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MENTAL HEALTH SERVICE USE

In the SMHWB, people were asked about the services they had used for "problems" with their mental health. These services included consultations with a health professional, for example, general practitioners (GPs), psychiatrists, social workers and counsellors, as well as any hospital admissions and self-management strategies. While the prevalence of mental illness is relatively high in young people, they have a relatively low use of mental health services compared with older age groups where the rate of mental illness is lower and the rate of service use is higher. In 2007, just under a quarter (23%) of young people with a mental disorder* had accessed mental health services in the previous year, compared with around 41% of people aged 45-54 years. (as shown in Graph 4.1) Graph 4.1 People with a mental disorder(a)(b) who used mental health services, Australia - 2007

(a) People aged 16-85 years who met criteria for diagnosis of a lifetime mental^disorder and had symptoms in the 12 months prior to interview. (b) A person may have had more than one disorder.

Young people with Substance Use disorders were the least likely to access mental health services (11%), while around one-third (32%) of young people with Anxiety disorders and almost half (49%) of all young people with Affective disorders did access mental health services. Of young people with a mental disorder, those with a severe level of impairment were more likely to make use of mental health services than those with milder levels of impairment (51% compared with 18% respectively). This pattern was consistent across all age groups. (as

shown in Graph 4.2) Graph 4.2 People with a mental disorder(a)(b) who used mental health services in last 12 months and their level of impairment, Australia - 2007

(a) People aged 16-85 years who met criteria for diagnosis of a lifetime mental disorder and had symptoms in the 12 months prior to interview. (b) A person may have more than one disorder. The components when added may therefore not add to the total shown.

GPs were the most frequently used health professional by young people with a mental disorder (15%), followed by psychologists (10%). Of young people with a mental disorder that did not access mental health services, most (85%) did not feel that they had a need for any type of assistance and 15% reported that they felt they had some level of unmet need (that is, their needs were met only partially, or were not met at all). Of all young people with a mental disorder, 14% felt they had an unmet need for counselling or talking therapy and 11% felt they had an unmet need for information about mental illness, its treatment and available services. In addition to using formal mental health services, some people have personal strategies for coping with mental illness. Of all young people with a mental disorder, around 332,700 used a self-management strategy specifically to help cope with their mental illness. Of these young people, around two-thirds sought support from family and friends (65%), while 59% did more of the things they enjoyed and around half increased their physical activity (48%) (as shown in Graph 4.3).
(b)

Graph 4.3 Self-management strategies(a)(b) of young people with mental disorders(c)(d), Australia 2007

(a) Of those who used a self-management strategy. (b) A person may have had more than one self-management strategy. (c) People aged 16-24 years who met criteria for diagnosis of a lifetime mental disorder and had symptoms in the 12 months prior to interview. (d) A person may have had more than one disorder.

*This article focuses on young people who met criteria for a diagnosis of a lifetime mental disorder and who experienced symptoms in the 12 months prior to the survey .

PREVALENCE OF MENTAL DISORDERS


In 2007, approximately three-quarters (76%) of all young people assessed their own mental health as excellent or very good. However, around one-quarter of all young people had a mental disorder* in the previous year (approximately 26% or 671,000 young people). The rate of mental disorders for people living in private dwellings gradually decreased from 26% in the 16-24 years age group to 22% in the 45-54 years age group, after which it declined more rapidly to 6% of those aged 75-85 years (as shown in Graph 1.1). Around one-quarter of people with a mental disorder in each age group had a severe level of impairment associated with their disorder, with the remainder having a mild or moderate level.

Graph 1.1 Prevalence of mental disorders(a)(b), Australia - 2007

(a) People aged 16-85 years who met criteria for diagnosis of a lifetime mental disorder and had symptoms in the 12 months prior to interview. (b) A person may have had more than one disorder.

The SMHWB focused on three main groups of disorders: Anxiety, Affective and Substance Use. The rates of each of these disorders differed with age. The rate of Anxiety disorders (15%) and Affective disorders (6%) for young people increased slightly to 18% and 8% respectively for those aged 35-44, after which rates declined in older age groups. The rate of Substance Use disorders, however, was highest in young people aged 16-24 years (13%) after which the rate dropped steadily to around 1% of people aged 65-85 years (as shown in Graph 1.2).

