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"The burden of suffering experienced by children with mental health needs and their families has created a health crisis in this country [USA]. Growing numbers of children are suffering needlessly because their emotional, behavioural, and developmental needs are not being met by those very institutions which were explicitly created to take care of them. It is time that we as a Nation took seriously the task of preventing mental health problems and treating mental illnesses in youth."¹

In 1995, as part of the National Mental Health Strategy, the Federal Government funded a national survey to establish the prevalence of mental disorders, disability and service use in the Australian population. The adult component (ie, people over 17 years) was conducted in 1997² and the child and adolescent survey (people aged 4-17 years) in 1998. Findings of the latter survey were released recently³ and are summarised in the Box.

The strength of the child and adolescent survey was that it considered mental health problems in a variety of ways, including psychiatric diagnosis, service use, and the impact of mental disorders on quality of life. Limitations of the survey were that diagnoses were based solely on information from parents (some questionnaire data were obtained from adolescents but no information was sought from teachers), and only three conditions were examined. These shortcomings may explain, among others, the high rates of attention deficit hyperactivity disorder found — as many as 19.3% of boys aged 6-12 years were found to be suffering from this condition.

Some findings are worth highlighting. First, the prevalence of mental health problems among the young (14%) is high and not much different from that found in adults (18%).² That is, half a million Australians aged 4-17 years have serious emotional and behavioural problems.³ Second, these conditions impair their functioning and quality of life. Disturbed young people also behave in ways injurious to health much more often than their healthy counterparts. Third, only a quarter of those who need help receive it.

Mental disorders impose a heavy burden on children, families and communities^1,2,4 and often persist into adulthood. The cost to society in human and economic terms is great.¹ There is broad agreement that we need to detect these problems early, provide effective treatment and attempt prevention.^1,4 A four-pronged approach is necessary:

• Increase awareness that mental health problems are a major issue in child health and try to prevent them. This will help give children the chance for a healthy start in life.¹

• Improve the use of resources and access to services. For example, general practitioners could, with appropriate training, play a central role identifying and treating children with mental health problems. GPs (after schools, the second most common source of help) are well placed to take on this role, especially as disorders are often chronic, and contact with specialist services is likely to be only episodic.⁵ To do this, GPs will need better support — for example, rapid access to specialist telephone advice and to psychiatric assessment, and good liaison with child and adolescent community teams.⁵ Psychiatrists, psychologists and other mental health professionals need to be more accessible and responsive, particularly in crises.⁶ It is poignant that, while Australia prides itself on providing universal access to free healthcare, half of the parents needing help believe it is too expensive.³

• Increase funding for mental health services for young people. In 1997-98, the last year for which data are available, State and Territory governments spent $1.4 billion on mental health services ($74 per capita).⁷ Of this sum, only $107 million (7%) was spent on the young, who make up a quarter of the Australian population — this amounts to an average of $23 per child, compared with $95 per adult.⁷

• Increase the number of specialists in mental health and carry out more research. The shortage and maldistribution of specialists^7,8 is well documented, and it is important to establish which treatments and service-delivery models work and which do not.^1,4

We must ask ourselves whether we as a nation take seriously enough the task of preventing and treating mental illnesses in the young. The recent proliferation of programs⁸ promoting mental health suggests we are moving in the right direction, but it remains to be seen whether this is a measure of real commitment or just window dressing. The findings of the latest survey of mental disorders in young people³ will at least give us a baseline for comparison when the next national survey is conducted.

Joseph M Rey
Professor, Department of Psychological Medicine, University of Sydney
Director, Child and Adolescent Mental Health Services
Northern Sydney Health, Sydney, NSW

1. Report of the Surgeon General's Conference on Children's Mental Health: a national action agenda. Washington, DC: US Public Health Service, 2000.
2. Australian Bureau of Statistics. Mental health and wellbeing profile of adults, Australia 1997. Canberra: AGPS, 1998.
3. Sawyer MG, Arney FM, Baghurst PA, et al. The mental health of young people in Australia. Canberra: AGPS, 2000.
4. Raphael B. Promoting the mental health and wellbeing of children and young people. Discussion paper: key principles and directions. Canberra, AGPS, 2000.
5. Garralda ME. Child and adolescent psychiatry in general practice. Aust N Z J Psychiatry (in press).
6. Australian Medical Workforce Advisory Committee. The specialist psychiatry workforce in Australia. Sydney: AMWAC, 1999. (AMWAC Report 1999.7.)
7. Commonwealth Department of Health and Aged Care. National mental health report 2000. Canberra, AGPS, 2000.
8. National action plan for promotion, prevention and early intervention for mental health. Canberra: Commonwealth Department of Health and Aged Care, 2000.

©MJA 2001
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