This annual report - Taranaki District Health Board

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Williams SB, et al. 2009. Screening for Child and Adolescent Depression in Primary Care Settings: A SystematicEvidence Review for the US Preventive Services Task Force. Pediatrics, 123(4), e716-e35.This systematic review assessed the health effects of routine primary care screening for major depressive disorderamong children and adolescents aged seven to 18 years. No studies that directly examined the health outcomes ofscreening children and adolescents for depression were identified, and it is therefore unknown whether the use ofsystematic screening improves identification, treatment, and outcomes of depression over standard identificationmethods. Eighteen RCTs assessed the efficacy of SSRIs and or psychotherapy in screen-detected children andadolescents. Pooled analysis of nine SSRI RCTs was undertaken, indicating higher response rates among those treatedwith SSRIs (absolute risk difference in the response rate between treatment and intervention groups 12%, 95% CI 7 to16). Nine of the 10 psychotherapy trials found that treated patients had higher short-term response rates or a greaterreduction in depression symptoms after interventions compared with a variety of control conditions. SSRI treatment wasassociated with a small absolute increase in risk of suicidality (suicidal ideation, preparatory acts, or attempts), and theauthors advise that this treatment should only be considered when appropriate clinical monitoring is possible.Evidence-Based GuidelinesBest Practice: Special Edition. 2010. Depression in young people. Best Practice Journal.http://www.bpac.org.nz/magazine/2010/youngdep/youngdep.asp?section=1.These evidence-based guidelines focus on the identification and management of depression in children and adolescentsin primary care and are based on the New Zealand Guidelines Group 2008 guidelines for the management of depressionin primary care. The guidelines include a section on the recognition and assessment of common mental disorders inyoung people, highlighting the importance of assessment of suicide risk at initial presentation and ongoing monitoring;recognition of severe depression; immediate referral to secondary care for all those with serious suicidal intent, psychoticsymptoms or severe self-neglect; assessing psychosocial as well as physical wellbeing at each interaction; andendeavouring to build a supportive and collaborative relationship with the young person and their family/whānau,recognising cultural identity and health care preferences. The HEEADSSS and HEARTS structured clinical assessmentsare recommended and outlined. It is recommended that mild or moderate depression should typically be managed inprimary care; a strength-based approach should be used; involvement of support services such as school guidancecounsellors should be considered; those with mild depression can be directed to http://www.thelowdown.co.nz/;antidepressant treatment in a young person (less than 18 years) should not be initiated in primary care withoutconsultation with a child and adolescent psychiatrist. Referral should be made if there is no improvement after six to eightweeks of treatment, or at any stage if there is serious suicidal intent, psychotic symptoms or severe self-neglect.Ministries of Health and Education. 2008. New Zealand Autism Spectrum Disorder Guideline. Wellington: Ministry ofHealth. http://www.health.govt.nz/publication/new-zealand-autism-spectrum-disorder-guidelineThis guideline provides evidence-based guidance to all those involved in the care of adults and children with autismspectrum disorders (ASD) in New Zealand, including health and education professionals, funders and carers. It coversthe identification and diagnosis of ASD, and the ongoing assessment and access to services and interventions forindividuals with ASD, with the aim of assisting informed decision-making to improve the health, educational and socialoutcomes for individuals with ASD.Ministry of Health. 2001. New Zealand Guidelines for the Assessment and Treatment of Attention-Deficit/Hyperactivity Disorder. Wellington: Ministry of Health. http://www.health.govt.nz/publication/new-zealandguidelines-assessment-and-treatment-attention-deficit-hyperactivity-disorderThis evidence-based guideline aims to assist New Zealand health professionals in the assessment and treatment ofpatients with ADHD. It has not been reviewed since initial publication in 2001. It contains sections on clinical assessment(including assessment and management in schools), and treatment options (medication, psychosocial interventions,support services and other therapies). The guideline highlights the importance of incorporating relevant whānau/culturalaspects, using a multidisciplinary approach, and addressing co-morbidities.Other Relevant DocumentsMinistry of Health. 2012. Healthy Beginnings: Developing Perinatal and Infant Mental Health Services in NewZealand. Wellington: Ministry of Health. http://www.health.govt.nz/publication/healthy-beginnings-developing-perinataland-infant-mental-health-services-new-zealandThis report provides evidence informed guidance on ways to address the mental health and alcohol and other drug(AOD) service needs of mothers and infants and their families, for planners, funders and provider of perinatal and infantmental health and AOD services. The aims are to promote good practice; assist, over time, with the achievement ofgreater consistency in the quality and delivery of services; and provide guidance on cost-effective models of care. Theneed for intersectoral collaboration; and a whānau ora approach for Māori, is recognised.Access to Mental Health Services Introduction - 356
Mental Health Commission. 2011. A literature review: Prevention and possibilities. A focus on children and youth.Wellington: Mental Health Commission. http://www.mhc.govt.nz/.This report sought to influence planners and funders in targeting funding at programmes aimed at achieving wellbeing forat risk children and young people, and reducing long-term mental health and addiction costs. The report included a briefliterature review on prevention in mental health in New Zealand and internationally, with a focus on cost-effectiveness.Findings included that there were financial benefits to prevention and early intervention; prevention initiatives wereunderdeveloped; and the determinants of mental distress, such unemployment, poor housing and poverty, should beconsidered in prevention activities. The Commission makes a number of recommendations for establishing a ‘preventionculture’ within District Health Boards including: maternal mental health and addiction services; developing expertise inprimary health to ensure early identification; ‘wraparound’ community-based services which strengthen whānau/familyresilience; and collaboration with other agencies to address the determinants of mental distress.Ministry of Health. 