ABOUT half of all mental illnesses emerge before the age of 18, and when left untreated, the effects can last well into adulthood. In Australia, almost 15% of young people aged 12 to 17 experience a mental illness each year, with that rate rising to 1 in 4 by the age of 24.
Yet when young people reach out for medical support for mental health illness, they often endure long waits between speaking to their GP and meeting with a clinician, such as psychologist or counsellor. Even prior to the COVID-19 pandemic, wait times for mental health services and treatments were long. The average wait time for a young person to access psychological treatment through headspace centres, for example, was greater than one month.
To explore possible solutions for support during the wait time, the Black Dog Institute is conducting an Australia-wide survey among GPs to better understand how they experience the wait times, how wait times impact their treatment decisions and behaviours, and their openness to recommending low intensity digital interventions (such as mobile apps) to their young patients. The Institute is also surveying young Australians about their experience of wait times, the services they are accessing, and what they think can help them during this time.
Approximately 1 in 5 young Australians do not engage with employment, education or training while seeking help for mental health problems. Mental illnesses represent the leading cause of disability among young people worldwide and sadly, suicide remains the leading cause of death of young people aged 5 to 17 in Australia in 2020. Unfortunately, current research overwhelmingly suggests that since the onset of the COVID-19 pandemic, young people have experienced a worsening of their mental health (here, here, and here), highlighting the importance and urgency for available, high quality, and evidence-based support and treatments.
Prevention and early intervention during the adolescent years can help reduce the onset and impacts of mental illness across the lifespan (here, and here). As the primary referrers to the mental health care system, GPs are well placed to provide this key early intervention and connect young people with appropriate services during this critical time.
While private psychological services can provide an alternative to lengthy wait times, a study conducted in Victoria and South Australia in 2019 reported that one-third of private practices had closed their books to new clients. A survey conducted by the Australian Psychological Society (APS) revealed that pre-pandemic, 82% of their members reported they saw new clients within 2 months of first contact, and only 29% reported a waitlist of 2–4 weeks. Since the pandemic began, almost 90% of APS members have reported an increase in their wait times, and half reported a waiting period of longer than 3 months. Concerningly, 1 in 3 APS psychologists are unable to take on new clients, which has increased from 1 in 5 since June 2021 (here, and here).
These wait times have an impact on both the GP and the young person.
For GPs, their referral behaviours and decisions are changed when wait times are long or services just are not available. One GP noted:
“I have to give people a long list of places to call and urge them to keep trying if the first ones are not taking anyone new on. I tell them to go on people’s waitlists in case others drop out”
“many families are needing more than one referral, so it is problematic and costly for them”
The GP’s role and capacity to provide care is also challenged when long wait times stall a patient’s access to mental health care. Many GPs lack confidence in their ability to help young people with mental health conditions and that, combined with the weight of their general workload, makes caring for these young people without specialised support extremely stressful, as GPs are forced to take on more of an active role in care.
The impact on young people is also significant, with long wait times negatively impacting both their health and treatment. Research suggests that long wait times are associated with treatment discontinuation, symptom deterioration and relapse, lower treatment satisfaction, and lower likelihood of future help-seeking (here, here, here, and here). The experience of waiting can also be challenging for young people. One young person told us that:
“It felt very distressing and the process wasn’t explained to me at all. At times I felt like I had been brave enough to talk out that I was having problems and then I was forgotten about. Things got better for me after I had my first counselling session and I’ve been seeing the same person since”
GPs often find themselves providing care for young people during the wait time but not knowing quite what to do. If a young person’s condition deteriorates in that time, it can be dangerous for the patient and very stressful for the GP.
Although the optimal solution is to increase the available local mental health services, these changes take time and require significant funding to implement. Therefore, consideration should be given to solutions that offer support and help young people to cope with their symptoms, but do not undermine the need to access professional care. It is estimated that approximately 500 000 Australians currently receiving mental health care could benefit from low intensity treatment, and this may offer a promising path forward in managing the crisis of current wait times for young people.
For instance, low-intensity treatments that focus on coping strategies and reducing the experience of distress and discomfort may improve clinical outcomes and increase the likelihood of future help-seeking, all while not undermining professional treatment and encouraging young people to continue to seek help.
If you are a registered GP currently practising in Australia and would like to provide your perspective, please follow this link to the Black Dog Institute study.
Dr Belinda Parker is an early-career researcher, having attained her PhD from the Queensland University of Technology in 2017. She commenced her role at the Black Dog Institute in 2018. Her research focus includes youth anxiety and depression management within both the primary care and the school context, and the development of e-mental health interventions and tools designed for general practitioners and educators. She is currently leading the While We Wait project, which aims to understand how we can best support young people while they await in-person mental health treatment and services.
Dr Jan Orman has had a long career in urban general practice with a special interest in mental health. She currently works at Black Dog Institute as GP Services Consultant, developing and delivering educational programs for the Institute’s arm of the eMental Health in Practice Project and in its Professional Education team.
Thomas Borchard is a Research Officer at the Black Dog Institute working on the While We Wait Project. He is currently completing his Masters of Clinical Neuropsychology at Macquarie University.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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