This annual report - Taranaki District Health Board

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