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oader contextual influences on the health of children and their families. A parental historyof mental disorders is one of the most consistent risk factors for the development of mentaldisorders in children.Contents of Access to Mental Health Services ChaptersThe following three sections use data from the Project for the Integration of Mental HealthData (PRIMHD) to explore access to mental health outpatient, community and inpatientservices for children and young people with specific mental health diagnoses. Thediagnoses reviewed have been grouped into three clusters, which are loosely based on theage groups most commonly experiencing these conditions:1. Children 0–14 years: Attention deficit hyperactivity disorder (ADHD), conduct/disruptive behaviour disorders, parent-child relational problems, autism/pervasivedevelopmental disorders, learning disorders and intellectual disabilities.2. Children and young people 0–24 years: Anxiety disorders, stress reaction/adjustmentdisorders, and eating disorders.3. Young people 15–24 years: Schizophrenia and other psychotic disorders, personalitydisorders; depression, bipolar disorder and other mood disorders; and substancerelateddisorders (alcohol, cannabis, and other substances). This section also includesa small subsection which uses the National Minimum Dataset to explore hospitaladmissions for young people with mental health diagnoses.In addition the In-Depth Topic commencing on Page 368 reviews Mental Health Issues inChildren in more detail, while the Suicide and Intentional Self-Harm section commencingon Page 417 considers suicide and self-harm in young people.Cautions Relating to the Methodology UsedBecause PRIMHD data is configured in a very different way to that contained in theNational Minimum Dataset (hospital admissions) the reader is urged to review the methodssection below, in order to become familiar with the strengths and limitations of PRIMHD, aswell as the methodology used in the sections which follow.Further, the information presented in this year’s report differs from that presented in theNZCYES’ 2009 Reports, because of differences in the data collections (PRIMHD vs. theMental Health Information National Collection (MHINC)) and the coding systems used tocode mental health diagnoses (in PRIMHD the data received were coded in DSM-IV,whereas in MHINC diagnoses were coded using ICD-10-AM).Data Source and MethodsDefinition1. Number of Children and Young People Accessing Mental Health Services by Mental Health Diagnosis2. Contacts with Mental Health Services for Children and Young People by Mental Health Diagnosis3. Inpatient Bed Nights for Children and Young People by Mental Health DiagnosisData SourceNumerator: Project for the Integration of Mental Health Data (PRIMHD)Individuals: Number of individuals accessing mental health services who ever received a specified mentalhealth diagnosis. Diagnoses included DSM-IV Alcohol-Related Disorders (305.00, 303.90, 291.89, 291.1,291.2, 291.5, 291.3, 303.00, 291.0, 291.9, 291.81); Cannabis-Related Disorders (305.20, 304.30); OtherSubstance-Related Disorders (305.70, 304.40, 292.11, 292.12, 292.81, 292.9, 292.0, 292.89, 305.60, 304.20,292.84, 305.30, 304.50, 305.90, 292.82, 305.50, 304.00, 304.60, 305.40, 304.10, 292.83, 304.80, 304.90);Schizophrenia (295.20, 295.10, 295.30, 295.60, 295.90); Other Psychotic Disorders (295.40, 295.70, 297.1,298.8, 297.3, 293.81, 293.82, 298.9); Bipolar Disorders (296.80, 296.56, 296.55, 296.51, 296.52, 296.53,296.54, 296.50,296.40, 296.46, 296.45, 296.41, 296.42, 296.43, 296.44, 296.40, 296.66, 296.65, 296.61,296.62, 296.63, 296.64, 296.60, 296.7, 296.06, 296.05, 296.01, 296.02, 296.03, 296.04, 296.00, 296.89);Depression (296.36, 296.35, 296.31, 296.32, 296.33, 296.34, 296.30, 296.26, 296.25, 296.21, 296.22, 296.23,296.24, 296.20, 311); Other Mood Disorders (300.4, 3011.3, 293.83, 296.90); Anxiety Disorders (300.02,300.21, 300.01, 300.22, 300.29, 300.23, 300.3, 309.81, 308.3, 293.84, 300.00); Adjustment Disorders (309.9,309.24, 309.0, 309.3, 309.28, 309.4); Eating Disorders (307.1, 307.51, 307.50); Personality Disorders (301.0,301.20, 301.22, 301.7, 301.83, 301.50, 301.81, 301.82, 301.6, 301.4, 301.9); Mental Retardation (317, 318.0,318.1, 318.2, 319); Autism/Pervasive Developmental Disorders (299.00, 299.80, 299.10); Attention DeficitHyperactivity Disorder (314.01, 314.00, 314.9); Conduct/Disruptive Behaviour Disorders (312.81, 312.82,312.89, 313.81, 312.9); Learning Disorders (315.00, 315.1, 315.2, 315.9); Parent-Child Relational Problem(V612.0).Access to Mental Health Services Introduction - 352
Contacts: Individual contacts, attendances, groups or day programmes reported to PRIMHD. Examples ofcontacts include mental health crisis attendances, individual treatment or group program attendances,healthcare coordination contacts, support needs assessment attendances, court liaison attendances, dayprogram attendances, home based care contacts, and contacts with family/Whānau.Bed Nights: Where a client occupies a bed at midnight in a ward or residential facility. Examples of bed nightsinclude acute, sub-acute and respite mental health inpatient bed nights; mental health maximum, medium andminimum secure inpatient bed nights; community mental health residential bed nights.Denominator: Statistics NZ Projected PopulationNotes on InterpretationNote 1: PRIMHD is the Ministry of Health’s national database covering the provision of publicly fundedsecondary mental health and alcohol and drug services. Commencing on July 1 2008, it integrates informationfrom the previous Mental Health Information National Collection (MHINC) and the MH-SMART data collection.It includes secondary inpatient, outpatient and community care provided by hospitals and non-Governmentorganisations (although data from NGOs is incomplete). It does not include information on outpatient visits topaediatricians, and in the context where local referral pathways result in children seeing a paediatrician ratherthan a mental health professional for behavioural or emotional problems, this may significantly underestimatethe prevalence of mental health issues (e.g. autism, ADHD, learning disorders) in the community. Referralpathways (i.e. the relative balance between paediatrics vs. mental