Most children and young people who come into care need assistance in achieving or sustaining mental health. This is hardly surprising given the high likelihood of early childhood trauma. The level of need and assistance required will vary but the key to successful intervention is timeliness and appropriateness to need.
We have become so used to rationing health resources that this sounds like a big ask. However, I have learnt from my conversations with experts that most of the healing work is done by the adults who spend the most time with children, such as carers, teachers and family. Regardless of who delivers the assistance, sound professional advice and timely intervention is needed.
In South Australia, we have good cooperation between Child and Adolescent Mental Health Services (CAMHS), Child Protection Services, the Youth Sexual Assault/Abuse Counselling Service and Families SA Psychological Services in providing therapeutic services for children in care. Since 2005 there have been improvements in timeliness and appropriateness as a result of the extra services under the Keeping Them Safe reform program and the Rapid Response commitment by government agencies. Assessments are now conducted within two to three weeks of a referral.
Late last year, the Royal Australian and New Zealand College of Psychiatrists adopted a position statement on the mental health care needs of children in out-of-home care. Among other things, the statement commits them to work collaboratively with state health departments and child welfare agencies to ensure all children in care are assessed.
It seems to me though that assessment is the easier bit to fix. The persistent gaps are with the follow-up services. Here, too, there have been steps forward and health services in general have been terrific in giving priority to children in care. However, I am hearing that children are waiting too long and that good alternative care arrangements are sometimes threatened by delays in getting professional advice and help. So in an attempt to understand better I asked what the most significant gaps are.
A delay of three or four months for a child who has been assessed as in high need of therapeutic assistance has an immediate adverse impact on their stability in placement and in school, and a longer term impact on their emotional and social development. Less often identified but equally important is the delay in working with traumatised infants and their primary carers. A child or adolescent’s distress and associated destructive behaviour often triggers the referral to therapeutic services. Much of this could be avoided if early work is done with infants and carers.
Other priorities for action were the development of more appropriate models for working with Aboriginal children and families, prompt professional assistance to carers when acute problems arise, specialist assistance to children and young people with very high need, and services for young people once they reach 18 years but are not accepted for adult mental health services. The good news is that those I spoke to were not short of ideas for tackling these problems.
The first gap that came to light did not, however, concern only children in care. Instead it was the torment of removing children from parents with mental illness. In 2007 a coalition of mental health and child advocates estimated that between 78,000 and 85,000 young South Australians live with a parent with a mental illness. Most continue to live as a family and the impact on children depends on the severity of the illness and access to support. The statutory child protection system cuts in only at the most serious end of disruption and isolation of children. Forty per cent of children taken into state care have mental illness of one or both parents as a major contributing factor. In 2007-08 this would have been about 180 children. South Australia needs to catch up with the other states and territories in implementing a strategy to assist children of parents with mental illness.
If we are serious about providing good care and education for children and young people, prevention of illness, good early childhood development, crime prevention, and strong families we will pay more attention now to the mental health care needs of children.