This annual report - Taranaki District Health Board

psychotic disorders including first episode psychosis, schizophrenia and bipolardisordersalcohol and other drug disorders including abuse and dependenceTourette syndrome.DHB provided/funded CAMHS are not contracted to provide services to children withconduct disorder as a sole presenting problem as other providers, among them the YouthHorizons Trust [362], are contracted to provide these. Disability services are fundeddirectly by the Ministry of Health, not DHBs. For this reason, children with behaviouralproblems secondary to intellectual disability are normally excluded from DHBfunded/provided CAMHS (unless they also have another diagnosis). These children canaccess Ministry of Health funded Behaviour Support Services via a referral from a NeedsAssessment and Service Coordination (NASC) agency [363].Access rates and service use for DHB mental health servicesOver the years from 2004 to 2009 there was a steady increase in access rates to mentalhealth services for the 0–19 years age group, from 1.15% in 2004 to 1.49% in 2009 [357].Provisional data from the Ministry of Health’s Programme for the Integration of MentalHealth Data (PRIMHD), indicated that in 2009/10, DHB mental health service access rateswere 0.136% in the 0–4 years age group, 1.38% in the 5–9 years age group, and 2.52% inthe 10–14 years age group [364]. Access rates for boys were over twice those of girls inthe 5–9 years age group, but access rates for girls climbed steeply from age 14 and weresimilar to rates for boys in the 15–19 years age group.When broken down by ethnicity, access rates were slightly higher for European childrenaged 0–9 years than for Māori children, but Māori access rates were higher from 14 years[364]. The vast majority of 0–9 year olds who accessed DHB services in 2009/10 wereseen by child, adolescent and family teams. For older children (10–14 years) child,adolescent and family teams were the most common team type seen, but significantnumber of older children were also seen by youth specialty teams and community teams.The next most frequently seen teams were, in decreasing order of frequency, KaupapaMāori teams, Kaupapa Māori tamariki and rangatahi mental health services, needsassessment and coordination teams and Pacific Island teams[364].2007/08 data from the Mental Health Information National Collection indicated that mostreferrals to child and youth teams came from general practitioners. Referrals also camefrom the education sector, self/relative referral, other hospital services (non-psychiatric andpsychiatric inpatient), social welfare services, and paediatric services [365].The 2011 Mental Health Commission report, Child and youth mental health and addiction[366], aimed to assess the need for mental health services among children and youth, andhow well this need was being met. Mental Health Commission (MHC) staff visited DHBservices and also undertook qualitative research involving youth. Some of the issuesidentified by the MHC were: difficulties accessing services due to not being considered tohave a serious disorder (although a person might have multiple moderate issues), lack oflocal child/youth inpatient beds, a need for prevention and early intervention services, aneed for intersectoral collaboration (between health, education, justice and social welfare),the importance of schools as a first point of contact for children with mental illness, a needfor addiction services, and difficulties with recruitment and retention of staff. The MHC did,however, identify some positive developments including the establishment of services inschools (such as health clinics and GP services) and youth one-stop shops which lessenthe stigma associated with seeking care for mental health issues.The Provision of Child Mental Health Services in Primary CareThere are a number of good reasons to provide child mental health services in primarycare: psychological and/or behavioural problems in children are relatively common,secondary services are under–resourced and may have long waiting lists, and there isresistance to attending specialist “mental health services” due to perceived social stigma[367,368]. Primary care providers usually see other members of a child’s family and thusIn-Depth Topic: Mental Health Issues in Children - 372