health services) are likely to vary both byregion (depending on the availability of specialist child and youth mental health services) and by age (with therole of the paediatrician decreasing as adolescence approaches). As paediatric outpatient data is currently notcoded by diagnosis, the workload of community/developmental paediatricians in this context remains invisible,making it difficult to assess for children in particular, the underlying prevalence of mental health conditions inthe community. For adolescents/young adults however, the PRIMHD may provide a better reflection of accessto secondary services for mental and behavioural issues.Note 2: The PRIMHD records principal, secondary and provisional diagnoses for clients at each contact,although in a large number of cases the diagnosis was either missing or deferred. In this section,children/young people have been assigned a diagnosis, if they ever received this diagnosis(principal/secondary/provisional) in the period under review (i.e. numbers = total number of individualsreceiving the diagnosis; rates = total number of individuals with the diagnosis divided by the number in thepopulation at the mid-point of this period (i.e. 2010)). Contacts and bed-nights have then been ascribed toindividuals with a particular diagnosis, irrespective of the reason the person sought care (e.g. contacts forADHD = number of contacts for children ever diagnosed with ADHD (including those where the consultationrelated to another diagnoses), rather than the number of contacts specifically addressing ADHD issues. Whereindividuals were assigned multiple diagnoses (e.g. ADHD and a conduct disorder), they appear twice in theanalysis. As a result, the figures in the tables which follow do not add to 100%, making it difficult to assess thecontribution each diagnoses made to the total volume of services accessed during this period.Note 3: In PRIMHD each diagnosis has a specified start and finish date. A number of children and youngpeople accessing services during 2009–2011 however had a diagnosis with a specified start date which beganin 2008, but which continued through the period under review. In addition, it is likely that a number of childrenand young people accessing services during 2009–2011 had their diagnosis deferred until early 2012, eventhough their care during 2009–2011 related to this diagnosis. Thus in this analysis, all children and youngpeople have been included if they accessed mental health services during 2009–2011 (with year beingdetermined by the service start date rather than the finish date). However, the diagnoses assigned to thesechildren and young people have been drawn from PRIMHD diagnostic data with diagnosis start datesextending from mid 2008 to mid 2012.Note 4: Where an individual accessed services on multiple occasions, and was thus recorded as havingmultiple ages, the mean age (averaged across the 3-year period) has been used, with the age being taken asthe age of the patient at the activity start date. All activities for patients where their age at the activity start datewas 25+ years have been excluded.Further detail on the methodology used is available from the NZCYES on request.Local Policy Documents and Evidence-Based ReviewsRelevant to Mental Health Issues in Children and YoungPeopleIn New Zealand, there are number of publications which address mental health issues inchildren and young people. These include publications which focus on specific mentalhealth conditions, as well as those which consider the delivery of mental health servicesmore generally. These are summarised in Table 91, along with a range of guidelines andreviews which consider the effectiveness of interventions in the overseas context. While alarge number of international reviews have considered the effectiveness of individual drugand psychological therapies, it is beyond the scope of the table below to provide acomprehensive coverage of this literature.Access to Mental Health Services Introduction - 353
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Cover Artwork: Long-tailed Blue But
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LIST OF FIGURESFigure 1. Gross Dome
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Figure 41. Number of Students Invol
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Figure 85. Proportion of Babies Bor
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Figure 127. Relationship Between th
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Table 21. Policy Documents Relevant
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Table 108. Proportion of Young Peop
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INTRODUCTION AND OVERVIEWIntroducti
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three then reviews mental health is
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Table 1. Overview of the Determinan
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Stream Indicator New Zealand Distri
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47MACROECONOMICINDICATORS
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Expenditure-based Measure of GDPThe
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Gini Coefficient: The Lorenz curve
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CHILD POVERTY AND LIVING STANDARDSI
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After Housing Costs (AHC)Relative P
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Figure 8. Proportion of Dependent C
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14 Items (Enforced Lacks) are inclu
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Local Policy Documents and Evidence
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Other Relevant New Zealand Evidence
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UNEMPLOYMENT RATESIntroductionIn th
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Figure 12. Unemployment Rates by Ag
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Unemployment Rates by Qualification
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Figure 18. Quarterly Unemployment R
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CHILDREN RELIANT ON BENEFIT RECIPIE
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Table 4. Number of Children Aged 0-