2010. Let’s get real: Implementation plan. Wellington: Ministry of Health.http://www.health.govt.nz/publication/lets-get-real-implementation-planMinistry of Health. 2008. Let’s get real: Real Skills for people working in mental health and addiction. Wellington:Ministry of Health. http://www.health.govt.nz/publication/lets-get-real-real-skills-people-working-mental-health-andaddictionThe Let’s Get Real framework and implementation plan describes the knowledge, skills and attitudes required by thoseworking in mental health and addiction treatment services. Let’s Get Real aims to strengthen shared understanding;affirm best practice; complement the HPCA Act 2003; improve transferability of knowledge, skills and attitudes; enhanceeffective workforce development; and increase accountability. The implementation roll out from 2009–2013 is describedand a variety of implementation resources are available at http://www.tepou.co.nz/supporting-workforce/lets-get-real.Office of the Prime Minister’s Science Advisory Committee. 2011. Improving the Transition: Reducing Social andPsychological Morbidity During Adolescence. A report from the Prime Minister’s Chief Science Advisor.Auckland: Office of the Prime Minister’s Science Advisory Committee. http://www.pmcsa.org.nz/.This report to the Prime Minister, by a multidisciplinary panel of experts, focused on how to improve outcomes for youngpeople in New Zealand in their transition from childhood to adulthood. It consists of a review of relevant peer-reviewedscientific literature on a range of topics, including transitions in the life course, life skills education and depression inyoung people, and a set of key recommendations. Recommendations include: a primary prevention or ‘life-course’approach to reducing the morbidity associated with adolescence, applied early in life; additional capacity in the mentalhealth work force, particularly those specifically trained to work with children and adolescents, to provide both screeningand treatment; and a strategic national approach to reducing depression in adolescence. The report found that althoughthe application of the evidence base to policy formation and programme development would lead to better outcomes foryoung people, many programmes that have been introduced are unlikely to succeed as they were not supported by theevidence-base. The authors identify the appropriate monitoring of effectiveness and cost effectiveness of all programmeswithin New Zealand, as a key challenge.Dowell A, et al. 2009. Evaluation of the Primary Mental Health Initiatives: Summary report 2008. Wellington:University of Otago and Ministry of Health. http://www.health.govt.nz/publication/evaluation-primary-mental-healthinitiatives-summary-reportThis report describes the evaluation of the Ministry of Health-funded Primary Mental Health Initiatives (PMHIs). Theevaluation found that up to 80% of patients benefitted from the PMHIs. Improvement was sustained at six months ininitiatives that collected sufficient data. Although the evaluation found that mental health needs arising from mild tomoderate common mental health conditions, including those involving social complexity, could be addressed by primarycare, the needs of children and young people were not sufficiently met by the PMHIs, as over half did not offer servicesto this group.MEDSAFE. 2009. Selective serotonin re-uptake inhibitors (SSRI) in children and adolescents. Prescriber Update,30(1), 1.Royal Australian and New Zealand College of Psychiatrists. 2005. Clinical Guidance on the use of AntidepressantMedications in Children and Adolescents. http://www.ranzcp.org/Files/ranzcpattachments/Resources/College_Statements/Practice_Guidelines/Clinical_Guidance_on_the_use_of_Antidepressant_med.aspxBrief MEDSAFE guidance on the use of SSRI medication in children and adolescents was published in 2009 following areview of their use. The guidance highlights that all SSRIs have consistently been associated with an increase insuicidality in meta-analyses of clinical trials of the use of SSRIs to treat major depressive disorder (MDD) in children andadolescents, and that the only antidepressant with overall data indicating efficacy better than placebo in children andadolescents is fluoxetine. Informed consent must be obtained before initiating an SSRI for MDD in children oradolescents. All patients diagnosed with MDD should be monitored closely for suicidality, and antidepressant treatmentshould only be considered in consultation with specialist services. Particular care should be taken in the period shortlyafter initiating antidepressant treatment, after a change in dosage, and after discontinuing treatment. The RoyalAustralian and New Zealand College of Psychiatrists guidance provides a general summary of the use ofantidepressants in children and adolescents, which endorsed MEDSAFE advice.Access to Mental Health Services Introduction - 357
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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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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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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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in one Cochrane review [274] (see p
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interventions to treat antenatal de
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
Page 320 and 321: INJURIES ARISING FROM ASSAULT IN YO
Page 322 and 323: New Zealand Distribution by Age and
Page 324 and 325: Midland Region Distribution and Tre
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 352 and 353: oader contextual influences on the
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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 374 and 375: Social Workers in SchoolsIn 2011 th
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Page 378 and 379: EpidemiologyThe 2009 review by Meri
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Page 382 and 383: programme using a questionnaire. Si
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Page 390 and 391: ACCESS TO MENTAL HEALTH SERVICES: L
Page 392 and 393: Table 97. Children and Young People
Page 394 and 395: Midland Region DistributionChildren
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Page 400 and 401: Numbers Accessing Services by Diagn
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Table 107. Young People Aged 15-24
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Table 108. Proportion of Young Peop
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Table 110. Young People Aged 15-24
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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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