Mental health support for primary school children: early intervention

ALTHOUGH Australian children have now largely returned to classrooms, we are still uncovering just how much 2 years of pandemic-related school closures and lockdowns have impacted their mental health and wellbeing.

We know social connection with peers is essential for the healthy development of children and young people. This fact, together with all the other disruption and anxiety caused by COVID-19 in Australian households means that some degree of mental health impact on children is an inevitable outcome from the pandemic.

Evidence from the initial phase of the pandemic shows children and young people’s mental health declined as a result of COVID-19, both in Australia (here, and here) and around the world. However, just how long this impact will last and how we can reduce these effects are unknown. What is clear, is that just like with the physical impacts of COVID-19, we should use the best available science to make the best policy decisions possible.

Even before the pandemic, about 14% of Australian 4–11-year-old, primary school-aged children were experiencing symptoms consistent with a mental health disorder (Table 2.2). While it is often thought mental illness can only emerge in adolescence, about half of all adult mental illness begins before age 14 years. While support for adolescents and youth aged 12–25 years is vital and has been a focus of recent government investment, prevention and early intervention for mental illness in childhood has been largely overlooked. The last federal Budget saw a $54.2 million investment in establishing a network of Head to Health Kids mental health centres in conjunction with the states and territories, in contrast to the $278.6 million additional funding to support headspace centres for youth.

Current evidence suggests that only half of children aged 4–11 years old with a mental disorder receive mental health support (Table 7.3), reflecting workforce shortages, long waiting times, and the financial barriers often blocking help from being provided. Many paediatric psychological and psychiatric practices are closed to new child referrals. One recent study found that less than 20% of children in Australia with clinical levels of anxiety receive evidence-based care. Our current system for child mental health requires significant reform to meet increasing demand.

An important landmark for children’s mental health was the federal government’s launch of the first National Children’s Mental Health and Wellbeing Strategy in October 2021. Prior to this, Australia had no strategic direction for approaching mental health and wellbeing in children. The Strategy highlights the lack of functional infrastructure for children under 12 years, stating that “there is no real ‘system’ of affordable integrated care, delivered on the basis of need”. However, there is yet to be any new investment in children’s mental health to address the concerns highlighted in the Strategy.

Evidence-based mental health support for children under 12 years in primary schools is needed urgently, especially in the context of COVID-19 recovery. Effective prevention and early intervention measures in primary school settings have been a missing piece in Australia’s proactive approach around youth mental health.

Primary schools are a critical and overlooked touchpoint for population mental health and prevention efforts. The development, implementation, and evaluation of a new model of care that provides mental health and wellbeing checks in primary school settings is urgently needed. This approach will support children and their families and facilitate timely help-seeking through connecting school settings to existing health infrastructure. While not novel, this type of approach is yet to be tested and put into practice in real-world settings.

Children whose mental health challenges are identified early and addressed effectively see both immediate and long term mental health and functional benefits across their lifespan (here, and here). Further, intervening early in life and early in illness makes economic sense, with benefits far outweighing the costs.

With a growing network of headspace centres nationally servicing the over 14-year-old cohort, there is significant unrealised potential to intervene earlier in life to mitigate the risk of long-term impacts. We hope the dual forces of needing to respond to the disruption caused by COVID-19 and Australia’s first National Children’s Mental Health and Wellbeing Strategy will provide the impetus for our country to seize this opportunity.

Professor Jennie Hudson is the Director of Research and a Professor of Clinical Psychology at the Black Dog Institute, specialising in youth mental health.

Dr Natalie Reily is a Policy Officer and Postdoctoral Researcher at the Black Dog Institute.

Caitlin Connell is the Government and Stakeholder Relations Advisor at the Black Dog Institute.

Professor Samuel Harvey is the Executive Director and Chief Scientist at the Black Dog Institute.

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.