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Table 5. Number of Children Aged 0-
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YOUNG PEOPLE RELIANT ON BENEFITSInt
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Table 7. Number of Young People Age
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New Zealand Distribution by Ethnici
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Figure 25. Young People Aged 16-24
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Table 10. Number of Young People Ag
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HOUSEHOLD COMPOSITION91
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Data Source and MethodsDefinitionPr
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Figure 29. Proportion of Children A
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Robertson J, et al. 2006. Review of
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Canadian National Occupancy Standar
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Figure 33. Proportion of Children a
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Other Relevant EvidenceMarmot Revie
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106
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108
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Note 2: The number of new school en
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Figure 36. Proportion of New Entran
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Sylva K, et al. 2004 The Effective
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Table 15. Enrolments in Māori Medi
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Table 16. Number of Students (Māor
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Local Policy Documents which Consid
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HIGHEST EDUCATIONAL ATTAINMENT AT S
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Figure 43. Highest Educational Atta
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Figure 46. Highest Educational Atta
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SENIOR SECONDARY SCHOOL RETENTION A
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Participation in Tertiary Education
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Midland Region Distribution and Tre
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The following section uses informat
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Figure 54. Age-Standardised Rates o
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Figure 56. Age-Standardised School
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TRUANCY AND UNJUSTIFIED ABSENCESInt
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Figure 60. Total Unjustified Absenc
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Figure 63. Total Unjustified Absenc
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152
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154
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156
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Table 22. The National Immunisation
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Figure 64. Immunisation Coverage by
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Figure 67. Immunisation Coverage by
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Figure 71. Immunisation Coverage at
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Soares-Weiser K, et al. 2012. Vacci
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Briss PA, et al. 2000. Reviews of e
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Data Sources and MethodsIndicatorPr
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Figure 75. Proportion of New Zealan
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Proportion Receiving Core Contacts
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Figure 81. Proportion of Babies who
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The B4 School CheckThe B4 School Ch
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Other Relevant EvidenceThe Scottish
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185SUBSTANCE USE
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Notes on InterpretationNote 1: The
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Maternal Smoking at First Registrat
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Table 32. Number of Cigarettes Smok
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National Institute for Health and C
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2. Proportion of babies born to mot
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Table 37. Number of Cigarettes Smok
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Figure 93. Proportion of Year 10 St
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Figure 95. Proportion of Year 10 St
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TOBACCO USE IN YOUNG PEOPLEIntroduc
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Figure 96. Daily Smoking Rates in Y
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2009 New Zealand Tobacco Use Survey
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Source of Tobacco in the Last Month
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Carson KV, et al. 2011. Community i
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Other Relevant PublicationsMāori A
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Other Cochrane Systematic Reviews o
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ALCOHOL-RELATED HOSPITAL ADMISSIONS
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Figure 100. Alcohol-Related Hospita
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Table 45. Listed External Causes of
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Shults RA, et al. 2009. Effectivene
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240
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Mortality from conditions with a so
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Table 50. Mortality from Conditions
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Figure 105. Hospital Admissions for
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Table 55. Hospital Admissions for C
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Table 57. Hospital Admissions for C