Graph 1.2 Prevalence of selected mental disorders(a)(b), Australia - 2007

(a) People aged 16-85 years who met criteria for diagnosis of a lifetime mental disorder and had symptoms in the 12 months prior to interview. (b) A person may have had more than one mental disorder.

Young people were more likely to have Anxiety disorders (15%) and Substance Use disorders (13%) than Affective disorders (6%). Young women were more likely than young men to have had any mental disorder in the year prior to the interview (374,800 or 30% compared with 296,300 or 23% respectively). Young women were also around twice as likely as young men to have an Affective disorder (8% compared with 4%) or an Anxiety disorder (22% compared with 9%). Substance Use disorders, involving Harmful Use of, or Dependency on, alcohol or other drugs, were more common in young men (16%) than in young women (10%) (as shown in Graph 1.3).

Graph 1.3 Young people with selected mental disorders(a)(b), Australia - 2007

(a) People aged 1624 years who met criteria for diagnosis of a lifetime mental^disorder and had symptoms in the 12 months prior to interview. (b) A person may have more than one mental disorder. The components when^added may therefore not add to the total shown.

The most common Anxiety disorder among young people was Post-Traumatic Stress Disorder (8%). This disorder arises as a delayed response to a distressing event that is outside the range of usual human experience (4), for example, combat experience, a life-threatening accident, or an unexpected death of someone very close. Among young people, the most common Substance Use disorder was Harmful Use of Alcohol (9%). Harmful Use is a pattern of use that is responsible for (or substantially contributes to) physical or psychological harm, including impaired judgement or dysfunctional behaviour (4). Bipolar Affective Disorder and Depression (both 3%) were the most commonly occurring Affective disorders among young people in the previous year. Bipolar Affective Disorder is characterised by repeated episodes in which an individual's mood and activity levels are significantly disturbed - on some occasions lowered (depression) and on some occasions elevated (mania or hypomania). Depression can occur in mild, moderate or severe episodes in which an individual experiences a state of gloom, despondency or sadness lasting at least two weeks. The person may experience a low mood, loss of interest and enjoyment, and reduced energy (4).

*This article focuses on young people who met criteria for a diagnosis of a lifetime mental disorder and who experienced symptoms in the 12 months prior to the survey .

One in four young Australians have a mental disorder: ABS


One in four young Australians aged 1624 years had a mental disorder in 2007, according to figures released today by the Australian Bureau of Statistics. Anxiety disorders were the most common, affecting 15% of young people, with Post Traumatic Stress Disorder the most commonly experienced Anxiety disorder (8%). Substance Use disorders affected 13% of young people with Harmful Use of Alcohol the most common Substance Use Disorder (9%). Around 6% of young people had an Affective disorder with Bipolar Affective Disorder and Depression (3% each) the most common Affective disorders. Almost one-third of young women had a mental health disorder compared with around onequarter of young men. Young women were more likely to have Anxiety or Affective disorders while Substance Use disorders were more common among young men. Young people with a mental disorder were more than 5 times as likely as those without mental disorders to use illicit drugs or misuse legal drugs; twice as likely to be current smokers and around 1.5 times more likely to drink alcohol at least weekly. Around 17% of young people with a mental disorder had a severe level of impairment, with the remainder having a mild or moderate level of impairment. While the prevalence of mental illness is relatively high in young people, they have a relatively low use of mental health services. Just under a quarter of young people with a mental disorder had used mental health services in the previous year. Young people with a severe level of impairment were more likely to use mental health services (51%) than those those with milder levels of impairment (18%). General practitioners were the service most frequently accessed by young people with a mental disorder (15%) followed by psychologists (10%). Of young people that did not access services, most (85%) did not feel that they had a need for any type of assistance. Young people with a Substance Use Disorder were the least likely to use mental health services. More details can be found in the Mental Health of Young People (cat. no. 4840.0.55.001)

COMORBIDITY AND SEVERITY


Comorbidity refers to the presence of two or more disorders experienced simultaneously by one person. The presence of a second disorder - physical or mental - is likely to complicate and intensify the medical, social and emotional difficulties faced by young people with mental disorders. Comorbidity of mental disorders is linked to greater impairment, higher risk of suicidal behaviour, and a greater use of health services (8).

