidality and deliberate self-injury
are two separate issues, they are somewhat
related as shown by the degree of overlap between
those reporting current thoughts of suicide and
those reporting engaging in self-injury. For those
reporting current thoughts of suicide in 2009, 56%
also reported engaging in self-injury. Similarly, 35%
of those engaging in self-injury were also reporting
thoughts of suicide. This data reflects the findings
6
of other research . Further information sheets on
contacts to Kids Helpline regarding suicide and
self-injury can be found at www.kidshelp.com.au/
grownups.
•
•
•
•
•
•
•
•
Nature of concerns about mental health
A review of 610 case notes recorded by Kids Helpline
counsellors regarding mental health counselling
sessions, provided details on the specific mental
health disorders presented. Additionally, risk
6
Depression
Anxiety (including phobias)
Psychotic disorders
Obsessive-compulsive disorder
Personality disorders
Post-traumatic stress disorder
Eating disorders
Bipolar disorder
A number of risk factors relating to both the
development as well as the maintenance of a
suspected or diagnosed mental health disorder
were reported and support the findings of the
research noted above. Child abuse was the most
common reported risk factor. Sexual abuse was
the most common form of child abuse along with
physical and emotional abuse and emotional
neglect. This particular finding relating to the
impact of sexual abuse on the development of
mental health disorders is also in line with other
16
research .
Other risk factors reported included familial
mental illness and substance use, homelessness
and living in supported accommodation,
substance use by the young person, bullying
and low socio-economic status. Relationship
breakdown and family conflict were other risk
factors cited by young people asking for help.
Referrals and emergency responses
While Kids Helpline is able to refer contacts to a
face-to-face service if needed, many young people
are unable or unwilling to seek assistance from a
support service other than Kids Helpline. Where the
young person is not assessed to be at risk of harm,
counsellors might spend many weeks developing
an ongoing trusting relationship with the client
while continuing to educate them about the
benefits of face-to-face support and/or medication.
In some cases, a young person contacts in crisis
showing signs of severe mental illness, having
already harmed themself or having a serious plan
to do so. In these situations, Kids Helpline, under
its Duty of Care policy, works in tandem with
emergency services such as police, ambulance,
hospital emergency departments or after hours
mental health assessment teams to ensure their
safety.
In 2011, there were 684 presentations linked to
mental health concerns including suicide and
self-harm that required a response under the
organisation’s Duty of Care procedures. In these
cases the service took responsibility for either
passing relevant information to emergency
services able to find and transport the young
person to a place of safety or negotiated with
mental health services and hospital emergency
departments on their behalf to have them
assessed for admission.
7
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BoysTown’s response to mental health issues
While Kids Helpline telephone and online services
support young people struggling with mental
health issues, BoysTown also provides face-to-face
services assisting young people and their families
with concerns impacting on their mental health.
These services include parenting programs and
support, drug and alcohol counselling, employment
and training services, family refuges and life skills
workshops.
In addition, BoysTown advocates for the needs
of children and young people affected by mental
health concerns to be considered in public policy
decision-making. Since 2009, BoysTown has made
submissions to state and federal government on a
number of mental health related issues including
suicide, drugs, bullying, body image, Indigenous
issues and the National Mental Health Plan.
BoysTown has also created a number of online
resources related to mental health, which can be
accessed by young people and those who care for
them.
Additional collaborative mental health related
projects in which BoysTown participates include:
8
•
The Inspire Foundation’s Technology and
Wellbeing Roundtable, exploring how technology
can enable young people’s wellbeing and
identifying possible issues to then develop and
promote best practice
•
Young and Well Cooperative Research Centre,
exploring the role of technologies in young
people’s lives and the opportunities to leverage
these technologies to improve their mental
health and wellbeing
•
The New South Wales Health development of
Guidelines for Discussing Suicide and Attempted
Suicide. The aim of the guidelines will provide
support for schools, workplaces, families and
communities to strengthen their capacity to
participate in suicide prevention action
•
Research studies with Griffith University and
Queensland University of Technology, exploring
the use of technology to support young
people’s mental health during job-seeking and
understanding the barriers to help-seeking for
young people with a range of issues including
self injury and thoughts of suicide.
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reasons
5.
Sawyer et al, Mental Health and Special
ProgramsBranch, Commonwealth Department
of Health and Aged Care, 2000: The Mental
Health of Young People in Australia; The child
and adolescent component of the national
survey of mental health and well-being
6.
Martin, G., Swannell, S., Harrison, J., Hazell, P.,
& Taylor, A. (2010). The Australian National
Epidemiological Study of Self-Injury (ANESSI).
Centre for Suicide Prevention Studies: Brisbane,
Australia
7.
Hider, P. (1998). Youth suicide prevention by
primary healthcare professionals: A critical
appraisal of the literature. NZHTA Report 4.
8.
SANE Australia. (2008). Factsheet: Suicidal
behaviour and self-harm. [Accessed
17/09/2010 at http://www.sane.org].
9.
Fryers, T., Melzer, D., Jenkins, R., & Brugha, T.
(2005). The distribution of the common mental
disorders: Social inequalities in Europe, Clinical
Practice and Epidemiology in Mental Health,
1(14), 1-12.
10. CDHAC (2000) Promotion, Prevention and Early
Intervention for Mental Health- A Monograph:
Canberra; Mental Health and Special Programs
Branch, Commonwealth Department of Health
and Aged Care
11. Williamson, A.B., Raphael, B., Redman, S.,
Daniels, J., Eades, S.J. & Mayers, N. (2010).
Emerging themes in Aboriginal child and
adolescent mental health: findings from a
qualitative study in Sydney, New South Wales.
Medical Journal of Australia, 192, 603-605
12. Beer, A. and Keane, R. (2000). Population
decline and service provision in regional
Australia: A South Australian case study.
People and Place, 8(2), 69-76
Caldwell, T.M., Jorm, A.F. & Dear, K.B.G. (2004).
Suicide and mental health in rural, remote
and metropolitan areas in Australia. Medical
Journal of Australia, 181, S10-S14
13. Caldwell, T.M., Jorm, A.F. & Dear, K.B.G. (2004).
Suicide and mental health in rural, remote
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