Australian children with mental disorders aren’t getting help

The vast majority of Australian children with mental health disorders aren’t getting professional help, and girls, younger children and families from non-English-speaking backgrounds are the least likely to be accessing services.

Our research, published in the Australian Journal of Psychology, looked at the mental health of nearly 5,000 children from the ongoing Longitudinal Study of Australian Children. We found that fewer than one in four children with mental health problems saw a health professional in the 18 months after they were identified as having a problem.

Our research found that girls were significantly less likely to access care than boys. For example, girls made up only 30 per cent of children who received support for emotional problems at ages 8-9 and 10-11, despite half of those needing help being girls.

Similarly, families from non-English speaking backgrounds were a lot less likely to access services given that 14 per cent of children with emotional problems came from a non-English speaking background but only 2 per cent received help.

The youngest age group in the story were aged 8 to 9 years and were the least likely of the age groups to access services, with 85 to 90 per cent of those needing help not accessing services.

As part of the research, parents were surveyed on their children’s emotional problems using the Strengths and Difficulties Questionnaire, and the children were grouped into three age ranges: 8 to 9, 10 to 11 and 12 to 13.

The results were then linked with Medicare Benefits Schedule data to see which families had accessed help.

To the best of our knowledge, no study has previously examined the mental health of Australian children and used objective, Medicare-linked data.

Previous studies have relied on parents’ anecdotal reports on whether their child uses mental health services, but the problem with this is that parents may tend to overestimate attendance.

The greater proportion of younger children not accessing service may reflect families’ hopes that a child will simply ‘grow out’ of a mental disorder, but as the situation worsens they finally seek treatment.

The gradual onset and increase in severity over time of many mental health problems means that children and their parents are more likely to seek services when the symptoms become severe or impact significantly on the child’s ability to function, typically as they grow older.

However, if left untreated, problems can become more entrenched and in turn harder to treat.

The higher access results among boys may be a result of boys being more likely to externalise problems, making their condition more obvious.

The reluctance of parents from non-English speaking backgrounds to get help may be because of different cultural norms, or they may struggle to find services for their child in their own language.

Mental problems may also be mistaken for a language issue rather than a mental health issue.

The results should underline the point that that mental health disorders don’t just start in adolescence but can begin in early childhood. Young children respond to and process emotional experiences and traumatic events in ways that are very different from adults and older children.

Consequently, diagnosis in early childhood can be more difficult than it is in adults.

Our other findings include:

• Children with emotional problems were more likely to receive mental health support than those with externalising problems. This may be because there is now increased recognition of depression and anxiety in the community, whereas externalising problems may be perceived as misbehaviour rather than a mental health problem
  

• The factors most consistently associated with getting support were symptom severity and parent perception that the child needed help
  
• There was little to no increase in service use in children from families of low socioeconomic status or single parents
• A larger proportion of children received mental health services from a paediatrician (13 to 28 per cent) than a psychologist (one to 20 per cent) or a psychiatrist (zero to five per cent). Between 12 and 17 per cent of children are estimated to be seeing a paediatrician for their mental health

Other previous research has found that 14 per cent of four to 17 year olds or 580,000 Australian children and adolescents meet diagnostic criteria for at least one mental health disorder over 12 months, and 50 per cent of all adult mental disorders begin before the age of 14 years.

But according to 2016-17 Medicare data, children under the age of 15 years have the lowest use of Medicare-rebated mental health services (5.1 per cent) of any Australian age group.

Over the past 20 years there has been little change in the prevalence of child and adolescent mental disorders reported in many countries despite increased investment in resources.

This is likely in part because the quality and the intensity of services provided haven’t improved.

Most children may not be receiving a high enough dosage or treatment sustained over a long enough period of time to meaningfully have an impact on their symptoms.

One problem is that the healthcare system in Australia rewards discharging patients within a set number of appointments rather than once they have improved. There is a need for a system-level shift to funding based on measured symptom improvement rather than a capped number of appointments.

The Victorian government is currently undertaking a Royal Commission into mental health services seeking to understand how to most effectively prevent mental illness and treat problems early in life, as well as improving access to and navigation of the mental health system for people of all ages.

Our research suggests we need to better understand parent and child drivers of why children miss out on care, particularly girls and younger children.

Ensuring access to adequate, high-quality care will benefit not only the child and their family now, but also the adult and parent they will hopefully become.

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