Conversations between adults and young people aged 15-20 years frequently focus on the steps they are taking towards their futures. This is set against strong government and community expectations that young people make direct and successful transitions from schooling to further education, training and or employment. The 2001 National Youth Pathways Action Plan Taskforce report, Footprints to the Future, advised on how this transitional process should be supported and is still being implemented.
But what if you can’t move to even make a footprint? What if that future, that hopeful horizon is disappearing before your eyes? What if you can’t look up to even notice that it still exists? When faced with overwhelming mental health problems, young people find themselves in quicksand. Thrashing around usually makes it worse and silently enduring means sinking to a lonely fate. Surviving requires help from someone who can give steady support while young people extricate themselves and manage the questions of faith that may occur along the way. This begs the question - who is the “someone”?
Our nation’s current mental health policies and plans advocate that the “someone” for young people could be friends, family, teachers, other adult role models or professional support workers. The research on young people and help-seeking suggests that young people are more likely to turn to their friends and family in times of stress than go to professionals. If things are more serious and young people are suicidal, they will consider going to professionals. But the more they become suicidal, the less likely they are to seek help. It then requires friends, family and teachers, or other people in their lives, to make that link for them. But which professionals take responsibility for responding when the link is made?
Although there has been considerable national concern and significant effort put into strategies and programs that assist young people to make transitions from schooling to further education, training and or employment, there is long-standing neglect of the transition between child and adolescent, and adult mental health services. This is despite long-standing concerns about this gap in services for young people in the 15 to 20 year age group. This age is a critical time, as the rates of more serious mental health problems rising sharply from age 15-16 years onwards. Young people who fall into the quicksand of serious mental health problems need more than family and friends' support and are at considerable risk of not surviving, or not surviving well.
For many years, mental health services across Australia have used 18 years as the dividing line between child and adolescent and adult mental health services. This is still the case, although there have been a number of pilot or short-term project services directed at young people in recent years that have used a different age range. These pilot projects have been funded under both federal and state grant programs. Occasionally they are successful in gaining longer-term funding, but are often limited in staff size, geographical reach and the length of time they can offer support. If you are lucky enough to be the right age and live in the right postcode, you could get a good service. This is far from an equitable arrangement and a long cry from universal access to an appropriate service (not that everyone has equitable access to both child and adolescent, and adult mental health services either).
The other problem with improving the transition is that child and adolescent mental health services and those for adults differ markedly from each other. They often advocate different intervention approaches and have different theoretical influences. They have different organisational cultures, staff composition and training, and treatment or therapy service length. They vary in their willingness to collaborate with other agencies, and engage with early intervention, prevention and mental health promotion strategies - even though these strategies are strongly advocated as part of our national mental health policies and plans.
Some young people who receive support through a child and adolescent service will not qualify for an adult mental health service, despite having high level mental health needs. In addition, adult mental health services are more likely to be regarded negatively by young people compared to child and adolescent services. This stigma can prevent young people from approaching an adult mental health service unless they are forced to by their circumstances. By that point they are usually deep in the quicksand.
Young people get the short end of the stick when it comes to effective, accessible, youth-friendly and appropriately resourced mental health services. It is not enough to adequately lever them out of the quicksand. Even if support is there for a short time it is easy for young people to slide back. Once again, responsibilities fall back on family members, friends, and other education and community service workers, to take up the task, usually with little or no support for them either.
The question has to be asked: are we committing enough resources to young people who we proclaim as our future in this country? Unless we value young people now and support them - all of them - to believe in and travel towards a future, we are letting them and the country down. We all might find ourselves caught in quicksand. Who will take responsibility then?
The Australia Government, along with state governments, expects and hopes much for its young people, but continues to offer a fragmented, uneven and poorly sustained system of mental health and support services. Improving the infrastructure, co-ordination, collaborative effort and collective responsibility around education, training and employment is commendable, but it is incapable of addressing the needs of young people with mental health problems when those young people are not actively considered or supported.
When governments step away from the responsibility of accounting for these young people’s needs, they are sacrificed in this system, and personally pay a high cost. They can be subjected to negative stereotypes based on their inability to make a successful transition to further education, training or employment and it is more than likely they will find themselves back in the quicksand, or never leave it.
As workers in youth mental health sector we are committed to supporting young people to extricate themselves from the quicksand - but a collective and committed approach is needed. We advocate policy-making and planning which introduce principles of prevention and early intervention, and the resources to undertake action where the young people are experiencing their mental health difficulties: in the communities where they live, in schools, at home and in the context of their peer relationships.
As a matter of developmental necessity adolescents focus overwhelmingly on these spheres, and this is where they need to be supported. What would such a model of service look like? Sound clinical expertise is of course essential, but in addition it might contain elements of other models of service, such as youth work and community development, where accessibility, flexibility and the capacity to interface with young people on terms acceptable to them, are primary values.