Of the 671,000 young people with a mental disorder*, around one-third (37% or 247,000 people) had two or more disorders, either a physical and mental disorder(s) or more than one mental disorder.

The severity of mental disorders is classified using a range of criteria, including the occurrence of substance dependence, suicide attempts or a degree of impairment that prevents an individual from performing their usual role (4). Around 113,000 young people with a mental disorder (17%) had a severe level of impairment, while around 236,000 (35%) had a moderate degree of impairment and around 322,000 (48%) had a mild impairment.

Young people with an Affective disorder were more likely than those with an Anxiety or a Substance Use disorder to have a severe level of impairment (55% compared with 22% and 15% respectively).

SUICIDAL BEHAVIOUR AND CAUSE OF DEATH While suicide accounts for only a relatively small proportion (2%) of all deaths in Australia, it accounts for a much greater proportion of deaths from all causes within specific age groups (9). In 2007, suicide accounted for 22% (or 272) of deaths from all causes for those aged 1624 years. Around four-fifths (79%) of young people that died due to suicide were male. Of young people with a mental disorder, 8% had suicidal thoughts, plans or attempts in the year prior to being interviewed. The rate was almost three times higher for young people with Affective disorders, with almost a quarter having suicidal thoughts, plans or attempts in the previous year (23%).
*This article focuses on young people who met criteria for a diagnosis of a lifetime mental disorder and who experienced symptoms in the 12 months prior to the survey .

This research has been commissioned as a mapping exercise to quantify the scope and scale of services that are available in Merton and surrounding boroughs. It does not set out to make any qualitative judgement or particular recommendations. The report can only offer a snapshot in time of services and due to the diverse range of services that support people with mental ill health, whether as the primary focus or incidentally in their work, the report cannot claim to be a definitive list of all mental health services. The report focusses on those London boroughs in which the local Mental Health Trust (South West London and St Georges Mental Health NHS Trust The Trust) works Merton, Sutton, Wandsworth, Kingston upon Thames and Richmond upon Thames. The services mapped in this report are those for adults with a wide range of mental health problems such as depression, anxiety, bipolar disorder, schizophrenia, personality disorders and eating disorders and their carers. The report does not focus on any specialist services for people with dementia or substance misuse problems or their carers, or for children, although some services mapped do include support for these groups as well as or as part of the services listed. It is also worth noting that many people receive a dual diagnosis of a mental health problem and a substance misuse problem, and it has been recognised that people with a dual diagnosis may not be as likely to try to get help, and they may have more complex needs than people with either mental health problems or substance misuse problems alone. 8

Mental health services are wide ranging and this report concentrates on particular aspects of services only. The report covers the following areas - Day opportunities for people with mental ill-health, including specialist services that offer regular activities and those that that help service users to access universal services - Out of office hours services available in the community for those with mental ill-health - Community-based specialist services for carers of people with mental ill health This report does not consider services that are directly provided by The Trust, most of which are common to all boroughs. Therefore, for example, Community Mental Health Teams and hospital based services are among those excluded from this report. A notable exception is that there is employment support for people with mental health problems delivered by the Trust that is commissioned by London Borough of Merton. This is not understood to be replicated in the other boroughs. The services outlined in this report are, as far as can be ascertained, correct at September 2012. However many have short term or uncertain funding arrangements and so this report can only provide a snapshot in time of the services available. Every effort has been made to ensure that the information about services is accurate but this cannot be guaranteed in all cases. Information about services available has been gained by speaking to individuals working in the organisations concerned in most cases. Many thanks are due to those who gave their time to talk to the researcher. Where this has not been possible, despite repeated attempts, information has been drawn from that available on the organisations website or elsewhere on the internet.

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