Young people with mental illness should not need to resort to extreme behaviour such as violence or suicide attempts before receiving the help they need.
La Trobe’s Dr Patricia McNamara – who has led the longest-ever follow-up study of adolescent inpatients in Australian mental health services – says more attention should be paid to the important role of family and friends during and after periods of hospitalisation or crisis.
A senior lecturer in the School of Social Work and Social Policy, Dr McNamara specialises in adolescent and family mental health and welfare.
The link between a supportive network of family and friends and the diff erence this can make to long-term wellbeing and mental health was a key finding of her 15-year study carried out in Victorian residential mental health facilities. It began in the early 1990s. Dr McNamara tracked the lives of young people during and after their admission, and their interactions with family and friends and the mental health, education and welfare systems. The results have been made available to mental health and welfare specialist and policy-makers in Australia and overseas, in the United States and Italy. Late last year, Dr McNamara led a workshop on the topic at the World Psychotherapy Congress in Beijing.
She says the study revealed that once young people return to the community, welfare and mental health systems are often slow and insufficient to respond to their need for help which – as media reports sadly testify – sometimes leads to tragedy.
Her work began in response to the Victorian Government’s closure of residential and community-based facilities for adolescents, part of the de-institutionalisation of mental health services during the 1990s. She was then a social worker responsible for finding alternative accommodation for young residents.
"At that time there had never been a longitudinal study of adolescent treatment in the Australian mental health sector," Dr McNamara says. "It is still the only qualitative post-discharge follow-up of adolescent residential treatment in the international literature."
Conducted in three stages, her research told the stories of young lives from their first contact with mental health services. Initially it involved eight young people at admission, discharge and six months post-discharge. Seven years later she reviewed six of the original group and their parents, and followed up with four of them after 15 years.
Dr McNamara says the four young people studied over the full period had been ‘heroic’ in the way they coped with their illness. All of them forged productive lives. Three had remained in long-term employment, two had completed tertiary studies, two were in long-term relationships and two were mothers.
"It seems the support of their kith and kin enabled them to have such productive lives. When young people are at their most vulnerable, if their family is able to support them with hospitalisation or getting a change of medication, they can weather the storm so much better than if they are forced to rely on community support."
Disturbing chasms in care
Despite finding some useful programs, Dr McNamara says she was disturbed by ‘chasms’ in community-based services. "It seems an indictment of our society that we cannot help young people who have shown enormous courage in coping with their mental illness. Professionals in health, mental health and welfare especially need to be vigilant.
"We need to be flexible and responsive and maintain an active monitoring role so we can pre-empt major struggles such as suicidal thoughts and self harm."
Dr McNamara’s recommendations include more intensive pre and post-discharge social and emotional support for young people with serious mental illness and for their families, and greater access to crisis care and ongoing psychotherapeutic services, particularly in rural Australia.
(Source: LaTrobe University: June 2009)