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Midland Region Distribution by Caus
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Figure 107. Hospital Admissions for
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INFANT MORTALITY AND SUDDEN UNEXPEC
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New Zealand Distribution and Trends
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Figure 111. Total Infant Mortality,
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Table 62. Neonatal and Post Neonata
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Table 65. Neonatal and Post Neonata
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Distribution by Ethnicity, NZ Depri
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Figure 116. Sudden Unexpected Death
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Vennemann M, et al. 2007. Do immuni
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276
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with a review of interventions aime
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deprivation in some parts of the wo
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who delay a second pregnancy by two
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Family ViolenceDefinitions and New
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need for multidisciplinary interven
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6 days to determine gestational age
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In New Zealand, information on fact
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post intervention. Engagement in ed
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antenatal care, including two nutri
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throughout pregnancy, birth and the
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Alcohol and Other DrugsNational and
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Zealand had a number of specialist
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Page 306 and 307: In ConclusionWhile it is hoped that
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Page 310 and 311: Data Source and MethodsDefinition1.
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Page 314 and 315: Midland Region Distribution and Tre
Page 316 and 317: Local Policy Documents and Evidence
Page 318 and 319: Other Systematic ReviewsLouwers ECF
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Page 326 and 327: Local Policy Documents and Evidence
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Page 340 and 341: Data Source and MethodsDefinition1.
Page 342 and 343: Family Violence Investigations Wher
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Page 346 and 347: Stover CS, et al. 2009. Interventio
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Page 354 and 355: In addition, Table 112 on Page 414
Page 356 and 357: Williams SB, et al. 2009. Screening
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Page 368 and 369: IN-DEPTH TOPIC: MENTAL HEALTH ISSUE
Page 370 and 371: this [350]. The review stated that
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Page 394 and 395: Midland Region DistributionChildren
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Table 103. Young People Aged 15-24
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Table 108. Proportion of Young Peop
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Midland Region DistributionAmongst
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Fletcher A, et al. 2008. School Eff
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New Zealand Distribution and Trends
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Figure 138. Mortality from Suicide
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Figure 139. Mortality from Suicide
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Ougrin D & Latif S. 2011. Specific
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426
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428
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Guide to Community Preventive Servi
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information on all of the events oc
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3. In addition, some providers admi
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as in the majority of the analyses
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APPENDIX 5: THE NATIONAL MORTALITYC
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As a result of these changes, there
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2. Research also suggests that ethn
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APPENDIX 8: POLICE AREA BOUNDARIESF
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Figure 142. Police Area Boundaries
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3. The condition exhibits a socioec
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REFERENCES1. Children's Commissione
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33. Mackay R. 2005. The Impact of F
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71. Ministry of Health. 2011. Immun
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107. ASH New Zealand. 2011. Nationa
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141. Child and Youth Mortality Revi
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175. Pihama L. 2011. Overview of M
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208. King-Hele S, Webb RT, Mortense
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244. Nelson Marlborough District He
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274. Ramsay J, Carter Y, Davidson L
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306. Jewkes R. 2002. Intimate partn
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347. Heflinger CA, Hinshaw SP. 2010
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376. Ministry of Education. 2012. W
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410. Ministry of Health. 2001. New
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443. Zeanah PD, Bailey LO, Berry S.
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480. Weinberg MK, Olson KL, Beeghly
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