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Scholar's Report

Travel: Vulnerable young people with mental health issues

2016/43 - Nicola Evans

How to ensure timely access to services and for those young people requiring hospital care how to help them keep in touch with life outside hospital - Observations of mental health services for children and young people in Canada, Malta and Australia


The aim of this study was to investigate two related aspects of mental health services for children and young people in Canada, Malta and Australia. The first issue was to explore how young people can access appropriate services in a timely fashion. The second area of investigation was understanding how for those children and young people who required inpatient care, how they kept their connections with their ‘normal life’ during their hospital admission. 

Outpatient and inpatient services were visited in Toronto, Canada, Malta and Melbourne and Sydney, Australia. There were 33 services available for children and young people in Toronto, offering a range of different approaches and access criteria in addition to private practice. These included a ‘What’s up Walk-in’ drop-in facility for young people and families. Malta had one inpatient service and one outpatient service to serve the islands of Malta and Gozo. Demand for these services was high and they operated a triage approach to determining priority. Different models of access were evident across Australia.  The Mental Health Triage Scale was used in Victoria to help determine priorities and appropriate services for children and young people seeking help for mental health issues. It was interesting across all three countries that there were facilities for families to self-refer into specialist mental health services.

I was particularly fortunate during this study tour to see examples of developing mental health nursing practice. In Toronto, they were in the process of cascading a model of groups for parents based on dialectical behavioural therapy groups, that complemented similar group intervention offered their adolescent children. In Melbourne, there was an interesting liaison and consultation to a burns unit that had been established to help young people and families develop coping strategies for that specific medical situation. 

The provision of inpatient care was also of interest. In Malta and Australia, there was a philosophy for young people to only be admitted for short periods, up to four weeks, to encourage them to stay connected to their friends and family. This model avoided the unintended sequelae of extended inpatient care, such as missing too much school, losing touch with friends in school and wider circles. In one unit visited it was accepted that parents may choose to stay with their son or daughter for the first few days of admission to help them settle in. The use of electronic devices was challenging in all locations, as it is in the UK but some units allowed the use of electronic devices in communal areas. 

This study tour has been a significant learning experience in my understanding of how families can access services in three countries outside of the UK and also to hear the story of inpatient care for young people. The clinical presentations of the children and young people was as I would expect to see in the UK. The services surrounding them was far ranging, challenging my assumptions that cultures between the UK and Canada for example are very similar, whereas I found that lifestyle can be very different, such the phenomena of summer camp which although commonplace in Canada and incorporated in the inpatient mental health service would not feature in the UK. Visiting services overseas has allowed me to think differently and more expansively about the possibilities for future developments in mental health services for children and young people. I am particularly minded to think where I might be able to influence services to consider self-referral options given their widespread use overseas.

This experience has given me ideas for further research into this area. It is important to build alliances with international colleagues, to share practices where there is evidence they are useful for families, and to think how to adapt ideas to suit the local context.